What is patient financial clearance?

Uncompensated care is a growing concern for hospitals, health clinics and skilled nursing facilities.

In 2016 and 2017, community hospitals provided $38.4 billion in uncompensated care—a $2.3 billion increase from 2015.1 Between 2012 and 2017, bad debt resulting from Medicare patients not paying deductibles and coinsurance increased by 17%.

How can healthcare organizations actively combat write-offs and payment delays while maintaining high patient satisfaction? One way to do so is through proactive financial clearance.

What is financial clearance?

Financial clearance is a process that determines a patient’s ability and likelihood to pay. Using that information, providers can design intake and collection processes tailored to the unique needs of different patient populations, including eligibility for financial programs, patient counseling and payment plans.

In short, financial clearance improves the patient experience and the productivity of your staff.

A rising need for payment flexibility

With high-deductible health plans on the rise, more patients are opting to self-pay for medical care—but it’s an uphill battle for the average American. Forty-four percent of adults don’t have the savings to cover an emergency expense of $400 or more,2 yet the average outpatient hospital visit costs almost $500.3

For those who do use insurance to cover medical expenses, the costs are also going up. The average patient balance after insurance (PBAI) rose from 8% of the total bill in 2012 to 12.2% of the total bill in 2017.4 The average family spent $7,726 on premiums and cost-sharing in 2018, an 18% increase over the $6,571 spent in 2013.5

The growing financial burden on patients makes it tougher for healthcare organizations to collect. Not only that, but it can lead to feelings of frustration and confusion, which hinder the patient experience.

Tackling financial conversations head-on with proactive financial clearance gives providers a clearly defined path toward the most likely payment method while helping patients feel confident about the options they have to pay for care.

How does financial clearance work?

Financial clearance combines two complementary components: patient identity verification and propensity-to-pay scoring.

Credit and non-credit data sources are used to verify identity and address data during admission or intake, which cuts down on patient information errors. Incorrect patient information is one of the leading reasons for claims denials and past due accounts, which cost time and slow down the revenue cycle.

Next, the patient (or financial guarantor) is assessed a propensity-to-pay score, which indicates the individual’s ability and likelihood to pay. The score is linked to a set of custom messages designed to help segment patients into various population groups. For example, a score within one range might prompt the user to collect a co-pay on the spot, while a score within a different range might recommend an installment plan.

In this way, healthcare organizations can capture payment more confidently knowing they’ve offered the most suitable option for the individual. In turn, staff spends less time acting as a bill collector and patients leave with a sense of empowerment over the cost of their care.

Boost payments with ABILITY COMPLETE Financial Clearance

Whether you’re a hospital, ambulatory care center or skilled nursing facility, ABILITY can help you analyze where and when you’re most likely to collect. Strengthen your financial performance, improve your staff’s productivity and most importantly, better serve your patients. Request a complimentary demo of ABILITY COMPLETE Financial Clearance today.



1 “American Hospital Association Uncompensated Hospital Care Cost Fact Sheet,” January 2019, https://www.aha.org/system/files/2019-01/uncompensated-care-fact-sheet-jan-2019.pdf

2 “Federal Reserve Report on the Economic Well-Being of U.S. Households in 2017,” May 2018, https://www.federalreserve.gov/publications/files/2017-report-economic-well-being-us-households-201805.pdf

3 “Study: Average hospital outpatient visit cost approaching $500,” Tauren Dyson, United Press International, December 13, 2018, https://www.upi.com/Health_News/2018/12/13/Study-Average-hospital-outpatient-visit-cost-approaching-500/6121544734917/

4 “Patient Balances After Insurance Continue to Increase in 2018, Driving Bad Debt and Uncompensated Care,” TransUnion, June 26, 2018, https://www.globenewswire.com/news-release/2018/06/26/1529420/0/en/Patient-Balances-After-Insurance-Continue-to-Increase-in-2018-Driving-Bad-Debt-and-Uncompensated-Care.html

5 “Tracking the rise in premium contributions and cost-sharing for families with large employer coverage,” Matthew Rae, Rebecca Copeland and Cynthia Clark, HealthSystemTracker.org, August 14, 2019, https://www.healthsystemtracker.org/brief/tracking-the-rise-in-premium-contributions-and-cost-sharing-for-families-with-large-employer-coverage/


ABILITY and design®, ABILITY® and ABILITY COMPLETE® are trademarks of ABILITY Network, Inc.

Market Share Made Simple: How Predictive Analytics and Insights Strengthen Your Competitive Advantage

What do predictive analytics and insights have to do with getting more hospital referrals?

When you brainstorm ways to gain more referral sources, what comes to mind first? You may think of sending your business development team out on more calls, or even hiring more representatives to reach a wider range of hospitals. But putting more feet on the ground is expensive — and it isn’t the only way to increase your market share.

In fact, if you leverage the latest technology, you can do a lot more to get those referrals — without hiring more staff and increasing your overhead. Let’s take a look at some of the ways you can boost your competitive edge with analytics.

Discover untapped referral opportunities

Have you been reaching out to the right hospitals for referrals? Traditional business development strategies lack the insight to see which hospitals need to refer patients to facilities with your strengths. Find out more about patient movement by referral source or destination, and monitor your organization’s performance along the way.

Use analytics to identify your competition

Should you be worried about the facility across the street? Let’s say, for example, that you know of a few post-acute care providers in your area. You know that they serve patients with many of the same conditions that you do, and you know that your target referral sources overlap with theirs. To stand out, you need to know how your care compares with theirs.

With the right tools and the right data, you can see where your quality of care surpasses other post-acute care facilities, where you have room for improvement and where you have a competitive edge. You can then make strategic decisions about which hospitals you should be targeting and how to approach them for referrals.

Analytics can help identify market trends

For years, analytics tools have provided access to past market trends. However, legacy analytics tools could only look back. Their data inevitably lagged and couldn’t accurately project what was to come.

Next-generation analytics tools give you an up-to-the-minute view of market trends with accurate projections. You can use this data to make effective improvements to your quality care, target the right hospitals at the right times and improve your messaging to stand out as the top choice for referrals.

With the analytics in ABILITY INSIGHTTM Referral Mapper, you have the power to improve your business development strategy and significantly increase your market share.

How to Track and Improve Billing Patterns with Predictive Analytics and Insights

Predictive analytics can do a lot for your facility. With a deeper, more accurate view into your billing patterns, you can see trends in billing mistakes, claims denials and other patterns that may cause delays and other problems in your revenue cycle.

Traditional analytics applications give you a look back at things like your billing, care required, care provided and reimbursements. While these insights are no doubt useful, they inevitably come with a delay. With analytics, you can leverage the power of machine learning and big data to identify trends and unintended billing patterns before claims are even submitted.

So, how can you implement analytics to track and improve your billing cycle?

Predictive analytics and insights in the shift to value-based care

In the transition to alternative payment models (APMs) and other value-based care reimbursement models, you will no longer simply bill patients and residents based on the services you provide. Rather, your reimbursements will depend on several factors, including the quality of care you provide, patient experience and patient outcomes.

This shift in billing and reimbursement models comes with new billing patterns and the opportunity for more mistakes. However, by recognizing and analyzing past billing mistakes, you can adjust accordingly to submit more clean claims the first time around. Using the latest technology to triple-check universal billing (UB) and other claims, you can create better continuity between the care you provide and the reimbursements you receive. And, by automating manual processes — such as the time-consuming UB-04 check — you can save time and labor for your billing staff, as well.

Better insights: Minimizing audit risks and increasing revenue

Monitoring and analyzing your billing cycle will make it easier to spot examples of when the underlying MDS does not support your billing, or vice versa. Getting this feedback and insight early and having the opportunity to correct it prior to submission can help your facility avoid an audit.

At the same time, you may find treatment listed in the MDS that was missed on a claim. The opportunity to make these corrections early will result in more accurate claims that represent higher reimbursements for your facility. And accurate, clean claims also tend to get paid faster.

Using analytics to track your billing trends is exceptionally valuable, especially when it turns up new opportunities for increased reimbursement. With a tool like ABILITY UBWATCH®, you can coordinate financial UB records, potentially increase reimbursements, accelerate A/R and guide your facility toward continuous improvements in billing and patient outcomes.

Better billing practices and increased cash flow are within reach. Check out our application landing page for tips that can transform your revenue cycle management.

predictive analytics and insights

How Predictive Analytics Create Long-term Patient Care Improvements

It’s hard to plan long-term care improvements when you’re focused on the immediate needs of the present. Between attending to patient emergencies, making time to see new patients and managing the day-to-day workflow of your skilled nursing facility, there’s practically no time to sit down and anticipate future needs.

This is just one reason why predictive analytics and insights are invaluable in healthcare. While you and your team are busy handling daily responsibilities, advanced systems can work in the background to track your activities as well as patient behaviors. Then, when you have time to make sense of the data gathered, you can identify actionable steps to implement.

These can influence many parts of your day-to-day, but they have one common purpose: to improve the standard of quality care you’re able to offer patients.

Here’s a closer look at ­three of the long-term patient care improvements you can accomplish by utilizing predictive analytics and insights.

1.    Reduce the risk of incidents

Why did one of your patients recently experience a fall? What was it that caused another individual to mistake their medication? How often do these things occur?

These are just a few of the questions that data can help you answer. When you give your staff the capacity to track every detail of an incident, you collectively lower the risk of future incidents. The information recorded highlights areas of care you can improve to better prevent negative patient experiences. It also provides full visibility into incidents that have already occurred, which can help you prioritize which patients now require the most attention.

2.    Increase intake of patients with conditions you specialize in

As beneficial as it is to record and analyze activities within your organization, you also need to keep an eye on what’s happening in your market.

Having market data accessible at your fingertips greatly improves your competitive advantage. It gives you the information you need to target the best potential referral partners – like hospitals who are releasing patients with conditions you specialize in.

Instead of reaching out to hospitals at random, a tool like ABILITY INSIGHT™ Referral Mapper offers detailed reports on local hospital releases and recent admissions by competing post-acute facilities. Analyzing the data allows you to identify the best opportunities in your local market. And by creating targeted partnerships, you’re setting your team up to succeed in the areas of care they’re most familiar with.

3.    Track and monitor quality measures

The final way that predictive data and analytics can improve patient care is by helping you monitor quality measures. As you’re tending to patient needs, intaking new patients and releasing others, predictive analytics and insights can make sense of your day-to-day activities. They’ll generate reports to identify how you can positively impact your quality measures, and help you track that progress over time. With the right tool, you can even benchmark improvements against state norms and competing facilities.

The benefits of analytics aren’t limited to patient care. Once you discover how to capture and make sense of all the data available to you, the opportunities to improve performance – from patient care to workforce management – are endless. Don’t wait any longer to take advantage of this information. Invest in the predictive analytics and insights you need today to offer more successful patient interventions tomorrow.

infection prevention

Skilled Nursing and Infection Prevention: 3 Strategies to Start Using Right Away

When did your facility last experience an infection outbreak? How many patients did it affect? In the United States, 1 in 3 million serious infections occur in long-term care facilities – and of those, 380,000 cases lead to death each year.

It’s a serious issue that can’t be ignored. But unfortunately, not all long-term care professionals know how to best prevent and control infection outbreaks. Regular cleaning and disinfecting, the use of disposable tools and even basic hygiene, such as flushing and hand-washing, is not enough. Caretakers need to do more to best ensure their residents’ well-being.

Here are three infection prevention strategies to start using right away.

1.    Record and monitor all infections

As much as you need to treat an infection, you should also be tracking every symptom and moment of intervention. This information is invaluable for better preventing similar infections in the future. It can help you identify the root cause of one patient’s infection as well as an outbreak.

But, how you record this data plays a critical role in how helpful it is. Paper files won’t get the job done. These are time-consuming to record, find and analyze. The easier, more efficient way to work is to digitally track all infection information with a tool like ABILITY INFECTIONWATCH™. Going digital gives you much more visibility to the infection trends affecting your organization. It simplifies how you track and treat each patient’s condition and how you prevent outbreaks from affecting all patients.

2.    Strengthen early detection efforts

One of the best ways to keep an infection from spreading is to identify it early on – either when an already existing infection enters your facility, or when a new infection occurs within the facility.


Some ways to improve the early detection of infection include:

  • Identify where an infection was acquired
  • Identify the prevalence of healthcare-associated infections (HAIs) and community-associated infections (CAIs)
  • Track cases of antimicrobial resistance
  • Record adverse drug effects
  • Utilize the information of previous outbreaks to identify high-risk trends

Early detection doesn’t just mean being aware of the potential for an infection outbreak in the future. It also means learning from past outbreaks to best minimize this risk.

3.    Prioritize your intervention plans

If one individual contracts an infection on Monday, and another is affected by a different, more serious infection on Tuesday, who do you need to see first on Wednesday?

Infections don’t happen exclusively. Depending on the size of your facility, it may not be that unusual to manage more than one outbreak – and many affected individuals – at a time. If you find yourself administering multiple intervention plans, you need to know how to prioritize them.

This way, there’s no question as to which patients need certain treatments and to what extent their infections should be tracked and monitored. To best prioritize your intervention plans, refer to the records you keep as symptoms arise and infections are identified. Then, continue to use these records to further enhance your infection prevention and control strategies long-term.

patient data

Continuing the Care Cycle: 3 Things You Can Learn from Tracking Patient Data

Patient care is an ongoing effort. Its success relies heavily on regular caretaker interventions, and it’s partially dependent on how invested a patient is in their well-being. Patient data also plays a role in the coordination and effectiveness of care.

When skilled nursing professionals are able to easily understand the recurring trends of their patients’ health, they can better focus their efforts. Over time, care efforts can shift from a reactive process of caring for the symptoms of serious conditions to a proactive approach that can prevent certain symptoms from affecting patients.

This can’t happen if patient data is sitting in silos. The data must be collected, compiled and analyzed for providers to utilize its full potential.

Wondering what you could accomplish with predictive analytics and insights?

Here are three things you can learn from tracking patient data.

1. Your biggest opportunities to improve care quality

Most providers assume they don’t need to track patient data because they already have a thorough understanding of each patient’s condition. This misconception causes them to miss out on the opportunity to greatly enhance the care quality levels of their entire organization.

By compiling the patient data of multiple people with similar conditions and treatments, providers can better understand how well they’re performing across the board. They can confirm which efforts work best and identify where their team has the most opportunities to improve.

Some providers may discover that assessment errors or lack of patient engagement have negatively affected treatment results. Others may be surprised to find that they’re performing below – or perhaps above – their state’s average star ratings. These are valuable pieces of information available via ABILITY CAREWATCH®, and they’re just scratching the surface of what utilizing comprehensive patient data can accomplish.

2. Why readmissions are occurring

Missed opportunities during treatment can lead to more serious conditions for patients and costly consequences for your organization. If you’ve seen a spike in readmissions, it’s time to take a closer look at what’s causing patients to leave your organization and return to a hospital. Assessing the data of a patient’s treatment from start to finish can help you find the turning point of their condition.

Analyzing patient data for a group of individuals, though, is what allows you to spot workflow trends in your organization that need to be improved. One benefits you on a case-by-case basis, while the other can significantly improve the results you’re able to provide all patients. By utilizing the data of all, you can reduce the risk of readmission for many.

3. How much revenue you’re not capturing

In addition to improving quality of care, patient data can boost financial performance. This occurs when you analyze the claims associated with a patient’s treatment records. If all the claims for a treatment haven’t been submitted, accepted and paid in full, revenue is slipping through the cracks.

There’s also a chance that you have untapped revenue in the form of claims that haven’t yet been created for services you’ve completed. This may happen because your billing staff is prioritizing other claims, or maybe, because they’ve overlooked the opportunity to bill for a service altogether. Another possibility is that the supporting documentation you currently have in place isn’t meeting payers’ requirements.

There are many additional reasons why a claim may not have been submitted or paid in full. But, you can’t leave money sitting on the table or allow conditions to worsen. With the right approach, a little bit of extra time spent analyzing patient data can lead to significantly stronger financial performance and more effective patient care efforts.

Healthcare IT

3 Healthcare IT Trends to Watch This Year

It’s easy to see how the relationship between technology and healthcare can benefit providers and patients in theory. But, it’s much harder for healthcare leaders to determine the most effective use of technology. Between the various tools and applications available and ever-changing healthcare IT trends, healthcare leaders are constantly having to adapt.

They must have a deep working knowledge of their organization’s biggest challenges and the technical understanding to recognize the best solution. They need to stay ahead of industry trends and local competitors – and part of that means being the first to adopt new technologies and processes. Sometimes, it also means catching up to where the market currently is.

Whether you’re getting ahead or gaining ground in your market, here are three healthcare IT trends you can’t ignore.

1. Electronic Health Record (EHR) optimization

Healthcare professionals across many disciplines anticipated that EHRs would significantly improve their daily workflows, financial performance and more. While there have been some good results of using EHRs, 40% of providers have seen more challenges than benefits.

Key challenges to note are:

  • Data silos
  • Increased weekly hours worked
  • Lowered professional satisfaction
  • Difficulty sharing information across teams/organizations
  • Lack of financial integration

Now is the time to address these issues. You may start to compile siloed data or invest more in training the staff who regularly work with EHRs. Or, you can transform their workflow to be faster and more accurate.

The concept of storing patient data and sharing this data across teams isn’t exclusive to EHRs. It can be done with various advanced healthcare applications created to simplify eligibility verification, claims management and/or generate predictive analytics. Instead of settling for EHRs as they are, try finding better ways to operate with the help of advanced applications.

2. Cloud migration

As you’re investing more and more into healthcare IT, consider the support you’ll need. No form of technology is perfect. Even the most advanced tools will have glitches, and they’ll need updates and regular monitoring to run smoothly. This can either be the responsibility of an internal tech support team, or it can be taken care of for you off-site.

When you invest in cloud storage, you also invest in a highly-experienced team of IT professionals who know how to best protect and manage your data. This gives you the functionality you need without the expense of maintaining technology on your own. You can enjoy a simple, stress-free cloud interface without worrying about what’s happening on the backend.

3. Manual task automation

This is arguably the most important of all healthcare IT trends on the list. Manual tasks are slow, they increase the risk of making mistakes and they often hinder staff engagement and patient satisfaction. It’s time to support your staff’s efforts by automating some of their tasks.

You may choose to automate anything from eligibility verification to infection monitoring or staff scheduling. There are various ways to turn a manual process into a simple, efficient workflow – all you have to do is identify the biggest areas of opportunity within your organization. The sooner you do this, the more you’ll be able to truly tap into the talent on your team. When staff members spend less time on manual tasks, they create better results as they work together and interact with patients.

Healthcare IT trends will continue to come and go. What works today may not necessarily be the best way of doing things tomorrow, but you need to make sure you’re operating as efficiently as possible. If you’re not caught up with the trends on this list, get to work right away. If you have adjusted to these shifts, don’t settle. Keep looking for ways to further enhance your organization’s performance.

predictive analytics and insights

How Predictive Analytics and Insights Can Improve Market Share

The post-acute care market is becoming more competitive every day. Hospitals’ selectiveness in referral networks is increasing as multiple new providers enter the market. This means your organization needs a stronger competitive strategy in order to maintain market share and continue to grow.

Luckily, predictive analytics and insights can help you easily identify the opportunities in your market. They can position you to gain more referrals whether you’re a new organization or you’ve been a post-acute care provider for many years.

Here are three ways you can leverage analytics to benefit your organization.

1. Closely monitor patient movement

What conditions does your organization specialize in? Which hospital do most of your patients come from? The answers to these questions can establish the foundation for your new and improved referral strategy.

The data available within ABILITY INSIGHT™ Referral Mapper can help focus your strategy on the most viable opportunities. By breaking down patient movement data into DRG-specific groups, you can better understand which referral partnerships would be the most beneficial. You can also track patient movement from a hospital to a competing organization, which may help you identify what your current competitive strategy is missing.

This information is invaluable. It has the potential to make your referral strategy go from a hit and miss to a much more direct, successful approach.

2. Present a stronger case to potential partners

Predictive data and analytics can make the difference between establishing a new referral partnership or losing this opportunity to a competing organization.

When you combine market trends with quantified metrics that reflect your expertise, it’s easier to express why a referral partnership would be mutually beneficial. The data lets you speak to the treatment results you create and how they match up to competitors’ performance in terms of occupancy targets, census ratings and more. And with the shift from a fee-for-service mindset to one of value-based care, results are at the top of potential partners’ minds.

3. Adjust your efforts with in-depth predictive analytics and insights

Being the first to know about new referral trends in your market makes you the first to act. It gives you the chance to reach out to potential partners before other organizations do. This ensures you maintain your competitive advantage – especially if you frequently generate and analyze reports to benchmark your performance.

Running a successful operation includes providing quality patient care and making smart business decisions. Using data to identify referral sources that align with your facility’s strengths is key to the continued growth and success of your business. Discover first-hand how predictive analytics and insights can transform the way you target potential referral partners and serve your audience.

Why We Need Data: Understanding How Healthcare IT Improves the Patient, Provider and Payer Experience

Manual processes increase the risk that a healthcare organization wastes time, makes mistakes and misses out on potential earnings. They can hinder the patient experience and put a strain on relationships with payers.

These are just a few reasons why some healthcare leaders invest in the support of technology. However, of those who use advanced systems and applications, not all are taking advantage of the predictive analytics and insights available.

The key purpose of automated work is to produce faster, better results. This occurs when advanced functions are introduced to an organization’s workflows, but it doesn’t stop there. By learning from the specific metrics and performance reports available in advanced applications, providers can further enhance the treatment experience for themselves, their patients and even for payers.

Here’s a closer look at what happens when healthcare leaders make their workflows data-driven.

Patient satisfaction increases

Delivering a high level of patient satisfaction requires more than medical care. The patient experience begins from the moment an individual schedules their appointment or is admitted. It continues as they interact with admissions, caretakers and billers throughout treatment.

Patient satisfaction may increase or decrease during this time for a variety of reasons. Analyzing data from previous patient interactions positions providers to produce higher levels of satisfaction.

If you were to have your team track care quality levels, infection outbreaks and slips and falls, you’d have a better understanding of the opportunities to increase patient satisfaction – as well as safety and treatment success. You could start working proactively to reduce the likelihood of negative experiences and focus your efforts on going above and beyond to exceed expectations.

Providers’ operational efficiency skyrockets

The use of advanced analytics helps you do more for patients as well as your staff. Imagine if your billers could create and send claims in half the time it takes them now. Or if you could better engage and communicate with your entire team.

With the right tools, you can access the data necessary to improve these things, too. Detailed revenue cycle performance reports can identify the most common mistakes your billers make.

Additionally, data on staff attendance can help you cut overtime costs and avoid burnout. Your scheduling program may even have credential tracking capabilities to help your entire staff stay up to date with required education.

Payers enjoy higher quality scores and better member retention

As patients become more engaged in their treatments and providers deliver higher-quality care, payers’ performance improves. Their quality scores go up thanks to the providers who deliver satisfactory data-driven results. Over time, this results in better member retention for payers and patient retention for providers.

Technology and healthcare are continuously becoming more intertwined. They will continue to enhance the patient experience throughout treatment, but only as providers and payers embrace the advanced tools and analytics available to them. This trend goes hand in hand with the rising importance of value-based care.

What is your organization doing to stay ahead of the curve?