Mass relocations during the pandemic caused seismic shifts in healthcare markets. With millions of Americans moving and reshuffling to be closer to family or take advantage of remote working opportunities, healthcare providers have extra work on their hands to ensure their patient base holds steady. Some attrition is inevitable; however, as more patients relocate, providers may see more patient churn than usual. Unfortunately, this means more dollars in lost revenue. On top of this, consumers have changing expectations and more choices when it comes to healthcare, which means even more patients coming and going. Providers must find new ways to differentiate themselves in an increasingly competitive market for patient recruitment and retention. In June 2021, our State of Patient Access 2.0 survey revealed that attracting and retaining patients was a top revenue recovery strategy for providers hoping to make up for the shortfall caused by the pandemic. An Interview with the Expert, featuring Mindy Pankoke, Sr. Product Manager of Patient Identity and Care Management at Experian Health, sheds some light on the opportunities that lie ahead for patient recruitment and retention. Pankoke also explains how consumer data can help providers deliver an outstanding patient engagement experience. Watch the interview below:   How have patient recruitment and retention been affected by the pandemic? The pandemic changed how patients live and work. Many have relocated, while others have overhauled their lifestyles to find a better work-life balance and/or to pay closer attention to their health. Pankoke explains that these changes not only push patient recruitment up the priority list, but also require providers to take a bird’s eye view of their evolving markets in order to develop a better understanding of who their patients are. She says, “Waves of employment, unemployment and remote working mean patients’ locations and lifestyles have changed. As the dust settles, we’re starting to see how the market has shifted. It continues to be highly competitive, with multiple health systems fighting for the same patient base, so it’s important to know who’s new to your market, who might have moved out, and how COVID-19 may have impacted their lives. You can use that data to better engage with them and offer the most relevant communications.” How can data help providers with patient recruitment and retention? Understanding patients’ needs and preferences call for fresh and accurate consumer data. But which specific data points are most useful when it comes to patient engagement and recruitment? Pankoke suggests three areas to focus on: “Accurate contact information will make or break your patient recruitment strategy. Providers need to be able to reach the patient they’re intending to contact. Then, you can enhance demographic data by making sure you’re speaking to patients in their preferred language. Finally, marketing data can offer non-clinical insights about patients’ lifestyles so you can reach out and engage them more effectively.” Pankoke says it’s important to consider how the content and format of marketing communications might resonate with different patients. For example, a 50-year-old diabetic patient who has a job and lives in a multi-generational household will have a completely different lifestyle to that of a 50-year-old diabetic patient who is retired and lives alone. Consumer data can help providers see the full picture of a patient’s life, so they can offer the most helpful, sensitive and personalized information. Using data to “meet patients where they are” One way to stand out from the competition is to demonstrate an understanding of what patients need right now. Data on the social determinants of health (SDOH) can be used to enrich patient records, by providing insights into the non-clinical aspects of care and lifestyle factors that can affect a patient’s access to services. This is especially important given that socially and economically vulnerable groups were among those hardest hit by the pandemic. In our survey, 23% of providers said they were planning to or already implementing SDOH programs, up from 13% six months earlier. With SDOH data at their fingertips, providers can tailor their communications, so patients are supported to access the services they need at that moment in time. Reliable consumer data also helps providers communicate that information in the most appropriate way, to improve engagement, outreach and access. Pankoke suggests that some patients may prefer to learn about healthcare services through TV advertising, while others may prefer a leaflet or brochure through their door. Knowing your patients’ level of comfort with technology also means you can make better decisions about who to direct to patient portals or telehealth services. Get in front of patients before they start looking In today’s consumer-driven and competitive healthcare market, every touchpoint matters. Communications that are consistent, relevant and personalized are key to attracting and retaining patients. With the right data and digital tools, providers can anticipate patients’ needs, address obstacles and reach out to help patients stay on track with their healthcare journey. They can offer convenient and flexible options to register, schedule and pay for services – using a format that best suits each patient. In some cases, this means knowing what the patient needs before the patient knows it themselves. It’s a lot easier to get in front of patients with useful healthcare information before they start looking. Consumer data gives providers a head start so they can integrate SDOH and other patient information in patient recruitment and retention strategies that are proactive, rather than reactive. Watch the full interview with Mindy and download our State of Patient Access Survey 2.0, to find out how your healthcare organization can incorporate consumer data to communicate the right message in the right format to attract and retain loyal consumers.

In the sixth article in our series on how the patient journey has evolved since the onset of COVID-19, we look at three ways to prevent claim denials and reduce the time to payment. Faster claims processing is at the heart of a better patient financial experience and reduces revenue leakage for providers. For more insights and strategic recommendations to improve the patient journey in 2021 and beyond, download the full white paper. Nearly seven in 10 healthcare leaders say claim denials have increased in 2021, with an average denial rate of 17%. Inefficient claims processing and claims management systems were already struggling, but the pressures of the pandemic are causing even more rejections. Vaccination programs, rescheduled electives, and residency relocations contributed to fluctuating patient volumes, putting extra strain on reimbursement workflows. Patients switching health plans, and missing codes for COVID-19 vaccinations and treatment caused further delays and errors. Payer rules for reimbursement of treatment for “Long Covid” remain unclear: the absence of research and standards means claims are rejected because there’s no agreed “medical necessity.” Slow processes, incorrect patient identities, and poor data management mean the upward trend in claim denials seen over the last five years shows that it is likely to continue. Denials create a fragmented experience for patients because they don’t know how much they’ll need to pay for care, and leaves providers battling to recoup revenue. An effective claims management system is critical for maintaining provider revenue, securing patient reimbursements, and promoting positive patient-provider relationships. Here, we recommend a three-part strategy that uses data and automation to get claims right the first time. Prevention is better than cure One of the primary frustrations for claims management teams is that the majority of denied claims are preventable. Many of the errors that trigger denials could be avoided if databases and records systems could talk to each other. Instead of a reactive response, providers should invest in tools that can proactively prevent mistakes and errors, to ensure they collect every dollar owed. Digital tools can analyze data to help providers weed out the vulnerabilities in their processes and keep up with payer changes. Incorporating such tools is a sensible first step toward reducing and recovering expenses. One option is ClaimSource, which helps ensure that all hospital and physician claims are clean before being submitted to a government or commercial payer. It unlocks access to extensive federal, state, and commercial payer edits, allows custom provider edits, and incorporates automation tools and customer support. Providers can become confident that their claims will be correct the first time. Improving the likelihood of approval is critical to provider profitability and makes for a smoother patient experience. Prioritize eligibility checks for cleaner claims the first time Experian Health’s revenue cycle management experts say that the number one reason for denials is inaccurate eligibility. A 2020 poll by the Medical Group Management Association (MGMA) backs this up: 42% of providers said inaccurate or incomplete prior authorizations were a top cause of denials. Most providers use a medical claims clearinghouse or have systems to check eligibility beforehand. However, if patient identities aren’t verified properly at every touchpoint in the healthcare journey, mistakes can creep in and cause confusion about eligibility. Similarly, if the patient needs additional treatment that isn’t covered in the initial authorization, the resulting mismatch could lead to a denial. Tools such as Prior Authorizations and Insurance Eligibility Verification can help providers validate patient coverage in under 30 seconds. These solutions integrate with ClaimSource to fill in the gaps of patient information and streamline the claims process. Patients will get better insights into what they owe, and providers can increase efficiency. Automate workflows to eliminate time-consuming errors with claims processing Providers are well aware that manual processing slows reimbursement and increases the risk of errors. Tools such as Prior Authorizations and Insurance Eligibility Verification can help by using data and automation to improve accuracy and efficiency. The Council for Affordable Quality Healthcare suggests that automation can shave 20% off claims processing times, which could translate to thousands of hours saved each month. With those extra hours, claims teams will be freed up to complete their lengthy to-do lists and focus their efforts on other priorities. In addition, automated workflows can help assign work to the right specialist, keep track of payer changes, and incorporate repeated identity verification checks to drive down denials. With a Denial Workflow Manager, providers can automate and optimize their entire denial management process to get real-time insights on denied claims. This system can eliminate manual reviews and quickly identify accounts for resubmission or appeal. It can be integrated with tools such as ClaimSource and Enhanced Claim Status, so providers can monitor claims, denials and remits on the same screen and accelerate the workflow. As the pandemic continues to pressure profits and patients come to expect more from their healthcare journey, it’s no longer reasonable to accept denials as a cost of doing business. To find out how Experian Health can help your organization reduce denials, recover pandemic losses, and improve the patient experience, contact our team today. 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

A little over a year ago, Experian Health surveyed healthcare providers for a snapshot of their views on the digitalization of patient access, and the importance of healthcare collections. At the start of the COVID-19 pandemic, patient collections emerged as a top priority, the result of rising unemployment and competing consumer demands that impeded patients’ ability to pay. By June 2021, provider attitudes had changed. Our follow-up State of Patient Access 2.0 survey revealed that patient collections were no longer the number one concern for healthcare providers. Patient perceptions of the billing process have improved too. In our latest Interview with the Expert, 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. Watch the interview below:   Why are healthcare collections no longer the number one concern for providers? In the six months between the two surveys, the number of providers saying they were “concerned or very concerned” about collecting payments from patients dropped from 50% to 41%. Baltzer explains that during this time, collection rates were relatively steady (when adjusted for volume), and providers received fewer calls about patient balances. Currently, the bigger concern for both providers and patients is to determine patients’ coverage status quickly and accurately. There are three main reasons for this shift. Firstly, multiple rounds of stimulus payments issued by the government helped consumers pay down their debts, including medical bills. Secondly, the pandemic caused a drop in consumer spending on travel, entertainment and dining out, which meant credit card usage was lower than pre-pandemic levels. Consumers had more cash available to pay healthcare bills. And thirdly, employment rates have started to recover. Around the time of the first survey, providers were faced with a surge in patients who had suddenly lost employer-based coverage, but as unemployment levels improve again, this is less of an issue. Those still affected by job losses have been able to access expanded government support, such as Medicaid. How should providers prepare as consumer spending returns to pre-pandemic levels? As Americans start to return to previous consumer habits and routines, household spending is likely to increase, which could squeeze medical bills again. Baltzer explains that “as we see stimulus programs winding down, and discretionary spending options increase, we can expect to see an increase in the utilization of revolving credit lines. For most consumers, that will mean it’s more difficult to meet unplanned out-of-pocket obligations.” Prior to the pandemic, a survey by the U.S. Federal Reserve found that 40% of Americans struggle to find $400 to pay for an unexpected bill. This means providers may not be able to rely on the steady collection rates seen in recent months. While efforts to improve transparency will help patients prepare for possible financial obligations, many providers are going further, implementing the right data, tools, and strategies to understand and address each consumer’s unique situation, making it as easy as possible for patients to pay. Baltzer says: “Data can help drive attention to the accounts with a higher likelihood to pay. This means you can identify those who just need a little more time to pay, and then help those truly in need of charity support. Things can change quickly, and having fresh, accurate data will be essential. Now is not the time to take our eyes off the ball, as the game may shift quickly.” With access to reliable and comprehensive consumer data and automated patient collections solutions, providers can tailor the patient experience according to individual needs and preferences. They can create a more empathetic financial experience, with upfront pricing estimates, personalized payment plans and flexible payment options. Not only will this be more desirable for patients, but it will also optimize healthcare collections, improve operational efficiency and increase the chances of more bills being settled in full. How can optimizing patient collections offset recent staffing challenges? Staffing shortages remain a growing challenge for healthcare providers. According to Baltzer, technology and automation can help ease the pressure on collections teams. He says, “Automation is key. Providers are being challenged to make the most of limited staff resources, especially for patient collections. It’s important to focus staff attention on the accounts most likely to pay. That means filtering out accounts that might be bankrupt or deceased and using automation for manual tasks – such as checking for charity eligibility or cleaning up patient records. Best-in-class providers are increasingly leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter.” Collections Optimization Manager can help organizations deploy a targeted approach to patient collections, using data and analytics to segment, screen and monitor accounts. By optimizing on the back end with user-friendly interfaces and efficient workflows, staff can focus their efforts on the accounts that need the most attention. On the front end, Patient Outreach solutions can help patients take control of their own financial journey with timely bill reminders and self-pay options, and requires minimal staff intervention. Automated text and IVR messages that connect directly to billing software ensure that more accounts are settled without adding to the organization’s headcount. Watch the full conversation, and download the State of Patient Access Survey 2.0, to find out more about how Experian Health can help your organization spot new opportunities to optimize healthcare collections.

This is the fifth in a series of blog posts that will highlight how the patient journey has evolved since the onset of COVID-19. This series will take you through the changes that impacted every step of the patient journey and provide strategic recommendations to move forward. In this post, explore the fifth step—treatment, and how social determinants of health can help your organization get a more holistic picture of your patients. To read the full white paper, download it here. How does a virus that does not discriminate produce such different healthcare outcomes across population groups? COVID-19 exposed population care challenges within the healthcare system. For example, data from the Centers for Disease Control and Prevention (CDC) consistently shows that American Indian and Alaska Native (AIAN), Black, and Hispanic people have a higher risk of COVID-19 infection, hospitalization, and death than their white counterparts. The AIAN community is 3.4 times more likely to be hospitalized due to the virus. An analysis shows that health disparities like these result in approximately $93 billion in excess medical costs and $42 billion in lost productivity per year. These differences in the health status of various population groups are socially influenced, unequal in distribution, and, most crucially, often avoidable. Arming clinicians with patient-level “Social determinants of health” insights can help When it comes to health outcomes and patient engagement, health providers can look beyond the immediate medical needs of a patient to understand non-medical factors that commonly act as barriers to accessing good healthcare and inhibit successful treatment. These can be things that influence a patient's social networks, socioeconomic situation, cultural and environmental conditions, as well as how they live from a health perspective. They are collectively known as social determinates of health (SDOH), and they account for up to 80 percent of health outcomes. Examples of social determinants of health include: Access to nutritious foods and opportunities for physical activity Access to transportation Education, job opportunities, and income Housing stability Language barriers and poor literacy skills Pollution and [lack of] access to clean water Racism, discrimination, and violence For example, a patient that suffers from a language barrier may have problems booking an appointment and understanding the steps for proper care. This can result in inconsistent treatment and poor treatment outcomes. A patient’s income can also play a part. Some patients may lose their jobs, move homes, lose access to cars, and more – resulting in food insecurity, housing instability loss of access to care and medication. According to a Gallup survey, 25% of patients defer treatment because it’s perceived to be unaffordable. It’s vital for healthcare providers to create a plan that includes touchpoints that screen for SDOH updates. Providers will need to actively educate their patients about alternative payment plans and other financial aid programs, to show their patients that care is accessible through a variety of resources. The benefits of addressing SDOH using digital solutions: to reduce health inequity and improve patient engagement Research found that integrating SDOH data into patients’ electronic health records and care plan considerations offered the potential for improved care and health. Adding this useful data allowed for a better understanding of patients’ social influences, as well as better collaboration between healthcare providers and community services – enabling patients to be treated and engaged from a holistic standpoint. When providers take SDOH into account and adjust patient engagement in care planning  accordingly, can alleviate: Readmissions Unnecessary emergency department visits Poor care quality ratings When employing an SDOH solution, providers can use data to develop new strategies that can target vulnerable populations. For example, SDOH research during the pandemic, conducted by the National Center for Biotechnology Information, revealed that school closures increased food insecurity for children, which led to greater rates of malnutrition. This led to lower immune system responses and increased the risk of infectious disease transmissions When trying to increase COVID-19 vaccination rates among populations living in low-income areas, healthcare providers can utilize SDOH data to develop ways to make care more accessible. Social determinants of health insights on access to care, medication, housing, and food barriers can also proactively identify patients with health inequity. Understanding differentiating drivers of individual SDOH profiles can help healthcare programs meet patients’ unique needs – ones that are hindering an equal playing field for their own health. Social determinants of health can help providers discover new opportunities Healthcare providers can also use this data to devise strategies to communicate more effectively with their patients, especially via the patient’s preferred channels. Technology and communication barriers that are typically overlooked should be examined as a part of SDOH. For example, a patient that prefers direct mail over email may ignore communications that they’re not receptive to. Meeting a patient where they are and through the channels they prefer is crucial to making a connection. Once they understand a patient's SDOH, providers can connect patients to relevant outreach or community programs that assist in removing some of the barriers to a patient's optimum care.  For example, if a hospital learns that their patient base has higher food insecurity, as opposed to access to care risk, they can work to prioritize partnerships with a local food bank or meal delivery programs. This allows providers to proactively help their patients make it easier to comply with their care plans when otherwise, a meal on the table would’ve taken priority over a wellness check. combining SDOH solutions with patient scheduling software, providers can automate proactive outreach for more and frequent follow-ups to encourage patient engagement. By utilizing social determinants of health (SDOH) insights, every patient visit becomes an opportunity to verify and address the non-medical factors that may be affecting the patient’s health and make better use of your organization’s community network. SDOH can help providers build robust patient profiles to display information that wouldn’t be visible in the clinical data. With Experian Health’s SDOH solution, providers can create robust profiles that can determine a patient’s readmission SDOH risk, and provide factors that are driving these risks. This solution can also provide recommended strategies that care team members can use to align appropriate resources and be proactive about their health outcomes. The healthcare system is designed to help patients during illness or injury.  However, delivering care equity is best achieved by also accounting for the non-clinical conditions that influence health. By looking at a patient holistically and combining clinical data with SDOH, providers can identify the unique challenges patients face and then tailor care to a patients’ individual needs. As providers adapt to life in the shadow of COVID-19 and move beyond crisis mode, it’s more crucial than ever to enrich patient identity management with SDOH, and close the gaps in care when the virus subsides. 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

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.

This is the fourth in a series of blog posts that will highlight how the patient journey has evolved since the onset of COVID-19. In this post, we address the fourth step – prior authorizations, and helping your patients get the approved care they need. This series will take you through the changes that impacted every step of the patient journey and provide strategic recommendations to move forward. To read the full white paper, download it here. Ask ten physicians how to improve healthcare administration, and they are likely to share dozens of conflicting answers. But if there’s one thing almost all of them can agree on, it’s the need to dramatically overhaul the processes around prior authorizations (PAs) for patient care. Prior authorizations for specific procedures, tests, and medications are designed to reduce financial surprises for patients and providers - while encouraging evidence-based care. The challenge is that criteria for authorizations changes frequently and can be complicated. Unfortunately, due to the COVID-19 pandemic, frequent change and complexity are difficult to manage. After months of avoiding in-person interactions, patients are now flooding back to their providers to catch up on deferred care. In many ways, the increase in volume is to be celebrated: providers are recouping lost revenue and patients are once again receiving necessary services. But with the return of patients comes the return of onerous paperwork, and providers are not entirely prepared to play catch up. In 2021, two-thirds of providers told Experian that they are finding it difficult to keep track of complicated criteria that keep changing during the pandemic. The same number expect to see ongoing challenges with securing authorizations for scheduled elective procedures, a marked increase from just over half of those surveyed last year. As providers, payers, and patients adjust to the new normal of COVID-19, it’s time for providers to streamline operations, increase efficiency, and improve revenue cycle predictability with automated prior authorizations. Coping with the multiplying burdens of prior authorizations Faxes and phone calls dominate the pre-authorization process. Practice staff – or even patients themselves – might spend hours working with multiple payer organizations trying to fill out forms, get more information, or appeal decisions. Without going through this tedious procedure, practices risk claim denials that can significantly impact their revenue cycles and patients may end up with unexpectedly large out-of-pocket bills. Over 80 percent of providers have seen an uptick in prior authorizations since 2020, building on a multi-year trend of increasingly complex PA requirements. In a recent survey from the American Medical Association (AMA), 85 percent of physicians confirmed that the burdens from prior authorizations are “high” or “extremely high,” and are affecting their practice operations. With an average of 40 prior authorizations per week per physician, some practices are spending more than two full working days each week on paperwork, the AMA says. Practices that want to get ahead of PAs will need to take a new approach to preapprovals and health plan relations. Fortunately, innovative automation technologies are available to help. Leveraging automation tools to streamline prior authorizations Prior authorization software can significantly decrease the cognitive burdens and person-power involved in completing PAs. With key features, such as an always-up-to-date knowledge base of current requirements for multiple health plans, staff members don’t have to search for obscure rule changes or the right payer portal to make sure their submissions are accepted the first time around. Exception-based workflows with dynamic work queues can easily guide staff members through convoluted requirements. Advanced status tracking, flags for manual review requirements, and procedure reconciliation tools also ensure that staff are always informed and prepared to take action. As a result, providers and physician groups gain the ability to complete more PAs in less time with a lower risk of errors, resubmissions, or claims denials. Meanwhile, patients can get the timely, evidence-based care they need and are less likely to find unpleasant surprises in their next medical bill. Integrating proactive preapprovals into the patient journey Providers can even take these newfound capabilities one step further to create a fully coordinated, cost-effective administrative experience for their patients. For example, automated Notice of Care tools are the perfect complement to digital prior authorization solutions. With these solutions, providers can send timely and accurate patient admission, observation, and discharge notifications while simultaneously gaining visibility into pending encounters. Uniting Notice of Care tools with data-driven PA strategies will make it simpler to proactively and holistically manage patient flow, anticipate resource allocation, and provide patients with timely and accurate information. As consumers begin to return to their pre-pandemic healthcare habits, it will be more important than ever for providers to get a handle on their administrative requirements and ensure they have the bandwidth to focus on reestablishing strong relationships with patients. With a combination of prior authorization tools and Notice of Care solutions, practices can complete necessary administrative tasks quickly and easily to support efficient, effective, and engaging patient journeys through the continuum of care. Learn more about how Experian Health can help your organization streamline patient access and improve revenue cycle predictability with automated prior authorizations. Download the white paper to learn more about how the prior authorizations process is changing post-pandemic.   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

This is the third in a series of blog posts highlighting how the patient journey has evolved since the onset of COVID-19. Explore how digital patient intake solutions are transforming the registration process - presenting patients with self-service options and providers with an automated and more efficient process. To read the full white paper, download it here. Registration is a familiar pain point in the patient journey, but COVID-19 has pushed both patients and providers to embrace digital patient intake processes and solutions. These new solutions move registration out of the waiting room, reduce errors and inefficiencies, automate billing, payments and create an enterprise-wide approach to data. Digital patient registration, once considered a “nice to have,” is now a widespread priority. A reveals that 88% of providers plan to invest in patient intake capabilities as a result of the pandemic, up 15% over a year ago. Patients lead the way on post-pandemic digital experiences COVID-19 marked a tipping point in the digital patient experience. Contactless care in the form of telehealth, along with increased use of patient portals and self-service scheduling tools, helped patients access care from a distance. Now, even though 81% of patients say they believe their provider has made on-site facilities safe, many still prefer online and mobile registration options. The study also revealed that 64% of patients prefer an online or mobile-enabled registration experience. “There’s an ‘ick’ factor,” explains Spiro Kalapodis, Director of Product Management for Registration Accelerator and Patient Financial Advisor at Experian Health. Patients actively dislike filling out paper forms, using registration kiosks and handling iPads set out for public use. “I don’t blame them,” says Kalapodis. “Even though the initial wave of COVID-19 restrictions has passed, I would prefer completing the registration process from the comfort of my car, rather than fill out forms in a crowded waiting room.” Simplifying a difficult process with digital registration and digital patient intake solutions One reason automated registration can be such a relief is that manual processes are notoriously difficult for providers to manage. Manual patient registration has always been labor-intensive and subject to human error; COVID-19 magnified these limitations. Paper forms are inefficient – they require design, printing, paper, clipboards, pens, secure storage and disposal. So many things can go wrong: receiving illegible responses, inputting data incorrectly, misplacing forms, the list goes on—and each step consumes valuable staff hours, with questionable results. Meanwhile, patients moved, visited new providers, changed jobs and switched insurance companies which meant there was more information needing capture. At the same time, providers are struggling to recoup revenue that was lost when patients deferred care during the pandemic. Optimizing both human and digital resources is key to delivering on an improved patient experience and regaining consistent profitability. “Patient intake solutions automate everything so data can be used consistently across the patient journey,” says Kalapodis. “For example, when a patient scans their insurance card and submits it through Experian Health’s Registration Accelerator, we leverage technology behind the scenes that can automatically indicate the patient’s insurance provider, policy details, and correctly return the patient’s subscriber details —information that staff members otherwise have to figure out for themselves. By automating this process, we’re saving time and resources, reducing misunderstandings and preventing data entry errors, which can be costly for providers and confusing for patients.” With the right data, providers can also create accurate estimates and even invite patients to pay their bills as part of the registration process. The patient receives a text message with a link to their estimate, along with the opportunity to pay online or on their mobile device. “Not only does this streamline the billing and collection process for providers, it creates a frictionless experience and increases greater transparency for the patient,” says Kalapodis. Getting to a single view of the patient Maintaining accurate data records can help providers deliver smooth patient experiences, better care, simpler payment processes and allows for better communication. Unfortunately, COVID-19 created another challenge on this front. During the pandemic, many patients signed into patient portals to schedule vaccine appointments. In their hurry to secure a shot, many inadvertently created duplicate accounts—and now have duplicate records. Obviously, multiple vaccine logins are not the only source of duplicate, inaccurate and incomplete patient data. But thanks to COVID-19, providers have this additional problem to contend with. Automation can make fast work of data issues. A universal identity manager creates a single view of the patient using unique patient identifiers, which prevent duplicate data records. The result: fewer billing errors and reduced associated costs, better care and a more frictionless patient experience. Patient intake can be painless Digital patient registration was a good idea even before COVID-19. Paper forms, entry errors, fragmented data, duplicate records, slow billing, and a lack of transparency made the registration process costly and inefficient. But COVID-19 made the need for digital more acute. Providers that hope to re-engage patients and recover profitability in the post-COVID-19 era need the power of data and automation. Learn more about how Experian Health can help you deliver a patient registration experience that fits post-pandemic expectations while improving efficiency, reducing errors and leveraging patient data. Download the white paper to learn how digital patient intake solutions are revolutionizing healthcare.   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