Patient Access

COVID-19 changed every aspect of the patient journey – placing unprecedented demands on the healthcare system and accelerating the need for digital transformation industry-wide. Telehealth, touchless engagement, and self-service scheduling became the new normal; however, this created new stress on operations, administration, and finance. While this new normal comes with many challenges, data and digital tools have created greater accessibility, engagement, transparency, and control for patients and providers. In this blog, we examine COVID-19’s impact on the patient journey and explore the digital tools and data that are helping the healthcare industry recover and thrive. To get more insights, read the full whitepaper here. COVID-19 strained the healthcare system more than ever before. To say that COVID-19 challenged the healthcare system is a massive understatement. Seven in 10 patients deferred or canceled treatments during the pandemic, causing disruptions to both revenue and patient engagement. Even behind the scenes, novel diagnostic codes and new sources of information—together with rising inpatient volume and government intervention—affected costs, billing and reimbursements at scale. Patient-provider relationships became much more complex. Many people moved, changed jobs and changed insurance during the pandemic. In fact, an estimated 40 million Americans lost work during the pandemic and just over half of all workers in North America plan to look for new work in 2021.  As a result, relationships between physicians and patients became disrupted. While re-engagement is critical for providing care, simply finding patients remains a challenge. The digital experience raised patient expectations. As consumers turned to technology to cope with changes, digital engagement increased in healthcare services and elevated consumer expectations. This trend began before the pandemic: A pre-COVID-19 AARP survey of older adults (50+) found that a majority would prefer to have their healthcare needs managed by a mix of medical professionals and technology. During the pandemic, patients used telehealth to access care from home, mobile registrations to avoid filling out paperwork in the waiting room and digital payment options that made paying bills simple and seamless. Now that patients have experienced telemedicine, self-service scheduling and easy digital payments, there is no going back. Expectations have changed permanently, and providers that don’t offer an updated patient experience may suffer by comparison. Opportunities for better outcomes: transforming the patient journey with digital transformation We looked at key parts of the patient journey where technology is helping healthcare providers engage and care for their patients successfully across the marketing, scheduling, registration, authorization, treatment, claims and payment. Here are a few strategic opportunities for providers to consider post-COVID: 1. Use smart data for better outcomes Third-party data is helping providers find and re-engage patients, deliver more holistic care and facilitate better financial outcomes. For example, integrating data on social determinants of health (SDOH), can provide physicians with a more holistic picture of non-medical factors that may influence medical outcomes, such as a patient’s socioeconomic status. SDOH data can also shine a light on a patient’s ability to pay, which in turn may inspire a wider range of payment options so that more patients can afford care, and more providers can avoid write-offs. 2. Continue using technology and automation for the recovery to come Using digital self-service applications for registration does more than just provide the patient-friendly option of completing paperwork at home (instead of the waiting room). It also eliminates the need for staff hours spent inputting information, reduces the potential for error, and improves efficiency. Advances in automation make it possible for providers to reduce the effort of manual tasks - like sorting through patient records from disparate sources to create a single, comprehensive patient file, or gathering the information necessary to revisit claims authorization for deferred care. Across the board, digitalization provides greater transparency, flexibility, and seamless experiences for patients and providers alike. 3. Clear the path for payments Going digital can help patients and providers better navigate the patient journey, especially when it comes to payments. As many as half of nonretired adults expect long-term financial effects as a result of the pandemic. This makes it more imperative than ever to improve and accelerate authorization, claims, and payment processes so that both patients and providers have a clearer understanding of how care will be paid for. Accurate patient estimates, coverage discovery, automated authorizations, and payments all play a role in creating a better financial experience going forward. Digital transformation gains traction as we look to the future Although the digital transformation was already underway before COVID-19, the pandemic has accelerated the need for data, automation, and self-service tools. Find out how Experian Health can help your organization meet the data challenges of the post-COVID-19 patient journey by downloading our white paper.

"93% of providers say creating a better patient experience remains a top priority, up 3% from last year." - Experian Health's State of Patient Access, June 2021 In November 2020, we surveyed patients and providers for their sentiments on how patient access changed because of the pandemic. During this time, patients welcomed the convenience and control that came with digital, contactless care. Providers knew they needed to improve their digital front door to withstand the financial impact of COVID-19, but implementation was difficult for many organizations. Six months on, and millions of immunized Americans later, the pandemic landscape shifted again. In June 2021, we revisited these questions to find out if patient and provider views have changed - in our State of Patient Access 2.0. Now, patients tell us they feel more confident about returning to facilities, though they still want the flexibility and convenience of digital scheduling, registration, and payment options. Providers feel a growing urgency to make sure online services are sufficiently agile enough to withstand any future surges in COVID-19 case numbers. The findings of the survey reveal four major opportunities to rethink how we “do” healthcare. By innovating and building on the digital advances made possible during the pandemic, providers can create better patient access experiences for the future. To start, providers should: 1. Match consumer expectations for convenient and flexible patient access Our recent survey shows that the pandemic has cemented consumer expectations around convenient access to care. Digital and remote channels for scheduling appointments, completing pre-registration, and making payments have become the new baseline in patient access. Nearly three quarters of patients told us they want to schedule their own appointments online. Providers know this: 93% say creating a better patient experience remains a top priority, up 3% from last year. Online self-scheduling can help providers continue to meet their patients’ demands for flexibility and convenient access to care. Patients can find, book and cancel appointments whenever and wherever they prefer. It’s also a win for providers, who can expect to see a drop in administration errors, no-shows, and denied claims. 2. Streamline prior authorizations as more patients return to care Interestingly, new data reveals that patients are less anxious about in-person care. In 2020, 40% of patients were uncomfortable coming into waiting rooms and seeing their doctor in person. Now, only 16% say they wouldn’t be comfortable in a waiting room. As more patients rush to reschedule deferred care, providers are faced with the challenging combination of higher patient volumes, patients jumping health plans as a result of job losses, and changing payer rules around prior authorizations and coverage checks. Automated pre-authorization and automated coverage checks can relieve the pressure, and help providers save time and resources. 3. Promote price transparency for fewer missed payments An encouraging piece of insight from our latest survey reveals that far fewer patients say they’ve been surprised by their final medical bill. In 2020, more than 50% received a final figure that differed significantly from estimates. Six months later, that figure has dropped to just 14%. Price transparency remains important, and the gap between estimated and final costs seems to be closing. More providers are offering patient billing estimates, with 9 in 10 agreeing that accurate estimates increase the chance of bills being paid on time. Many are also giving patients more options to pay bills earlier in the journey, which has helped to minimize the risk of late and missed payments. Easy and accessible digital options are featured heavily in acquisition and retention plans, and can help drive financial recovery. 4. Tighten up data strategies with better security, quality and insights While our first survey revealed that the sudden shift to digital-first patient access was a shock to the system for many providers, the second study shows that both patients and providers are settling into digital ways of working. But as these digital services become the new baseline, providers must make sure their data strategies are fit for purpose, and prioritize data security, quality and insights. Moving forward, a multi-layered approach will help providers authenticate and secure patient identities. When these identities are enriched with information about how patients are affected by the social determinants of health, providers will be better positioned to offer personalized patient access experiences and support marginalized groups. The future of healthcare is digital. Is your organization prepared? It’s clear from our recent survey that the digital trends that emerged in 2020 are set to continue throughout 2021 and beyond. Download the State of Patient Access 2.0 white paper to get the full survey results and explore how data and digitalization can power a 24/7 patient access experience in your healthcare organization.

As the country strives to ramp up the pace of COVID-19 vaccinations, providers need to take new approaches to drive registration volume. Healthcare experts are increasingly concerned about the rapid spread of the highly contagious delta variant, which now makes up over 83% of COVID-19 cases. This variant is estimated to be 60% more transmissible than previous strains, and while vaccination doesn’t eliminate the risk, it does reduce the likely severity of infection, which is better for both individuals and health services. Ramping up the vaccination program and ensuring that a large proportion of the population receives the injection just became a lot more urgent. This is also critical for vaccine management plans as the U.S. looks to offer and roll-out booster shoots later this year. The initial vaccine rollout was plagued with issues, many of which remain unresolved. An uneven rollout, confusion over where to get vaccines, and logistical obstacles with preparation, distribution and funding at the state level meant the program got off to a slow start. Consumers were deterred from registering due to inefficient scheduling systems, while others were left frustrated by basic user interface challenges. And for those less familiar with digital technology, the shift to online platforms took some getting used to. Now, with the delta variant taking hold, and vaccine hesitancy on the rise, healthcare providers need to consider how digital technology can make vaccinations more accessible, rather than becoming the obstacle. Improving the user experience through digital tools and automation can reduce barriers to care, drive up vaccine registrations, and ultimately lead to better outcomes for individual and population health.   Poor UX creates avoidable barriers to scheduling care One of the major accessibility challenges for consumers was being able to schedule vaccine appointments. In the initial rush to get vaccinated, demand outstripped supply, and online scheduling systems struggled to bear the load. Some providers tried to rely on email booking systems or third-party event schedulers – which resulted in communication errors, delays, missed appointments, and huge burdens on call center staff. For individuals who were unable to use online systems due to limited internet access, disability, or unfamiliarity with the technology (for example, as reported by some older people), the inaccessible and non-intuitive user interfaces created a digital divide. The poor user experience also contributed to some individuals feeling hesitant about seeking the vaccine, eroding their trust in the system as a whole. Efforts to increase and ramp up vaccination rates will be much more successful if the scheduling process is simplified.   Frictionless scheduling and registration can drive up vaccine rates  With the right data and digital tools, many of these patient access challenges can be resolved. Frictionless self-scheduling and streamlined registration processes can make it easier for people to book appointments and register for the vaccine. For example: Online scheduling platforms allow patients to book and reschedule vaccine appointments whenever and wherever it’s most convenient, as part of a multichannel approach. Automation enables providers to create an outreach list of patients who may be waiting for the vaccine, and send automated reminders by text or email. These can be used to disseminate accurate information to alleviate vaccine hesitancy. The messages can also be personalized to follow the patient’s individual communication preferences. Consumer data and analytics on the social determinants of health can be folded into communications, to tailor information to specific segments of the population who may have been adversely affected by barriers to care. Scheduling software can pull together real-time booking and registration data into a single, holistic view of patient access, whether patients booked via online platforms, call centers or in provider offices. This will help alleviate bottlenecks and make better use of staff resources.   Digital tools can improve the patient experience and supercharge vaccine management plans, but only if they are implemented properly. Experian Health’s Director of Product Management, Liz Serie, says, “The old way of doing patient intake involves piles of paper, clipboards and long waits in the waiting room. The new way involves automation, pushing relevant and personalized information to patient’s devices, and seamless data management to initiate the patient journey. It’s a reassuring, simple and reliable user experience, especially as many still need to be vaccinated. And as patient volumes drive back up, investing in a welcoming digital front door is critical.” The future of patient access is digital, and providers that get their systems up and running effectively now will reap the benefits in the long run. Find out more about how data and digital tools can make vaccine appointment scheduling a breeze for your patients and patient access team.

  Consumer-led care hit its stride during the pandemic. COVID-19 unlocked healthcare’s digital front door, giving patients more control over how and when they schedule and manage appointments. Unfortunately, while digital patient access has made navigating the healthcare system more convenient and flexible in many ways, consumers are discovering that one of the more frustrating aspects of the healthcare experience has failed to keep pace with scheduling, payments and other digital advances: registration.   Waiting rooms. Paperwork. Misplaced insurance cards. Confusing copays. More paperwork! A hassle before the pandemic, registration has become even more challenging for staff and patients in the context of “contactless care.” With more patients starting to come back through the door as a result of vaccination programs and rescheduled elective procedures, there’s an opportunity for providers to smooth out the kinks in the registration experience.   Vaccine “hesitancy” has exposed wider issues in patient registration Headlines suggest that large numbers of patients are fearful of being vaccinated against COVID-19. But dig a little deeper, and the issue is more complex. Many patients do want to be vaccinated, but struggle to navigate complicated registration websites, and therefore aren’t showing up for their shot. The Kaiser Family Foundation reported in January that two thirds of patients were unsure of how to access the vaccine. The high volume of patients having trouble getting the information they need is shining a light into the dark corners of the registration process, where improvements have long been needed.   Improving the patient registration process isn’t just a pandemic problem   While it’s true that COVID-19 is driving the push for online patient registration, improving the overall experience offers wider, longer-term benefits to patients and providers:   A convenient and consumer-friendly registration experience Online registration is easier, faster and simpler for patients. With 73% of consumers saying they want to manage their healthcare admin through patient portals, convenient self-service solutions are a trend that’s here to stay. (Find out more about consumer attitudes to patient access in Experian Health’s Patient Access Survey.)   More accurate patient data and fewer duplicate records When consumers are the ones responsible for entering their patient information, and when they can do it in a time and place that suits them best, that data is far more likely to be accurate. Not only does this create a better patient intake experience, it also reduces the risk of patient identity errors and duplicate records.   With a text-to-mobile registration tool, patients can begin the process with one click, and then easily verify and edit information to make sure their records are up to date and correct.   Operational efficiencies and better claims recovery Beyond the customer experience, improved registration can reduce the risk of denied claims, because the data is processed more accurately and quickly, and can be automatically verified against comprehensive datasets.   Patients can also choose to pay copay amounts upfront through online registration tools, which makes bad debt far less likely, and improves the overall revenue flow.   Safer and smoother registration during flu season COVID-19 put unprecedented pressure on registration processes. But more streamlined systems with remote, mobile-friendly registration tools will make a typical flu season more bearable for patient access staff and patients too.   Patients and staff have suffered through cumbersome registration processes for years. Perhaps one unforeseen benefit of the COVID-19 pandemic is that the days of sitting in busy waiting rooms, filling out multiple forms, will be a thing of the past? Discover how Experian Health’s patient intake solutions could help your patient access department create a registration experience that matches today’s consumer expectations.

  “The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.”   This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior authorizations requirements were particularly messy, and as more patients return to care, there’s a risk they’ll become even more chaotic.   During 2020, many in-person healthcare services were canceled, delayed, or avoided for fear of infection. Now, patients feel more comfortable about returning for care. When we first surveyed consumers in November 2020, 58% said they’d wait until COVID-19 subsides before rescheduling. In June 2021, only 19% said they’d wait. Canceled procedures have dropped by half, and while the opportunity to recoup lost revenue is a relief for providers, processing prior authorizations for the sudden influx of patients is a worry.   Two thirds of providers say they find it difficult to keep track of changing pre-authorization requirements. Two in three also expect to face issues in securing authorizations for scheduled elective procedures, up from just over half last year. Embedding accurate and efficient workflows will be paramount as patient volumes rise, which means it’s time to rethink the archaic manual processes that often result in delays, errors, and non-compliance. Could automation offer a mess-free way to manage the growing challenge of prior authorizations?   Manually managed prior authorizations cost time, money, and quality of care   Even before the pandemic, prior authorizations were a thorny issue for healthcare organizations who wanted to offer the best possible care to patients, without risking denied claims. According to the Medical Group Management Association (MGMA), 80%-90% of medical groups say prior authorization requirements have grown year over year.   In an ideal world, prior authorizations protect patients from undergoing therapies that are overpriced, ineffective or unnecessary. They assure providers that they’ll be reimbursed for the services they deliver, and confirm that treatments are high-quality, evidence-based, and safe.   In reality, while prior authorizations can help incentivize value-based care, the admin and financial burden for providers is growing exponentially. Frequent changes, increasing denials, and lengthy negotiations with payers mean many providers need to employ additional full-time staff to handle prior authorizations. As the cost of drugs soars, they’re forced to lay out huge sums and cross their fingers as they wait to recoup the costs.   There was a hint of respite at the peak of the pandemic, when payers lifted many requirements, or extended authorizations already held on file. But these changes took time to filter through, and some providers continued to lose up to two entire business days per week to prior authorizations work during the pandemic.   Now, as the pandemic starts to settle, those requirements are back (and growing), and providers are scrambling to re-join the dots using their old, manual processes. As patient numbers surge, traditional manual methods for such an admin-heavy process are straining under the pressure. With so many accounts to authorize, the need for an automated solution is even more apparent.   Leveraging automated solutions for speedy, accurate prior authorizations To ensure patients get the care they need and to keep a lid on further revenue loss, hospitals and medical groups should consider tapping into automated authorizations engines. With an integrated Authorizations management system, you can initiate more authorizations in less time, run automated status checks to avoid rescheduling care, keep abreast of changing payer rules, and avoid unnecessary reworking of claims.   Users are guided through the workflow, which auto-fills essential real-time payer information. Patient information is populated by the SmartAgent feature, so pre-certification can be progressed quickly behind the scenes. Users only need to step in when clinical questions pop up. Notice of Care (NOC) generates a worklist of all pending patient encounters, to ensure that no payer notification requirements for notice of admission, observation or discharge are missed. Staff can escape the time-suck of repeatedly checking payer websites or calling up payers to verify yet again whether a patient encounter qualifies.   Say goodbye to Excel spreadsheets and lengthy calls to payers For organizations worried about rising patient numbers choking their existing manual workflows, switching to an automated system could be a timely move. Chasing paperwork is never a good use of resources, and with the lingering possibility of pandemic flare-ups, automated authorization inquiries could help minimize time spent on tedious manual tasks and running checks with payers.   Find out more about how Experian Health’s Prior Authorization software could help your organization minimize the risk of missed reimbursements, and give your team the breathing space needed to focus on maximizing support for patients returning to care.

More than 40% of patients surveyed skipped medical care in the early months of the pandemic, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health. Of those who needed care, 58% missed scheduled preventive care. Similar trends are observed in cancer screening, with appointments for breast, colorectal, and cervical cancers – in some cases dropping by around 80%-90% in March and April 2020, compared to 2019. Diagnostic testing for several cancers also plummeted, as did HPV vaccinations.   These trends aren’t unexpected: COVID-19 forced medical facilities to cancel or scale back services, while fear of infection and financial worries kept many patients away. But with most services operating at near-normal capacity again, and the vaccine program tipping the balance in favor of rescheduling care, preventative services are still lagging. Many patients remain reluctant to attend screening and wellness visits, despite the health risks associated with delaying care for potentially serious conditions.   Re-establishing a preventive care routine is essential. For patients, getting back on track with earlier diagnosis means more timely treatment and a better chance of recovery. It promises a better financial outlook for patients, payers, and providers alike, who all suffer higher costs when medical conditions escalate. And providers want to get their day-to-day business back on track to smooth out what has been a heavily disrupted workflow and revenue cycle over the last year.   Providers must reassure patients that returning to care is safe and necessary. Compassionate and personalized support will be key to making sure patients get the right care at the right time. Automated patient outreach strategies built on comprehensive patient data can help reverse the trends in forgone care.   How can data and automation support personalized patient outreach?   Kelly E. Anderson, one of the authors of the John Hopkins study, suggests that “physicians can mitigate some of the long-term harmful effects of this forgone care by proactively reaching out to patients who missed care, to try and reschedule the care either in-person or through telehealth.”   Automated outreach combined with easy patient scheduling platforms can help providers identify and invite healthcare consumers to get much-needed preventive care appointments back on track. For example:   Automation makes scheduling easy for patients and efficient for providers Online scheduling platforms allow patients to reschedule missed appointments at a time and place that suits them. A targeted outreach list of those patients most likely to need screening (for example, based on age, lifestyle, or health risk factors) can be used to send automated booking prompts and reminders by text message or interactive voice response (IVR). It’s simple and convenient for patients and reduces pressure on call center staff. Plus, it generates a wealth of useful real-time data on response rates to pinpoint areas for improvement.   With the right data, providers can direct patients to appropriate services For patients that can’t or prefer not to attend their usual healthcare facilities, directing them to telehealth services or alternative venues might be a good option. Similarly, patients with a medical or family history that suggests a higher risk of cancer ought to be prioritized for screening. But you can only do this when you know who those patients are, and what exactly they need. Social determinants of health can be a powerful tool to help providers determine a holistic view of patients’ clinical and non-clinical needs.   ConsumerView collates consumer data from over 300 million individuals, across multiple demographic, psychographic and behavioral attributes, so providers know more about the lifestyles and interests to be able to effectively resonate and engage. Data helps create a better patient financial experience Since many patients are worried about the loss of health insurance, outreach efforts might also involve pointing patients towards appropriate financial support. When socio-economic data reveals that a patient is struggling financially, providers can quickly check for missing coverage, offer tailored payment plans, and help obtain charity care if required.   Automated outreach can also deliver the upfront information about healthcare pricing that so many patients demand, and help staff collect faster patient payments by providing easy payment links through text and IVR campaigns. Consumer data can inform compassionate patient communications With the majority of patients opting out of scheduled appointments because of concerns about COVID-19 exposure, any invitation to reschedule care should offer plenty of reassurance about hygiene protocols. Some patients may need a gentle nudge to reschedule appointments, so if you can help them feel comfortable visiting facilities and tell them what to expect, they’ll be more likely to return.   Offering additional reassurance and support to communities who are traditionally underserved by healthcare services, or who have been harder hit by COVID-19, will be even more important. Best contact information, social determinants of health insight and ethnicity insight can support efforts to promote screening to groups who may face additional barriers to care.   With the right data, you can go beyond compassionate messages and choose an appropriate communications channel that’s the right fit for the consumer, too.   One thing that hasn’t been hindered by COVID-19 is the trend toward healthcare consumerism. Patients have a choice about which provider they use. Proactively supporting patients to catch up on missed care is a surefire way for providers to stand out as the easy choice.  

Will handshakes become a thing of the past? Will face masks become a regular feature of flu season? Will home-working remain popular, even after workplaces re-open? COVID-19 forced some abrupt behavior changes that challenged existing cultural norms, but as the pandemic subsides, how many of these adaptations will survive?   For healthcare executives, the return to on-site medical visits raises similar questions. Healthcare consumers were already expressing an appetite for more convenience and control, and the pandemic accelerated the use of digital solutions for everything from patient access to telehealth. Being able to book appointments, complete pre-registration forms and make payments online is the new baseline.   As patient volumes start to increase, hospitals and physician groups shouldn’t take their foot off the gas with digitalization, particularly in patient intake, which doesn’t have to involve in-person contact. There’s an opportunity now to learn from what’s worked well over the last year and cement the pandemic’s digital legacy.   What does the new normal look like in patient intake? Getting back to basics with convenience and compassion Once crisis mode has passed, providers can refocus their efforts on the building blocks of an optimal health service: high quality care and a convenient and compassionate patient experience. After the uncertainty and loss of control over the last year, patients want autonomy and choice. Initiating a smooth patient journey through online pre-registration, patient portals, virtual waiting rooms and digital scheduling can contribute to this.   Many will be happy to say goodbye to piles of paper forms and long waits in the waiting room. But any digital strategy must also support those with limited access to devices and broadband or limited digital literacy. Liz Serie, Director of Product Management at Experian Health, says:   “The goal is to give patients the same exceptional experience and care, regardless of when or how they complete patient intake. Using the same tools that we know our patients are already comfortable with will help to ensure an inclusive approach.”   Digital technology can support a multichannel approach, for example, using automated dialers to make phone calls where mobile apps aren’t an option, or using patient data to segment individuals according to contact preferences. Re-engaging hesitant patients The CDC reported in September 2020 that around 40% of adults delayed care due to the pandemic. While more recent data suggests fewer patients are deferring care, some experts worry that patient volumes won’t return to normal until 2022. How can providers ease the return to care?   Online health portals were helpful in keeping people out of facilities during the pandemic – can they now serve a different purpose in reminding patients to come in for check-ups?   Patients will need clear information about what protocols to follow during patient intake and what to expect from virtual waiting rooms, as well as reassurance that the experience will be safe. Streamlining patient access with accurate data Unlocking the digital front door made logistical sense during the pandemic. It’s even more critical as patient volumes drive back up. Providers will want to review their protocols to be sure that speedy implementation has not left that door open to costly data errors. Is the right information being collected at the right time?   Consumers are looking for flexible and accurate appointment slots for self-scheduling, and they want their financial ducks in a row as soon as possible with quick authorizations and coverage checks. Getting data right first time makes for a smoother patient experience, more efficient staff workflows and fewer claim denials down the line. Preparing for an uncertain future Looking ahead, patient intake protocols will need to be flexible enough to adapt to changing patient needs, particularly if there are further waves of the pandemic. Digital solutions can help providers prepare for the unexpected and shift from a reactive response in a crisis to a proactive step towards the future.   For many providers, future-proofing the patient intake experience is also an important remedy to the financial losses suffered during the pandemic. Digital solutions built on accurate data, consumer needs, accessible information can protect against further revenue loss by giving patients reliable ways to access and pay for care, no matter what the future holds.   Medicine is built on in-person care, but we don’t need to be face-to-face to fill out forms. Patient intake is one area where “the old way” doesn’t have to return. Find out more about how your organization can build on the pandemic’s digital legacy and create a leading patient intake experience.

    Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding strategy to sustain vaccination efforts. We interviewed J. Scott Milne, senior director of product management at Experian Health, about what’s changed and what providers can do to prepare. How can providers ensure that vaccine administration codes are billed correctly? The ICD-10 and CPT codes for the COVID-19 vaccine haven’t existed until now, which means providers have a new set of codes to learn and unfortunately, those codes seem to change or update almost daily. As more vaccines are introduced, more codes are also introduced, and not just for the vaccine as a whole, but for each specific dose of the vaccine. For example, dose one of the Pfizer vaccine will have a code that differs entirely from dose two of the Moderna vaccine. Keeping up with these changes isn’t only difficult for provider staff, who are likely already stretched thin, but they certainly don’t want to run the risk of submitting a claim with incorrect information. The errors are what result in denials or undercharges. A solution like Claim Scrubber ensures code sets are current on a daily basis – a necessity for times like these – but applies an extensive set of general and payer-specific edits before preparing the claim for processing. That means claims for vaccine administration are error-free before submission to the payer or clearinghouse. Providers can eliminate undercharges, boost first-time pass through rates and do away with costly, time-consuming rework. But proper coding is only the first piece of the billing puzzle. The second piece is to verify the accuracy of payment received from third-party payers. How can providers ensure that third party payers will reimburse at the contracted rates? Providers can certainly get reimbursed for administering the vaccine, but there are a lot of moving parts to keep up with. For example, both Medicaid and Medicare will reimburse providers for administering COVID-19 vaccines, but the percentage of what is covered will differ by carrier and the reimbursement rates can vary both by state and type of arrangement. Reimbursement rates will also vary amongst private payers. Then there is the variation in reimbursement based on vaccine type and dosage -- vaccines that require a single dose may be reimbursed at a rate different than those that require two doses. Even without the vaccine rollout underway it can be a headache for hospitals and health systems to manage multiple payer contracts and reimbursement methodologies. A solution like Contract Manager will pinpoint variance in reimbursement quickly and easily, accurately pricing claims and comparing actual allowed amounts to expected amounts. It is a tool built to adapt to changes within the industry, so providers can capitalize on emerging reimbursement schemes and changes in payer payment policies. It can also help identify sources and patterns of errors so recurring issues can be promptly resolved. The end result: the provider organization can the payer revenue that is due for vaccine administration. Interested in learning more about how providers can optimize vaccine-related reimbursements?   Other blog posts in this series: Segmenting your patient population for the COVID-19 vaccine Engaging patient segments with convenient, secure scheduling solutions Authenticating portal access with automation Optimizing reimbursements by capturing missing coverage

You may also like: Supercharge your COVID-19 vaccine management plan with digital solutions “Experian Health’s ability to move quickly and adapt their self-service platform to schedule vaccines for patients has been an invaluable improvement not only for our operations, but to the patient experience. The power to schedule the vaccine’s second dose after the first is administered helps us deliver on our commitment to providing reliable, quality care.” - Julie Frahm, director of consumer digital products at Sharp HealthCare The unpredictable nature of patient volume is a large part of what makes scheduling for the COVID-19 vaccine so difficult. Before now, providers haven’t had to manage mass appointment slots and registrations tied specifically to vaccinations. And even with those features streamlined, providers are still unsure of the best way to reach out to patients who are eligible for the vaccine to prompt them to schedule their appointment. Already a user of Experian Health’s Patient Schedule solution, Sharp HealthCare turned to online self-scheduling to improve patient access to the COVID-19 vaccine. With the solution in place, patients of Sharp HealthCare who are eligible for the vaccine can schedule their first dose online via computer or mobile phone. After answering a short set of questions, the scheduling solution will guide patients to a calendar of available day and time slots for receiving the first vaccination. After the first shot is administered, Sharp HealthCare staff can schedule patients for their second dose onsite, prior to leaving the office. Patients of Sharp HealthCare are consistently utilizing online self-scheduling to book appointments for their vaccinations. More than 1,000 vaccinations were scheduled in the first three weeks of online self-scheduling being available to patients. The ability for provider staff to help book the second dose of the vaccine for patients has also helped Sharp HealthCare deliver on their commitment to quality care, further ensuring the efficacy of the vaccine for each and every patient. Patients are also enjoying the expanded use of a self-service digital service, especially for a process that has been widely known to, at least thus far, be a detriment to the patient experience. Discover how Patient Schedule can improve vaccine management.