Tag: patient financial advisor

Hospitals continue to face a capacity crisis as COVID-19, flu and respiratory syncytial virus (RSV) converge. Staffing shortages in both clinical and administrative teams further constrain the delivery of optimal care, with consequences for patient satisfaction and provider cash flow. With this challenge still ongoing, providers must find ways to maximize operational efficiencies and maintain patient flow. Accelerating patient intake with automated patient registration is a good place to start. Too often, registration requires patients to spend hours in a waiting room, filling out forms on a clipboard and conjuring up insurance information and medical history details from memory. These clunky processes cause delays, errors and stress for both patients and staff. In the current climate, healthcare providers should leverage digital tools that allow patients to complete registration easily and efficiently before they come in. Pitfalls of paper-based patient intake During registration, patient access teams must put considerable effort into collecting and checking patient information, documenting medical history and medications, verifying insurance eligibility and making sure the patient knows the details of their appointment or referral. Often, these checks are completed manually, with patients filling out paperwork in person when they arrive. It’s a slow and tedious process for patients and staff, made worse when there aren’t enough staff available. Unfortunately, manual processes also open the door to errors, creating additional work for staff members. If a patient’s address is inputted incorrectly, they may not receive important communications about appointments or billing, causing delays and confusion further down the line. In The Digital Healthcare Gap, a report by Experian Health and PYMNTS, Experian Health President Tom Cox says the “waiting room experience” is a common pain point for patients: “Having to schedule appointments at exactly 8 a.m. when the office opens isn’t convenient or efficient. Filling out paperwork that one has completed several times as a prerequisite to seeing a care provider aggravates just about everyone. And finding out how much the doctor visit and treatment costs long after the visit is complete is an experience unique to healthcare.” It's not an ideal first impression for patients, and it only compounds the pressure on short-staffed teams. Accelerate patient intake with advanced registration In The Digital Healthcare Gap, one-third of patients surveyed said they filled out registration forms from home. Enabling patients to complete registration in advance can greatly speed up patient intake. Patients can fill out forms in their own homes, with all their medical details at hand. It’s a more comfortable experience for patients and saves staff time by reducing the risk of errors. Shifting registration out of the waiting room can also help protect patients and staff from infection. But these survey results suggest that many patients are still completing registration in person. Providers should consider offering faster alternative options to those that want them, especially as waiting rooms fill up. With Experian Health’s Registration Accelerator, patients can complete intake forms from their mobile devices, anywhere and anytime. Details can be pre-filled automatically to save time and reduce errors, resulting in an easier intake experience with fewer issues for staff to resolve. By reducing administrative overhead, self-service tools can help providers manage unpredictable patient numbers and avoid bottlenecks during busy times. Automated patient registration for a more streamlined patient experience The current crisis magnifies the need for automated patient intake solutions, but patient access is already evolving. More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s State of Patient Access 2.0 survey. In another report, 6 in 10 patients said they’d switch providers to one that offers a patient portal. Providers must open their digital front door or risk losing patients to competitors. A seamless patient intake experience that integrates scheduling, registration and payment systems will make patients feel taken care of. With user-friendly interfaces, automated appointment reminders and pre-filled insurance information, Registration Accelerator offers patients the speed and convenience that today’s consumers have come to expect. Patients can initiate registration with one click, then upload photos of their driver’s license and insurance card. Optical character recognition technology captures the necessary identity and insurance details, so patients and staff don’t have to fill it out manually. Patients can check their details and confirm appointments before completing authorization and consent forms. They don’t have to spend a minute more on registration than necessary and are less likely to miss appointments, leading to faster care. Maximize operational efficiency with automated patient registration solutions Registration Accelerator integrates with other automated patient-facing intake tools, such as Patient Scheduling and Patient Financial Advisor, to create a frictionless experience. Giving patients more control is not only more satisfying and convenient for them, but it also helps drive efficiency – which is increasingly important as hospitals reach capacity. Using digital systems instead of manual processes also enables easier integration with other data management systems, such as electronic medical records, hospital information systems and eCare NEXT®. Data need only be added once, which reduces the burden on staff and helps to avoid errors arising from ineligible handwriting. In addition to having greater confidence in the integrity of their data, providers can also use patient intake software to generate performance reports, revealing further opportunities to improve efficiency. Providers can allocate staff to high-priority tasks and use customizable workflows to maintain operational standards. The impact on the bottom line can be significant. Automated registration solutions reduce administrative costs. But perhaps more importantly, they prevent delays in reimbursement by avoiding time-consuming errors and inefficiencies. In this way, faster registration leads to earlier care, with better outcomes for both patients and providers. Find out more about how Registration Accelerator can ease the pressure on providers by speeding up patient intake during the busy winter period.

Can greater clarity and providing patient estimates at the beginning of the patient's financial journey set the stage for better access to care and a smoother path to payment? Millions of Americans struggle to pay for healthcare. A 2022 survey conducted by West Health and Gallup found four in 10 Americans, or roughly 112 million people, are cost insecure or cost desperate when it comes to healthcare. The issue is not just affordability; it’s also anxiety. Patients who fear they won’t be able to cover their out-of-pocket healthcare expenses may postpone or avoid treatment. At a minimum, anticipated medical expenses are a source of stress, especially for the growing number of patients who have high-deductible health plans. Pre-treatment patient estimates can help alleviate the stress. By taking some of the mystery out of medical bills, accurate estimates help patients understand and plan for costs. By opening a dialogue about treatment costs early in the process, patient estimates pave the way for further discussions about insurance coverage, payment plans, charity help, and more. As inflation wreaks havoc with household finances and talk of recession turns up the volume on financial stress, patient estimates and other tools that ease the payment process offer a bit of welcome relief for patients. A better patient financial journey offers benefits to providers as well. For healthcare organizations that are thinking about adding or improving pre-treatment patient estimates, here are 4 key benefits to consider: 1. Patients are more likely to forgo care if they can’t see how much it will cost. According to Experian Health and PYMNTS data published in July 2022, nearly half of consumers who canceled appointments last year did so because they were concerned about costs. Their concerns were not unfounded: the same survey revealed that one in five respondents spent more on healthcare than they could afford. Especially in uncertain economic times, the ability to understand and plan for out-of-pocket medical expenses is critical to patients. A Commonwealth survey found that deductibles were equal to 5% or more of household income in some cases; out-of-pocket costs were equal to 10% of household income in others. Add in concerns about the rising cost of living and the prospect of lost jobs, and the anxiety level surrounding healthcare costs only intensifies. Patient Payment Estimates help alleviate patient fears by providing clear, easy-to-understand estimates prior to treatment. Armed with this information, patients can make clear-eyed decisions about their care and ask about payment options if they’re needed. 2. Price transparency regulation is helping to create a new competitive environment. The No Surprises Act and CMS price transparency final rule are bringing price transparency into focus for patients and providers alike. These regulations require providers to offer accurate estimates in advance of treatment and disclose their pricing for common procedures. Although these regulations continue to evolve and providers are still working toward full compliance, patients are beginning to see more access to pricing information and a greater likelihood of receiving pre-treatment estimates. That’s creating a new competitive environment—and new choices for patients who are contemplating care. “In this new world, patients have the ability to branch out and research their own options,” says Riley Matthews, Senior Product Manager at Experian Health. “Patients have the pricing information to make informed decisions about healthcare and can shop between different providers based on price.” As a result, patient perceptions around transparency and trust are changing: “If providers want patients to keep walking through the door, they need to provide tools to help patients understand their financial obligations and feel that they’re being treated honestly and fairly.” Price transparency may have an additional benefit. According to Experian Health’s State of Patient Access: 2021 survey, eight in ten providers believe price transparency correlates with patients being more likely to pay bills on time. By simplifying pricing and payments, providers literally make it easier to pay. 3. Patients who know out-of-pocket costs in advance are more satisfied with care. In a March 2022 survey from Experian Health and PYMNTS, 88% of patients who received pre-treatment estimates were satisfied with the care they received from their family doctor, compared to 78% of patients who did not get an advance notice of costs. “Our ideas about patient satisfaction and care are changing,” says Matthews. “Healthcare is about more than physical health: It also encompasses mental, emotional, and financial health, all of which are affected by the patient payment experience. When healthcare costs or confusion stand in the way of patients getting treatment, or when healthcare bills create real financial challenges and stress, a transparent and compassionate billing process can make a crucial difference.” 4. Providing clear and accurate patient estimates is the first step to a better payment experience. Helping patients anticipate their healthcare bills with pre-treatment estimates is only the beginning of the journey. The same patient-centered payment tools that make the healthcare billing and payment process easier for patients also make it easier for providers. PatientSimple, Experian Health’s secure online patient portal, lets patients generate price estimates, apply for charity care, set up payment plans, update insurance information, make payments to hospitals and physicians, and even schedule appointments. Patient Financial Advisor delivers personalized estimates and payment options using the patient’s mobile device. Estimates are based on real-time benefits information and the payer’s contracted rates and pricing. Giving patients access to a range of information, using channels they prefer, helps them navigate the process at their convenience. Collections Optimization Manager helps providers target their collections, so they can direct resources where they’re most likely to succeed. Altogether, digital solutions that help improve the payment experience for patients can also help optimize the payment process for providers by making cost and payment information easily accessible to patients. It also creates behind-the-scenes efficiencies that streamline billing and collections for providers. Providing patient estimates is just the start.  Improving the patient payment experience at every step is a win for both patients and providers. Patients need clear information about treatment costs, insurance, and payment options to proactively plan their treatment and finances. But when providers put the systems in place to improve the patient's financial journey, they benefit too, by making these processes easier and more efficient. An improved patient payment experience may also reduce the need for difficult conversations with patients who are surprised by their medical bills and unsure how to pay them. More information, upfront, sets the stage for a healthier process overall. Learn more about Patient Payment Estimates and the full suite of Experian Health solutions to bring your patient payment experience up to speed.

With 2023 just around the corner, healthcare executives are teasing out their strategic priorities for the next 12 months. Where should they be focusing their attention? Here are the top 3 healthcare predictions to watch in 2023 and the actions needed to help providers prepare. Prediction 1: AI and automation will continue to gain traction “The time is now for providers to get ready, prepare and implement these technologies.” - ­Jason Considine, Chief Commercial Officer at Experian Health Automation came to the forefront during the pandemic, enabling essential access to care and filling in gaps created by staffing shortages. By now, the use of remote and digital tools is pretty well-established. Automation is the norm, but there’s room to leverage these solutions for an even greater ROI. As Jason Considine says, investing in technology that makes it easier for providers to get paid will be a particularly effective use of digital tools. One such example is in the digitalization of healthcare claims. Healthcare claims management processes have typically relied on manual systems. These can be slow and error-prone, creating avoidable extra work for staff and friction for patients. In the State of Claims 2022, 78% of executives said their organization would be likely to replace their existing claims management solution if convinced something else can deliver better ROI. Eliminating inefficiencies and optimizing reimbursement would certainly check that box. Tools like Denials Workflow Manager, Enhanced Claim Status and ClaimSource® use automation and detailed analytics to improve claims management performance. More claims can be processed more accurately, resulting in fewer denials and faster reimbursement. With denials increasing by 10–15%, claims automation is likely to be a top priority for many providers in 2023. Prediction 2: Patients will increasingly choose providers that offer a user-friendly financial experience  “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” - Victoria Dames, Vice President of Product Management at Experian Health The economic downturn has put pressure on providers and patients, which we can expect to last into 2023. Patients are concerned about healthcare costs, but they’ve also come to expect a more transparent and compassionate financial experience. Experian Health's top healthcare predictions finds that reliable pricing estimates, support to find the right payment plan, and convenient and flexible payment options will be table stakes in 2023. For providers, implementing digital payment options to meet these needs may be challenging, but it’s an investment that will yield positive long-term results. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch healthcare providers for a better experience in future, placing transparent medical billing at the core of attraction and retention strategies. The medical billing software outsourcing market is already experiencing historic growth as providers respond to patient demand for a digital financial experience: the market’s value is expected to grow over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032. Experian Health leads the way when it comes to creating a patient-friendly billing and payment experience, with solutions such as Patient Financial Advisor and Patient Estimates. Giving patients greater control over their financial journey with upfront estimates and tailored payment plans makes it easier for them to prepare for payments. Prediction 3: Providers that fail to create a welcoming digital front door could be closing off revenue opportunities  “Deliver convenience. People are consumers before they are patients.” - Tom Cox, President at Experian Health Automation offers opportunities for optimization throughout the revenue cycle, but one of the most crucial points is in patient access. Making patient access easier is on the list of top healthcare predictions, and for good reason - a frictionless first impression can have a powerful lasting effect. What should this look like? Cox advises that providers should “anticipate the needs of digital-first customers.” Patients expect the same personalized service they are accustomed to in other sectors, with convenience, choice and control at the center. Administrative “relics” such as the traditional waiting room clipboards and repetitive forms must be minimized where possible. A report from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods. 61% of patients even said they’d consider changing healthcare providers to one that offers a patient portal. Online scheduling software and self-service registration makes it easy for patients to complete these tasks in advance. Providers can then round out a user-friendly patient experience with Patient Payment Solutions. This gives patients a choice of payment methods, leading to faster payments. Providers have realized that many patient access functions can be achieved more efficiently and cost-effectively using self-service and remote digital tools. By streamlining intake operations, organizations can make better use of staff time, reduce errors and increase productivity, while improving the patient experience simultaneously. As revenue cycle technology continues to develop in 2023 and beyond, providers need to ensure they are capitalizing on the latest software to improve their bottom line, deliver on patients’ service expectations, and keep pace with healthcare predictions. Learn more about Experian Health's revenue cycle management solutions and contact us to find out how these solutions can help healthcare organizations open their digital front door and prepare for 2023.

Up to 15 million Americans may find themselves without healthcare insurance when the COVID-19 public health emergency (PHE) ends. The PHE has been renewed until January 11, 2023, and while further extensions haven’t been ruled out, the Centers for Medicare and Medicaid Services (CMS) has advised healthcare providers to prepare for a return to pre-pandemic rules. Looming uncertainty over coverage has consequences for both providers and patients. This article looks at what providers may expect as the PHE comes to an end, and specifically, how to proactively verify insurance eligibility to maintain cash flow and help patients navigate the changes. How will insurance coverage change when the PHE ends? Emergency legislation has required Medicaid and the Children’s Health Insurance Program to maintain continuous enrollment for the duration of the PHE. When the previous rules resume, states will have 14 months to process eligibility checks for Medicaid and CHIP enrollees. The US Department of Health and Human Services (HHS) estimates that around 8.2 million Medicaid enrollees will no longer be eligible for coverage. Another 6.8 million eligible individuals may lose coverage through “administrative churn.” Churn occurs when patients fail to provide annual confirmation of Medicaid eligibility. This can occur because of short-term changes in circumstances or because they don’t reply to or understand requests for information. Some patients will qualify for Marketplace tax credits under the Affordable Care Act and others may seek employer-sponsored coverage. But a large proportion may fall into the “coverage gap,” earning too much to be eligible for Medicaid, but too little to qualify for Marketplace credits. The Inflation Reduction Act of 2022 extends access to enhanced Marketplace provisions until 2025, which may bridge the gap for some. HHS lists a number of additional actions that may be taken at the state level to mitigate potential coverage loss. This includes the adoption of Medicaid expansion, outreach and engagement campaigns. It also includes investments in end-of-PHE preparedness, staffing capacity and in eligibility and renewal systems. What do these changes mean for providers? Providers must be proactive in managing the disruption that could occur when millions of patients lose or change coverage. If more patients are without coverage and unable to pay for services, this could lead to an increase in uncompensated care, which costs providers millions in lost revenue. The process of verifying insurance for those with coverage is likely to be more complex, which could also affect providers’ bottom lines. Changes can increase the risk of errors, which could lead to more claim denials. Longer verification checks may cause delays in patient registration and higher call volumes, creating extra work and stress for staff and a poor experience for patients. The end of the PHE may also affect access to vaccines and food benefits, both of which were expanded under the emergency legislation. These changes could lead to an influx in calls and queries which could compound pressure on staff. These staff pressures are a particular concern given ongoing hospital staff shortages. A possible surge in COVID-19 and flu hospitalizations over winter could ramp up the challenge even more. How can providers verify insurance eligibility? The process of verifying insurance eligibility and benefits involves confirming that: the patient’s insurance information is valid and current they’re eligible to have the services in question covered under their existing plan. A patient insurance ID card is useful, but it’s not enough to prove eligibility. Patient access staff will often check payer websites or call payers directly to verify coverage. This can be a time-consuming and laborious process. Some providers use clearinghouses to run these checks in batches. This can be more efficient than verifying each account in-house but usually takes time to receive confirmation. Another option is to deploy insurance verification software. Experian Health’s Insurance Eligibility Verification solution allows providers to confirm patient eligibility in real-time. The tool connects with over 890 payers to access up-to-date eligibility and benefits data. Responses from multiple payers are modified so registrars can view patient information in a consistent format. Staff gets notifications when edits or follow-ups are needed. The tool also checks self-pay patients against Medicaid databases, which will be invaluable when the PHE ends. Why are automated, real-time insurance checks so important? No one wants patient care to be delayed. By validating a patient’s coverage before the patient arrives, Insurance Eligibility Verification helps fast-track registration. Automated checks also ease the manual burden on staff and handle higher patient volumes more efficiently. This improves operational efficiency, increases cleaner claim submissions and accelerates reimbursement, creating a more satisfying patient experience. Patients will have a clearer idea of what they’ll owe at the time of service, leading to fewer payment delays. What else can providers do to close the gaps in health insurance coverage and verify insurance eligibility? Providers can streamline coverage checks by incorporating automated searches for any missing or forgotten active coverage. Coverage Discovery runs multiple checks throughout the patient journey, using proprietary data repositories, advanced search heuristics and matching algorithms to comb through government and commercial payers to find previously unknown insurance coverage. Fewer accounts end up going to bad debt or written off as charity. This maximizes reimbursement for providers, while reassuring patients who may have believed they were uninsured. A further step to ease the financial burden on patients and increase the likelihood of reimbursement is to combine these solutions with tools that give patients greater clarity about their healthcare bills. For example, Patient Payment Estimates offer patients clear and accurate estimates of their financial responsibility before they come in for care. Patient Financial Advisor provides personalized payment plans so patients can spread out payments in a way that works for them, together with easy payment methods. Find out more about how Insurance Eligibility Verification helps providers verify insurance eligibility, speed up eligibility checks, maximize reimbursements and ease pressure on patients and staff as the continuous enrollment provision unwinds.

Healthcare can be a serious expense. Around half of U.S. adults find it difficult to keep up with the costs, according to research from the Kaiser Family Foundation. As a result, roughly 4 in 10 have delayed medical care or gone without it over the last year. That’s where patient payment estimates and price transparency come in. When discussed at the outset of care, it can help patients prepare their budgets and understand their payment options. Consider it a built-in opportunity for healthcare providers to increase patient satisfaction and collections. “We’re all patients, so we all know the struggles,” said Riley Matthews, Senior Product Manager at Experian Health. “There is real frustration when faced with personal health challenges. On top of that, you’re burdened with meeting financial responsibilities. There’s no upfront explanation or seamless user experience to guide you through the cost of those services.” How to approach patient payment estimates The best time to share cost estimates is before the patient receives care. Healthcare providers can frame it as a two-way conversation, where the patient can ask questions and understand their projected out-of-pocket costs. When pricing is unclear, the patient might forgo care altogether. That’s a lose-lose for both the patient and the provider. Price transparency tends to lead to a better patient experience. According to a recent study conducted by PYMNTS and Experian Health, those who aren’t aware of their financial responsibility beforehand are less satisfied than patients who are. It then comes down to calculating patient estimates that are accurate and reliable. Patient Payment Estimates from Experian Health provide a clear breakdown of their out-of-pocket costs for the recommended services. It’s a simple but empowering thing that can help patients feel more in control. When patients are engaged and know what to expect financially, providers are more likely to collect payments in a timely manner. The Patient Payment Estimates platform offers: Price transparency, including financial assistance options An improved patient experience that allows for mobile payments Increased point-of-service collections Helping patients understand their payment options Once patients have a clear cost estimate, you can shift the conversation toward their payment options. Some may prefer to pay their bill in full beforehand. Others may need a more flexible arrangement — otherwise, they could opt out altogether and seek better payment options elsewhere. According to the PYMNTS and Experian Health study mentioned earlier, nearly one in 10 patients used a payment plan for their most recent doctor’s visit. What’s more, many patients who use payment plans are highly interested in switching providers if it means a better payment experience. Payment plans are valuable because they bend to fit patients’ unique financial situations. They can also increase the collections rate for healthcare providers. Experian Health’s Collections Optimization Manager can help providers be more intentional with their collections strategy. It scores and segments patient accounts based on which ones are most likely to be paid. From there, it directs them to the right resources to make payments. It essentially uses account data to bump up collections. Giving patients what they want Experian Health’s State of Patient Access 2.0 survey drove home an important point for healthcare providers — patients want clear, transparent pricing, along with payment plans and easier ways to pay. It’s precisely why patient-centered payments are so important. The idea is to give patients realistic financial expectations and fast, convenient payment options. Doing so can increase patient loyalty and revenue. Online patient payment software answers the call. This type of patient-first digital solution can optimize communication between patients and providers and allow for simple online bill pay. Patients are managing much of their finances online these days, from their bank accounts and student loans to their mortgages and credit cards. PatientSimple is a secure online portal where patients can set up payment plans, update their insurance information, schedule appointments and more. As the healthcare industry evolves, the patient experience is growing right along with it. Digital solutions, which make room for transparent pricing, are part of that journey. Patient Financial Advisor is a prime example. It provides an accurate snapshot of costs and payment options in advance. Patients receive a personalized estimate based on their benefits information and the provider’s payer contracted rates and pricing. Patients are also directed toward secure payment options. When all is said and done, healthcare providers want to deliver excellent care while also hitting their revenue goals. Patient payment estimates can be a driving force in getting there. Discover how Experian Health can help healthcare organizations provide price estimates and create better patient experiences.

Healthcare consumers should find it easier to access information about how much their care will cost, with the Government’s twin price transparency final rules both now in effect. The Transparency in Coverage Final Rule came into effect on July 1, 2022, placing new requirements on health insurers to disclose rates for specific items and services. This follows the similar Hospital Price Transparency Final Rule, which came into effect in January 2022. Taken together, the regulations are a significant step toward helping Americans understand and plan for the cost of care. However, this means that providers will need to implement healthcare price transparency tools to help them follow these regulations. While it remains to be seen how health insurers will fare, implementation has not been straightforward for many hospitals: only 16% achieved full compliance as of August 10, 2022. No fines have been issued yet, but with the maximum penalty increasing from $300 per day to $5500 per day in 2022 (up to $2 million per year), providers are under pressure to resolve compliance issues. To support this, Experian Health and Cleverley + Associates have joined forces to introduce new healthcare price transparency tools that providers can implement now. Bridging the price transparency gap When consumers don’t know how much their care will cost, they’re more likely to delay or default on payments, avoid care, or consider switching to a different provider. Transparent pricing should help consumers shop around for affordable, high-quality services and estimate the cost of care in advance. However, there’s still some work to do to close the gap between expectations and reality. Despite the legislative changes, patients continue to receive inaccurate estimates and unexpected medical bills. Survey data from Experian Health and PYMNTS found that of these patients, 4 in 10 ended up paying more for healthcare than they could afford. Even where the required pricing information is available, it’s often too complex to meaningfully inform patients’ healthcare decisions and financial planning. Experian Health and Cleverley + Associates have partnered together to offer providers a solution for the list of 300 shoppable services and a machine-readable file for items and services offered. This can help providers deliver better patient experiences with accessible pricing information. Healthcare price transparency tools are the key to compliance Under the Hospital Price Transparency Final Rule providers must display payer-specific rates for 300 shoppable services in a consumer-friendly format. Experian Health’s Self-Service Patient Estimates solution facilitates the first requirement, by enabling providers to list shoppable services and deliver accurate estimates to patients. It draws in current chargemaster data, payer-negotiated rates and patient benefits data so estimates are as accurate as possible. Patients receive a personalized estimate with links to convenient payment methods. Providers can deliver a better patient experience and increase upfront collection rates while minimizing the admin burden associated with manually uploading price lists. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their financial responsibility straight to their mobile device, again connected to payment options. It’s designed to arm patients with a clearer understanding of their costs and payment options, so they’re better prepared to manage their financial responsibility. The price transparency mandate also requires providers to make available a machine-readable file for items and services offered by the hospital, including gross charges, cash prices for self-pay patients, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. Under the new partnership, these machine-readable files are powered by Cleverley + Associates. The files incorporate standardized payer-specific negotiated charge formats and providers can access consultancy support to manage price changes. These files are created using the following process: Model the payer-specific contract terms and rates Apply those terms and rates to patient claims to determine the amount to be paid Assign a Medicare Severity Diagnosis-Related Group (MSDRG) and Ambulatory Payment Classification (APC) to each claim Calculate the median expected payment for items and services by MSDRG, APC and the relevant payer Disclose payer-specific negotiated charge on machine-readable file. An enhanced option is available which allows hospitals to benchmark prices, evaluate different pricing scenarios, and select the most appropriate pricing strategy. That strategy can then be incorporated immediately into the transparency file, so the output is based on the most current data. With this model, Experian Health and Cleverley + Associates can help providers meet both parts of the price transparency mandate. Leverage price transparency investments to improve consumer satisfaction While upfront estimates and clear pricing information are essential for compliance with the Final Rule, providers can further assist patients to manage payments by offering swift support to those who are entitled to financial assistance. Patient Financial Clearance automatically screens patients before or at the point of care to see if they’re eligible for financial assistance, Medicaid or other financial support. Experian’s proprietary Healthcare Payment Risk ScoreSM predicts propensity to pay, so patients can be assigned to the most fitting financial pathway. The final piece of the patient-friendly pricing puzzle is offering clear and convenient ways to pay. Patients welcome a choice of payment methods, including access to the same digital payment tools they use in other purchasing experiences. Experian Health’s Patient Payment Solutions enable providers to securely accept multiple payment types, including eChecking, credit cards (which can be kept on file), and recurring billing. PatientSimple brings all of this together to allow patients to pay balances, see payment plans and apply for charity care via a single self-service portal. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations to implement price transparency tools, comply with regulations and deliver outstanding patient experiences.

Paying for healthcare has long been a complex experience for patients. Inflation means more families are tightening their wallets, so the demand for clarity and flexibility is increasing. At the same time, the pandemic’s digital legacy means patients have had a taste of contactless and online payment methods – and they want more. This means that providers will have to focus on creating a better patient payment experience. Could a modern financial experience that benefits patients and providers finally become the norm? Experian Health President Tom Cox addresses this question in a recent PYMNTS publication of healthcare leaders’ predictions for the second half of 2022. Concerns about economic uncertainty, along with a desire for more financial predictability, means that providers can benefit from delivering a better patient payment experience. How? These 3 emerging trends could guide the way: 1. Patients expect a frictionless payments experience As patients bear more financial responsibility, they expect paying for healthcare to be as easy as buying a new sweater. Experian Health and PYMNTS data found that one-quarter of consumers used digital methods to pay for their most recent healthcare visits, with patient portals being the most common at 14%. Contactless and mobile payments are also becoming more popular. To eliminate friction, providers must start by identifying the pain points in their payment processes. Do patients know in advance how much their bills will be? Are they given advice and options to spread out payments if they can’t afford to pay the entire bill in one shot? When it comes time to pay, can they find a familiar and convenient payment method? Providers that can answer yes to these questions will have the edge when it comes to delivering a satisfying patient payment experience. When it takes an average of more than 30 days for providers to get paid, any strategies to make it easier for patients to pay sooner and in full will help provider cash flow. Offering quick and convenient digital payment methods that patients can access anywhere, pre-and post-service, will be the key to delivering a better patient payment experience and accelerating collections. 2. Amidst concerns about cost, patients want transparent pricing New research by Experian Health and PYMNTS found that consumers who were under financial pressure were more likely to cancel appointments out of concerns about costs. More than 2 in 5 patients who received inaccurate estimates ended up spending more on healthcare than they could afford. It’s no wonder that 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better experience. Cox notes that alongside consumer demand for a better patient payment experience, regulatory change is giving providers a further nudge toward price transparency: “The Hospital Price Transparency Final Rule and the No Surprises Act have put accurate data at the forefront of efforts to transform the patient’s financial experience. Together, these regulations can create the same pricing experience that consumers enjoy in other verticals, namely knowing the cost before making a purchase.” To date, implementation has been patchy. In August 2022, only 16% of hospitals were found to be compliant with the federal price transparency rule. In a recent conversation with Healthcare Finance News, Experian Health’s Chief Commercial Officer, Jason Considine, acknowledges that providing accurate estimates takes work: “Getting these estimates involves having information about the patient's benefits and insurance plan to create an accurate estimate… On top of mind for most provider organizations is an expectation of spending to increase for technology as regulations expand.” Investing in the right technology can help providers deliver financial clarity to patients. For example, Patient Estimates is a web-based price transparency tool that generates accurate estimates for patients before and at the point of service. It can also direct patients to payment plans and charity care, to help them plan and spread out the cost of care. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their expected financial responsibility delivered straight to their mobile devices, and offers methods to make a secure payment. 3. Digitalized patient payments require better data and analytics Maximizing the impact of the above strategies relies on having the right data and technology in place. For example, in Accessing Healthcare: Easing Digital Frictions in the Patient Journey, Experian and PYMNTS found that patients may pay in person most often, but at least a quarter would prefer to pay online. Some may want to pay in full while others want to spread the cost. How can providers tailor their approach if they don’t know which patients want which option? Considine says that “Providers have to figure out the right financial pathway. It takes leveraging data to know the right financial experience." Achieving this requires a combination of consumer data, financial information and demographic details to create a complete picture of each patient’s needs and preferences. Patient Financial Clearance leverages Experian’s unrivaled datasets to calculate an optimal payment plan for each patient, based on their unique situation. Patients are guided to the right plan, giving them a sense of confidence about what to expect. It automatically screens those who can afford to pay upfront and those who may need more time. It’s a more supportive experience for patients and increases point-of-service collections for providers. Another option is PatientSimple®, which identifies the optimal financial pathway for consumers and makes that pathway available through its consumer-friendly, mobile-compatible, self-service portal. In short, patients want better payment methods, upfront price estimates and personalized payment plans. Data and technology can bring these to life. Find out more about how Experian Health can help healthcare organizations deliver a payments experience that meets and exceeds patient expectations, complies with regulatory change, and accelerates collections to help providers ride out financial uncertainty.

Does a patient’s age influence their experiences with rising healthcare costs? A recent report from Experian Health and PYMNTS points to a generational gap when it comes to the impact of and responses to medical bills. The study takes a deep dive into how Gen Z, millennials, Gen X and seniors are reacting to the growing cost of care. From canceling appointments to being surprised by out-of-pocket expenses, this article looks at the key differences in generations and healthcare costs, and the tools and solutions providers can implement to support their patients. Millennials are most likely to cancel appointments due to high-cost estimates A worrying proportion of patients are choosing to delay or forego care because of concerns about cost. This seems to be felt most acutely among younger patients. According to the new data, 74% of millennials and 56% of Gen Z patients have canceled a healthcare appointment after receiving a cost estimate that was higher than they could afford, compared to 13% of baby boomers and seniors. Gen X patients fell in the middle, with just over half canceling appointments after receiving high estimates. That said, healthcare costs affect all generations. While older patients seem less likely to cancel appointments due to cost, the “Medicare Effect” suggests that many hold off seeking care in the first place, until their costs are covered at age 65. Many households, regardless of demographic, are walking a financial tightrope as inflation continues to climb and patients bear responsibility for a greater portion of healthcare costs. Providers can help minimize the number of patients forgoing essential care by helping to track down any available coverage, so patients aren’t inadvertently billed for care that could have been covered by a forgotten health plan. Coverage Discovery continuously scans commercial and government coverage using multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms. Finding missing coverage means upfront estimates will be more accurate, and patients will be likely to see a lower co-pay amount. In 2021, Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts and found more than $66 billion in corresponding charges, removing a huge burden for patients and providers alike. Gen Z patients are most surprised by out-of-pocket expenses Overall, 19% of patients found they spent more on healthcare than they could afford in the last 12 months. As would be expected, those who received inaccurate estimates (43%) experienced more financial distress than those who received accurate estimates (26%). Among those who paid out-of-pocket expenses for their most recent healthcare visit, Gen Z patients were the least aware that they would be required to make a payment, with 32% not knowing that they’d need to make co-payments. Only 20% of Gen X and 10% of baby boomers and senior patients were unaware. One way to alleviate the strain of unexpected bills is to issue cost estimates automatically, before the patient’s visit. Only 34% of surveyed patients received estimates automatically before their visit, so it’s no surprise that many are caught unaware when the final bill arrives. With Patient Estimates, patients get a breakdown of their expected costs based on real-time provider and payer data. The estimates are delivered automatically to the patient’s mobile device (along with links to convenient payment methods. An earlier report by Experian Health and PYMNTS found that patient satisfaction rose by 10% when billing estimates were provided, underscoring their value. Millennials pay the highest out-of-pocket expenses Millennials appear to have been hardest hit by out-of-pocket bills. The average across all respondents was $363, but millennials paid an average of $619. This could explain why millennials were more likely to cancel appointments. Providers can help patients manage balance bills by providing tools that make it easier to plan and pay their bills. For example, Patient Financial Clearance screens and segments patients so providers can help guide them to the most suitable financial pathway. PatientSimple and Patient Financial Advisor help patients access cost estimates, identify best-fit payment plans, apply for financial assistance and make payments, via their patient portal or mobile device. Baby boomers and seniors are most satisfied with the healthcare payment process Most patients were generally satisfied with the payment process for their medical bills. Older patients appeared to be slightly more content, with 77% of baby boomers and seniors saying they were satisfied, compared to just under 70% of Gen X and millennial patients. Gen Z was the least satisfied, at 60%. With 22% of unsatisfied patients saying they’d consider switching providers, getting the payment experience right is high stakes for providers. So, how can providers improve the payment experience for those who are less than completely satisfied? Accurate estimates, tailored payment plans, clear communication and convenient payment methods will all be in the mix. For most healthcare organizations, this will mean embracing digital tools and automation. Experian Health’s State of Patient Access 2.0 survey revealed that while younger patients may be especially receptive to a digital patient payment experience, it crosses generational lines. Members of “Gen C” – digitally-connected consumers of all ages – are looking for a streamlined payment experience. When patient loyalty and decisions about when to receive care are so heavily influenced by the financial journey, it makes sense to offer digital estimates, billing and payments where possible. The good news for providers is that prioritizing patient satisfaction doesn’t mean sacrificing efficiency. Automation and digitalization can facilitate greater choice and convenience for patients, without requiring additional staff input. In fact, it’s likely to yield productivity gains and free up staff to focus on delivering an even better patient experience, and support patients to get the care they need. Find out more about how Experian Health’s suite of patient payment solutions can help providers deliver a financial experience that satisfies patients of all generations and healthcare costs.

As the COVID-19 pandemic collides with another winter flu season, patient volumes are likely to climb – which could leave traditional patient registration processes crumbling under the pressure. Healthcare providers should identify opportunities to improve the patient registration process and guard against bottlenecks in patient access over the coming months. Streamlined patient intake isn’t just about alleviating pressure – it lays the foundations for the entire patient journey. The question for providers is whether this first touchpoint signals efficiency, compassion and convenience, or hints at errors and delays to come. The answer to that question will most likely depend on the organization’s success in delivering a digital patient access experience. Patients don’t want a stack of papers to fill out by hand in the waiting room. They don’t want to make lengthy phone calls at inflexible times. They want frictionless processes, user-friendly tools, and quick, accurate information. Pre-registration should demand as little of their attention as possible. For this reason, automated and digital patient registration solutions are likely to be differentiators for healthcare providers. Here are 5 ways to improve the patient registration process before flu season hits: 1. Offer patients convenience and choice with virtual registration options More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s 2021 State of Patient Access 2.0 survey. In a more recent study, Experian Health and PYMNTS found that a third of patients filled out registration forms at home. It’s no wonder: completing forms in the waiting room is time-consuming, inconvenient, and exposes patients to the risk of infection. With Registration Accelerator, providers can offer a simple text-to-mobile experience so patients can begin registration with a single click. Registration forms can be filled out from the comfort and convenience of home, where patients are more likely to have insurance details to hand. Alternatively, some patients may choose to do this in their car before their appointment, which reduces waiting room traffic. Not only does this meet the expectations of Gen C healthcare consumers, but it also helps patients prepare for their appointments, so they’re more likely to remain actively engaged in their care. 2. Increase efficiency and reduce delays with streamlined workflows Automated patient intake also alleviates the administrative burden for busy staff. Manual patient registration incurs high labor costs, and as patient numbers increase, patient access staff cannot afford to lose time to inefficient paper-based systems. Self-service options such as patient portals allow patients to take care of more of these tasks themselves, freeing staff to focus their efforts on patients who need extra help. Automated reminders to complete forms and schedule appointments also help to reduce delays, in turn creating more efficient workflows. An added benefit of software-based processes is the ability to generate detailed insights and performance reports, which eliminates redundant tasks and flags up opportunities for further improvement. 3. Avoid costly errors with integrated data management systems One of the biggest advantages of an automated registration solution is that it can be integrated with other data management systems, including hospital information systems, electronic medical records, and project management systems. This means that staff no longer need to input the same data multiple times into different systems. It saves time and avoids errors that lead to delayed reimbursement. When patient data is pre-filled and checked automatically against information on file, there’s a far lower risk of error than in situations where a patient or staff member writes it out by hand or communicates it verbally across a noisy reception desk. Reimbursement need not be delayed while errors are found and fixed. This is the thinking behind eCare NEXT®, which integrates and automates patient access activities within a single platform. When Martin Luther King Jr Community Hospital integrated eCare NEXT® with Cerner, they saw a huge improvement in their registration processes, saving two to three minutes on more than half of their registrations. For healthcare organizations grappling with increasing registrations this winter, those minutes add up. 4. Accelerate payments from patients and payers to improve the patient registration process According to the State of Patient Access 2.0 survey, 88% of providers said they were planning to invest in patient intake capabilities in 2021, up 15% on the previous year. While the shift to online and virtual patient registration was undoubtedly motivated by the pandemic, the opportunity to accelerate reimbursements and reinforce the revenue cycle was another major driver. Registration Accelerator works alongside Patient Financial Advisor so patients can get accurate, personalized pre-service price estimates and payment management options through a single unified experience. Providers may also consider running repeated coverage checks from the moment a patient registers, to find any missing or forgotten coverage. If coverage is found, claims can be submitted promptly to payers, further increasing the options and likelihood for reimbursement. 5. Reduce no-shows and increase bookings with automated scheduling Finally, as service utilization increases over the winter months, providers will want to ensure that every possible appointment slot is filled. Integrating registration solutions with digital patient scheduling tools can help to reduce no-shows and improve the patient registration process. Patient Scheduling is a multi-channel platform for guided search and allows 24/7 access to scheduling options, which makes it easier for patients to book appointments. Automated reminders can be sent to patients so they don’t miss their appointments, with easy links to reschedule if they can no longer attend. These tools can be customized to meet the specific needs of the organization’s workflows, to increase the number of bookings and reduce the number of patients lost to follow-up. Find out more about how Experian Health’s digital patient access solutions can help improve the patient registration process ahead of the busy winter period.