Issue link: https://beckershealthcare.uberflip.com/i/674245
84 Executive Briefing process is often done manually and hospi- tals end up losing reimbursement for care during that window. In states that expand- ed Medicaid, approximately 8 percent of hospitals' uncompensated care costs are attributable to missing retroactive eligibil- ity, compared with 3.5 percent of uncom- pensated care costs in hospitals in states that have not expanded Medicaid. While many hospitals already devote sig- nificant efforts and resources to improve coverage discovery processes internally, many can benefit from the added support of a third party. Boutique Healthcare "Healthcare is one of the last remaining industries that provides services to con- sumers without requiring any payment upfront," says Jonathan Wiik, principal for revenue cycle management at TransUnion Healthcare. But in the next three to five years patients will realize the financial stakes involved in their insurance cover- age and medical treatment. A more con- sumer-minded populace will shape the healthcare landscape into one of "bou- tique medicine," where patients will de- mand increased financial clarity to more easily shop for their care. For now, consumers are slow to adopt new behaviors when it comes to choosing care providers. According to Castlight Health, only 1 percent of households said they used price tools to search for imaging ser- vices, 3 percent searched for lab services and 20 percent searched for office visits. To help patients think about medical treat- ment in financial terms, "hospitals will need to act more like banks or car salesmen, with the tools to determine what consum- ers can afford, and then offer an array of financing options to help consumers make those payments," says Jason Lerch, princi- pal of healthcare solutions at TransUnion. Tools that assess a patient's propensity to pay enable hospitals to engage patients in financial discussions that are both com- passionate and productive. Moving Back-End Processes to the Front TransUnion gives hospitals the tools to be proactive at the front end of their revenue cycle. eScan, an insurance discovery solution from TransUnion's healthcare division, is designed to increase efficiency in the bill- ing process by identifying patient eligibil- ity for Medicaid, SSI, Medicare, TRICARE coverage and commercial insurance ben- efits at the time of discharge. By discovering payer coverage on day one instead of day 60, hospitals can avoid the myriad of ancillary costs associated with patient collections, including labor costs, paper billing expenses and third party col- lection fees. Hospitals that deploy eScan early in the revenue cycle have seen a dra- matic drop in days in accounts receivable, uncompensated care and collections costs. eScan can also help hospitals recover leaked revenue by finding secondary payer coverage. Currently, most hospitals do not have secondary payer discovery capabilities, and captureable revenue slips through the cracks. In some cases, hospitals may unknowing- ly charge secondary payers for the prima- ry reimbursement amount not knowing a primary payer exists. Often a hospital is not informed of their mistake until well after the submission deadline expires for the correct payer, losing out on total reim- bursement altogether. TransUnion's eScan solution enables pro- vider organizations to actively rectify bill- ing and submission mistakes because it delivers secondary coverage discovery within 60 days of patient discharge. Checking for retroactive eligibility can present a near impossible feat for large hospitals that provide care for hundreds of thousands of self-pay accounts each year. eScan alleviates this burden by automati- cally scanning each self-pay account for two full years after care is provided in case coverage becomes available. eScan has already saved individual hospi- tals millions in combined operational costs and recovered revenue. As of December 2015, the eScan solution recovered more than $1 billion in total reimbursement re- covered for its hospital clients. Total reve- nue recovered continues to grow at about $100 million each month. TransUnion's ClearIQ solution helps hos- pitals determine patient out-of-pocket costs prior to care, so providers can help patients prepare financially. ClearIQ also meets growing consumer demand for in- creased price transparency in healthcare. It analyzes historical charges, payer contract terms and payer benefit levels to predict what patients are likely to owe for services provided. The payment estimator then of- fers a credible, printable and customizable letter containing patients' demographic, benefit and payment information. While these technological solutions help prevent revenue leakage by automating tedious manual tasks, hospitals will see added benefit by making patient educa- tion a priority. If patients don't understand their financial responsibilities, they are less likely to pay on time or at all. By providing accurate cost and coverage estimates to a patient before services are rendered, patients become more invested in their healthcare and are more likely to fulfill their financial obligations while feeling good about doing so. Mr. Wiik reinforces this. "Shifting back end processes to the front of the patient experi- ence will offset bad debt, uncompensated care, and enhance the patient experience," he says. "A patient's first and last experi- ence with a hospital often revolves around accounting, which is complex and confus- ing for many. In my experience, I have had patients actually thanking me for having financial discussions in advance of care. I needed the tools and processes in place to have these discussions, as did the patient." The Bottom Line Is your revenue cycle leaking reimburse- ment? Proven tools are available that can be used to prompt candid and productive financial conversations with patients at the point of service. Providers that are capa- ble of recognizing and securing collec- tions on day one of the revenue cycle see the results reflected in their bottom line. n Sponsored by: TransUnion Healthcare is a trusted provider of revenue cycle management solutions for maximizing reimbursement, driven by a belief that information can help advance our industry, improve patient engagement, and ultimately increase the effectiveness of the healthcare system. Powered by industry-leading data, analytics and revenue cycle technologies, our solutions provide deep insights into patients' financial behavior, reduce uncompensated care—and create a better, more transparent financial experience for patients.