Tag: Coverage Discovery

How can healthcare providers improve revenue cycle predictability? Experian Health's suite of RCM solutions can help.

“I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.”—Andrew Pederson, Director of Patient Experience, UCHealth Challenge UCHealth, in Aurora, Colorado, is an integrated system of 12 hospitals and more than 30,000 employees. When the state of Colorado released data on non-profit hospital charity care and community benefits, UCHealth's spending was lower than anticipated despite having policies on equitable charity care in place. Additionally, the state was about to implement new legislation on charity care, setting a cap on charges for low-income patients. UCHealth proactively sought to revamp how they handled charity care in preparation for higher patient volumes in the future. The organization decided to review its charity policy and processes. After examining other providers, UCHealth determined that it lacked presumptive charity functionality early in the patient encounter. New technology would help patients avoid the accrual of unpaid medical bills and keep UCHealth from accruing bad debt. Solution UCHealth added Patient Financial Clearance in 2023 after their favorable experiences with Experian Health's Coverage Discovery® and Insurance Eligibility Verification. Patient Financial Clearance allowed the provider a more nuanced understanding of each patient's ability to pay by going beyond their reported income to look at the Federal Poverty Level ratio and their propensity-to-pay. The technology used powerful analytics to create a Healthcare Financial Risk Score, encompassing historical credit activities, including payment of past medical bills. Importantly, Patient Financial Clearance helped UCHealth staff determine options for financial assistance automatically, without relying on the patients themselves. Automation in the platform reduces time spent per encounter, improving the patient and staff experience and, ultimately, the bottom line. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery Discover how Experian Health's Coverage Discovery helped UCHealth create a more streamlined approach to verification and billing. Outcome Thanks to Patient Financial Clearance, UCHealth achieved the following results: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). Overall, Patient Financial Clearance helped UCHealth create a more streamlined approach to providing charity care to patients who need it. The technology integrates easily with the provider's electronic health record (EHR) system, eliminating the back-and-forth between multiple systems during patient registration. Identifying patients who need financial assistance saves the UCHealth team from misclassifying them as bad debt, minimizing financial losses on the organization while improving their overall experience. Andrew Pederson, Director of Patient Financial Experience at UCHealth, highly recommends this software and the team that provides it, stating, “I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.” For providers seeking to streamline the revenue cycle, Pederson says, “Get out of your own way and just do it.” Learn more about how Patient Financial Clearance streamlines patient charity screening while maintaining an outstanding experience at every step of the encounter. Learn more Contact us

In this blog post, learn about the basics of medical billing in the revenue cycle and how it helps providers improve patient collections.

Learn about medical insurance verification software, how it works, the benefits, and things to consider when selecting the right solution.

This article discusses how healthcare organizations can prevent medical fraud and ensure eligibility integrity.

Discover how artificial intelligence (AI) can help solve common challenges in revenue cycle management (RCM) with just a single click.

In this blog post, experts at Experian Health provide an update on Medicaid redetermination and ways providers can mitigate the effects.

“We wanted the right technology that could look for insurance coverage for self-pay patients without the need for us to increase our manpower. The cost savings were a big win for the department.” — Brent Rikhoff, Director of Pre-Access, UCHealth Challenge UCHealth is an integrated health system with a network of 12 hospitals and more than 30,000 employees. At the height of the COVID-19 pandemic, UCHealth maintained its commitment to an excellent patient experience by giving all patients access to tests and vaccinations. Costs for uninsured and self-pay patients could be recovered under the Health Resources and Services Administration's (HRSA) COVID-19 Uninsured Program (UIP), but only after confirming that the patient had no relevant active coverage. If they missed this step, UCHealth would be landed with bad debt, increasing collection costs and unwanted audits: they needed a reliable way to track and verify insurance coverage accurately and in real-time. Solution UCHealth chose to use Coverage Discovery® after experiencing positive results with Experian Health's Eligibility solution. Coverage Discovery allowed them to scan the entire revenue cycle for billable commercial and government coverage that patients may have been unaware of or forgotten about. The tool gave UCHealth access to Experian's proprietary databases, including employer group mapping and patient search history, so they could track and verify potential coverage in multiple locations. This made it much easier to find insurance information for plans without a self-pay search feature. After seeing positive results, UCHealth expanded their use of Coverage Discovery to self-pay and emergency department patients. This helped them root out discrepancies in patient accounts and prevent accounts from being misclassified as bad debt or charity. Uncovering additional active coverage was also a major benefit for patients. Improving patient collections: strategies and best practices Discover the top 4 strategies to optimize patient collections while delivering a more compassionate financial experience for patients. Outcome Thanks to Coverage Discovery, UCHealth achieved the following results: Over $62 million in insurance payments in 2022, a 25% increase from 2021, includes payments from their top three payers $45 million in coverage found between May 2022 and May 2023 Over $3.5 million in collection costs savings in 2022 Overall, Coverage Discovery has helped UCHealth create a more streamlined approach to verification and billing. The batching feature made it easy for staff to process the backlog of patient accounts awaiting insurance verification, while access to large, current datasets facilitated more accurate billing. Director of Pre-Access at UCHealth, Brent Rikhoff, said the ability to integrate Coverage Discovery with Epic® enabled the team to achieve proper reimbursement for services rendered. Expanding the solution to include Medicaid coverage identification would be an obvious next step for UCHealth, following this impressive return on investment. Learn more about how Coverage Discovery identifies missing and forgotten billable coverage, so healthcare providers can get fully reimbursed while maintaining an outstanding patient experience. Learn more Contact us

Learn how Experian Health's MBI Lookup tool helps providers verify active coverage to give patients peace of mind following a data breach.