Tag: patientsimple

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.

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.

Whether by necessity or choice, the way patients navigate the healthcare payments system has transformed over the last few years. Healthcare’s digital front door swung open during the pandemic, offering patients far greater choice and flexibility in their use of digital payment methods. New legislation around surprise billing and transparent pricing gave patients greater visibility into the cost of care, improving their ability to plan for their financial responsibility. Many individuals switched between health plans and became responsible for a greater percentage of their healthcare bills. And the economic downturn continues to exert pressure on patients’ ability to pay, causing concern to patients and providers alike. Patient payment software can help ease these challenges. In this context, providers looking to attract and retain loyal patients must ensure the patient payments experience aligns with these changing needs and expectations. Clear communication, straightforward billing procedures and seamless payment options are essential to make it easier for patients to pay and protect provider profits. Here are 5 ways the right patient payment software can create a more satisfying patient experience and accelerate collections. 1. Offer clear and transparent medical billing processes As deductibles, co-payments and co-insurance arrangements become more complex, calculating patient financial responsibility is more challenging. Patients may find it hard to gauge what their final bill will be, prompting some to delay payments or even forego care altogether. A study by Experian Health and PYMNTS found that 46% of patients had canceled care after receiving a high-cost estimate, while 19% had experienced financial distress after spending more than they could afford on healthcare. Accessible, easy-to-understand billing procedures give patients a sense of control and encourage engagement in the healthcare process. This starts with reliable price estimates. In fact, around 60% of patients who received inaccurate pricing estimates would consider switching providers. With digital tools such as Patient Payment Estimates, providers can generate accurate estimates and give patients a clear breakdown of their financial responsibility before they come in for care. They also have the option to make secure payments via their mobile device. At the same time, insurance coverage discovery tools can be used to verify the patient’s insurance coverage and check for any forgotten coverage, so they have a better idea of what payer(s) will cover. Not only does this make the billing process more transparent and manageable for patients (resulting in faster payments for providers), but it also helps providers comply with new price transparency regulations. 2. Deliver flexible patient payment options Experian Health’s State of Patient Access surveys confirmed that patients want choice and control when it comes to paying for care. Experian Health President Tom Cox notes that “digital-first consumers are digital-first patients.” They want to see the “Amazon experience” replicated in their healthcare payments experience: “I will tell you, for myself as a patient, I much prefer to pay before I get there. Or I’d like to pay when I leave so that I don’t have to get the bill. If I do get the bill, I want to be able to pay online. What I don’t want is to fill out the slip with a check — the worst — or my credit card information and mail it to someone.” Digital payment methods can help providers remove friction in the payment experience by giving patients 24/7, self-service payment options, with options to pay by credit card, mobile wallets, online portals and peer-to-peer services. Experian Health’s suite of Patient Payment Solutions gives patients the flexibility they crave while helping providers increase patient satisfaction and accelerate collections. 3. Prioritize a personalized financial experience Just as there’s no one-size-fits-all remedy when it comes to clinical care, financial options must be tailored for each patient. Some patients will be willing and able to pay their bills in full and be keen to do so pre-service so they can forget about billing and focus on their health. Some may need to spread out payments into manageable chunks. Others may have no means of paying and feel unsure about their options. Patient Financial Clearance gives providers the data they need to customize payment plans based on each patient’s individual financial circumstances. With PatientSimple, patients can manage their payment plan through a user-friendly self-service portal, which allows them to generate pricing estimates, update insurance information, store credit card details, apply for charity care, combine payments to different providers and schedule appointments. This personalized service helps providers avoid missed payments and reduces the risk of having to involve multiple collections agencies, as patients have more confidence in their capacity to meet their financial responsibility. 4. Reduce patients’ financial worries While the uninsured rate has dropped, there are still more than 27 million Americans without health coverage. More will potentially lose coverage when the COVID-19 public health emergency ends. But even those with coverage may still worry about being able to pay for their out-of-pocket costs. Coverage Discovery runs automated checks to scan for any missing or forgotten billable coverage. Accounting for all possible coverage often reduces the patient’s financial responsibility and the accompanying anxiety that comes with a higher medical bill. Automation can also be used to pull together information from a provider’s chargemaster, claims history, payer contracts and patient benefits to generate accurate good faith estimates of the patient’s financial responsibility, which can eliminate ambiguity and help a patient better prepare for what they may owe. Read the report from Experian Health and PYMNTS, The Healthcare Conundrum: The impact of unexpected patient costs on care. 5. Improve operational performance Automation and digital tools also support operational efficiencies. Time-consuming manual tasks can be reduced or eliminated, allowing staff to focus on activities that need a human eye, or to support patients who need more personal assistance. Automation also reduces the risk of error, which can lead to contested bills and more work for staff to resubmit denied claims. For example, Kootenai Health used Patient Financial Clearance to automate presumptive charity checks and streamline a clunky workflow. They observed an overall accuracy of 88% in assigning patients to the right financial assistance program, reducing the number of accounts written off to bad debt. Sixty hours of staff time were saved, which were re-directed to priority tasks, eliminating unnecessary paperwork and improving the patient experience. Similarly, self-service payments allow patients to pay quickly and easily with minimum interaction with their providers. Not only does this reduce the burden on staff, but it also improves the patient’s financial journey. Patient payment software can increase satisfaction and accelerate collections What’s clear in these examples is that patient payment software and automation lead to faster, more flexible, and friction-free payment experiences for patients, while increasing recovery rates and operational efficiencies for providers. Find out how Experian Health’s Patient Payment Solutions help healthcare organizations reinvent patient billing and collections to boost revenue and improve patient satisfaction.

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.

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.

The medical billing software outsourcing market is experiencing historic growth as providers respond to patient demand for digital payment options. The market’s value is expected to grow by five times over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032, according to a recent Future Market Insights report.  The pandemic has been the main driver of digital transformation in healthcare billing, embedding patient expectations for the same friction-free experience that has become the norm in other retail environments. By implementing medical billing software and digital collections solutions, providers can offer patients the flexibility and choice they desire. They can also capitalize on operational efficiencies ­– but only if they choose the right tools. Without the time or resources to undertake these activities in-house, many revenue cycle management teams are starting to outsource, in order to optimize medical billing processes, reduce costs and improve the patient payment experience. Choosing the right medical billing software Digital solutions can support every step of the patient’s financial journey, from receiving initial pricing estimates to paying at the click of a button. What criteria should providers consider when evaluating solutions that cater to patient demands for a better payment experience? Here are a few to look out for: Automation - Digital solutions do more than simply remove the need for paper-based billing. Software and machine learning can complete tasks to reduce the burden on staff and patients. Patient payment reminders, auto-filled claims forms and coverage checks are just a few examples of how automation can deliver speed and simplicity to patients, while saving staff time. User-friendly interfaces - A digital tool that’s difficult to use is never going to gain traction. Whether patient-facing or for use by front or back-office staff, user interfaces should be clean, simple and intuitive. Tracking and reporting - Digital billing solutions should offer the ability to monitor progress and generate instant status updates on payments and claims. With real-time insights, staff can further optimize collections and reimbursements. Reliable and secure data - Software and digital solutions are only as good as the data on which they’re built. Fresh, accurate patient data is essential. Data should be held in standardized and interoperable formats to streamline data exchange between different electronic records management systems. This will help to avoid errors, keep data secure and ensure compliance with HIPAA. A single vendor - A piecemeal approach can result in tools that don’t speak to each other. Instead, it makes sense to select a vendor that offers integrated systems for greater reliability and ease of use. Information from multiple billing and claims tools can be pulled into a single dashboard, so staff can capture the details they need at a glance. Setting up and optimizing digital solutions can be easier with a single vendor too. That’s why Experian Health offers consultancy and technical support to help users get started quickly. Here are 4 medical billing solutions that check these boxes: 1. Generate accurate estimates during patient registration with Patient Payment Estimates Providers can set the tone for a positive financial experience by deploying digital billing solutions from the start of the patient journey. One example is to offer patients accurate estimates of the cost of care before or at the point of service, so they can concentrate on treatment without worrying about unexpected bills. Patient Payment Estimates give patients a breakdown of their financial responsibility along with information about relevant payment plans and links to convenient payment methods. These can be accessed via a web-based tool or sent straight to their mobile device. Given that 6 out of 10 patients who received inaccurate cost estimates would switch providers for a better payment experience, tools like these could deliver a strong ROI. 2. Verify coverage as early as possible with Insurance Eligibility Verification and Coverage Discovery Verifying a patient’s active insurance coverage is a painstaking task when undertaken by hand. Staff must pore over payer websites and call insurance agents to check what the patient’s plan will cover. Automated tools like Insurance Eligibility Verification and Coverage Discovery can identify coverage quickly and accurately. Not only does this reduce the patient’s financial responsibility, but it also lowers the risk of uncompensated care and saves valuable time for staff. 3. Submit clean claims the first time with Claims Management Software Automating claims management takes a huge amount of pressure off staff teams. It also guarantees a higher level of accuracy than if claims were managed manually. Claims management software can automatically add patient information to claims, incorporate customized edits and review coding to ensure claims are correct before they are submitted electronically. Claims adjudication can be monitored in real-time to reduce the risk of denials. 4. Provide personalized payment plans and point-of-service payment options with PatientSimple Ideally, bills will be settled as early as possible. Neither providers nor patients want a protracted process of overdue statements and repeated phone calls from collections agencies. If patients are offered a choice of convenient payment methods at each touchpoint, they’re more likely to pay before or at the point of service. PatientSimple leverages Experian Health’s unrivaled data to identify the most suitable payment pathway for each patient and helps them manage it through a user-friendly, self-service portal. Patients can view statements online and pay balances immediately with cards kept on file. With the right medical billing solutions, providers can alleviate pressures on staff, reduce the risk of errors and support compliance with new regulatory requirements. But more importantly, it creates a healthcare experience that’s efficient, flexible and simple for patients, resulting in higher consumer satisfaction and faster patient collections. Find out more about how Experian Health’s medical billing solutions help providers maintain a healthy revenue cycle and meet patient expectations for a 21st-century consumer experience.

Healthcare providers that fail to embrace automation and digital tools to optimize patient collections could be leaving money on the table. Patient financial responsibility is higher than ever; however, the number of patients that struggle to pay is increasing, with 3 in 10 patients saying they’d be unable to pay a $500 bill and nearly a fifth of patients with medical debt believing they would never pay it off. As patient payments account for a growing portion of revenue, providers cannot afford to rely on subpar collections processes. Manual and paper-based patient collections remain the standard for many providers, but the reality is these outdated methods are unreliable and inefficient. Billing is slow and vulnerable to errors, and staff loses valuable time to the many pitfalls of paperwork. Optimizing patient collections with data-driven automation and user-friendly digital tools is a much smarter approach to accelerating payments, improving recovery rates and reducing operating costs. Why providers need to optimize patient collections Collecting patient payments has long been a pain point for providers. Recent changes sweeping across the insurance landscape and economy have exacerbated the challenge. More patients are turning to health plans with higher deductibles, which may seem more affordable in the short term, but leave patients footing a greater portion of their healthcare bills overall. At the same time, these bills – along with most other household expenses – are increasing at a rate that outpaces salary growth. For providers, this raises the risk of uncompensated care. Until recently, most write-offs in patient collections were associated with uninsured patients, but the uptick in high deductible health plans has nudged the burden of debt toward insured populations. Rather than waiting until the final bill has been determined and then mailing out a billing statement to the patient, providers must shift their focus to the earlier stages of the collection process. If they can calculate exactly how much each patient owes and route their account accordingly, collections will be smoother and faster. The task of calculating patient financial responsibility is complex, though. Applying automation technology to tackle this challenge is no longer optional. Benefits of automating patient collections The digital revolution accelerated during the early stages of the COVID-19 pandemic. Scheduling and registration – which lay the groundwork for efficient patient collections – were managed through remote online self-service tools, while contactless payments became commonplace. The drivers of data and automation may have shifted now, but the benefits remain clear. Aside from the financial savings associated with transitioning to fully electronic transactions, automation facilitates operational efficiencies. Automation can counter staffing shortages in patient collections teams, by helping staff focus on the accounts most likely to pay. They can filter out bankrupt or deceased accounts and use automation to check charity eligibility. Automated dialing and texting can be used for more efficient patient communications. Optimizing billing and payments can also create a more compassionate experience and make it easier for patients to understand what they owe and how to pay, without the need for endless phone calls to patient collections teams. Providers should consider the following five steps to leverage data and automation for improved patient collections: Step 1: Establish clear financial policies for patient collections Streamlined collections begin with clear patient communications. Patients should be advised of payment policies as early as possible. For example, does a particular type of appointment have to be paid for at the point of service? Could they be eligible for a discount if they pay a larger bill sooner? When patients are fully informed of their financial obligations, it’s easier for them to plan. Automated upfront Patient Payment Estimates give patients an accurate idea of what they’re likely to owe, reducing the risk of missed or delayed payments. Automated data analytics can help providers tailor patient communications based on the patient’s preferred method of communication and offer the most relevant information when it matters most. Step 2: Prioritize point-of-service payments to optimize patient collections The longer a bill sits in accounts receivable, the less likely it will be recovered in full. Encouraging patients to pay as much of the bill as possible, as early as possible, helps improve recovery rates. This starts with verifying the patient’s insurance coverage. Giving the patient clarity about their coverage, co-pays and deductibles at the time of service reduce payment delays and confusion. For the Director of Patient Financial Services at Kaiser Permanente Northern California, applying automation in this way has helped staff and patients navigate a more complex coverage environment and drive up point-of-service payments: “At Kaiser, we’ve implemented financial assistance patient identity verification tools to help us identify what our members would be able to pay at the point of service, and how we would manage them on the back end if they end up with a patient balance. Before we had these tools, we were blind as to what our patients would be able to pay.” Step 3: Give patients personalized payment options Offering a choice of payment methods that patients can access anytime, anywhere, can also increase point-of-service payments. Patients repeatedly say they want flexibility, having grown accustomed to the digital and contactless payment methods used in everyday retail scenarios. Experian Health’s Patient Payment Solutions enable providers to accept multiple forms of digital and contactless payments, including eChecking, credit and mobile payments. Patients also welcome the option to spread out payments and set up automatic recurring payments to manage larger balances. Providers can deliver a more satisfying patient experience and accelerate collections by offering personalized payment plans. Data and automation help providers identify and deliver the best-fit options for each patient. For example, PatientSimple is a consumer-friendly self-service portal that identifies the best financial pathway for each patient and allows them to pay balances with ease. It also stores payment information so patients don’t need to input their card details every time they want to pay. Step 4: Use smart strategies to pursue bad debt Determining the best collection approach for each patient requires current and comprehensive insights into their financial situation. Collections Optimization Manager pulls together data to help providers prioritize accounts by payment probability. Communications regarding accounts with a high payment probability can be automated and managed through self-service options. Accounts that are less likely to be paid can be routed to collections agencies or managed in-house, to increase workforce productivity. Cari Cesaro, Senior Director of Enterprise Healthcare Consulting at Experian Health, explains how automated collections insights reduce bad debt: “We’re able to extract data from the accounts receivable file and produce robust analytics and insights. That allows us to screen or scrub out those accounts that we should not be scoring or segmenting. Then, we shift to the customized segmentation, which allows the client to better narrow down those accounts that represent the highest potential for payment and match these to their calling capacity in-house.” Step 5: Train staff to have compassionate conversations Finally, with the right data, staff can have more compassionate and useful conversations with patients about how best to manage bills. Medical debt is a growing concern for patients, and staff should be trained to handle these conversations sensitively. Providers can further maximize their collections strategy by training staff to use collections optimization software to its fullest potential. Staff may worry about the learning curve when transitioning from paper-based to digital processes. Experian Health’s Collections Optimization Manager is designed with a user-friendly interface for intuitive navigation. Staff can easily view reporting and benchmarking insights and identify opportunities to improve collection rates. Find the right revenue cycle management partner With support from a trusted revenue cycle management company, providers can improve patient payment collections for increased revenue and streamlined operations. Speak to Experian Health today to find out how our best-in-class solutions are helping healthcare providers optimize patient collections, reduce bad debt, boost recovery rates and deliver a stand-out patient financial experience.

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.