Tag: Coverage Discovery

Because so many healthcare claim denials originate in the front end of the revenue cycle, providers should focus on improving insurance eligibility verification at the early stages of the patient journey. Verifying coverage earlier in the billing process with automated eligibility verification software increases the chance of submitting clean claims the first time and protecting future revenue. As coverage and benefits become more challenging for patients to navigate, prioritizing eligibility could also hold the key to better patient-provider relationships. Given the complexity of the healthcare billing system, patients have little tolerance for errors and delays. Many already worry about being able to cover their financial obligations, so denied claims are the last thing they want to see. Insurance verification reduces denials, gives patients greater clarity over their upcoming expenses and allows healthcare organizations to focus on providing the best possible care. This article looks at why improving insurance eligibility verification can help healthcare providers optimize cash flow and achieve higher levels of patient satisfaction and loyalty. What are the steps in the insurance eligibility verification process? Before filling out a claim, providers must be sure that the services they’re seeking reimbursement for are covered by the patient’s health insurance. They must also check that the patient’s details match those on their insurance plan. If a provider offers treatment or services and it later turns out that the patient’s coverage has expired or the patient is ineligible for those items, the claim will be rejected. To verify eligibility, providers must therefore be able to answer the following questions: Are the patient’s contact details current and correct? Does the patient’s insurance plan cover the planned treatment or services? Do any exclusions apply under the patient’s plan? Have all necessary pre-authorizations been obtained? Is the coverage active? What are the thresholds for deductibles, co-pays or coinsurance, and do any annual or lifetime limits apply? Confirming eligibility early on lays the groundwork for better claims management and minimizes the chance of errors. How does an effective eligibility verification system benefit patients and providers? Accurate and timely insurance verification clarifies to all parties how bills will be covered (or not) ahead of time. If a claim ends up being rejected, the patient will find themselves with responsibility for more of the bill, the provider will be left uncompensated for services rendered – or both. Clarifying coverage in advance avoids these scenarios. When providers can generate and communicate pre-service patient estimates with confidence, patients can plan for their bills and even make payments before or at the time of service. The financial benefits are clear, but patient satisfaction is also likely to increase: a study by Experian Health and PYMNTS found that patients who received pre-treatment estimates were more satisfied with their care than those who did not. Automated pre-service eligibility checks also improve communication between patients, providers and payers by reducing the manual workload on staff. Instead of spending time checking and fixing errors, staff can focus on helping patients with more complex cases. According to the CAQH, as much as $10 billion could be saved each year by switching to electronic eligibility and benefits verification. How does it help the claims process? In Experian Health’s report on the State of Claims 2022, the most common reasons given for claims being denied included: issues with prior authorizations, provider eligibility, patient information, changing payer policies and services not being covered. Automated eligibility verification helps solve each of these. With fewer errors in the pipeline, organizations can file claims faster and receive payments in a timelier manner. Eligibility Verification accesses up-to-date eligibility and benefits data from multiple sources, generating an instant read-out of a patient’s insurance status. More accurate information increases clean claims rates, accelerates reimbursement and allows providers to forecast future revenue levels more reliably. Staff can view responses in a clear and concise format and receive alerts when follow-ups or edits are required. This sets the tone for a more efficient claims process all around. Proactive and error-free claims management saves staff time that might otherwise be spent on reworking claims and engaging in lengthy disputes with payers. From the patient's perspective, earlier verification can fast-track registration because much of their information is checked before they even arrive for care. Waiting time is reduced because staff benefit from more streamlined workflows. As noted, finding missing coverage gives patients clarity over what they owe, so they’re more apt to pay bills on time. Automation can also be used to connect patients to the appropriate financial support. For example, with Patient Financial Clearance, providers can offer compassionate financial counseling and get patients on the right financial pathway. It improves the patient experience while reducing the risk of bad debt. What does a good insurance eligibility verification system look like? When it comes to choosing an insurance eligibility verification solution, the checklist should include the following features: Compatibility with existing systems and electronic health records - Eligibility Verification accelerates verification and registration by drawing together accurate patient data. And through eCare NEXT®, clients can manage multiple patient access functions through a single interface. Simple methods for updating or changing patient information - User-friendly interfaces allow staff to make changes from any device, as and when new information arises. Integration with patient portals means patients can spot errors themselves, too. And tools such as Registration QA can drive data accuracy by highlighting errors as soon as they occur, both pre-and at the point of service. Rapid results, with patient benefits information readily available when needed - Eligibility Verification confirms patient eligibility and calculates reimbursement estimates with precision. This incorporates CAQH COB Smart® data for enhanced coordination of benefits in relevant transactions. Ability to calculate patient estimates - A verification tool that integrates with automated patient payment estimates ensures patients understand their coverage, co-pays and deductibles before treatment proceeds so that they can plan for their final bills. Integration with pre-authorization tools - For some services, a payer may require the provider to seek authorization before going ahead. An insurance verification solution can flag up where prior authorization is needed to prompt action and prevent delays. Ability to source data from major health insurance carriers, including Medicare - Eligibility Verification connects with nearly 900 payers with advanced search functionality to match patients to current eligibility and benefits data. This can be used alongside an optional lookup service for Medicare beneficiaries to find and validate MBI numbers. Ongoing changes to the health insurance landscape mean that providers must pay close attention to the process of verifying coverage and benefits. Although insurance verification is a small step in patient access, the impact can be felt throughout the patient’s journey and the provider’s revenue cycle. By optimizing for earlier and more accurate insurance verification with workflow automation and advanced data analytics, providers can reduce the risk of denied claims, improve financial performance and protect patient-provider relationships. Find out more about how Experian Health can help healthcare providers streamline their claims process with front-end improvements to verify insurance eligibility, file error-free claims and get paid faster.

On April 1, 2023, millions of Medicaid recipients are set to lose coverage as the U.S. government’s COVID-19 public health emergency (PHE) expires. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Of this group, 6.8 million may be eligible to re-apply for Medicaid, but in the immediate term, it falls to patients and providers to sort through coverage questions, navigate charity and Medicaid eligibility, and keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, shares her insights on how Patient Financial Clearance and other digital solutions can help providers and patients cut through the confusion to achieve the best healthcare and financial outcomes during this time. Q1: The public health emergency is ending on April 1, which means that many will lose Medicaid coverage. How will this impact providers and patients? “Patients who qualified for Medicaid under the Public Health Emergency requirements during COVID will be dropped from Medicaid on April 1, leaving them without coverage,” explains Pankoke. “Healthcare organizations have been trying to reach out proactively to pre-enroll some of these patients, but others may not know what their options are or may show up to receive care without realizing they no longer have coverage.” Patients will face a range of financial challenges. “Self-pay patients may defer treatment, which could keep them from receiving the care they need and may ultimately lead to more costly hospital visits,” Pankoke says. “Also, patients may be confused about what’s happened to their coverage and what their options might be going forward. If they end up being responsible for paying out of pocket for care, some may have to choose between paying their medical bills and paying for food or utilities.” Providers will see a surge in patients needing help after losing Medicaid coverage With millions of patients in flux, providers will need to dedicate time and attention to helping patients sort through their concerns, including: Confirming whether Medicaid coverage is still in force Verifying coverage with new insurance Determining eligibility to re-enroll in Medicaid Qualifying patients for full or partial charity care Explaining patient financial responsibility and working out payment plans Managing billing and collections with a higher volume of accounts in AR Optimizing outcomes so that patients get the best care possible and providers end up with the least amount of bad debt Time is a critical element. Lengthy processes and administrative delays are likely to increase patient stress levels. Meanwhile, many providers face industry-wide staffing shortages. Time-consuming manual processes, multiplied by a sudden surge of affected patients, could quickly become overwhelming for staff. “For providers, this could be a hard situation to navigate,” says Pankoke. “At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offering them help can be powerful.” Q2: That raises an important question: How can providers create a compassionate experience for patients? “I think awareness is one place to start: making sure your staff knows this change is coming and that they understand the impact,” Pankoke says. “Your staff are the ones who’ll be working with patients personally when they come in and find out they no longer have Medicaid coverage.” But compassion doesn’t end there. “Many providers already have charity programs in place to provide relief for patients who can’t afford care,” says Pankoke. “The challenge lies in identifying the patients who need that charity assistance and connecting them to the help that’s available, while also learning which patients may still qualify for Medicaid and need help to re-enroll. Patient Financial Clearance uses credit and non-credit data to identify patients who may still be eligible for Medicaid, as well as self-pay patients who may qualify for charity assistance.” Using data-driven digital tools to quickly and proactively size up patient financial needs and offer personalized help can make the patient experience more humane. “Making these steps easier is another piece of being compassionate.” Q3: Screening for charity can be complicated, especially when new regulations are introduced – how do providers streamline this process? “My best advice is to embrace your charity programs and use a partner like Experian Health to help you automate the financial assistance screening process,” says Pankoke. “Patient Financial Clearance removes the manual screening for the likelihood to qualify for your charity programs and Medicaid.  It can automate the document-gathering in a patient-friendly way, and speed up the process to extend charity assistance, or work to enroll those likely to qualify for Medicaid early on before patients go through a costly uncollectable experience.” Automating these processes doesn’t have to be onerous. “Clients can provide their charity policy  requirements to Experian Health and let our expert consultants help to create the most effective and efficient workflows for Medicaid and charity screening both  up-front and as back-end scrubs.” Pankoke also urges providers to consider patient self-screening options as well: “Providers should consider other options aside from paper applications.  We’ve seen clients shrink the application process from 60 days of paperwork down to 3.5 days by enabling patient self-screening options via text.  This creates a better experience for the patient and hospital staff.” Q4: What else can providers do to help patients manage the cost of care? Providers can focus their resources on improving the patient's financial journey—for all patients, not just those who are struggling with their Medicaid status. Pankoke’s suggestions: Reach patients on their preferred channels - “Providers can empower patients with less paper-heavy ways to apply for financial assistance. Text and online applications embedded on your website or patient portal put the power into the patient’s hands using the channels they prefer.” Providers can also offer patients the ability to make payments right from their mobile devices using Patient Financial Advisor, making it easier to pay outstanding bills anytime and anywhere. Use data to gain insight into patient finances and offer personalized options - “In addition to screening for possible charity and Medicaid eligibility, Experian data enables providers to offer realistic payment plan options that consider how much the patient is likely to afford, enabling patients to bite off what they can chew with higher likelihoods of making payments successfully.” Customize collections - Sending patients who are struggling to collections may not be cost-effective or compassionate. “Providers don’t want to hound people for payment if the patient is having trouble covering their basic expenses and could qualify for Medicaid or charity care,” says Pankoke. Using Collections Optimization Manager, providers can tailor collections processes to their own specific needs. “A partner who is agnostic to your in-house and early-out agencies can help you manage, monitor, and optimize agency performance for maximum revenue.” Providers who are concerned about upcoming shifts to Medicaid coverage may want to consider leveraging solutions like Patient Financial Clearance, Collections Optimization Manager and Patient Financial Advisor to help them meet this challenge—along with the many challenges of managing patient financial needs in a rapidly-changing world.

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

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

“With rising patient costs, there has been a need to increase engagement and keep costs low, while utilizing our resources wisely. Collections Optimization Manager is doing that for us, saving time and resources.” — Kristine Grajo, Director of the Self-Pay Management Office at Stanford Health Care Challenge Stanford Health Care is a level-1 trauma center operating between San Francisco and San Jose. In pursuit of its mission to heal humanity through science and compassion, it delivers clinical innovation across inpatient services, specialty health centers, physician offices, virtual care offerings and health plan programs. With more than two million outpatients going through its doors each year, Stanford Health Care is alert to the impact of growing patient financial responsibility. To increase collections and deliver an outstanding patient experience, the organization looked for ways to increase efficiency, reduce manual workloads, and reduce costs using data-driven insights and automation. They set out to: Use data-driven insights to remove uncollectible accounts Maximize patient collections by prioritizing patient collection inventory Identify missed coverage on true self-pay and Medicare accounts Decrease manual interventions and collections calls and improve efficiency Reduce the cost to collect, particularly around contingency fees with third-party collection agencies Solution Stanford Health implemented Collections Optimization Manager to maximize recovery and reduce costs. This tool scrubs accounts that shouldn’t be targeted for collections, so staff can focus their time in the most efficient way. Using machine learning and data-driven insights, the tool scores, segments and prioritizes patient accounts based on ability and propensity to pay. This allowed Stanford Health to recover revenue efficiently while providing positive patient experiences. Finding missing coverage was another strategy to boost reimbursement and avoid billing patients unnecessarily. Experian Health’s Coverage Discovery® solution finds billable primary, secondary and tertiary coverage using the Collections Optimization Manager AR file. Accounts that would otherwise have been sent to collections or written off can be identified and submitted for immediate payment. Listen in as Kristine Grajo, MBA, Director, and Teresa Ceja-Diaz, Vendor Management Analyst, at Stanford Health discuss how Experian Health helped their organization optimize their collections strategy. Outcome With Collections Optimization Manager and Coverage Discovery, Stanford Health achieved the following results: $4.1m increase in average monthly payments (2019-2021) Efficiency gains of $109k per month and $1.3 million annually Saved 672 hours per month by automating the screening of patient accounts, and processed 4,296 accounts 29% of all Coverage Discovery searches resulting in coverage found Stanford also incorporated PatientDial and had efficiency gains of 900 hours per month, while automating 27,000 outbound calls. A further $1.26m in annualized collections was recovered thanks to Experian Health’s Return Mail solution, which ensures that patient accounts contain only accurate, current patient addresses. With accurate patient information on file, the organization can process accounts with greater accuracy. This saves a huge amount of staff time while improving the patient billing experience. "We have received a lot of positive feedback with Collections Optimization Manager’s Return Mail solution because it gives us the most updated contact information. Whenever we need to notify the patient, we have the most updated addresses in our system.” — Teresa Ceja-Diaz, Vendor Management Analyst, Self-Pay Management Office at Stanford Health Care Find out more about how Collections Optimization Manager and Coverage Discovery help healthcare organizations accelerate collections and deliver an outstanding patient experience.

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

“We serve our patients well when we can spend time explaining their bills, what’s been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at University of California San Diego Health (UCSDH) Challenge University of California San Diego Health (UCSDH) is one of the top health systems in the United States, ranked number one in San Diego by US News and World Report. With more than 9,000 employees, it generates over $2 billion in net patient revenue each year. Patient collections are managed by the Shared Business Office (SBO), which handles all queries about billing, financial assistance and payment plans. Providing a best-in-class financial experience for patients is the SBO’s top priority. The team implemented a three-part strategy to improve the patient billing experience and increase collections, focusing on people, processes and technology. They saw opportunities to use automation to support this. Solution The SBO implemented Experian Health’s Collections Optimization Manager to improve collections and deliver an outstanding patient experience. Using in-depth data and advanced analytics, this tool scores and segments patients according to their propensity to pay and automates the presumptive charity process, so patient accounts are handled efficiently. This helps UCSDH reduce the cost to collect by maximizing staff and agency resources. To further reduce the risk of bad debt, the SBO uses Coverage Discovery® to find billable commercial and government coverage that was previously forgotten or unknown. Listen in as Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, discusses how their organization used automation to optimize patient collections and improve the patient experience. Outcome Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH also used segmentation data to improve outbound call campaigns. The team was able to create automated messages that can be sent to specific segments, so patients get the right information at the right time. By sending during time periods when patients were most likely to respond to calls, they were able to increase their collections rate. The screening feature also identified patient accounts that were eligible for Medicaid or charity support, deceased or bankrupt, and placed them in the correct work queue. The SBO leveraged Return Mail to run checks against patient addresses, to ensure that statements and refund checks were sent to the right place. Accounts with non-verified addresses were allocated to an auto-dialer for automated outreach. This helped reduce the manual labor required to find patient addresses, reduce bad debt and realize improved collections rates. By leveraging these tools, UCSDH has achieved: Increased collections from $6 million in 2019-2020 to $21 million in 2020-2021, a 250% increase Autodialer outcomes 2020-2022: 2,818 connects on return mail accounts 8% collections rate Return mail updates 2020-2022: 10,630 new and improved addresses found 55% hit rate Screening outcomes: 1,700+ deceased patient accounts identified between 2020-2022 2,700+ patient accounts associated with bankruptcy identified between 2020-2022 And thanks to Coverage Discovery, UCSDH has tracked down active insurance coverage amounting to more than $5 million in 2021. More than $4 million in coverage was found for patients under the California Medical Assistance Program. Had this coverage been missed, these amounts would have been written off as bad debt. Finding missing coverage outcomes:  $5M+ value of coverage found in 2021 19% hit rate in 2021-2022 (4% increase from the previous year) $4M+ value of Medi-Cal coverage found in 2021 9% hit rate in 2021-2022 for Medi-Cal scrubs Discover how Collections Optimization Manager and Coverage Discovery can help healthcare providers improve the patient billing experience while accelerating collections and reducing bad debt.

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

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