Patient Experience

Staffing shortages continue to plague the healthcare industry, creating challenges for both healthcare providers and patients. In a 2022 CVS Health-Harris Poll National Health Project survey, 51% of 2,023 U.S. adults surveyed said they had been directly affected by healthcare staffing shortages. Among this group, 45% had trouble scheduling appointments, more than a third said their doctor was operating on reduced hours, and a quarter had treatments or surgeries delayed. Digital self-scheduling solutions help patients access care even when appointments are in limited supply. It allows patients to schedule care whenever they decide they need it—during the work day, in the evening, or overnight when a child wakes up coughing—without having to rely on front desk or call center availability. Coupled with digital registration and patient outreach, self-scheduling helps to uncomplicate early steps in the patient journey, making it easier for patients to access care, prepare for their visits, and keep their appointments without canceling. Getting provider scheduling right is a critical step With staff and inventory in short supply, healthcare organizations are under increasing pressure to optimize scheduling. “Some doctors may only be available a few days a week,” explains Sanju Pratap, Vice President of Product Management at Experian Health. “They may prefer to see new patients only on certain days or reserve a certain number of next-day or same-day appointments for patients with urgent needs. Scheduling has to account for these details, while effectively connecting patients with the care they need, and ensuring that next-day or same-day appointments are available to book when appropriate.” At the same time, overbooking and scheduling glitches can contribute to burnout, a growing problem that contributes to the industry staffing shortage. “It’s absolutely critical to get scheduling right,” Pratap says. Digital solutions help keep complex schedules in order, while also making inventory available via a variety of channels. “We’ve been able to offer appointments across multiple access points: hospital websites, practice websites, our contact centers, and in our texting and referral outreach programs,” says John Mercer, Executive Director of Online Scheduling at HCA Healthcare. “Experian Health's Patient Schedule has been well-received by our provider population, both employed and affiliated,” Mercer says. “It affords providers the opportunity to receive new patients from a digital domain even when the office is closed. We can also specify certain appointment types and dedicated inventory for patients with acute needs." Listen in as John Mercer, Executive Director of Online Scheduling at HCA Healthcare, discusses how they utilize Experian Health's Patient Schedule solution to improve the patient experience: In a digital world, patients would rather do it themselves Meanwhile, 90% of patients want easier access to care in the form of digital self-scheduling tools, according to a 2021 Salesforce survey. This isn’t surprising in a world where consumers use digital self-service to accomplish logistically complicated tasks every day. Summoning a late-night ride in a strange city or finding replacement parts for a 1970s-era light fixture used to seem difficult. Now, the integration of digital self-service into daily life means a majority of consumers feel willing and able to handle scheduling themselves. It may be a happy accident: At a moment when scheduling and staffing have become key challenges for healthcare providers, patients want to take scheduling into their own hands. And interest in digital self-service doesn’t end with scheduling: Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Opening the digital front door with patient self-scheduling, pre-appointment registration, and patient outreach solutions not only reduces the need for staff time, but also meets patients where they live. Digital scheduling works for patients in part because they manage their own calendars digitally. Receiving appointment reminders by text is helpful because texting is the channel patients already use to communicate with friends, family, and coworkers. Remote registration continues to meet the patient where they are. Using digital scheduling solutions to combat healthcare staffing challenges Patient self-scheduling and other digital front door solutions offer providers the opportunity to serve patients effectively while improving their own efficiency. Digital solutions can alleviate the burden on call center or front-desk staff and reduce the potential for human error when collecting patient identification and insurance information. Capturing this information accurately has downstream benefits when it’s time to process claims and manage billing. “Digital scheduling also plays a role when providers are bringing in new patients,” Pratap says. “Patient Schedule asks a series of questions that helps patients choose the right provider and the right type of appointment for their needs, even across specialties like orthopedics and cardiology, and subspecialties within these areas. Digital scheduling that is capable of complex decisioning makes it less likely that staff will need to follow up and reschedule. Having access to this level of self-service is invaluable for new patients who find providers on third-party sites: As they learn about each provider, they can see their availability and book an appointment on the spot. Positive experiences with scheduling can set the tone for a patient’s interactions with a provider.” The need for automation and digital solutions is intensifying as patients continue to gravitate toward digital self-service and providers continue to grapple with healthcare staffing challenges. Providers and their partners will need to evolve. “As we’ve grown from website scheduling and contact center scheduling to new forms of patient outreach, Experian has been able to provide us with those solutions and work with us to develop new ones as well,” Mercer says. The time to incorporate patient self-scheduling solutions is now. Learn more about how Experian Health can help address healthcare staffing challenges and close gaps in care by allowing patients to schedule appointments on their preferred device, anytime.

Clear, convenient and compassionate – patient-friendly billing should check off all three. But how many patients see this in practice? For many, the healthcare billing and payment process can be intimidating, confusing and rooted in paper-based systems that are slow and prone to error. With the right technology, providers can improve the billing experience by making it easier for patients to understand their financial responsibility and plan their payments. Online patient payment software can streamline the billing process by giving patients more flexibility and control. Here are 5 patient-friendly billing practices that providers can implement to improve the patient experience and protect revenue: 1. Provide proactive and reliable cost estimates Patients don’t want to feel like they’re in the dark when it comes to figuring out their financial responsibility. Unfortunately, too many receive no upfront estimates of the cost of care or receive estimates that aren’t accurate. This financial uncertainty can have a knock-on effect on patient care and provider cash flow. A survey by Experian Health and PYMNTS found that 46% of patients had canceled care after receiving a high-cost estimate, while 60% of patients with out-of-pocket expenses said they would consider switching providers after receiving inaccurate estimates. Patient Payment Estimates generates accurate, personalized estimates for each patient before and at the point of service. The patient’s liability is clearly broken down so they know exactly what to expect. Patients feel more in control and can make quicker, better decisions about how and when to pay (including paying upfront if they wish). This tool also helps providers comply with the Hospital Price Transparency Rule. 2. Eliminate confusing billing information In the age of Amazon, patients expect billing information to be clear, accessible and provided through their preferred channel. Long paper statements sent by mail or a single phone number to call during limited office hours likely won’t cut it. Providers should consider a multichannel approach that uses relevant patient financial data and consumer preferences to deliver personalized options. PatientSimple® is a self-service payments portal that allows patients to view statements online, generate pricing plans and manage their bills, all from a single dashboard. Patients can get automated email reminders and even pay in full. When patients have all the information they need at their fingertips, providers can spend less time handling queries and chasing payments. 3. Find missing coverage early Another ingredient in patient-friendly billing is to help patients reduce their liability, by tracking down any insurance coverage that might have been forgotten. Many patients relocated or changed employers during the pandemic, leaving many unclear about their current coverage. They may be misclassified as self-pay or assumed to have only one form of insurance. Coverage Discovery automatically checks for any active coverage that may have been missed. In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts, finding over $66 billion in corresponding charges. This greatly reduces the financial burden on patients, while increasing reimbursement rates for providers. It’s just one example of a non-patient-facing tool that works behind the scenes to streamline patient collections. Discover how Stanford Health Care collaborated with Experian Health to optimize collections and improve the patient experience with Coverage Discovery and Collections Optimization Manager.  4. Patient-friendly billing requires personalized payment plans When it comes to payment, some patients will prefer to pay upfront and in full, while others want or need to spread out the cost into more manageable chunks. Providers can pull together financial, demographic and consumer data to point patients toward the right pathway. This is how Patient Financial Clearance works: patients are guided to a payment plan that makes the most sense for their individual situation, with a clear breakdown of what they’ll need to pay and when. Patients are automatically screened for financial assistance programs and can fill out applications online. 5. Allow convenient and flexible ways to pay Patients want simple and easy ways to pay. They expect a choice of quick and convenient digital payment methods that can be accessed anytime, anywhere. The preference for digital payment solutions is especially apparent among younger generations. More than half of millennials say they’re “very” or “extremely” interested in digital services. With online patient payment software, patients have the option to pay multiple providers at once, using multiple forms of digital payments. They can store credit card information on file or set up a digital wallet, and set up automatic recurring payments to stay on track. Offering secure, flexible and instant payment methods to patients from the start of their healthcare journey increases the chance of prompt payment. Patients are free to focus on their health, while providers will see an increase in cash flow with less time spent on collections. Patient-friendly billing practices create better patient experiences  Outdated patient portals, poor communication and clunky billing processes do not make for a patient-friendly financial experience. The good news for providers (and their patients) is the growing menu of digital tools to offer patients the clarity and flexibility they expect. Experian Health President Tom Cox says: “Payment options are increasingly digital and more convenient, payment plans are more common, and price estimates have become less of a rarity. There is also greater use of non-clinical data to get a broader view of patients and their unique financial solutions. Data, coupled with the right technology, can help providers make sense of it all and enhance the patient journey.” Find out more about how Experian Health’s online patient payment software can help healthcare organizations build a modern financial experience to benefit patients and providers.

Medicaid continuous enrollment will come to an end on March 31, 2023, as the temporary provisions are decoupled from the COVID-19 public health emergency. The federal government introduced the protections to ensure individuals did not lose coverage during the pandemic, leading to record enrollment levels. But as states prepare to resume routine renewals, up to 15 million people could end up without adequate insurance. Coverage gaps could disrupt access to health services and increase the risk of uncompensated care for providers. With Medicaid continuous enrollment coming to an end, how can providers prepare? Mitigating the effects of the unwinding of the Medicaid continuous enrollment provision Under the Consolidated Appropriations Act passed in December 2022, states will have 14 months to complete renewal processes for Medicaid and the Children’s Health Insurance Program (CHIP). While 6.8 million people are likely to remain eligible, churn and administrative delays could leave some without coverage. Analysis by the Kaiser Family Foundation suggests that in recent years, around 65% of people who disenroll from Medicaid or CHIP experience a gap in coverage for all or part of the following 12 months. Some transition to other forms of coverage, but around 41% eventually re-enroll. Implementation of the forthcoming “unwinding” process largely falls to states. While the new legislation and associated guidance bring welcome certainty, concerns remain around how to avoid unnecessary disenrollment and expedite redetermination. That way, patients (and providers) aren’t left holding bills that could have been covered when the Medicaid continuous enrollment period ends. 4 things providers can do if a patient loses Medicaid coverage As patients steel themselves for the return of renewal paperwork, providers are considering how they can help patients maintain coverage and get the financial assistance they need. Digital self-service tools to apply for financial assistance can help patients access the appropriate support, with tailored payment plan options based on their individual financial situation ­­­– all through automation. Here are 4 key actions for providers to consider: 1. Find missing coverage with Coverage Discovery Healthcare providers should put automated processes in place to find any active coverage that may have been overlooked. Coverage Discovery searches for any billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient’s status changes, their bill won’t be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 2. Quickly identify patients who may be eligible for Medicaid and financial assistance A lack of clarity around enrollment and eligibility could cause chaos for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Claim denial rates are already a top concern for providers, on top of wasted time from seeking Medicaid reimbursement for disenrolled patients. Equally, patient collections will take a hit if accounts are designated as self-pay when the patient is entitled to financial assistance and charity care. It may be difficult to tell who’s who without a robust process to check patients’ ability and propensity to pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient’s ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps providers secure reimbursement and means patients are less likely to be chased for bills they can’t pay. 3. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, and will be particularly important when federal support ends. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. With access to Experian’s consumer credit data, the Collections Optimization Manager segmentation models are powered by a more unique and more catered approach that includes robust and proprietary algorithms.  It screens out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. Altru Health System also used this solution to ensure that patients who were eligible for Medicaid were not allocated to collections and their insurance was billed promptly. Over a 10-month period, more than 4,000 accounts were flagged as eligible for financial assistance, representing nearly $2.7 million. This automated process also alleviates the burden on staff, who will likely be handling greater numbers of queries from anxious patients when continuous enrollment ends. 4. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they’d struggle to pay an unexpected medical bill of  $500, providers need to take steps to make it easier for patients to gauge their upcoming bills. Digital, self-service tools such as Patient Financial Clearance can help self-screen for charity and financial assistance. Patient Financial Advisor and PatientSimple can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage the fluctuating Medicaid continuous enrollment landscape efficiently and offer extra support to patients who may be facing disenrollment. Find out more about how Patient Financial Clearance and other digital solutions can help healthcare organizations deliver compassionate financial experiences to their patients.

Digital tools are gradually helping to modernize healthcare, but there are still many gaps to fill when it comes to meeting critical needs. Outdated billing, payment and pricing models continue to be a hindrance for healthcare providers and patients. In an article for Chief Healthcare Executive, Tom Cox, President of Experian Health, made the case for using digital tools and online payment software to help patients better understand, manage, and live up to their financial responsibilities. “At a hefty $140 billion price tag, medical debt in the United States is a growing crisis,” Cox wrote. “There are many contributing factors, but it doesn’t help that costs are often unclear upfront and confusing at best once the bill arrives, with a lack of seamless digital payment options throughout the journey.” Better digital solutions exist, including tools that provide clear, accurate pre-treatment estimates and mobile billing and payment options, but not all healthcare providers are up to speed. Meanwhile, a study by Experian Health and PYMNTS found that 60% of millennials are “very” or “extremely” interested in digital services; 61% of patients who are interested in using patient portals would change healthcare providers for more digital convenience. Managing healthcare expenses is a growing challenge for patients Too often, patients enter treatment without a clear understanding of what they’ll be required to pay. External factors contribute here: Many patients have changed jobs and insurance coverage or have moved to high-deductible health plans that carry greater out-of-pocket expenses. Receiving a personalized estimate that shows projected costs, insurance coverage, potential discounts, and payment options helps patients anticipate costs and plan for payment. Yet, Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that only a third of patients received cost estimates prior to their visits and another 14% only received estimates after requesting them. Knowing out-of-pocket costs in advance matters to patients. The survey also found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. A lack of modern payment options is an additional challenge. “Younger generations raised on digital banking expect immediacy and convenience in how they handle finances,” Cox said. A range of choices, including digital card payments, digital wallets, or personalized payment plans, gives patients tools for managing their healthcare costs. Online payment software removes friction and enhances the patient experience If providers are ready to offer a better digital patient experience, where do they begin? Giving patients accurate cost estimates before treatment, at the point-of-service, and via a patient self-service portal offers greater clarity and control. Experian Health’s Patient Estimates solution creates personalized cost estimates using the provider’s chargemaster, claims history, payer contract terms, and the patient’s insurance. Estimates may also include information on discounts, payment plans, and financial assistance where appropriate. Patient Financial Advisor enables patients to review estimates, make payments, and even set up payment plans using their mobile devices. “Reaching patients where they are—on their mobile devices—brings the patient payment experience in line with the way people already shop, manage money, and transact in other areas of their lives,” says Riley Matthews, Senior Product Manager at Experian Health. “Consumers who routinely see an upfront, detailed breakdown of costs when they order lunch delivery or hail a ride, then pay seamlessly on a mobile app, want a frictionless digital experience when they’re dealing with something as consequential as healthcare.” Confusion, unexpected costs, and a lack of payment options can all slow the collection process. Patients are more likely to delay payment if they don’t understand their charges—or if they aren’t able to pay anytime, anywhere using the payment method of their choice. But the cost of living may also play a role – as household budgets tighten, patients may need more time and better tools to handle expenses. “The good news is that providers have access to digital solutions that improve the patient payment experience. Implementing new technologies that provide patients with accurate cost estimates and familiar online payment options removes friction and makes it easier for patients to understand and pay their bills, which ultimately boosts the bottom line,” says Berenice Navarrete, Product Director at Experian Health. Patient experiences can speak to individual needs By helping patients succeed at managing their healthcare costs, patient-centered payments may also help speed up collections. Digital tools help, not only by providing clear up-front estimates and easy-to-use mobile billing and payments, but also by using data to get a broader view of patients’ financial situations. By better understanding individual insurance coverage and factors like a patient’s propensity to pay, providers can create patient payment experiences that speak to individual needs. “Digital solutions like Coverage Discovery and Patient Financial Clearance give insight into what a patient’s insurance will cover and whether they might benefit from a payment plan,” says Matthews. Effectively communicating with patients throughout the patient journey—all the way through to payment—is an additional consideration. Automated bill reminders, self-pay options, and text or voice messages keep patients aware of outstanding bills, especially when they may need extra time to process and plan. Improving the patient experience is part of patient care Ultimately, billing and payment are part of patient care. When providers bring greater clarity and ease to the patient payment experience, they eliminate barriers to both treatment and payment. And while implementing digital technology requires an investment, improving the patient experience, accelerating collections, and extending care with less pain in the process is valuable to patients and providers alike. Learn more about Patient Estimates, Patient Financial Advisor, and Experian’s full suite of online payment software solutions.

Healthcare has witnessed significant shifts over the last few years, driven by a combination of economic turbulence, legislative change, technological advances, and, of course, the COVID-19 pandemic. Thanks to contactless and remote care, it’s much easier for patients to speak to their doctor and manage their healthcare journey from any location. Personalized medicine and wearables are providing insights and recommendations tailored to every individual. Chatbots and AI are enabling fast and efficient interactions between patients and providers. All of these innovations have a common purpose – to improve the patient experience. The other feature these innovations have in common is that they’re all driven by digitalization. Digital technology has reshaped the way healthcare is delivered. Providers have more tools at their fingertips to create a great patient experience. Those that leverage digital technology will see a rise in patient acquisition and retention, better health outcomes, and increased profitability. This article suggests 3 strategies to help build a better patient experience – and one thing to stop – to improve patient satisfaction and secure a competitive edge in 2023. One practice that must change to improve the patient experience A 2022 report by Experian Health and PYMNTS analyzed responses from more than 2000 patients that revealed some common frictions in the patient journey. The results showed that patients are enthusiastic about digital technology but often can’t access the tools they’d like to see. Patients are frustrated by poor communications, clunky, opaque billing processes, and a lack of digital options (such as patient portals). There’s a clear message: outdated technology and manual processes are hurting the patient experience. If there’s one thing to stop in 2023, it’s reducing reliance on antiquated systems and technology. Opening the digital front door with automation, advanced data analytics, AI and self-service tools can offer patients reliable, personalized, anytime-anywhere access to the care they desire. 3 ways to leverage digital tools to build a better patient experience 1. Give patients control with on-demand patient access Patients are no longer passive participants in their healthcare experience; they're thinking and acting like consumers. They’re choosing providers that give them choice, convenience, and above all, control. This should start with their first interaction with the provider: appointment scheduling. In Experian Health’s State of Patient Access 2.0 survey, almost 80% of patients said they preferred to schedule their own appointments at any time and from any device. Sanju Pratap, Vice President, Product Management at Experian Health, says, “when patients have to wait for the office to open or negotiate with a call-center representative to make an appointment, scheduling feels like a hassle. For patients who are accustomed to online scheduling in other areas of their lives, lack of access could be a reason to look elsewhere for care.” But the digital front door doesn’t close when the appointment is booked. Patients will be frustrated if a great online self-scheduling experience is followed by a stack of paper registration forms to be filled out in the waiting room. Experian Health’s suite of patient access solutions offers patients a consistent and frictionless experience that includes online self-scheduling, mobile-enabled registration, automated price estimates and payment management. 2. Provide financial clarity and support with patient-friendly billing Many of the most common complaints about the patient experience involve payments and billing. Patients want clarity and will switch providers to get it. For that reason, one of Experian Health’s “predictions for 2023” is that patients will increasingly choose providers that offer a user-friendly financial experience. Healthcare providers can improve the patient experience by making it easier to navigate the payments side. This includes: Providing upfront Patient Payment Estimates so patients can predict and plan for their financial responsibility Locating patients’ missing insurance coverage (and reducing the risk of uncompensated care) with Coverage Discovery Using data to determine the right financial pathway for each patient and deliver personalized payment plans to take the stress out of healthcare billing Offering a variety of patient-centered payment options like contactless payments, mobile wallets and online portal 3. Personalize communications with targeted outreach Delivering a quality patient experience requires more than just offering good medical care - effective communication is key. For providers, it's essential to provide clear and personalized communication that speaks directly to the individual patient. Mass-marketing emails may appear more efficient but are often ineffective in conveying key information or fostering a sense of connection with healthcare providers. This leaves room for gaps in care, as well as confusion among patients. Targeted patient outreach can ensure patients get the right message at the right time, through their preferred communications channel. With the right combination of data and digital tools, providers can make sure their patients feel heard and understood throughout their patient journey. Bridging the digital divide Not everything can or should be automated. Patients still want face-to-face interactions. Automation and AI should be used to manage repetitive, process-driven tasks, so staff are free to support patients with more complex needs. To leverage the full potential of these digital tools, providers must understand how to use them to create a connected patient experience that flows seamlessly between face-to-face and digital domains, from scheduling appointments to paying for care. Find out how Experian Health is helping healthcare providers improve the patient experience in 2023.

The consequences of failing to properly verify patient insurance eligibility can wreak havoc on the healthcare revenue cycle. Incorrect patient information, expired policies and missing pre-authorizations can all contribute to denied claims and delayed payments. But with patients bearing a greater responsibility for the cost of care and switching health plans more often, verifying eligibility has become more complex. As patient volumes grow, manual verification processes are increasingly vulnerable to errors. Health insurance eligibility verification software helps providers solve this problem. Few things are more frustrating for healthcare leaders than costly denials that could have been avoided. In a survey by Experian Health, one in three healthcare executives said claims are denied 10%–15% of the time, costing billions of dollars in lost revenue. An automated solution that eliminates errors and reduces denials could pay big dividends across the revenue cycle. This article breaks down the key revenue-boosting benefits of health insurance eligibility verification software: What is eligibility verification? Eligibility verification is the process of checking that a patient’s insurance information is correct and that the services they are seeking are covered under their existing plan. Providers are responsible for verifying the patient’s enrollment status before offering care. Once active enrollment is confirmed, providers will also need to verify the benefits included in the patient’s plan, to be sure that the cost of specific services and items will be covered. This involves the following steps: Checking the patient’s identity and contact information and ensuring that the details on their insurance card match their electronic health record Determining whether the patient’s insurance plan covers the services they expect to receive and that no exclusions apply Confirming that the patient is eligible for proposed services or treatment, for example by ensuring that any pre-authorization or referral requirements have been fulfilled Double-checking that the patient’s coverage is active and that they haven’t exceeded any annual or lifetime limits. "If providers don’t have a full picture of the patient’s payable benefits, deductibles, co-pay thresholds out-of-pocket maximums, and other policy details, they run the risk of non-reimbursement," says Kate Ankumah, Product Manager at Experian Health. "For that reason, these checks should be carried out before a patient’s appointment or procedure, to prevent awkward billing issues and delayed payments. This gives providers peace of mind that they’ll be reimbursed for the services they provide and accelerates patient registration." Carrying out these checks manually can be a time-consuming and laborious process. Staff must check individual payer websites and portals or phone insurance companies to get hold of the necessary information, all while speaking to the patient. Batch processing by medical claims clearinghouses can be a more efficient way of managing eligibility checks, though individual accounts may take longer to clear. What are the benefits of using health insurance eligibility verification software? Given the scale and impact of eligibility checks, many providers turn to insurance verification software to streamline the process and achieve higher levels of accuracy. This offers several benefits to providers and patients: Reduced risk of bad debt - In the world of healthcare claims, errors are expensive. Eligibility verification software can pull from multiple data sources at the click of a button, to give an instant and accurate read-out of a patient’s current insurance details and identity information. Reliable data helps prevent billing errors, thus reducing the risk of disputes with insurance companies. Providers are less likely to bill for services that aren’t covered by the patient’s insurance. Improved patient experience - Billing errors and delays are also major sources of stress for patients. The mismatch between estimated and actual costs is a common complaint. With 3 in 10 patients feeling unable to pay a $500 bill, providers must take steps to provide clarity around the billing process. Automated pre-service eligibility checks help to inform patients of their financial obligations so they can plan accordingly. The software can also support the delivery of tailored, proactive communications to patients, to avoid misunderstandings and queries. Patients are more satisfied with their overall payment experience, while providers see fewer payment delays. Increased revenue - The cost of eligibility errors goes beyond revenue lost through claim denials. If a patient’s insurance information isn’t checked properly, providers bear the financial burden of productivity losses, delayed patient payments, and reputational damage. Eligibility verification software can root out potential mistakes lurking beneath the surface so that claims and communications are correct the first time. By minimizing denials and helping to find missing coverage, this software maximizes reimbursement and accelerates payments. Optimized operations - As noted, using eligibility verification software instead of manual processes can result in significant productivity and efficiency gains. The CAQH reports that electronic eligibility and benefits verification could save medical providers 21 minutes per transaction, amounting to a potential cost saving of nearly $10 billion per year. Automation can release staff from time-consuming calls to insurance companies, reducing their workload and freeing them up to help patients with more complicated needs. This creates a positive patient experience while easing the pressures of staffing shortages. By improving overall revenue cycle management, verification software can increase financial stability. Key features to look for when choosing insurance eligibility verification software By now, most providers will be familiar with automation’s promise of speed, efficiency and accuracy.  To fully capture these benefits, providers should choose a software solution with certain key features. Real-time updates allow providers to confirm patient eligibility instantly, without falling foul of any changes to the patient’s coverage that could hamper reimbursement. For example, Experian Health’s Insurance Eligibility Verification solution connects with over 890 payers so providers can access up-to-the-minute eligibility and benefits data. Optimized search functionality increases the likelihood of finding a patient match. An optional Medicare beneficiary identifier (MBI) lookup service finds and validates MBI numbers, ensuring timely reimbursement, which is especially important as COVID-19 funding comes to an end. Next providers should look for a user-friendly interface. Insurance Eligibility Verification adapts responses from multiple payers so that registrars can access patient details in a consistent format, regardless of the original layout. Customizable alerts notify staff when action is needed. A major advantage of automated solutions lies in the possibility for more detailed reporting and analytics. A tool that synthesizes performance data can provide at-a-glance status updates for senior managers and help staff identify opportunities for improvement. Similarly, providers should look for a tool that fits neatly with their existing electronic systems and interfaces, to fully leverage data analytics and streamline operations. Integration with electronic health records can fast-track verification and registration by providing a single source of truth regarding patient information. Existing Experian Health clients will be able to access Eligibility Verification through eCare NEXT®, providing a single interface from which to manage several patient access functions. Automated verification: a smart investment? Rachel Papka, Director of Health Systems at Steinberg Diagnostic Medical Imaging says Experian Health’s eligibility products have helped her team to validate patient coverage in under 30 seconds: “The Eligibility and eCare NEXT piece allows us to see if the patient is eligible with the insurance they just presented quickly and in real-time – in under 30 seconds. As I'm facing the patient, I'm not hiding behind a phone. I'm not trying to log on to a different website. I'm literally interacting with the patient at the time of service with the eCare NEXT platform, and it's telling me their deductible or coinsurance or co-payments, and I can accurately collect from that patient right there. And it directly writes into my electronic medical record, so users only need to use one system.” For the 3 in 4 healthcare executives who said reducing denials was their top priority, automated insurance verification could be a wise investment. Find out more about how Experian Health’s health Insurance Eligibility Verification software could hold the key to streamlined claims management, fewer denials and faster cash flow.

As household finances tighten, providers face a growing challenge to address patients’ financial needs while caring for their health. A new survey from LendingClub and PYMNTS found that 64% of Americans live paycheck-to-paycheck. That leaves little or no room for healthcare expenses and could mean there’s less in savings to tap as well. Healthcare organizations will need to take extra steps to provide patients with financial support during tough times. Survey results match up with Kaiser Family Foundation data on healthcare affordability. KFF found that 41% of Americans currently carry some form of medical or dental debt: 24% have bills that are past due or that they’re unable to pay 21% are paying providers directly over time 17% owe a bank, collection agency, or other lenders 17% have credit card bills 10% owe a friend or family member “The idea that patients are willing and able to access the healthcare they need regardless of cost is not in line with economic realities,” says Alex Harwitz, Experian Health's VP of Product, Digital Front Door. “But patients and providers may be encouraged to know that there are many digital solutions that can improve access to financial information and provide personalized pathways to meeting healthcare costs, so patients don’t have to go without needed care—or end up with medical debt they can’t manage and the massive stress that goes with it. By helping patients deal with the financial aspect of getting care and offering patient-centric payments, providers can also reduce the need for collections and bad debt.” How does a paycheck-to-paycheck reality affect healthcare and how can providers better support their patients? Here are a few things to consider: 1. There may not be enough money to cover unexpected medical expenses. Roughly half of the adults in the KFF study – including three in ten who do not currently have healthcare debt – are at risk of falling into debt. These respondents say they would be unable to pay a $500 unexpected medical bill without borrowing money. Identifying patients who might need additional information or help is one way providers can offer support. Coverage Discovery finds a patient’s available insurance coverage, including billable commercial insurance that may have been unknown or forgotten, and potential Medicare or Medicaid coverage, so both patients and providers get a clearer picture of what insurance will pay. Patient Financial Clearance is an automated solution that determines which patients are most likely to be able to pay prior to service and which patients might benefit from a payment plan or financial assistance. This solution helps healthcare organizations provide empathetic and supportive financial counseling by allowing staff to connect patients to the assistance programs they qualify for, and can even auto-enroll them. Because Patient Financial Clearance provides this information in real-time, providers can begin a conversation about costs and offer help early in the process when patients can benefit most. 2. Healthcare costs are difficult for patients to gauge. While the average consumer may be able to ballpark the cost of a new car or refrigerator, many can’t accurately predict the cost of a medical or dental procedure. Patients may not know what a complex procedure entails, what the charges for each line item might be, and what insurance will or will not cover. Facing the unknown can trigger anxiety, especially when finances are tight. Increasingly, providers are stepping up with pre-treatment estimates that give patients information about what their expected costs will be—even more so as new regulations require providers to share pricing information with patients and provide detailed cost estimates in advance of service. Patient Estimates is a web-based price transparency tool that generates accurate cost estimates patients can review prior to treatment, to help them understand their anticipated costs and begin planning for payment. 3. Patients who don’t think they can afford healthcare costs may avoid getting treatment. Providing accurate cost estimates is a critical first step, but with so many patients living paycheck to paycheck, estimates alone aren’t always enough. A 2022 survey from Experian Health and PYMNTS found that 60% of patients living paycheck to paycheck with issues paying their bills have canceled a healthcare appointment after receiving a high estimate, as have three in four millennials. “Providing patients with accurate cost estimates in advance of treatment is important to helping them understand and manage healthcare costs,” says Harwitz. “But adding digital tools that can help providers and patients explore their options is an equally important next step. Following through with additional support regarding insurance coverage, payment plans, and financial assistance can help ensure that patients don’t forgo needed care due to financial concerns.” PatientSimple is a self-service portal that allows patients to generate cost estimates, pay their balances using a card on file, set up payment plans, view and update insurance information, and apply for charity care. Behind the scenes, PatientSimple uses advanced analytics and Experian data to identify options for each patient, providing personalized support that can ease the patient's financial journey. Self-service digital tools are the key to providing better support for patients. Self-service tools empower patients to manage their healthcare expenses. Patients living paycheck to paycheck appreciate digital tools that help them work through estimates and bills. Digital tools like PatientSimple and Patient Financial Advisor, which provides mobile access to pre-service estimates and payment options, give patients access to financial information where they’re most likely to use it: on a computer or mobile device. “Solutions like PatientSimple and Patient Financial Advisor use data analytics to create personalized options that take a patient’s insurance coverage and financial situation into account,” says Harwitz. “Patients are not only getting a user-friendly interface, but also powerful support to navigate complex healthcare finances.” Financial health is inseparable from patient health. “The financial challenges facing patients living paycheck to paycheck and the providers working to serve them are increasing,” says Harwitz. “Fortunately, digital tools can provide real support for both patients and providers: pre-treatment estimates, digital access to insurance coverage and billing information, and personalized payment recommendations powered by data analytics. Automated processes mean these additional capabilities are available in real-time and don’t place a massive burden on human resources.” Helping patients mind their financial health is good for providers’ bottom lines: It’s key to maintaining revenue and avoiding costly collections and bad debt. Moreover, supporting patients’ financial well-being is an integral part of providing effective healthcare in the current economy. By recognizing financial realities and improving the patient payment experience, providers can help ensure that financial health enables patient health. Learn more about how Experian Health can help healthcare organizations better support their patients and improve the patient experience.

With eCommerce and SaaS companies delivering frictionless digital-first experiences, patients today often get frustrated with their somewhat less digital-forward healthcare providers. Paying via check, handwritten patient intake forms, calling to make an appointment - these are now widely considered to be artifacts of a bygone era. However, many healthcare providers still operate this way, which can hurt the patient experience. Recent data from Experian Health and PYMNTS found that 61% of patients would consider switching to a healthcare provider that offers a patient portal or a digital front door. But this is rapidly changing. With staffing shortages, rising labor costs and the pandemic-inspired turn towards telehealth, providers are fast adopting a strategy of creating digital front doors to improve patient access, boost engagement, and streamline care coordination. According to a May 2022 report by market analysts at CB Insights, funding for digital front doors reached a record high of $1.9 billion in 2021, up 67% year over year, and is expected to continue growing. A 2022 survey by the Center for Connected Medicine revealed that 55% of health system leaders offer some form of digital front door technology and the remaining respondents said it was on their radar. What is a digital front door? Today, digital healthcare means much more than giving patients the option of booking an appointment online. It’s a holistic approach to empowering the patient, delivering convenience, and improving access to healthcare at every touchpoint of the patient’s journey – a wholesale embrace of digital capabilities at every step in the patient journey. A digital front door gives patients a streamlined single point of access to all of the tools that empower them to engage with their healthcare provider proactively, independently, and often asynchronously. HIPAA-compliant and highly secure, patients can log into a digital front door from their computer or mobile device to schedule visits, send a message to their practitioner, sign patient intake forms, provide insurance information, get advanced knowledge of prices, and pay for care. On the back end, a digital front door is a platform that seamlessly integrates into a healthcare provider’s existing systems, improves workflow, and generates analytics and insights to grow their practice. What are the benefits? Patient satisfaction: More than eight in 10 patients now say that they prefer an online registration experience, according to Experian’s State of Patient Access 2.0 survey. Fewer no-shows: Patients are less likely to cancel or no-show when they have the option of scheduling and managing appointments that work for their time and needs. Frees up resources: By automating administrative tasks like registration, booking, payment, and other processes, the office staff is free to focus on other things. Fewer errors: Manual processes are rife with human errors. Problems like misspellings or errors in data can lead to denied medical claims, cut into revenue and require more time on the back end to resolve. Digitizing patient registration can reduce these errors and minimize these issues. Where to start When choosing a digital front door provider, it’s important for healthcare providers to remember to keep their patients at the center. They should ask themselves how it will make life easier for their patients and make their patients more likely to engage with them. By giving patients meaningful solutions that are compassionate to their needs, providers can build a platform that can take their practice to the next level. But they needn’t go it alone. Providers can get advice and support on digital healthcare trends by working with a healthcare vendor. The right partner will bring specialized expertise to help design and implement a digital front door with the capabilities to meet the provider’s needs. Three digital front door options 1. Omnichannel Patient Scheduling Online appointment booking gives patients access to the kind of 24/7 self-service scheduling they’ve come to expect. Automating patient scheduling has been shown to reduce call center call times by 50% while offloading 30% of call center volume to self-service. Patient scheduling software from Experian Health integrates with a provider’s website, call center, and physical office. 2. Registration Accelerator Up to 50% of denied medical claims can be traced back to errors in patient registration, and health systems can see as much as 10% to 20% of their revenue diverted to remediating these claims. An automated, data-driven patient registration process improves access to care and also reduces the opportunity for these costly errors. 3. Patient Financial Advisor Surveys show that as many as 90% of U.S. patients significantly underestimate the costs of major medical procedures. Some 77% say it’s important to know what they’ll owe before treatment begins. And yet, price transparency is still far from the norm. Patient Financial Advisor provides a personalized price estimate based on the patient’s insurance information, payer contracted rates, and provider pricing. Staying competitive with a digital front door With healthcare becoming increasingly consumer-focused, a digital front door is no longer optional. To stay competitive, healthcare systems must put their patients at the center of their digital transformation and offer a more comprehensive digital experience. A high-quality platform is one that’s not only convenient for patients but increases engagement and transparency throughout their healthcare journey. By investing in the right digital infrastructure now, providers can boost patient satisfaction and engagement while also improving efficiency and streamlining collections. Experian Health can help healthcare providers open their organization's digital front door. Discover our suite of revenue cycle management solutions or contact us to learn more.

Two years after the No Surprises Act was signed into law, healthcare price transparency and billing remain trending topics in the healthcare world. Together with the CMS final rule on price transparency, new regulations aimed at helping consumers better understand and plan for healthcare expenses have the potential to reshape the patient experience. Patients, providers, and politicians share an interest in improving price transparency. But developing and implementing the necessary processes has proven to be a challenge for providers. Meanwhile, the regulatory landscape continues to evolve, creating new challenges and expectations across the board. Where does price transparency stand today? Experian Health caught up with Riley Matthews, Senior Product Manager at Experian Health, to talk about the future of patient estimates and healthcare price transparency. Q1: As regulations have taken effect, how are patient perceptions changing when it comes to price transparency? “Patients are definitely here for these mandates,” Matthews says. “Most consumers have had the challenge of going to a hospital for care and finding out the bill is not what they expected. Maybe they didn’t even know what services they were getting in advance, or what the price for those services would be.” Now that price estimates and online pricing information are increasingly available, the consumer mindset is changing. Armed with greater access to information, patients feel empowered: “It’s changing the marketplace,” says Matthews. “Until now, healthcare hasn't truly been a free market: Pricing information has been kept very close to the chest and, often, patients didn’t see pricing until services were about to be rendered. At that point, they didn’t have time to evaluate. Patients can now see what the price of a radiology visit is at different facilities and compare.” As price transparency gains traction, consumers can be more proactive about the cost of care and managing their financial responsibility. Q2: What are the incentives for providers to comply with regulations and provide greater price transparency? “If someone is buying a car, they can search multiple dealerships online and compare pricing. Now, because of these mandates, patients can do the same for knee surgery,” Matthews explains. “If providers and hospitals aren't complying—if they’re not giving patients tools to help them understand and meet their financial obligations—they’re taking a risk.” In a study from Experian and PYMNTS, six in 10 patients who paid out-of-pocket for healthcare costs and received either an inaccurate estimate or a surprise bill said they would switch providers for a better payment experience. Separately, the regulatory consequences for failing to meet mandated requirements could escalate if the industry fails to comply. “CMS is likely to do more audits to enforce these mandates,” says Matthews. “The mandates themselves aren’t necessarily changing, but the amount of financial impact to providers and hospitals who don't comply is increasing. Price transparency violation fines start at $300 per day for a breach in the mandate, but they can go up to $5,500 a day or just over $2 million per year.” Q3: Have regulations been effective at motivating providers to get up to speed on implementation? “Implementation is accelerating but it hasn’t been quick,” Matthews says. “Compliance is on everybody's list of priorities but bringing systems up to speed has been a challenge: Technology takes time. Experian Health offers two solutions to help providers meet the core mandate for the CMS final rule. The first is Patient Estimates, a self-service portal patients can use to generate price estimates, make payments, and more. “Our self-service payment estimates portal provides a searchable list of prices for 300 common services, so patients can go to their hospital’s website and get a quote or view pricing,” Matthews says. “We’ve checked the box on that part of the CMS rule.” To meet the second part of the CMS mandate, Experian Health is partnering with Cleverley + Associates to create a downloadable, machine-readable pricing file for providers that can be digested and used across the organization. “Because there’s no standardization, providers haven’t been sure how to build this file,” Matthews says. “Many don’t have the tools or capability to do it themselves. “Combined with our self-service patient estimates, our partnership with Cleverley means Experian now has a full end-to-end solution that can solve for price transparency,” says Matthews. “And now that clients have a solution they can purchase and use, we expect to see an acceleration in adoption and compliance.” Q4: How are price transparency regulations evolving? What’s ahead for 2023? Both the CMS price transparency rules and the No Surprises Act are already having an impact on patients, who can now expect to receive a cost estimate prior to treatment. New online tools are on the way to help them understand their upfront costs. “Both of these regulations are meant to ensure that—there’s no better way to describe it—there are no surprises when a patient gets their bill, especially in self-pay scenarios,” says Matthews. “We already see providers moving in this direction.” But there are changes ahead. “The No Surprises Act isn’t fully fleshed out,” Matthews says. “Additional rules are going into effect January 1, 2023, and the industry is waiting on future regulations for insured patients that haven’t even been seen yet. Existing regulations will continue to evolve.” States are enacting additional mandates as well. According to Matthews, New York, Florida, and Colorado have all started to refine or expand their state regulations. Mandates in Colorado, for example, will allow patients to get price comparisons or dispute charges in advance of service. Q5: What actions should providers be thinking about as we move into 2023? Providers need to find the strategy that best fits their organization: “If a provider lacks a solution for both parts of the CMS mandate, they may want to reach out to a partner who can help support both, like Experian Health and Cleverley,” Matthews advises. “And if providers already meet half the mandate—if they currently have a portal like ours where those services are listed but lack the machine-readable file—they can identify whether it makes sense to partner to meet that other half. Providers can consider their costs and risks in each area and identify what works best.” At the same time, providers and their partners need to keep the patient experience top of mind. Although patients welcome greater price transparency, offering up-front cost estimates and pricing tools are only half the equation. Patients may also need financial help in the form of easy online and mobile payment options, payment plans, or charity assistance. “Philosophically and culturally, patients have been conditioned to approach healthcare without focusing on price,” Matthews says. “If they need specialized care, their doctor refers them to a specialist and they go. They don't see who's in or out of network or research what the prices will be. This has been the accepted process for many patients, including me. But perceptions are changing, especially as high-deductible health plans have become common now. Patients are becoming a little bit more skeptical.” Price transparency has the potential to make patients better consumers by empowering them to take charge of their own healthcare and their financial well-being. “Regulations are giving providers greater responsibility for price transparency, but a change in the consumer mindset is creating an equally compelling need for improvement,” says Matthews. “The game is definitely changing.” Discover how Experian Health can help healthcare organizations comply with healthcare price transparency and create better patient experiences.