Tag: collections

No two healthcare organizations are the same. Each has varied workflows that optimize efficacy and overall care for patients. That’s why healthcare software solutions should never be considered one-size-fits-all approaches. It isn’t fair, or terribly productive, to force healthcare organizations to adapt to new software. Rather, the healthcare software should adapt to them. At Experian Health, we’ll never supply a software product and then expect you to adjust workflows to suit it. Instead, we embed ourselves into your company to ensure we deeply understand your productivity needs and the reasons behind them. Only then can we tailor the solution we provide around you. It’s never too early to get it right The conversation about customizing your healthcare organization's solution begins before you even sign up. As soon as a solution interests you, we’ll start looking at how to tailor it to your unique needs. We’ll hold a meeting that includes subject matter experts and implementation leadership groups to uncover your greatest usability needs. Then, we’ll document those needs to better prepare whoever runs your project and ensure he or she has all the necessary information upfront. Then, gears start moving during the sales process. After choosing a solution, our team of experts works with members from every department in your organization to iron out the appropriate design and functionality details. We believe the people who will be using and relying on the solution every day should have a significant say in these details. However, we’ll do all the legwork of actually building and implementing the solution itself. By the time we’re ready to run internal tests to make sure the software works, members of every department will already know what to expect. Consequently, when they run user acceptance tests to check whether the solution fits into their workflows, they can accurately measure the solution’s performance against their input into its design. Afterward, we can iron out any hiccups they run into before initiating the organizationwide training and “go live” steps of the process. It’s never too late to make adjustments Our deep involvement in customizing your solution also begins before you select it, and it continues long after it's successfully implemented. We don’t go away just because we marked you as “live.” Instead, we understand that the healthcare industry is in constant flux and you might experience operational changes that warrant additional tinkering and tailoring to our solutions. We’ll stick around for a couple of days after going live, and we’ll stay available forever after, just in case. For example, if you purchase a new physician group six months after going live, you’ll face quite an uphill battle onboarding them all into your software system and, in turn, getting them up to speed. Because the group is new, you might face opposition to bringing on any change in general. In this case, you could use help facilitating the training and the adoption of your system into this new group, and that's where we step in. Additionally, what if this implementation requires a work queue structure that’s vastly different from yours? If the new group operates in a different area of the state, they might also have unique rules for some of their payers. These rules have to be incorporated into their system to accommodate the patient population. None of this, though, should fall solely on your shoulders. We can worry about the system's features so you can focus on the operational change management aspect. For our clients, we’re always on call. This devoted availability could range from six months or even six years. Whatever the situation, we know that you’ll eventually face circumstances that your software wasn’t originally designed to address. Instead of feeling stuck and frustrated, clients can find comfort in knowing we are here for every step of the process. And beyond tailoring your solution before implementing it, we also offer continued customization to help you tackle new circumstances without compromising workflow. Overall, here at Experian Health, we understand the pressures facing healthcare organizations today, and we are eager to be partners with you in securing the best solution for you needs and guiding you through the challenges ahead.

For healthcare providers, revenue cycle management has become more important than ever. Due to increasing complexity in the payer mix and patients encountering more out-of-pocket costs, revenue cycle directors are also finding management an uphill battle. To maximize their reimbursement rates, today’s healthcare providers must take control of revenue cycles, and that requires optimizing three particular areas: estimates, claims, and collections. However, this task is much bigger than one person or department to enforce. For success, revenue cycle directors require an array of reliable, automated solutions that allow leveraging a wide range of data and comprehensive analytics with minimal employee input. At Experian Health, we offer a variety of solutions that help optimize healthcare systems' revenue cycle management by simplifying the three key areas mentioned above. Unlock vital revenue cycle management capabilities With patients taking more responsibility for their medical costs, modern revenue cycles are most successful when tailored to patients. This includes providing accurate cost estimates upfront, making sure claims are clean before submitting, and prioritizing debt collection efforts where they are most successful. 1. Patient Estimates: providing accurate estimates early In our consumer-centric environment, patients expect a greater level of insight into the costs of medical procedures, preferably before receiving treatment. No one likes to be surprised months after treatment with medical bills that far exceed what they expected. In addition, state laws now require hospitals to provide more accurate patient estimates. For consistently accurate cost estimates, a healthcare provider must have a dependable price-generation process. For example, the estimates should incorporate a patient’s specific insurance information for accuracy. They should also be compared to the patient’s propensity to pay so a payment plan can immediately be set up, much like how financial institutions treat automobile loans. Patient Estimates, Experian’s price transparency tool, auto-populates much of the necessary data so healthcare providers can deliver accurate patient estimates as early as possible. In turn, consistently accurate cost estimates raise healthcare providers' chances of collecting revenue upfront and help avoid unnecessary headaches during the claims and collections processes. 2. Claim Scrubber: submitting clean claims The conflicts caused by denied claims are expensive to fix. Interactions with payers cost medical groups thousands of dollars per physician each year. Many of those interactions result directly from denied claims, which often stem from inaccurate data. Claims data can be edited in Experian Health's Claim Scrubber, which reviews each claim line by line and makes edits based on the platform's data. Claim Scrubber combines the data with general, payer, and patient-specific information to guarantee each claim is properly coded every time. 3. Collections Optimization Manager: collecting debt strategically and efficiently If a healthcare provider wants to redesign its collection processes to center around patients, it should rely less on random outbound calls and focus more on insight regarding each patient’s propensity to pay. The burden of collecting on past-due balances is a demanding task. It also reduces a healthcare provider's chances of successfully collecting bad debt. One of the most important reasons — among many — to consistently provide accurate estimates and claims is to make collecting debt more successful and less time-consuming. Granted, a healthcare provider can't expect to collect every single outstanding fee. However, by concentrating on patients who are able to pay, a much greater percentage can be collected. Furthermore, Experian Health's Collections Optimization Manager helps complete revenue cycle management by using in-depth collected data to identify patients who are most likely to pay their hospital bills. In turn, staff members can utilize their time and resources more efficiently by contacting these specific patients first. Like most companies, healthcare providers are beginning to realize that patient engagement is a top priority. With this elevated engagement comes the need for consistent price transparency for medical care. Luckily, Experian’s automated engagement solutions can help your healthcare system provide the increased transparency it needs while also optimizing its revenue cycle management.

In 2014, Sanford Health set out to improve its success rate in collecting past-due patient bills. The health system increased its in-house collections by more than $40 million, and in a single year, it sent 28.5 percent fewer collections to outside agencies. How did Sanford Health do it? The patient account team improved its collections process with a hybrid approach of new tools and new ideas for patients and employees alike. Create a transparent system to identify the highest-yielding accounts Collections Optimization Manager allows the team to better manage patient collections by finding the patients who can and will pay. This is a big win. The team avoids wasting time and other resources on low-yield accounts. More importantly, when patients need Sanford Health’s financial assistance and charity services, they get the compassionate care they deserve. Previously, Sanford Health manually tracked and called patients who were late paying their bills. It was a cumbersome collections process, and the team had no way to focus its efforts on those people with the propensity to pay. The Collections Optimization Manager’s analytical models use precise algorithms to create segmented groups according to those patients who would prefer to pay in full at a discount, those who would prefer to pay on an installment plan, and those who are likely to be eligible for financial or charity assistance. Seamlessly integrate the new tool with existing ones The team coupled the new optimization manager with PatientDial, which they were already using and which routes calls to patient account representatives based on segmentation and decreases the cost of the collections process. Integrating with other products made it possible for Sanford Health to build upon previous success and easily implement the optimization manager with limited intervention from its IT department. Sanford Health was already using two other Experian Health products as well. First, Claim Scrubber helps Sanford Health submit clean claims to insurance companies and other payers, thus reducing undercharges and denials, optimizing staff time, and improving cash flow. Contract Manager and Contract Analysis audit payer compliance so the patient accounts team is assured that collections align with contract terms. Couple new tools with fresh, simple ideas Patient Statements is the final tool Sanford Health had already implemented when it embarked on its journey to improve the patient collections process. But it went a step further by redesigning the cover page. Now, patients can easily understand their payment options, including prompt-pay discounts. Also, the health system instituted an employee incentive program, which rewards staff members for their collections performance. Sanford Health is the largest nonprofit rural healthcare system in the nation. It has 45 hospitals and 289 clinics in nine states and four countries. It employs more than 28,000 people, including more than 1,300 physicians in more than 80 specialties. As Sanford Health grew and acquired new services, it realized that it couldn’t rely on a purely manual process to handle its collections process. Collections Optimization Manager turned out to be a profitable and otherwise satisfying collections solution. Collecting past-due bills is about money. And any business — even one focused on health and healing like Sanford Health is — must turn some of its attention to making money. But collections can be about more than that. It can be about making patients happier. It can be about figuring out who needs your help and exactly what kind of help they need. That’s what Sanford Health focused on, and it paid off. Learn more about how Sanford Health improved its process and collections success rate. Read the case study.

As deductibles and premiums increase, more patients struggle to pay healthcare bills, and, in turn, the patient collections process becomes more and more daunting. Hospitals and clinics are now relying on debt collection agencies more than ever. At Experian Health, we estimate a 119 percent increase in this specific outsourcing over a four-year period, from 2014 to 2018. A third-party debt collection agency is attractive for many reasons. For one, it frees up your healthcare practice’s valuable resources. Also, patients with delinquent bills typically respond well to a debt collector’s call. However, using a debt collection agency does not relieve all concerns because you must consider vicarious liability. By law, your hospital or clinic can be held responsible for the debt collection agency’s actions when it acts on your behalf. To keep your healthcare practice out of legal trouble and clear of costly fines, ensure the debt collection agencies that you hire comply with relevant laws and regulations. Also, consider using tools to make sense of these complex requirements. Do You Know the Laws Controlling Debt Collection? The legal requirements governing debt collection are varied and frequently evolving. It can take a lot of work to keep up with them, but there’s a tool to help you. We’ll describe this tool in just a moment, but first, let’s review a sample of federal debt collection laws and regulations to make sure you’re up-to-date: The Fair Debt Collection Practices Act (FDCPA) limits the behavior and actions of collectors who attempt to collect debts on behalf of another person or entity. This federal law aims to eliminate “abusive, deceptive, and unfair debt collection practices.” The Telephone Consumer Protection Act (TCPA) governs interactions between businesses and their customers, including healthcare providers and their patients. In many cases, this federal law requires consent before a provider can communicate with a patient’s mobile device through automated dialing systems, such as auto-texting or “robocall” systems. The Fair Credit Reporting Act (FCRA) regulates the collection, dissemination, and use of consumer information, including credit information. The Gramm-Leach-Bliley Act (GLBA) requires institutions to explain their information-sharing practices to customers and any available opt-out provisions. IRS Code 501(r) is a federal regulation enacted by the Affordable Care Act. It mandates certain financial assistance practices in order for an organization to maintain a nonprofit 501(c)(3) status. A key provision holds many hospitals and healthcare systems accountable for the acts of their debt collection agencies. The Electronic Fund Transfer Act (EFTA) establishes the rights and liabilities of consumers in electronic fund transfer activities, as well as the responsibilities of all parties. The Truth in Lending Act (TILA) requires disclosures about lending terms and the costs associated with borrowing.  

Look forward to a better bottom line—and increased patient satisfaction Many providers face a of lack insight into agent performance and call durations, as well as the ability to route telephone calls to representatives based on experience or inquiry type. Others use manual vs. automated processes to call patients with outstanding balances. Having the ability to both contact patients and take inbound calls using a cloud-based dialing platform can significantly increase your collections and penetration rates. Some platforms can even provide the ability to monitor agent activity for performance and take payments after hours when no live agents are available, and provide access to actionable insight into call volumes and durations, giving you the ability to make more strategic decisions and adjust process flows. Increase the effectiveness of your collection and patient engagement strategies by pairing online and print communication channels using outbound and inbound dialing technology. Experian Health’s new cloud-based dialing solution, PatientDial, arms providers with the tools and data needed to make strategic decisions and increase calling campaign effectiveness and the collections bottom line—all without the need for costly hardware and software upgrades. PatientDial assists with patient outreach for patient collections and patient engagement processes and workflows. Services include inbound, outbound and blended call environments and can accommodate both live agent and blaster (unattended) messaging campaigns. IVR services are available to route calls to the proper type of agents and handle payments after hours. When combined with our PaymentSafe solution, PatientDial enables patients to make automated payments via telephone, and combining with our Collections Optimization Manager solution further increases ROI by leveraging screening results and segmentation to drive strategy solutions. Learn more about PatientDial Read the Sanford Health case study  

Remember those commercials for the hamburger chain in the mid-1980’s? An elderly lady angrily shouted, “Where’s the beef?” in response to seeing a tiny burger on a large, fluffy bun. If that same creative concept were applied to healthcare today, perhaps the lady would proclaim, “Where’s the data?” when looking at the revenue cycle. While healthcare as a whole is moving toward using clinical data and analytics to enhance patient care, most organizations aren’t realizing the true potential of financial data to drive revenue cycle performance. So where does that potential lie? Quite simply, it lies in the vast amounts of financial data that healthcare organizations can access, yet do so ineffectively. By leveraging this existing data more appropriately, organizations can build and sustain margins while improving performance and enhancing the patient experience. Consider these three areas of opportunity to use data to drive the revenue cycle. Patient Access Correctly capturing and analyzing patient data at the initial point of contact allows an organization to reap large rewards, both clinically and financially. For example, correct patient identification reduces the risks of fraud and identity theft and ensures that medical records are being provided for the right patient, thus preserving patient safety. In addition, using data to provide accurate estimates of the patient’s payment responsibility up front and developing customized payment plans can elevate patient satisfaction as well as propensity to pay, allowing the healthcare organization to enhance collections and reduce bad debt. Claims and Contract Management Another area of opportunity is in payer contracts and claims. During contract negotiations, data and analytics help identify new service line opportunities for enhanced financial performance. Claims are more accurate and efficient when analytical tools review them before submission, comparing them with contract requirements and kicking out those with errors or ones that require further information. Consider the example of a healthcare organization that improved its recovery rate on denials by almost 50 percent by leveraging data to compare the amount received for the claim with the contracted amount. Collections Data and analytics also can be used to improve internal collections efficiency and profitability. Organizations can use data to segment accounts that share demographic and financial profiles, rather than simply looking at balance amounts and number of days open. This allows collections staff to prioritize work based on a patient’s likelihood to pay, which improves both collections and the patient experience. For example, a patient scoring in the “most likely to pay” segment may not need a call until day 75, while someone in a lower segment may need additional calls and help setting up a payment plan within the first month. Segmenting in this way not only increases the likelihood of successful payment, it preserves patient satisfaction at the same time. Realize your revenue cycle’s true potential by leveraging financial information to enhance performance. Moreover, marry these activities with efforts to use clinical data to improve care, and you can realize a comprehensive approach to elevating overall quality and performance. You’ll no longer need to ask, “where’s the data?” Learn more about leveraging data and analytics to drive the revenue cycle with this white paper: The new revenue cycle imperative: A data-driven approach to minimizing risk and optimizing performance.

Sometimes it’s all in the cards. And, in the end, it’s usually not a winning hand for the healthcare organization. In this case, the “card” is the patient’s insurance coverage and the “hand” is the increasing amount of bad debt that can be avoided. For example, a patient presents his or her insurance card at registration. The patient’s employer recently changed plans, and the patient mistakenly pulls out the card for the old plan. The claim is processed using the expired insurance information, and the payer rejects it and reclassifies the account as self-pay. After a time, the account goes to collections, and the patient is sent letters and receives collections calls. Both are ignored because the patient has coverage and assumes the provider simply made a mistake. Unable to resolve the issue, the provider ultimately writes the account off as bad debt. When accounts like this one are misidentified, the healthcare organization loses revenue, time and patient satisfaction. Misclassifying accounts can happen because of registration errors, changing insurance or patient miscommunication. When an account is misclassified, it increases the likelihood the account will turn into bad debt, especially when the account is misclassified as self-pay. Even when caught during the collection process, misclassification errors can impact A/R days, payment speed and cash flow. So, how do you play your cards right? Using the most up-to-date payer data, healthcare organizations can systemically search for current commercial, Medicare and Medicaid insurance coverage. An automated process reveals and prioritizes potential active coverage, allowing staff to rectify any mistakes and file claims in a timely manner. Staff can even proactively identify and correct routine data entry errors, such as incorrect birth dates or transposed Social Security numbers, before the claim is submitted. While the organization improves cash flow and productivity, there also are patient benefits. Using data to identify the right insurance coverage upfront makes patient interactions more efficient. In addition, reduced payment misunderstandings and unnecessary collections calls drive overall patient satisfaction. Curious about how your organization can have a winning collections hand? Use data and analytics to improve the accuracy of upfront business processes and enhance the patient experience. Learn about one of our newest products, Self-Pay Coverage Finder℠, and see how automating the search for insurance coverage can positively impact your organization’s bottom line and the patient’s experience.