All posts by Experian Health
Yale New Haven Health is an award-winning academic healthcare system, and a big part of why its people achieve success is because they continually ask, “How can we do better?” For two years, the financial preservice team used focus groups and other feedback to learn about the financial concerns of patients and their loved ones. Then, they pursued a rigorous, tech-driven transformation to better develop estimates, identify patient payment solutions, explain billing and collections, and engage with patients. Yale New Haven Health employees and executives view patients’ financial care as an important facet of healthcare. By pairing their own dedication and know-how with Experian Health products, they’ve improved the patient experience and increased staff satisfaction. Here’s how: Create transparent, plain-language patient estimates The preservice team wanted to give patients cost estimates that were easier to understand and more accurate. Now that they’re using Eligibility, team members know exactly what procedure a patient is having and are better equipped to verify eligibility and explain the patient’s deductibles, co-insurance, and out-of-pocket expenses. For example, the team has standardized the varying (and sometimes cryptic) eligibility responses returned by hundreds of different insurance companies and other payers. Team members give patients the same clear answer — no matter how many ways payers use to describe what their plans will and won’t pay for. Find alternative payment solutions Another challenge confronting Yale New Haven Health was helping patients find ways to pay for procedures. The preservice team deployed Coverage Discovery, which can find and verify insurance coverage that patients didn’t even know they had. As patients register for their procedures, the tool searches for previously overlooked Medicare, Medicaid, and commercial insurances. Patients can sometimes avoid costly self-pay situations, and Yale New Haven Health avoids write-offs and unwarranted charity designations. Also, the preservice team is watching trends in what Coverage Discovery finds so they can spot potential problems earlier and identify payment alternatives sooner. Make it less painful to receive a bill It’s nearly impossible to achieve pain-free billing, but the confusing terms and codes found on most healthcare statements shouldn’t add to the pain. As part of its financial care transformation, Yale New Haven Health started using Patient Statements to combine hospital and physician billing into one easy-to-understand document. It even added customized messages to further explain the procedures and costs. Patients have said that they’re happy with the new design. Give patients a way to be self-sufficient Patients want an easy, digital way to evaluate options and understand what products and services cost. Healthcare is no exception. Yale New Haven Health uses Patient Self-Service to serve up a self-service portal that gives patients a greater say in their healthcare and connects them to their providers. For example, patients can set up their own payment plans (within parameters set by Yale New Haven Health). It saves time for the patients and the preservice team, which enjoys a reduced volume of customer service calls. Yale New Haven Health already had a relationship with Experian Health. It was already using Payer Alerts and Collections Optimization Manager to improve back-end revenue cycle operations. This time around, it focused on preservice processes and added Eligibility, Coverage Discovery, Patient Statements, and Patient Self-Service to its financial care system. These tools have garnered more satisfied patients, to be sure. They’ve also served as physical expressions of Yale New Haven Health’s commitment to excellence. Staff members can take greater pride in their jobs knowing they have the tools to better fulfill their patient-centered mission. A lot is said about treating the whole person instead of just the disease. By approaching financial care as an important companion to clinical care, Yale New Haven Health has discovered countless ways to answer the question “How can we do better?” Learn more about Yale New Haven Health’s patient financial care transformation. Read the case study.
As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.
Today’s healthcare consumers are at the center of healthcare transformation. They demand a personalized experience, use devices to monitor their health and are vocal when they are not satisfied with their service or care. Healthcare organizations are being challenged to think differently about healthcare engagement. To succeed, you must become consumer-facing and expand your reach. You need to attract and retain patients for service line growth. Connecting with consumers by tailoring their journey is expected, so you using data to predict health conditions and message effectively is critical. Do you know who your patients are? How to build a relationship with them? Can you improve their satisfaction and retention? Are you providing personalized communications? Superior data with actionable insights can help you remain competitive in this new healthcare landscape. This is a new approach to most healthcare organizations, but it provides an exciting opportunity. Leverage data the right way and gain deeper insights to improve patient and consumer engagement. To learn more, visit Experian Health’s Marketing Services page, contact your account representative or email us at experianhealth@experian.com
Recent industry shifts, including the transition from volume- to value- based reimbursement, lower reimbursement and shrinking inpatient margins, increased bad debt due to high deductible health plans and other challenges, are causing undue stress for healthcare providers. It’s difficult for some organizations to manage complex reimbursement models or handle complex claims, so providers are often underpaid or write off revenue they are due. The cost to collect continues to rise when staff produces poor results or turnover is high. Additionally, hospital information system (HIS) conversions traditionally result in a backlog of accounts receivable (A/R), requiring incremental staff to support the conversion. 78% of CFOs are concerned about their revenue cycle platform capabilities for value-based payments and will outsource in lieu of investing in new technology.^ Experian Health's Revenue Cycle Services leverage Experian’s proprietary technologies and experienced staff to optimize revenue cycle management (RCM) performance to help you meet your financial goals, such as increasing A/R yield, lowering operating costs, and resolution of revenue leakage issues and denials. Contact us today to learn more about Experian Health’s Revenue Cycle Services. ^2015 Black Book Survey
The MongoDB Innovation Awards celebrate organizations building the world's most innovative applications, recognizing those with a transformative impact on their respective sectors. Recently, Experian Health was recognized for our innovation in healthcare. Our Universal Identity Manager (UIM), which integrates with MongoDB to accurately sequence patient data, can accurately match, manage and protect patient identity. Drawing on more than 40 years of experience managing identities across various industries, Experian Health’s interoperable patient identification solution leverages consumer credit data to improve record quality. Our UIM creates a unique, universal patient identifier to identify patients and link their records to allow entities (pharmacy, lab, payer, and provider) with disparate databases, systems, and data formats to share a single view of the same patient. Accurate and complete information is securely exchanged, minimizing medical and billing errors, and fraud. “We leverage MongoDB to deliver UIM information in real-time – and that makes performance critical,” said Michael Ochs, chief technology officer of Experian Health. “If patient data is delivered out of sequence, it can create multiple issues in the delivery and accuracy of patient information. This technology makes the interoperability and exchange of information across the healthcare ecosystem is an achievable goal. With UIM, it is possible to successfully address problems caused by data integration challenges and fluid patient data.” Our consumer demographic information combined with reference data and referential matching methodologies allow the UIM to achieve higher matching rates and mitigate matching challenges associated with data quality. “We encourage health organizations to adopt universal patient identifiers because there is a well-documented need for it – the absence of which poses both business and safety issues,” said Jennifer Schulz, group president of Experian Health. “Our UIM batch product is being offered to organizations at no charge* to provide a universal patient identifier that will help address the complexities of managing patient identification by identifying consumers in the healthcare ecosystem more accurately.” Michael accepted the award on behalf of Experian Health at the annual MongoDB World event in Chicago on June 21, where he joined 13 other innovative companies being awarded in different categories. This award for Experian Health comes shortly after being recognized in the healthcare industry by Healthcare Informatics as no. 45 on the list of “Top 100 Companies by Revenue.” *Offer is limited to Experian Health’s UIM Batch Process product and shall remain open for such time as Experian Health may decide.
Reimbursement pressures and the real potential of changing regulations require that revenue cycle leaders leverage data and technology to be as efficient and nimble as possible to maximize net revenue, reduce denials, and lower operating costs. Shifting reimbursement models, complex benefit designs and limitations, increased patient responsibility, and growing regulatory pressures are driving near-constant change in the healthcare revenue cycle. Healthcare organizations that used to be paid by the encounter are adapting to emerging trends of also being selected, measured, and paid for how they perform and collaborate with other providers to improve outcomes. This value versus volume movement has forced hospitals, physicians, and other providers to focus on delivering high-quality, collaborative care at a lower cost while enhancing the patient experience, including efficiency and patient sensitivity in the revenue cycle. Experian Health’s Revenue Cycle Analytics provides visibility across the revenue cycle continuum, transforming operational and financial information into actionable insights. By tapping into Experian Health’s vast product workflow data and revenue cycle transactions, you can hone in to optimize specific workflows and compare your facility’s operations and processes against industry peers to make more informed business outcomes. Relevant data is presented for users based on responsibilities. With your internal data, we can Improve your workflows, operational performance, and financial results by leveraging your data across the revenue cycle, matching it, and analyzing the account across the various revenue cycle workflows and transactions Ensure accurate reimbursement by analyzing workflows and optimizing activities Create and monitor revenue cycle KPIs around pre-service, point-of-service, post service, denials, etc. to provide data points needed for process and financial optimization Provide comparative analysis and benchmarking that scores payer performance based on claim, rejections, denials, and exceptions Identify trends by drilling down to the staff, department, and service levels to uncover insightful details Maximize return on investment in Experian Health revenue cycle management products Enable the calculations of HFMA Map Keys and NAHAM Access keys for true peer-to-peer benchmarking With decades of Big Data experience, and as experts in gathering and securely managing huge quantities of data, Experian Health’s Revenue Cycle Analytics manages an unrivalled breadth and depth of data to help clients gain a deep understanding of people, businesses, places, economics, and health.
Consumers have come to expect the ability to check things off their to do list while online, like booking travel, shopping, etc., so it only makes sense for healthcare organizations to empower patients to schedule their medical appointments online, too. Not only is it easy and convenient for them, but it also saves your staff time. With today’s focus on value-based care, providers must ensure patients follow through with orders for care. Typically, over one-third of patients receive an order, but 20% never schedule a visit, putting their health—and your organization’s reimbursement levels—at risk. Using an online scheduling platform enables patients to schedule appointments online—improving patient access by fostering the integration and communication to make sure both patients and providers have a better care experience. Experian Health’s Patient Schedule is an online, data-driven scheduling platform that enables patients to schedule their appointments online. Patient Schedule helps you ensure patients are being scheduled for follow-up into your network, automates scheduling workflows with business rules to enable you to define appointment criteria, and even integrates in real-time with your practice management system and electronic medical records. If you’re ready to upgrade the patient experience, improve completion rates, optimize capacity, outcomes and practice performance, acquire new patients and keep them engaged, save time by enabling call-center agents to schedule directly into referral providers’ systems and improve staff efficiency and optimize provider calendars, find out more about Patient Schedule. Read our press release: Experian Health and MyHealthDirect team up to improve practice workflow with cloud-based patient scheduling across healthcare networks On Demand NAHAM-hosted Webinar: "You Can Book Flights Online – Why Not Medical Appointments?
Look forward to a better bottom line—and increased patient satisfaction Many providers face a of lack insight into agent performance and call durations, as well as the ability to route telephone calls to representatives based on experience or inquiry type. Others use manual vs. automated processes to call patients with outstanding balances. Having the ability to both contact patients and take inbound calls using a cloud-based dialing platform can significantly increase your collections and penetration rates. Some platforms can even provide the ability to monitor agent activity for performance and take payments after hours when no live agents are available, and provide access to actionable insight into call volumes and durations, giving you the ability to make more strategic decisions and adjust process flows. Increase the effectiveness of your collection and patient engagement strategies by pairing online and print communication channels using outbound and inbound dialing technology. Experian Health’s new cloud-based dialing solution, PatientDial, arms providers with the tools and data needed to make strategic decisions and increase calling campaign effectiveness and the collections bottom line—all without the need for costly hardware and software upgrades. PatientDial assists with patient outreach for patient collections and patient engagement processes and workflows. Services include inbound, outbound and blended call environments and can accommodate both live agent and blaster (unattended) messaging campaigns. IVR services are available to route calls to the proper type of agents and handle payments after hours. When combined with our PaymentSafe solution, PatientDial enables patients to make automated payments via telephone, and combining with our Collections Optimization Manager solution further increases ROI by leveraging screening results and segmentation to drive strategy solutions. Learn more about PatientDial Read the Sanford Health case study
During HIMSS17 in Orlando, Jason Wallis, Senior Vice President, Patient Access at Experian Health, sat down with IntrepidNOW to talk patient access and how Experian Health's solutions help providers across the revenue cycle. Excerpt below: "We have the eCare NEXT platform that drives a lot of our integration and patient access products. So anywhere from orders, all the way back to collecting payment from the patients, so right identity, checking eligibility, authorizations, medical necessity, patient estimates and then a tool to collect payment from that patient for those estimates. ...we’ve really taken this eligibility rail that has been pretty standard in the industry, and we’ve added a lot of content and innovation on top of those rails. So I almost call our clearing house a content network. So we drive more value in that transaction by normalizing, cleaning the data and enriching it with other data assets, so that downstream our clients and our products are better because of that advanced content. ...our integrated platform takes this data and be able to start chaining products together, and deliver back to the provider an exception based workflow that really has their staff only looking and working when something’s gone wrong. And the more we can automate around products and even products chaining off of other products, so eligibility to notice of admission, we are able to remove some of those manual single point solutions because it’s integrated in a single workflow." Listen to the full podcast Learn more about Experian Health's patient access solutions and eCare NEXT platform