Price Transparency

Healthcare isn’t known for its consumer-friendly payment processes and trails behind other service sectors when it comes to matching consumer preferences for convenience, choice and control. Is healthcare about to change and adjust to patient-centered payments? Healthcare still gets the most votes as the industry that makes payments the hardest, but it’s certainly evolving. In large part, this is a result of the pandemic. Providers were forced to modernize processes and embrace contactless technology that consumers are familiar with, from their purchasing experiences in retail, hospitality and banking. Consumer expectations for better payment tools were already there – the pandemic demanded the experience met the expectations. However, patient-centered payments is more than simply catering to consumer preferences. The quality of the healthcare payment experience can affect how and when patients receive care. If patients are worried about managing medical bills alongside their other household financial responsibilities, they may be tempted to delay or forego care. If making payments is time-consuming, they may put off dealing with bills. If their provider doesn’t offer convenient tools to help with financing, payment plans and mobile payments, patients may jump ship to a provider that does. Providers will need to overhaul their existing payment system and give consumers what they need or risk losing revenue and patient loyalty. So, where are the opportunities for providers to deliver a more patient-friendly payment experience? Experian Health’s State of Patient Access 2.0 survey showed that patients are looking for clear, transparent healthcare pricing, payment plans and support, as well as faster ways to pay. Simplifying the patient payment journey is key. Here are six ways providers can make healthcare payments easier and faster in 2022. Think like a consumer It’s likely consumerization of healthcare payments will take place in 2022. Providers must put themselves in the patients’ shoes and imagine the ideal payment experience – fast, flexible and secure. Jason Considine, Senior VP at Experian Health, says providers are already seeing the benefits of a digital-first approach that gives patients a variety of payment options. He notes, “In one of our surveys last year, 93% of providers said improving the patient experience is a top priority for them. We’re aware of the need to change and modernize payments.”Experian Health’s Patient Payment Solutions help providers simplify the patient's financial journey with self-service, mobile-optimized payment options. This allows consumers to manage their healthcare payments as easily as they pay for groceries. Give patients more mobile payment options As more health services are delivered in retail health clinics, such as CVS and Walgreens, providers must offer the same convenient digital payment options to remain competitive. More than half of consumers say the pandemic affected how they pay for healthcare. Contactless payments, mobile wallets and online portals have become popular choices. Peer-to-peer payments such as PayPal, Venmo and Google Pay also saw increases in usage in 2021. Forward-thinking providers are offering mobile payment solutions with tools such as Patient Financial Advisor, which allows patients to see estimated cost breakdowns and take advantage of payment plans. Provide a compassionate patient experience with automated reminders and prompts Navigating healthcare payments can be stressful for patients. As a result, they’re more likely to choose a provider that offers a compassionate experience. An integrated payment solution can act as a “financial concierge” for patients, guiding them through the payment experience with appropriate prompts and reminders, through their preferred communication channels. Patient Outreach solutions help patients stay organized with timely bill reminders, self-pay options and automated text and voice messages. Consumer data supports these tools by giving providers insights about a patient’s ability to pay, so they can engage in supportive financial conversations to help the patient decide on their next step. Offer transparent pricing and upfront estimates Experian Health’s State of Patient Access 2.0 survey showed that price transparency had improved considerably between 2020 and 2021, and remains important to consumers. Demand for healthcare price transparency will continue to grow, so providers must keep pace with developments. Giving patients an accurate cost breakdown straight to their mobile device means they can pay faster and more efficiently. Patient Payment Estimates and Patient Financial Advisor work together to help patients understand their financial responsibility. This can help them plan for upcoming bills and pay immediately if they choose. Patients get a pre-service, personalized pricing estimate based on real-time insurance status, payer contracted rates and provider pricing. Use data to prescribe the right financial pathway Not all patients are able to clear their entire bill in one payment. Personalized payment plans are an ideal way to help patients manage their balances and apply for charity assistance if necessary. PatientSimple is a consumer-friendly self-service portal that allows patients to generate pricing estimates, figure out pricing plans, and store cards securely on file, all in one place. Not only does this eliminate much of the confusion and frustration that causes negative healthcare experiences, but it also helps increase patient payments and reduce providers’ time and cost to collect. Run repeated coverage checks to give patients financial certainty Jason Considine notes that “patient populations shifted dramatically during the pandemic, with many individuals losing jobs, finding new jobs, and moving around the country. Their ability to pay has also shifted, so providers are going to need to adopt tools and technologies that help them validate and understand each patient’s insurance coverage.” Solutions like Coverage Discovery can help providers run checks throughout the entire patient journey to find missing or forgotten coverage. This gives patients certainty that their bills are covered and helps providers collect faster. Other tools, such as Collections Optimization Manager, can help providers adopt a targeted collections strategy and segment patient accounts based on propensity to pay. Ultimately, getting paid faster comes down to creating the best possible patient payment experience. The more compassionate, convenient and flexible this experience, the easier it will be for patients to pay and the more likely it will be that bills are settled in full. Find out more about how Experian Health’s patient-centered payments solutions can help providers increase patient collections in 2022.

The No Surprises Act, effective Jan. 1, 2022, requires that healthcare providers include a “Good Faith Estimate” that covers all relevant codes and charges. This was established to increase price transparency for patients. For a summary of the No Surprises Act, read our previous blog. In our recent webinar, hosted on December 15, 2021, industry expert Stanley Nachimson, principal of Nachimson Advisors*, answered our audience’s most pressing questions about “Good Faith Estimates.”** To read the FAQs from our first webinar, click here. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  Here’s what Nachimson had to say: Q1: What are the top things to do now to prepare for the No Surprises Act by Jan. 1? SN: Set up processes to avoid out-of-network billing for emergency and in-network facility services Out-of-network providers need to make sure they have the right processes set up to avoid surprise billing patients. Evaluate in-and-out of network status for all providers Implement Good Faith Estimate for Uninsured/Self Pay from a single provider Make sure to have a process in place for self-pay or uninsured patients Prepare patient notice documents Train staff and ensure they’re aware of new rules and changes Q2: What must be included in the Good Faith Estimate starting 1/1/22? SN: Starting Jan 1, 2022, the only Good Faith Estimates required are for “self-pay” or uninsured patients. These are the only ones that will be enforced/mandated on January 1st. CMS has created forms that show what GFEs should include. This includes individual services that will be provided in an encounter, line-item descriptions of services, procedure codes, diagnosis codes, and more. Estimates should be within $400 of the final bill for any provider or facility that was included, assuming there are no extenuating circumstances. Q3: How should providers deliver the Good Faith Estimate to the patient? Payers? SN: For patients, Good Faith Estimates should be delivered in a written document. This can be done through email, USPS, or delivered in person. Currently, providers do not need to worry about sending anything to payers. Regulators put this requirement on indefinite hold until they have more clarity on the technical delivery/transition of this data. CMS expects to provide a ruling clarification on this in 2022. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Q4: What are the differences between Insured & Self-Pay Good Faith Estimates that providers should consider starting Jan. 1? SN: There will probably be no significant difference in the GFEs for self-pay vs insured individuals. However, the GFEs will be sent to health plans for the insured individuals. At this point, there is no standard electronic delivery method. Individual providers/organizations may come up with their own paper or electronic form, assuming it contains all the required information. At some point in the future, the GFEs will be sent to health plans for insured patients, and that will most likely be a standard transaction. CMS is currently waiting on guidelines for what this transaction will look like. Q5: How does an estimate get calculated when there are multiple providers involved? Who is the “convening provider?” SN: A convening provider is the provider that (1) is responsible for scheduling the primary item or service(defined as “the initial reason for the visit”), or (2) receives a request from an individual shopping for an item or service)—must determine at the time an item or service is scheduled or when a patient is shopping for care whether the patient is a self-pay patient, as defined above. This will not be enforced on Jan. 1, 2022. In 2022, each provider will be expected to provide the GFE for their own services. Because there aren’t any processes in place, the healthcare industry will have at least 1 year to develop a standard guideline for gathering this information. The requirement that the convening provider combines all provider GFEs into one GFE will not be enforced until 2023.This means that over the course of 2022, the convening provider will not be required to include estimates from other providers.  The industry will need to create a standard guideline and establish communication processes first. Until then, patients will need to ask every provider involved for a Good Faith Estimate.  Providers may wish to consider how they will accomplish this during 2022. Q6: Does the Good Faith Estimate apply to all services – even office visits? Labs? Urgent care? Drop-ins? SN: It applies to all types of services. However, depending on when the service is scheduled, the timeframe will vary on when the Good Faith Estimate can be sent out. Q7: If the actual charges are more than $400 greater than the Good Faith Estimate, what consequences will be there for providers starting Jan. 1? SN: The latest rule established an independent dispute resolution process.  The patient must initiate the process within 120 days of receiving the bill, file the required documentation and pay a $25 administrative fee. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of December 23, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey – including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.  

The final blog of our post-COVID-19 patient journey series explores how patients have come to expect convenience, flexibility and transparency when paying for healthcare. How can providers ensure the real-life patient payment experience delivers? Read the full white paper here. Despite creating a more transparent approach to healthcare pricing, medical bills remain a major concern for many Americans. Nearly three in ten worry about the cost of healthcare. The prospect of an unanticipated and unaffordable final bill looms large over their entire healthcare experience, exacerbated by the job losses and insurance changes that left many on unsteady financial ground during the pandemic. Patients aren’t only looking for greater certainty about what they’ll owe, they also want the payment experience to be easier. The pandemic created a new baseline in digital patient access and pulled healthcare closer to other service experiences, where digital and contactless payment methods are the norm. To ease patients’ concerns and meet consumer expectations, providers should focus on redefining payment operations through the eyes of the patient. Patients want to know about their medical costs upfront so they can prepare. Experian Health’s State of Patient Access 2.0 survey found that nine out of ten providers agree that this also increases the likelihood that bills will be paid. They want quick and convenient ways to pay and utilize digital apps with user-friendly interfaces. They don’t want a one-size-fits-all approach to their healthcare experience ­– and that includes the payment process. Personalized estimates, payment plans and proactive reminders can all help patients feel confident about their medical bills. The right tools exist to help providers create a great patient experience and reduce the amount of revenue lost to bad debt – it’s all a matter of integrating those tools into existing systems. Help patients plan for bills with transparent pricing According to a study by Pew Research, around half of nonretired adults feel the pandemic has made it harder for them to reach their long-term financial goals. Many patients are keeping a closer eye on household finances in the wake of COVID-19, so helping them to understand their bills from the onset is key. This can help providers enroll patients in the right payment plans, and will lead to smoother patient collections. Accurate, upfront estimates should be utilized to improve the patient payment experience. Patient Payment Estimates give patients a clear cost breakdown straight to their mobile, so they can plan accordingly for out-of-pocket payments. Providers that implement these solutions now will be better prepared as price transparency legislation continues to evolve and grow. Offer flexible payment methods for faster payments Accurate estimates are just the first step: next, providers should make it as easy as possible for patients to pay their bills. Healthcare has typically lagged behind other industries when it comes to quick and convenient digital payment options. However, the pandemic nudged consumers and providers alike to embrace alternate payment models for medical bills. Many patients want to continue using digital and contactless payment methods – including credit cards and mobile payment apps. With a service such as Patient Financial Advisor, providers can direct patients to an appropriate and flexible payment plan, as well as secure ways to pay, without the need for multiple patient calls. Create a personalized payment experience with third-party data and analytics These tools are effective because they enable personalized experiences for every patient. Some patients may prefer to pay in full before they come in for care, while others may need to pay in installments. Some may prefer to pay via a mobile app, while others may choose to pay in person with their credit card. Certain patients may prefer to receive statements and other communications via email, while others will want to speak to an advisor on the phone. A personalized approach not only creates a better patient experience but also increases patient payments and reduces providers’ cost to collect. Achieving this requires access to accurate and reliable third-party data that paint a fuller picture of an individual patient’s needs and preferences. With consumer data that draws on lifestyle, demographic, psychographic, behavioral and financial information, providers can tailor the payment experience to make it as accessible and frictionless as possible. Similarly, Collections Optimization Manager draws on multiple datasets to check coverage information, segment and prioritize patient accounts, and use staff resources efficiently to maximize revenue recovery. Heather Grover, VP of Product Management and Consulting – Patient Payments and Collections, says, “Clients seek processes that are not only tailored to each patient’s unique situation but one that helps automate their collections and payments workflow. Minimizing the use of resources in today’s environment – whether IT, operational or call center – helps lower the cost of collections while delivering a positive patient experience.” Find out more about how Experian Health’s suite of patient estimates and payment tools can help your organization offer a personalized and compassionate financial experience. Missed the other blogs in the series? Check them out: 4 data driven healthcare marketing strategies to re-engage patients after COVID-19 How 24/7 self-scheduling can improve the post-pandemic patient experience COVID-19 highlights an acute need for digital patient intake solutions Automated prior authorization: getting patients the approved care they need Getting a holistic picture of patients with social determinants of health 3 data-driven denial management strategies for faster claims processing

There are a number of topics that draw a full house for a webinar, but the recent “Unpacking the No Surprises Act” presentation produced by Experian Health was exceptional in its attendance. Participants listened intently to the general parameters and compliance criteria that make up the regulation and what it is intended to accomplish. More than 130 questions poured in during the 1-hour webinar and they were still coming in as the event closed. Read our blog to learn more about the No Surprises Act. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more.   The Big Takeaway: there are a lot of questions from across the spectrum of healthcare participants. We looked through those that were submitted during the webinar, pulled together the ones that were similar, and grouped them into categories. Then we asked the expert we’ve worked with to better understand the No Surprises Act – Stanley Nachimson, principal of Nachimson Advisors* – to shed more light on some of the most common inquiries.** In another blog, Nachimson also answers your FAQ about the Good Faith Estimates. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. GENERAL SCOPE Who does the regulation apply to? Insured? Uninsured? The No Surprises Act is meant to protect the uninsured, self-pay patients and those covered by commercial insurance. It DOES NOT apply to government-reimbursed care, i.e., Medicare and Medicaid – essentially because balance billing is already prohibited by these payers. On the other side of the coin, the regulation generally applies to all providers of healthcare. Is this restricted to “emergency care” and has emergency care been defined? The regulation was established to make sure patients are only responsible for in-network charges related to emergency services or scheduled services, in any hospital. As for the definition of “emergency,” the regulation defines that in the Prudent Layperson language, which defines an emergency medical condition as manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: a) placing the patient’s health in serious jeopardy; b) serious impairment to bodily functions; or c) serious dysfunction of any bodily organ or part. Does the No Surprises Act supersede state laws? The federal regulation is the default in states where there are no similar laws to protect against balance billing. In states that do have laws addressing this, NSA takes priority when the state law provides less protection to the patient. Also, in states with No Surprise regulations already in place, the federal law defers to state law as to how much fully insured plans must pay a provider for surprise OON services, rather than requiring arbitration mandated by the federal regulation. Is there an explanation of how this will be enforced? Enforcement procedures are still being worked out, as several entities are impacted. Three levels of enforcement have been proposed: State enforcement – states will have primary enforcement responsibility and CMS would step in for states that will not enforce the law or “fail[s] to substantially enforce” the law Civil penalties (at $10,000 per violation) Possible mechanisms that could initiate enforcement actions, which have been discussed, include patient reporting tools and market conduct investigations initiated by CMS. OPERATIONAL IMPACT What are the primary provider workflows impacted by the No Surprises Act? The most impact will be around scheduling, estimates and producing a good faith estimate (GFE). The systems and solutions in place to determine eligibility and coverage will have additional pressure for accuracy. At this point, if necessary or desired, the mechanism for securing patient consent for OON services will come into play, too. The timing requirements of the law’s expectation of when a GFE will be provided put the front-end operations under a microscope. The “convening provider” challenge of which entity will be responsible for assembling the GFE is a major issue.  The convening provider must present the GFE in a standard format to either the health plan for insured patients; or to the patient in a manner that is clear and understandable stands to require substantial modifications to workflow. The most recent guidance from CMS states that there will be a one-year postponement in enforcing the rules, for uninsured patients, requiring a provider to get estimates from other providers involved in the care. Are office visits included in the regulation? Radiology? Lab work? It appears to be so. The industry is questioning the required range of services.  Any Advance Explanation of Benefits that contains out-of-network providers must include information on how to find in-network providers for those services.   This is definitely one area of the law that the healthcare community is looking to help shape. Is there a best practice for identifying OON status? Most providers should be aware of their network status for any health plan.  That is going to be a question answered at the medical system and very likely individual provider facility level. However, determining the network status of other providers may be a problem.  Most health plans have provider directories available for their members or on their websites.  There won’t likely be a “standard” other than the very clear expectation of the law that no one will be balance billed for any care received that is OON, unless that is consented to by the patient. The systems and communications with the payers and protocols required to meet this compliance standard are going to be unique to different facilities. It sounds oversimplified, but the best practice may be not to balance bill a patient for the care they receive without their consent. SPECIFICS Will there be standardized documentation provided by CMS and, if so, will they be required? No matter the document format, there is a set of requirements for patient notices. These include: A statement that the provider or facility is OON (if that is the case) An itemized, good faith estimate of the cost of care Information on prior authorization and utilization management limitations The notice must be in a format the patient can understand and is accessible (i.e., preferred language and apart from other documents). A variety of model forms and notices are available on the CMS “Overview of Rules and Fact Sheets” page: Standard notice & consent forms for nonparticipating providers & emergency facilities regarding consumer consent on balance billing protections: Download the Surprise Billing Protection Form Model disclosure notice on patient protections against surprise billing for providers, facilities, health plans and insurers: Download Patient Rights & Protections Against Surprise Medical Bills Paperwork Reduction Act (PRA) model notices and information collection requirements for the Federal Independent Dispute Resolution Process: Download Model Notices and Information Requirements Paperwork Reduction Act (PRA) model notices and information collection requirements for the good-faith estimate and patient-provider payment dispute resolution Download Model Notices and Information Requirements Additionally, The Department of Labor published a Model Notice link on its No Surprises Act overview page. Which entity is considered the “lead” and responsible for coordinating the GFE, consent forms and other documentation required to show compliance? The “lead”, or “convening provider” entity is widely expected to be the scheduling provider but that has not been established officially. This is another of the areas where input is needed from multiple stakeholders. What parts of the law have been postponed? Good faith estimates to INSURED individuals have been postponed "until rulemaking to fully implement this requirement…is adopted and applicable." The delay for insured individuals was the result of a general expectation that it is not possible for payers and providers to stand up necessary systems to achieve this by Jan. 1, 2022. The distinction was made that insured patients have means of recourse if they receive an incorrect estimate. Similarly, advanced explanation of benefits (AEOB) is expected to be delayed until the data transfer systems and other requirements to provide an accurate AEOB to the patient are in place. It is expected that short-term remedies to this will be put into effect by HHS. It is important to note that these delays in enforcement do not change the core of the rule, which prohibits balance billing of OON care and services that a patient is unaware of and does not consent to. On-Demand Webinar: “Unpacking the No Surprises Act” - October 20, 2021 Listen in as Roger Johnson, VP of Payer Solutions at Experian Health, and Stanley Nachimson, Health IT Implementation Expert, help providers get up to speed on what they need to do to comply with the No Surprises Act in this 60-minute session. This on-demand webinar will help your organization make sense of the new regulatory requirements and provide strategic recommendations on how to prepare. *Stanley Nachimson is not an employee or representative of Experian Health. **The scope and details of the No Surprises Act are evolving. The information provided here is up to date as of November 18, 2021. This content is intended for information and education purposes only.  Experian Health cannot and does not provide legal and compliance guidance.  It is recommended that all organizations review the regulation thoroughly and seek appropriate legal and compliance guidance to determine an appropriate strategy for compliance. Experian Health offers solutions across the healthcare journey - including patient engagement, revenue cycle management, identity management, care management and analytics – that may contribute to meeting compliance requirements.

Being able to settle bills anytime, anywhere, is one of the reasons why 110 million Americans switched to “digital-first” payment methods last year. Today’s consumers can pay household bills with their mobile devices while cooking dinner or waiting in the school pick-up line. They can pay for their morning coffee by tapping their phone at the point of sale. Imagine their frustration when paying for healthcare still involves paper bills, multiple phone calls, and limited payment options. But the healthcare industry can make the same “anytime, anywhere” payment promise. Berenice Navarrete, Director of Product Management for Patient Payments at Experian Health, says: “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” “We’ve seen healthcare make great strides in using automation and digital tools for scheduling, registration, and telehealth, fueled in no small part by the pandemic. As consumer payments are constantly evolving, there are huge opportunities for improvements in the patient payment experience too.” -Berenice Navarrete, Director of Product Management for Patient Payments Experian Health’s recent Payments Predictions white paper identifies seven emerging healthcare payment predictions and trends heading into 2022. This blog offers a preview of the top three insights that will be of interest to providers intending to leverage – or considering – digital tools that simplify payments and speed up healthcare collections. Prediction: Patients want fast, secure and smooth payments to match their experience in other industries. According to Experian Health’s State of Patient Access 2.0 survey, providers are feeling more confident about collecting payments from patients now, compared to a year ago. However, the collections landscape is always changing; providers should continue to find ways to match consumer expectations with tailored communications, flexible payment options and automated payment methods. Listen in as Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. As cash usage declines, patients are looking for a wider variety of payment options – a trend that’s likely to gather steam as digital payment platforms like Apple Pay and Google Pay continue to gain traction. Providers must keep pace with these advances in consumer payment technology. Utilizing Patient Financial Advisor is one way to give patients the flexible experience they want. This solution sends personalized text messages with links to convenient and contactless ways to pay.  Patients may have different preferences about payment methods, but they all want to feel confident that their payment is secure. With PaymentSafe, healthcare providers can collect any form of payment securely and quickly, regardless of the payment option a patient chooses. Prediction: Patient loyalty will be tied to a convenient and compassionate payment experience. A poor payment experience will leave a bad taste in the patient’s mouth, regardless of how good the rest of their healthcare journey has been. With 70% of consumers saying healthcare is the industry that makes it hardest to pay, any provider that offers a smooth, supportive and transparent payment experience is going to stand out from the competition and foster greater patient loyalty. Comprehensive consumer data can give providers early and accurate insights into a patient’s specific financial situation. This information can help providers direct the patient to the most appropriate financing options. Automation can then be leveraged to send timely reminders of open balances, improve patient engagement and minimize the risk of missed payments. Tools such as Patient Financial Advisor and Patient Payment Estimates can help providers give patients transparency, control and reassurance from the very start of their financial journey, so bills are settled quickly and easily. Prediction: Automation will be used for an increasing number of payment-related tasks. Artificial intelligence and automation aren’t just for cars and the metaverse. Technological advancements are opening up a wide range of benefits to healthcare providers, from faster patient payments to fraud prevention. Automation also enables operational efficiencies in reporting and reconciliation, while protecting and processing unprecedented amounts of patient data. For example, Collections Optimization Manager uses extensive datasets and advanced analytics to segment patient accounts according to each individual’s specific financial situation. Patient satisfaction will improve because patients receive the right support at the right time. Additionally, providers will be able to use monitoring and benchmarking data to spot previously unseen opportunities and further improve collections. Keeping that “anytime, anywhere” promise COVID-19 was a catalyst for the evolution of healthcare payments. Digital payment solutions that give patients easy, convenient, and safe ways to pay not only help meet changing consumer expectations but will also allow providers to boost loyalty and revenue for years to come. Download the white paper to discover a full list of healthcare payment predictions and find out how to create a modern payment experience that meets patient expectations.

As payers and providers count down the days until the implementation of the No Surprises Act in January 2022, healthcare price transparency and billing remain trending topics in the healthcare world. The Act is the latest in a series of federal and state commitments to help healthcare consumers feel more prepared and informed about their medical costs. Consumers have come to expect a payment experience that matches the way they shop around for other household budget-eaters, such as cars and laptops. But healthcare isn’t like other purchases – it’s complex, high stakes, and often incredibly opaque. Lists of shoppable services are often difficult to navigate, information on quality can be hard to come by, and the reality is that patients don’t always have the power to choose how they access care. The CMS final rule on price transparency and the new regulations for balance billing signal a high-level desire to improve the healthcare experience with patient-friendly pricing. It seems to be working. Experian Health’s State of Patient Access 2.0 survey, fielded in June 2021, reveals that price transparency remains important to both patients and providers. It’s also improved substantially in the six months since the first survey. Back in November 2020, more than half of survey participants had final costs that differed significantly from their billing estimates. By June, this figure had dropped to just 14%, which means more patients are able to plan for their final bill with confidence. Given these improvements, what’s on the horizon for price transparency? In the latest of our expert interview series, Greg Young, Senior Director of Marketing, talked to Dan Wiens, Product Director for Patient Estimates at Experian Health, about the future of patient estimates and price transparency. Watch the interview below: What’s driving the change in patient perception when it comes to healthcare price transparency? According to Wiens, two major factors are improving patient attitudes to pricing estimates: “At the height of the pandemic, hospitals were seeing fewer patients and many elective procedures were canceled, so there weren’t a lot of estimates going out. Secondly, there has been a massive push for price transparency from governments and providers. In January 2021, federal regulations came out specifically to give patients a better view of their out-of-pocket expenses. Many more facilities are launching price transparency tools, as opposed to using databases that guess what a patient’s obligation will be.” As those regulatory requirements come into force, fewer patients are surprised by their final bill. By providing accurate estimates ahead of time, supporting patients to manage their financial journey, and providing personalized patient statements, hospitals are pushing forward with transparent pricing strategies that help patients feel in control of their medical bills. Is the problem of price transparency solved if patients, providers and politicians are in favor of these new regulations? Providers recognize the benefits of transparent pricing: 9 out of 10 providers told us they agree that providing accurate estimates helps patients to pay their bills. With everyone seemingly supportive of this approach, some might see the challenge as resolved. The problem then becomes a question of implementation. Wiens says the job isn’t quite finished yet: “Healthcare price transparency will continue to evolve and grow. Now that patients can see their out-of-pocket expenses for very specific procedures, they’ll want it for the rest. Hospitals are very quickly learning that when a patient knows what they owe, they can accommodate larger expenses and take care of smaller bills immediately. And the government is clear that they don’t want patients to be in the dark about what they owe, so we’ll see more and more transparency requirements.” Hospitals looking to step up their pricing estimates now have a variety of tools at their disposal. Offering patients personalized information in a convenient and easy-to-understand format should be top of the list. Patient Payment Estimates help patients understand their financial responsibility before even coming in for care. Patients get a cost breakdown straight to their mobile device and can immediately pay then and there if they want. This can also be integrated with Patient Financial Advisor, which provides real-time benefits information, and directs patients to appropriate payment plans and charity options. It makes the process less stressful and reduces the risk of uncompensated care for providers. Is there more healthcare price transparency regulation on the horizon? Regulations will continue to be a major driver of evolving healthcare pricing policy in the next few years. In addition to the federal government’s price transparency mandate in 2021 and the No Surprises Act, which takes effect in January of 2022, at least 22 states have followed suit in implementing price transparency and balance billing requirements. Wiens says, “price transparency and balance billing regulations will continue to evolve. A lot of hospitals want to make changes on their own, but some will need a little bit of extra motivation, which will come from regulations.” As focus shifts into more complex areas of healthcare finance, regulatory requirements will continue to ramp up. While the price transparency rule focused simply on helping patients understand their out-of-pocket expenses, the No Surprises Act is much more comprehensive and complex. This new regulation covers patient benefits, insurance claim processes, and determines whether patients are in or out of network. Further regulations are likely to dig deeper, to make sure patients understand what they’re paying. Providers that embrace a transparent approach to patient payments will be ahead of the game when those changes come into play. Download the  State of Patient Access Survey 2.0, to find out more about the future of patient-friendly pricing.

COVID-19 transformed the patient journey, and it's clear when we evaluate every step. Data and technology gave patients the convenience, flexibility, and control to get care on their terms, and these changes will be here to stay. From marketing to scheduling to payments and more - providers and payers have ample opportunities to respond to these changes and will need to adapt their future strategies accordingly. Self-scheduling, mobile registrations, and automated authorizations are a few examples of tools and technologies that are more than likely to remain prominent in healthcare. What other changes are here to stay? In this new infographic, we take a dive into each of the 7 steps to see how data and technology has impacted the patient journey, and provide strategic recommendations on how providers and payers can adjust post-pandemic: The use of data and digital tools opened up new doors for greater patient access, engagement, transparency, and control. The post-COVID-19 patient journey is going to continue to evolve - payers and providers will need to adapt to keep up with the changes, to ensure that patients experience the best outcomes. To get a deep dive into all of the changes to the patient journey, download our white paper.

Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct result of surprise billing, with a third of insured adults saying they’ve received an unexpected bill in the previous two years. What’s no surprise, then, is that two-thirds of US adults worry about being able to afford these unanticipated medical bills. It’s a problem that concerns so many patients that it now has the attention and action of both state and federal governments. To help solve this problem, Congress signed the No Surprises Act into law. Experian Health can help your healthcare organization navigate the regulatory landscape  and implement solutions ranging from transparent, patient-friendly estimates to our all-new FREE No Surprises Act (NSA) Payer Alerts Portal.  The No Surprises Act, effective January 1st, 2022, aims to protect consumers from at least one contributor to the problem: unexpected bills for out-of-network care in emergency and non-emergency settings. Around a fifth of emergency claims and a sixth of in-network hospital stays include an out-of-network bill, often due to emergency or ancillary care. Since patients lack meaningful choices when it comes to choosing these unexpected services, they have no option but to pay up or face negative marks on their credit reports. Typically, while health plans cover some of the bills, patients will still be responsible for the remaining balances. Webinar Series: Unpacking The No Surprises Act and Q&A with an expert Industry expert Stanley Nachimson, Health IT Implementation Expert, recently hosted a series of webinars to help providers get up to speed on what they need to do to comply with the No Surprises Act. Learn about the Good Faith Estimate, how NSA will apply in different care settings, and more. By enforcing better price transparency and consumer protection, the new regulations will help to create better patient experiences and ensure that fewer bills are written off to bad debt. However, according to a recent survey conducted by Experian Health, only 72% of providers are familiar with the No Surprises Act. That’s not all - only 40% of respondents are moderately confident their organization will be able to solve for the No Surprises Act. Payers and providers must act now to ensure their processes are ready to comply with the changes. Experian Health is now offering a FREE comprehensive, updated list of No Surprises Act (NSA) payer policy alerts for United States hospitals, medical groups, and specialty healthcare service organizations. Tackling the price transparency problem with the No Surprises Act Healthcare pricing has been under the spotlight for a while, with several new regulatory measures introduced over the last few years. The new Act, which was signed into law under the Consolidated Appropriations Act of 2021, builds on previous federal actions to empower patients by giving them greater access to healthcare cost information. Come January 2022, balance billing will no longer be permitted for out-of-network emergency services, out-of-network air ambulance services, and out-of-network non-emergency services provided at in-network facilities. Insurers must cover emergency services without any prior authorization, regardless of whether the provider is within the health plan’s network, and patients should expect to pay the same as in-network services. The Act requires both providers and health plans to help patients access healthcare pricing information, and providers must provide consumers with tools to get better price estimates, including a “Good Faith Estimate” covering all relevant codes and charges. The Act sets out a process for health plans to reimburse providers and an arbitration path in the event of disagreement. Summary of provisions in the No Surprises Act: Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network facilities Holds patients liable only for their in-network cost-sharing amounts, and requires that the patient’s share cannot exceed in-network rates without patient consent Provides guidance for how providers and insurers can negotiate fair reimbursement for out-of-network services Includes the requirements that providers submit Good Faith Estimates to payers and that payers utilize those estimates to create and provide Advance Explanation of Benefits to members. However, enforcement of this requirement has been delayed until more guidance can be provided related to standards for the transmission of these files (as of October 2021) What do providers need to do now to prepare? Creating a “no surprises” billing experience will require payers and providers to make major process changes. Roger Johnson, VP of Payer Solutions at Experian Health, says, “The new regulations require the industry to innovate significantly in a very short timeframe. Determining network status is a huge challenge for providers, as is engaging patients electronically pre-service. There will also be challenges in tracking and submitting consent forms, producing Good Faith Estimates, applying appropriate cost-sharing, billing, payment reconciliation, and the new dispute resolution process.” See what Roger had to say in our Interview with the Expert: CMS has provided a list of documents and requirements for patient notices. These include: A statement that the provider or facility is OON (if that is the case) An itemized, good faith estimate of the cost of care Information on prior authorization and utilization management limitations The notice must be in a format the patient can understand and is accessible (i.e., preferred language and apart from other documents). A variety of model forms and notices are available on the CMS “Overview of Rules and Fact Sheets” page: Standard notice & consent forms for nonparticipating providers & emergency facilities regarding consumer consent on balance billing protections: Download the Surprise Billing Protection Form Model disclosure notice on patient protections against surprise billing for providers, facilities, health plans and insurers: Download Patient Rights & Protections Against Surprise Medical Bills Paperwork Reduction Act (PRA) model notices and information collection requirements for the Federal Independent Dispute Resolution Process: Download Model Notices and Information Requirements Paperwork Reduction Act (PRA) model notices and information collection requirements for the good-faith estimate and patient-provider payment dispute resolution Download Model Notices and Information Requirements Additionally, The Department of Labor published a Model Notice link on its No Surprises Act overview page. Experian Health is engaging with industry partners to clarify the regulations and collaborate with clients to adapt workflows for a smooth transition. Find out more in our on-demand webinar. What price transparency tools are available for healthcare organizations?  In the meantime, various price transparency tools exist to help providers meet ongoing regulatory requirements and create a better patient experience with easy-to-understand cost breakdowns. For example: Patient Payment Estimates give patients clear and accurate estimates of authorized services before, or at, the point-of-service, so they feel more in control of their financial obligations. With a user-friendly interface, the tool helps patients plan and pay their bills – while directing them to appropriate financial assistance options. And because it’s automated, hospital staff will no longer need to manually update price lists. For providers, this tool can create an on-demand Good Faith Estimate using out-of-network benefits. Patient Financial Advisor is a text-to-mobile service that lets patients see their estimated costs of care before they come to the hospital. This solution provides a full breakdown of the procedures, as well as a total estimated amount based on in-network benefits. Registration Accelerator has the ability to collect provider forms and return them back to the client’s document imaging system. ClaimSource can identify claims that are at risk, prior to being submitted to payers. Claim Scrubber can identify claims at risk from various angles, such as: Non-Network payers Non-participating providers Services provided without an approved authorization Services provided outside of the approved authorization criteria While regulatory change can seem daunting, price transparency is already trending in the right direction. Our second State of Patient Access survey indicated that both patients and providers want more price transparency. Nine out of ten providers told us they agree that price transparency improves the customer experience and increases the likelihood that patient bills are paid. The regulations may be a catalyst for change, but making it easier for patients to understand and pay their bills continues to pick up momentum. That’s good news for patients’ wallets and for providers’ bottom lines. Download our on-demand webinar, "Unpacking the No Surprises Act," to learn more about how the new regulation will impact patient and provider workflows.

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.