Providers and payers have an obligation to fulfill contractual obligations to one another. However, mistakes happen, and when they do, they can be costly. More and more, providers are turning to healthcare contract management technology to ensure accountability, protect against revenue losses and streamline efficiencies – all while improving the relationship between providers and payers. Finding the right contract management solution (and technology partner) is critical for contract managers who want to meet the challenges of today and tomorrow head-on. This article explores how healthcare organizations can benefit from adopting contract management technology and key features to look for when choosing a contract management solution. Understanding healthcare contract management Healthcare providers need reassurance of proper reimbursement, while payers are focused on cost control. Healthcare contract management encompasses the many processes providers use to negotiate, execute and audit payer contracts. As services (and financing) evolve in complexity, contract management helps providers and payers avoid costly disputes and maintain effective working relationships. A robust contract management system in healthcare quickly and efficiently pinpoints potential issues to ensure providers are paid per contract terms and payment policies — maximizing revenue recovery. Challenges in managing healthcare contracts Managing healthcare contracts can be complicated. Key challenges in healthcare contract management often include: Complex negotiations: Managing thousands of contracts with multiple plans and provisions can be time-consuming and overwhelming, especially with ever-evolving regulatory requirements. Limited data visibility: To evaluate contract terms effectively, contract managers need to factor in performance data for existing contracts and current figures for patient mix and volume, which can be challenging when accessing the right data and models is difficult. Claim denial conflicts: Payers reportedly deny 15% of all claims initially. When claims are denied, it can lead to disputes over payments and contract interpretations, straining relationships and disrupting revenue cycle performance. Inefficient processes: Disjointed paper processes, manual systems and miscommunications often lead to errors, delays and wasted dollars during contract management. Benefits of healthcare contract management technology Healthcare organizations that embrace contract management technology typically see the following benefits: Maximized revenue recovery Contract management software, like Experian Health's Contract Manager, increases revenue by validating reimbursements and reducing underpayments. Through automated oversight of payer contracts, providers are easily able to validate reimbursement accuracy by comparing expected allowed amounts to actual allowed amounts. Contract Manager also pinpoints variances buried in contract clauses, so providers avoid missing out on potential reimbursements, and provides support for contract-based appeals to recover underpayments. Stronger contract negotiations (and relationships) Contract management technology allows providers to evaluate existing contract results and use that information to assess proposed terms for new contracts. As a result, providers are empowered to negotiate stronger terms with payers. Improved contract negotiations often mean more effective communication and quicker resolutions, too, leading to stronger provider-payer relationships. Improved workflow efficiencies Automated workflows in contract management software combine data to process claims faster and at scale. This translates to a more predictable revenue cycle, improved cash flow and lower administrative costs. Instead of managing contracts, staff are freed up to focus on patient care and revenue-building activities. Hear how Experian Health's Contract Manager solution helped Boston Children's Hospital resolve underpayments and collaborate with payers to ensure every dollar is recovered. Key features to look for in contract management solutions Contract management technology helps healthcare providers stay ahead of some of the key challenges in healthcare contract management. Key features to consider in contract management solutions include: Scalability: Flexible single solution that enables users to easily audit claims across an entire organization – whether one medical group or a large health system. Automation of manual tasks: Accurate authorization rules and rates are automatically populated to reduce manual effort and potential errors. Real-time reporting: Configurable online dashboards that provide staff with immediate access to reimbursement reports to monitor contract performance and quickly compare expected and allowable amounts. Contract analyst team: Dedicated contract analysts assess the provider's contract terms, fee schedules, carve-outs and payment policies. Regulatory compliance: Built-in features, like contract mapping and claim valuation logic, that reduce the risk of audits and penalties, plus automated alerts to help providers make sure contracts remain with current healthcare regulations. Watch the webinar: Hear how OrthoTennessee used Contract Manager to validate reimbursements, pursue bulk appeals and recover underpayments at scale. Future trends in healthcare contract management As providers grapple with continued complexities in contract management, regulatory shifts and staffing shortages, contract management technology will likely remain an important tool for providers that want to level the playing field. Providers can benefit from choosing innovative solutions that help them stay ahead and do more with less – like Experian Health's Best in KLAS award-winning Contract Manager. Clarissa Riggins, Chief Product Officer at Experian Health, says, “In the ever-evolving healthcare landscape, our Contract Manager solution has once again been recognized as the #1 Revenue Cycle Management tool by KLAS for the third consecutive year. This prestigious ranking underscores the significant value our solution delivers to our clients by identifying underpayments and facilitating revenue recovery. We are honored to continue supporting our clients with innovative solutions that drive financial success and operational efficiency.” Find out more about how Experian Health's contract management software for healthcare providers validates reimbursements, reduces revenue loss and strengthens relationships with payers. Learn more Contact us
“Reducing denials upfront would improve our revenue, which could be channeled into current and future investments that support our mission.” —Joshua Gayman, Revenue Cycle Manager at UT Medical Center Challenge The University of Tennessee Medical Center (UT Medical Center) is a leading 710-bed acute care hospital with a rich history of exceptional patient care and award-winning services. During the pandemic, the hospital faced revenue losses of around $45 million that put serious strain on its capacity to invest in bigger and better facilities. UT Medical Center needed to find a strategy to recover some of this revenue by reducing claim denials at the point of patient registration. UT Medical Center relied on eligibility checks that often missed errors in patient registration, resulting in increased claims denials, costly reworks, and wasted staff time. The hospital urgently needed a solution to help staff identify and resolve potential patient registration errors in real time to prevent denials before they occur. Finding a more efficient way to capture accurate patient and benefits data would be essential. Proactively preventing claim denials would provide the hospital with a much-needed boost in cash collections and free up staff to focus on patient care. Solution To address its claims denials challenge, UT Medical Center partnered with Experian Health and implemented Registration QA, a solution designed to find and fix registration errors upfront. Now, when patients first arrive, front-end staff enter their data to verify insurance. If Registration QA finds an error, it alerts staff in real-time so they can resolve it within 72 hours. Alongside more than 400 alert rules curated by Experian Health, UT Medical Center also built custom alerts based on the organization's specific requirements, using demographics and benefits data. The tool easily integrates with existing workflows, and its configurable dashboard gives UT Medical Center Management detailed insights into department performance and allows staff to track trends and identify areas for improvement. This proactive approach to correcting errors significantly reduces the risk of downstream denials and helps patient registration staff take proper corrective actions for their errors without management intervention. More accurate patient registration is also better for patients, as fewer errors make for a smoother intake experience. Outcome UT Medical Center successfully optimized patient registration by using Registration QA to identify registration errors before and at the point of service, reducing denials and boosting revenue. In the 12 months after implementing Registration QA, UT Medical Center saw the following results: Now that registration errors can be identified before and at the point of service, UT Medical Center has seen initial denials drop from an average of $5 million per month in 2022 to just $1.7 million in 2023, representing a 66% decrease in average monthly initial denials value. Cash write-offs also decreased, dropping 57% from an average of $1 million to just over $400K, helping the organization keep bad debt low. Gayman notes that UT Medical Center's partnership with Experian Health was central to its success. Experian Health shared the organization's vision and provided weekly support to help realize it. They developed a customized curriculum to make sure staff were confident using Registration QA and offered insights into what was happening more widely in the industry, so UT Medical Center's team could benchmark their performance against similar organizations. Thanks to these savings, the hospital can increase its capacity to invest in new projects and deliver operational excellence, while improving patient satisfaction. Find out more about how Registration QA helps healthcare organizations minimize denials and increase cash flow through accurate patient registration. Learn more Contact us
Missed payments, delayed reimbursements and rising debt are often symptoms of a struggling financial clearance process. According to Experian Health's State of Patient Access survey, more than six in ten patients say they'd feel more confident about covering their portion of healthcare costs if offered a payment plan. Still, many remain unaware of financial assistance that could further ease their financial burden. Automating financial clearance helps get patients on the right financial pathway as quickly as possible, resulting in streamlined collections and a better patient experience. In a recent on-demand webinar, Brandon Burnett, VP, Revenue Cycle at Community Health System, shared how his organization is using Patient Financial Clearance (PFC) for financial assistance automation, and to increase efficiency throughout the revenue cycle. By using Experian Health's data to quickly identify charity care eligibility and generate appropriate payment plans, they've been able to increase the amount covered by charity care by 30% and reduce bad debt without any additional staff. This article summarizes the key takeaways. Why automate patient financial clearance? Kim Berg, Director of Product Consulting and Optimization at Experian Health, set the scene by explaining how Patient Financial Clearance helps healthcare organizations assess patients' financial capacity and guide them accordingly. Using data like estimated income, spending habits and household size, the tool calculates Federal Poverty Level (FPL) percentages and assigns propensity-to-pay scores, so providers have a more realistic idea about what patients can afford. “We're not collecting pay stubs or tax returns,” Berg said. “We're using aggregated consumer data to estimate income and figure out the patient's ability and propensity to pay.” With this, health systems can quickly identify charity care eligibility and offer customized, affordable payment plans. “It's about understanding a patient's ability to pay and guiding them down the right financial path.” Using data to support state regulation compliance and automate financial clearance processes Rising healthcare costs and uncompensated care are the main motivations for improving presumptive charity screening. Berg noted that changes in state regulations add pressure, introducing additional checks for charity care eligibility before patients are sent to collections. “We're seeing more states passing legislation that introduces some kind of charity requirement,” she said. “We can provide the data to help prioritize those patients sooner in the process and work with you one-on-one to understand how the data can help you comply with state requirements.” Burnett said that automating presumptive charity screening with Patient Financial Clearance has helped his organization manage these changes, including California AB-1020. “We're using Experian's data to automate the decisions when patients apply. It means we don’t require any additional documentation or information.” It helps “move eligible patients out of accounts receivable and into charity approval faster.” Automating charity approvals to reduce manual work and bad debt Sharing a look inside Community Health System's financial clearance workflow, Burnett described how Patient Financial Clearance had led to a 30% increase in the amount approved in charity care compared to 2023, with no increase in bad debt. They comfortably handle an average of 1,400 applications each month, with only one to two full-time equivalent staff. “We've automated about 80-85% of our charity approvals,” he said. By integrating PFC data with Epic, the system automatically identifies charity-eligible patients and processes adjustments without staff intervention. “The adjustments happen automatically, the letters are generated, and nobody has to touch it. That's a huge efficiency gain for our charity team, because it's exception-based now,” he said. Finding additional efficiencies throughout the revenue cycle While Community Health System is also using Experian Health's Collections Optimization Manager to automate collections, they've also integrated PFC data into their broader collections workflow. “Using Collections Optimization Manager, we can identify patients through their propensity to pay, their presumptive FPL, and if they look like they would be approved for one of our financial assistance programs,” said Burnett. “We're also screening for bankruptcy and scrubbing to see if patients are deceased. So beyond PFC, Collections Optimization Manager is a great way to continue to leverage that data throughout your collection cycle.” He highlighted that Experian's support had helped them get even more out of automation. “Experian will come on-site and walk through the workflows. You don't always know what other organizations are doing or what's possible, so having that consultative approach has been so helpful.” These reviews helped uncover further opportunities to use PFC data, resulting in hundreds of staff hours saved. “We weren't even looking at these extra benefits at first,” Burnett said. “Experian pointed out that we could use the same data to automate more processes, and it ended up saving us hundreds of hours of staff time. That wasn't something we expected, but it's already paid for itself.” Using Patient Financial Clearance to improve patient experiences with self-service For Berg, two particular benefits of Patient Financial Clearance are worth highlighting for their impact on the patient experience. Firstly, it paves the way for more compassionate payment discussions with patients, by giving financial counselors a more complete picture of the patient's financial situation. “You can prioritize financial counselors' work queues to focus on certain patients first, because they're most likely to qualify for Medicaid or charity. You can offer estimates, and make sure patients understand their responsibility and their options,” she says. “If you understand your self-pay population sooner, you can guide them to the right path and free up more time. There's a lot of cost savings and resource savings downstream.” Secondly, Berg points out that many patients prefer to manage their financial assistance applications digitally, without recourse to a financial counsellor. “A lot of people want to handle everything on their mobile device or through a website,” she says. The recent State of Patient Access survey found that 56% of patients want more digital options for managing healthcare, while 67% want to be able to apply for financial assistance online. To support this, many Experian Health clients are using PFC's self-service options to allow patients to complete applications on their own, whenever and wherever it is most convenient. These include: Mobile links are sent via text message, with the option to submit an application through eCare NEXT® Websites and patient portals, where patients can apply and upload documents online. Offering these digital options meets patients' demand for more control over their financial journey, while reducing manual work for staff. “A great way to leverage data throughout the collections cycle” Community Health System's experience shows how automating financial assistance delivers value throughout the revenue cycle. Patient Financial Clearance helped accelerate and increase charity care approvals, reduce the administrative load for staff and lower bad debt, while ensuring patients receive the support they need. With a clearer understanding of each patient's financial capacity, Community Health System can proactively guide patients to the right pathway, making financial assistance more accessible and reducing friction when it comes to payments. The hidden benefits of using the same data to streamline collections are a strategic advantage for efficiency-conscious providers. As costs and complexities continue to trend upwards, data-driven automation is an increasingly useful way to improve financial health for both providers and patients. Learn more about how Patient Financial Clearance uses data to help healthcare organizations implement financial assistance automation, to improve patient satisfaction and increase collections. Learn more Watch the webinar
According to Experian Health's State of Patient Access report, patients want two things when it comes to medical billing and collections: clear insurance information and accurate cost estimates. Yet, when they ask, “How much will this cost me?”, many find themselves without a clear answer. Slower payments are an inevitable result. For providers, sub-par billing hurts revenue and limits investment in patient care. Modernizing patient collections with digital tools helps deliver accurate estimates, tailored payment plans and simpler ways to pay, while giving patients the financial clarity they desire. This article looks at the key components of patient collections, and how software-led solutions support a more transparent, patient-friendly and sustainable healthcare revenue cycle. How medical billing and collections impact the revenue cycle Every revenue cycle manager knows that unreliable billing and collections processes can throw the entire revenue cycle into disarray. A single mistake during patient registration, such as an omission in insurance verification or a typo in an address, can lead to inaccurate cost estimates, claim denials and delayed payments. Outdated collections methods force staff to spend valuable time clarifying and chasing payments, instead of focusing on patient care. When these billing inefficiencies pile up, the financial strain spreads beyond the revenue cycle, jeopardizing the organization's ability to make good on its core mission. A reliable medical billing and collection process is essential for both patient satisfaction and organizational resilience. Breaking down the collection process in medical billing To meet the needs of both patients and providers, an ideal medical billing and collection process should include the following components: Pre-visit insurance verification and cost estimates – At registration, staff verify coverage, confirm patient responsibility and provide an upfront cost estimate to prevent any surprise bills. Service and charge capture – Throughout treatment, clinicians document services accurately, and coding staff ensure all medical codes are correct, so bills and claims are error-free. Claim submission – With accurate data from the start, billing teams are set up to submit clean claims the first time and maximize the likelihood of reimbursement. Patient billing and payment – Once insurance processing is checked off, patients receive clear, itemized bills with links to convenient payment options. Follow-up and collections – Rather than pestering patients with phone calls, automated reminders sent via text or email give a less intrusive nudge to encourage timely payments. Healthcare organizations can offer flexible payment plans and, if bills remain unpaid, initiate a structured collections process that balances firm follow-up with compassionate financial counseling. How to optimize the process for maximum revenue If billing and collections teams are used to manual systems, making the switch to automated tools may seem daunting. Focusing on a few core principles, like transparency, accuracy and flexibility, will help ensure they prioritize areas that matter most to patients. Here are a few examples of how digital tools tackle the most common problems that get in the way of better billing and collections: 1. Problem: Patients don't understand their bills Fix: Provider accurate estimates and clear, itemized statements The State of Patient Access report found that 96% of patients want accurate upfront estimates. Yet, 64% did not receive them – and 14% said their estimates were wrong. Tools like Patient Payment Estimates software quickly pull together all the essential data to generate a more precise breakdown of who owes what. Patient Financial Advisor sends patients a pre-service text message with a secure link to their estimated patient responsibility, based on real-time rates, pricing and benefit information. Patients get instant confirmation of what they'll owe and the option to make a secure payment then and there. 2. Problem: Payments are delayed Fix: Offer online and mobile-friendly options With 60% of patients saying they want more online options to pay bills, providers that continue to rely on checks and phone calls are missing a major opportunity. Digital billing and payment methods remove friction and make it easier for patients to keep track of their bills and remember to pay. An integrated payment processing system like PaymentSafe® enables providers to collect payments 24/7 from an increased number of collection points. The tool automatically pre-populates fields in patients' accounts, allowing them to pay multiple bills simultaneously. 3. Problem: High administrative burden is taking a toll on staff Fix: Use technology to prioritize high-value accounts and automate follow-ups and reminders Automation can be a lifesaver for providers struggling with manual follow-up workflows, especially as increasing patient volumes outpace staffing levels. For providers, tools like Collections Optimization Manager help revenue cycle management staff collect more patient balances based on patient segmentation. This solution categorizes patients into different tiers according to their ability and likelihood to pay, using data analysis and predictive modeling. Collections Optimization Manager helps staff prioritize high-value patient accounts, so they don’t pursue uncollectable accounts and collect more with fewer resources. On a recent webinar with Experian Health, Kristen Shoup, Revenue Cycle Director at Wooster Community Hospital, shared how Collections Optimization Manager and automated patient text reminders reduced the administrative burden on staff while offering a more convenient way for patients to pay their balances. Read more about how automated collections strategies helped Wooster achieve a $3.8 million increase in patient payments. 4. Problem: Unpaid balances are piling up Fix: Implement flexible payment plans Patients who are worried about being able to afford their medical bills are more likely to seek out providers that offer flexible payment plans. Personalized plans allow patients to explore tailored payment options and break bills into manageable amounts. For example, Patient Financial Clearance screens patients for Medicaid or other assistance programs, and directs them to the most suitable payment plan. This reduces the risk of unpaid bills and means fewer accounts are written off to bad debt. See how UCHealth used automated financial clearance to identify $26 million in charity care. Strengthening the revenue cycle through better billing and collection practices Providers that listen to what patients say they need to help them stay on track with their financial responsibility will not only improve patient satisfaction, but also gain a competitive edge. Making the medical billing and collection process more compassionate and efficient drives higher collections, reduces bad debt and builds a revenue cycle that is both patient-centered and financially strong. Find out more about how Experian Health helps healthcare organizations improve patient billing and collections. Learn more Contact us
A positive patient experience can quickly sour when difficult financial conversations enter the picture. High out-of-pocket costs and confusing medical bills make payments a sensitive issue for many patients. For providers, the challenge is clear: how to improve patient collections while delivering compassionate care. This article considers proven strategies and best practices to simplify patient collections, maximize revenue, and keep the focus on patient-centered care. The importance of optimizing patient collections for healthcare providers For many patients, an unforeseen medical emergency can quickly become a financial one. According to a 2024 report by the Consumer Financial Protection Bureau, medical debt rose from an average of $2,000 per person to over $3,100 in a year, while 15 million Americans carry medical collections on their credit reports. Such financial strain erodes the patient experience, with one in five patients experiencing distress over healthcare costs they can't afford. Experian Health's State of Patient Access 2024 survey found that both patients and providers agree that understanding coverage helps patients manage their healthcare costs. Still, unpaid bills and aging accounts are a persistent concern for providers. Hospitals' operating margins may have rebounded, but remain extremely tight. Remaining alert to risks and opportunities in patient collections is essential for long-term financial health. As patients shoulder a greater share of their medical costs—and those costs continue to rise—efficient collections are critical for patient trust and financial resilience. Breaking down the patient collections process The patient collections process involves determining how much of the cost of care falls to the patient, and then billing and collecting the correct amounts. During registration, providers verify insurance coverage and eligibility to estimate what the insurer will cover. Accurate cost estimates can then be provided to patients upfront, giving them the option to make payments before or at the time of service. The bulk of billing and collections activities take place post-visit, sometimes involving third-party agencies. However, collections can be thwarted by several challenges. Staff must keep up with frequent changes in insurance policies to prevent errors in billing or cost calculations. Patients may worry about affordability, leading to late payments. Billing teams often lack information about patients' financial circumstances, making it hard to predict how likely they are to pay. On top of this, many patients expect more convenient payment options, such as online or mobile payment methods, and will express frustration if the process feels inconvenient. Proven strategies to collect more revenue, sooner Three ways to create a patient-friendly billing experience and ensure prompt payment include the following: 1. Reduce stress with clear pricing and flexible payment plans Patients want collections processes to be clearer and more transparent. The State of Patient Access survey found that more than four in ten patients say they would be more likely to cancel or postpone care without an accurate estimate. Six in ten say they'd be more confident in their ability to pay for care if they were offered a payment plan that took account of their financial situation. Automated patient estimates arm patients with accurate information about the expected cost of care in advance. They have more time to make their financial arrangements and are less likely to be surprised by a surprise bill. Providers can offer additional clarity and flexibility through tailored payment plans. Experian Health's Patient Financial Clearance software uses advanced analytics and data to analyze individual patient accounts and determine their ability to pay. This allows front desk personnel to quickly choose the most appropriate financial pathway for each patient. It also supports more compassionate financial conversations, as staff can adjust their approach to suit each patient's financial situation. 2. Help patients find and understand coverage Relying on manual processes can slow down registration and miss potential payment sources. Since 2000, unidentified coverage opportunities have landed hospitals with more than $745 billion in uncompensated care. Given that patients are asking for help understanding coverage, it makes sense to build coverage discovery into the collections process. Experian Health's Coverage Discovery® automatically scans patient accounts throughout their care journey to uncover alternative payment methods and reduce financial strain. This has helped healthcare organizations like Luminis Health identify over $240k in active coverage per month, greatly reducing the financial risk for patients and providers. 3. Make payments easier to prevent delays Improving patient collections processes will be fruitless if patients can't easily make payments. Digital and mobile payment options are non-negotiable for today's digital-first consumers. Accepting payments at multiple collection points, including mobile devices, kiosks and patient portals, gives patients the convenience and choice they need to pay promptly. Best practices for patient collections management Aside from automation and digital tools, the strongest strategies for improving patient collections rest on one key ingredient: robust data. Collections software is only as good as the data behind it. With a tool like Collections Optimization Manager, providers can deploy advanced analytics to segment patient accounts so they can be handled appropriately. Using credit, behavior and demographic data, it applies a proprietary propensity-to-pay score to each account, so staff know which accounts to prioritize, write off or refer out. This approach has helped organizations like Novant Health and Cone Health bring in millions of dollars with personalized, patient-centric collections. On-demand webinar: Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager. Tracking patient collections success By monitoring key performance indicators like collection rates, accounts receivable days and patient feedback, providers can continue to fine-tune their processes. Collections Optimization Manager captures this data in user-friendly dashboards and reports, so staff can assess their performance against their own history and industry trends. Users also benefit from expert support from Experian Health consultants, who help teams evaluate reports and recommend the right collections strategies every step of the way. How to build a patient collection strategy that gets results For millions of Americans, medical debt isn't just a financial burden: it's a barrier to care. To overcome this challenge, providers need proactive collections strategies that prioritize patient well-being and financial stability. By incorporating automation, analytics, and digital tools, healthcare organizations can create patient collections processes that are clear, compassionate and effective, delivering better outcomes for both patients and providers. Find out more about how Experian Health's suite of healthcare collections products helps providers boost collections, cash flow and patient satisfaction. Learn more Contact us
“Our call strategies did not yield the desired outcomes, and we recognized the need for additional data to better support our goal. We were also mindful of the potential risk of staff burnout and the impact it could have on overall performance.” —Carey Lawrence, Revenue Cycle Administrator Customer Service and Self-Pay Collections, Weill Cornell Medicine Challenge Weill Cornell Medicine is a leading medical school and research institution with $1.3 billion in annual patient revenue. Facing $42 million in annual bad debt and rising call center demands, Weill Cornell needed to upgrade their collections strategy. Staff lacked real-time insights into patients' propensity to pay and often resorted to calling most patients — a frustrating and inefficient process. They needed a better way to verify insurance coverage, understand patient payment history and determine eligibility for Medicaid eligibility, charity care or other financial assistance. The company had three specific objectives: Increase net revenue by improving self-pay collections through better segmentation and prioritization. Optimize call center operations through automation and better communication with patients. Select the right partner with expertise to provide technical solutions, consultative guidance and process improvements. Solution Weill Cornell turned to Experian Health's Collections Optimization Manager to increase cash collections with smarter segmentation. The partnership provided access to dedicated support from an analytics consulting manager at Experian Health. Together, they used Collections Optimization Manager to create a more targeted collections strategy, and to automatically segment patient accounts based on propensity-to-pay scores. This allowed staff to focus on high-value accounts and stop wasting time on uncollectible accounts. They were able to use Collections Optimization to screen out accounts that weren't deemed collectible, such as accounts for deceased patients, those in bankruptcy, or those eligible for Medicaid or charity care. Access to better data also reduced manual workloads. Validating the database with their existing Epic data also helped catch and correct some missteps. “We were able to eliminate skip tracing, for example, because Experian's extensive data sources ensure our mailing addresses are up to date,” says Lawrence. To improve call center efficiency and deliver a more compassionate payment experience, Weill Cornell also implemented PatientDial, an automated dialer that uses the segmentation data from Collections Optimization Manager, to run targeted outbound patient call campaigns. The initial implementation of automated dialer campaigns increased net collections from 65% to 83%. Outcome Thanks to Collections Optimization Manager and PatientDial, Weill Cornell saw a 7:6:1 return on investment and achieved the following results: $15M collected in pending patient payments $7M reduction in annual bad debt placements 92% of recoveries trending at Champion Benchmarks Automating call campaigns also led to a noticeable improvement in staff morale. Lawrence observes that “staff are more satisfied with the new, automated processes because they can be more productive and don't have to guess at which accounts to call or when. Our operations are flowing more smoothly which decreases all our stress levels.” Lawrence also notes the power of good data: “The detailed, customized reports on our bad debt helped us identify issues early, allowing us to target collections more effectively. We reduced the number of accounts sent to agencies, ultimately saving time and money.” Looking ahead, Weill Cornell plans to explore new ways to use automation to improve management of Medicaid eligibility, presumptive charity and agency reconciliation. Discover how Collections Optimization Manager and PatientDial can streamline your collections process, enable higher collections rates and improve patient communications. Learn more Contact us
Finding missing health insurance is critical to keeping revenue cycles on track. Insurance eligibility verification is an important process providers use to confirm active coverage, including additional coverage a patient may have forgotten. According to Experian Health's State of Claims 2024 survey, almost a fifth of providers say missing coverage is a top reason for claim denials. It helps providers determine what insurance a patient has and what's covered and plays a key role in billing. When a patient has more than one type of active coverage, providers use insurance eligibility verification checks to determine how much should be billed to the correct payer and in what order. However, searching for missing coverage is often time-consuming and error-prone thanks to manual systems, disjointed databases and ever-changing payer regulations. When mistakes are made in the early stages of patient intake, it affects every step of the patient journey and revenue cycle. The struggles to confirm patient coverage are likely to worsen as patient volumes increase, medical needs get more complex and staffing shortages continue. Despite these mounting obstacles, insurance eligibility verification checks remain a critical first step to reducing claims denials, improving patient outcomes and minimizing lost revenue. This article explores why insurance eligibility verification checks matter and how providers can adopt new strategies and digital tools to find missing health insurance and prevent revenue from slipping through the cracks. The hidden costs of missing health insurance Today, more Americans are struggling to afford their medical bills — even with insurance. A KFF study reports that 48% of U.S. adults find affording healthcare difficult, while 25% say they or someone in their household had issues covering medical costs in the past twelve months. About half of those surveyed say paying an unexpected $500 medical bill would put them into debt. Insured patients aren't immune from the burden of high healthcare costs, though. Thanks to rising deductibles, co-pays and premiums, patients are taking on more financial responsibility, and 74% are worried about covering out-of-pocket costs. Nearly half of U.S. adults expressed concerns about affording their monthly insurance premiums. When medical bills go unpaid, provider revenue can take a serious hit. Uncompensated care is a huge financial burden for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. Patients often have additional insurance coverage that could help close the gaps, but they've either forgotten about it or are unaware of their eligibility. Finding missing coverage is a top priority for providers who want to ensure revenue streams stay in check — especially as healthcare costs continue to rise. Benefits of resolving missing health insurance issues Resolving missing health insurance issues has many benefits for both providers and patients, beyond verifying that services are covered and medical bills are paid. These include: Reduces claim denials: Claims denials are on the rise, and missing coverage is a top reason, according to Experian Health data. Incorrect or incomplete information can result in errors on claim forms or providers sending claims to the wrong payer. Finding missing coverage before claims submission reduces errors, denials, delays and rework. Minimizes wasted staff time: An eligibility recheck is needed when providers discover an incomplete claim, due to a change in active benefits after claims submission. With 43% of providers reporting that eligibility rechecks add at least 10 additional minutes per claim, finding missing coverage in advance is critical to freeing up valuable staff time. Improves the patient experience: Patients are often confused about what insurance covers and what they'll be on the hook for out-of-pocket. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care. When providers are able to find missing coverage during insurance discovery, patients are more likely to receive accurate upfront estimates. Complete and transparent pricing allows patients to prepare for the cost and avoid any surprises, while accelerating collections for providers. Tools and strategies to find missing health insurance Insurance eligibility checks help providers verify insurance status, coverage details and benefits in advance. However, performing insurance checks isn't always straightforward, and often requires searching for missing coverage. Patients sometimes forget to let providers know about secondary coverage or insurance changes. Or, coverage can be forgotten because a patient has moved to a new house, changed states, switched employers or signed up for a different policy. In some cases, patients may be misclassified as self-pay or have only one form of insurance. Providers can improve their insurance eligibility verification process and discover missing health insurance at every stage of the revenue cycle with the following strategies: Implement digital insurance discovery solutions Outdated manual systems are often error-prone and make finding missing coverage a labor-intensive task for already overburdened staff. Automated eligibility verification solutions offer a more streamlined approach to finding missing coverage faster with more accurate results. Tools like Experian Health's Coverage Discovery work across the entire revenue cycle and search government and commercial payers to find previously unknown insurance coverage. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Streamline patient intake and updates Matching patient information to payer databases starts at registration. However, patient information, including insurance coverage details, can change anytime. Patients may switch insurers, move states or change their contact information. Catching errors before a claim is submitted is key to keeping the revenue cycle moving and collections. Providers often can't keep up with changes or may struggle with tool overload, with nearly 60% of providers reporting using at least two different tools to gather the necessary patient information for claim submission. Digital tools, like Experian Health's Patient Access Curator, can help solve for bad data quality with real-time correction. This solution uses artificial intelligence (AI) and performs eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, to ensure that all data is correct on the front end. Patient Access Curator also interrogates 271 responses to indicate any secondary or tertiary coverage data. Other tools, like Registration Accelerator, puts the patient in control of inputting and updating information. Using an automated link, patients can enter their personal details and insurance information from their mobile phone or the web-based app, with no login required. Providers can prompt patients to complete registration details during the initial intake process and send reminders to update information that may have changed, like an address or insurance policy, when follow-up appointments are scheduled. Provide accurate upfront estimates The lack of accurate care estimates is an ongoing challenge for both providers and patients. According to Experian Health data, four in 10 patients report spending more on healthcare than they could afford. When providers don't have access to the most up-to-date patient insurance information, or coverage is missing, estimates are often incorrect and patients end up with surprise bills. Inaccurate estimates create a negative patient experience, resulting in unpaid bills and extra work for staff to resubmit claims or chase down collections. However, tools like Eligibility Verification can help providers easily confirm coverage, co-pays and deductibles at the time of service. When armed with real-time coverage data, providers can build more accurate estimates and help patients prepare for the cost of care. How technology makes finding missing health insurance easier 43% of Experian Health's State of Claims survey respondents say that eligibility checks take 10 to more than 20 minutes to complete. Eligibility checks are taking longer, are filled with more errors, and only 54% of providers feel their claims technology can handle current revenue cycle demands. Using technology at every step of the revenue cycle helps providers bridge the gap between front-end eligibility checks and back-end claims management. Digital tools, like Coverage Discovery, fit anywhere into the revenue cycle, allowing providers to easily check for health insurance through the patient journey, not just at registration. Emerging AI and automation tools also help providers find missing health insurance faster. Automated eligibility verification solutions, like Experian Health's Eligibility Verification, seamlessly check insurance benefits across 900 payers using advanced patient matching tools. Patient Access Curator uses AI-based data capture technology to return real-time data in a single click from hundreds of payer responses, allowing providers to quickly verify active coverage, billing information, plan level details, and more. Case studies: See health insurance discovery in practice How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Learn more about how automated health insurance discovery helps providers find missing health insurance, reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us
For five years straight, patients responding to the State of Patient Access survey have ranked “seeing a doctor quickly” as a top priority. Unfortunately, 94% of patients are still waiting more than two weeks for an appointment. Too many find themselves stuck in scheduling dead-ends, with unanswered calls, endless hold times and limited options when they finally get through. Providers are working hard to cut wait times, but an aging population, rising rates of chronic conditions and elevated levels of seasonal flu are driving up demand. Failure to manage spikes in patient volumes isn't just a scheduling problem; it has wide-reaching financial and operational consequences. Providers must find more efficient ways to help patients move through the healthcare system more quickly without compromising the quality of care. Could online self-scheduling be the answer? This article looks at how opening the digital front door with patient appointment scheduling software gives patients more control over their health journey, while easing operational strain. Challenges in patient appointment scheduling for healthcare providers Efficient scheduling is the only way to help patients see the right physician at the right time. So, what's getting in the way? Demand outstrips supply — Growing demand for specialists, increasing numbers of older patients, and more people with complex chronic diseases mean there are more patients than available appointments. In some “medical deserts,” there are too few medical providers to support local populations with basic primary care. Staffing pressures — Heavy workloads, seasonal illness spikes and lingering burnout (improving, but still affecting nearly half of physicians) affect staff availability and scheduling operations. Administrative complexity — Specialist care often requires longer visits, specific equipment, or multi-provider coordination, making scheduling more complicated. Poor management leads to bottlenecks and inefficiencies, while reliance on manual scheduling increases errors, double-bookings and delays. Rising patient expectations — When patient volumes are high, keeping patient access running smoothly is challenging. Patients now expect healthcare to function like other service industries, with digital scheduling, same-day appointments and clear communication. Appointment scheduling software is key to delivering on those expectations while maintaining operational efficiency. No-shows and cancellations — Missed appointments create inefficiencies, disrupt workflows and lead to revenue loss, while last-minute cancellations create costly gaps in the schedule. They're a drain on resources that providers can't afford. Without an effective waitlist or rebooking system, providers miss opportunities to help patients and bring in more revenue. Benefits of patient appointment scheduling software in healthcare Self-service patient scheduling tools address many of these challenges by allowing patients to book, cancel and reschedule appointments online and on their schedule. It's convenient for patients, while alleviating the burden on staff. Patient Schedule, Experian Health's online scheduling platform, takes a two-pronged approach. With Patient Schedule – Online Scheduling, new and returning patients can book appointments at any time, from any device. Automated integration with provider calendars and business rules prevents patients from booking the wrong appointment type. It updates immediately when a cancellation occurs, so patients are shown real-time availability and can see their doctor sooner. And for those that need more assistance or prefer to speak to an agent, Patient Schedule – Call Center Scheduling uses sophisticated decision technology to help call center staff schedule faster and more accurately. Automated prompts guide staff through the conversation, so teams can easily find the right providers based on an organization's business rules. Together, these tools allow providers to increase their capacity and improve patient engagement. Discover how IU Health used guided scheduling to transform operations, which resulted in a 114% increase in patient utilization within one year. Patient Schedule by the numbers: Up to 50% reduction in scheduling time, thanks to fast and efficient guided search Staff training is completed in just one hour, so they can start taking calls the same day 89% patient show rate as a result of automated reminders 32% more patients scheduled monthly, as self-scheduling attracts patients and increases market share. The growing importance of patient appointment scheduling software With 89% of patients saying they value the opportunity to book appointments anytime, via online or mobile tools, patient appointment scheduling software is fast becoming a competitive advantage. As more healthcare organizations adopt these automated scheduling tools to streamline booking, reduce no-shows and improve access, those relying on outdated manual systems risk losing patients to other providers and falling behind. Streamlining administrative tasks with digital patient intake solutions The State of Patient Access survey found that 63% of providers offered self-scheduling in 2024, up from 40% in 2022. With a further 16% planning to onboard self-scheduling software, the future looks bright for patients who want to call time on slow and outdated booking systems. However, patient scheduling software is only one piece of the patient access puzzle. When integrated with other automated registration and intake tools, scheduling software reduces paperwork, minimizes errors and accelerates check-in. For example, Registration Accelerator allows patients to complete forms, verify insurance and update their contact information before arrival, while Patient Payment Estimates cut the confusion around medical costs. This means that from the moment an appointment is scheduled, staff can focus on patient care, rather than administrative tasks. With the right digital solutions, patients can take control of these processes themselves – wherever and whenever is most convenient. Find out more about how Experian Health's patient appointment scheduling software can simplify and accelerate patient access. Learn more Contact us
“You know when the Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” —Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences Challenge Exact Sciences is a prominent cancer diagnostics laboratory with an annual net revenue of around $2.6 billion, that's best known for its flagship cancer screening test, Cologuard. After a period of rapid growth demand for its test, Exact Sciences faced the difficult task of collecting accurate patient data and verifying insurance eligibility at scale. Anticipating a 25% growth in annual testing volumes, Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences, says the organization “needed an automated, real-time solution" to capture accurate data from the start. The company had four specific objectives: Improve the accuracy of patient insurance data to reduce errors and denials. Streamline processes to handle rising testing volumes without increasing headcount. Reduce claim denials to bring in more revenue (especially those related to eligibility and timely filing). Ensure accurate identity verification in lab settings, where patient, physician and lab data aren't unified within a single data management system. Watch the webinar: Hear our pre-recorded session from our annual Experian Health High-Performance Summit 2024 (HPS), featuring Exact Sciences and Trinity Health, as they reveal how Patient Access Curator helped their organizations automate eligibility, reduce denials, and more, all with a single click. Solution In need of a single solution to solve multiple challenges, Exact Sciences turned to Experian Health's Patient Access Curator. This new product provided the team with a way to run inquiries for eligibility, Medicare beneficiary identifiers, coordination of benefits, insurance discovery and demographic data with a single click. Instead of juggling multiple products and vendors, registrars would be able to capture and verify patient data in a single transaction. Through automation and machine learning, Patient Access Curator could deliver results in less than 30 seconds and help submit clean claims the first time – reducing the risk of denials even as volumes increased. Experian Health's implementation experts configured the tool to Exact Sciences' needs, integrating over 4,000 payer plans nationwide and customizing parameters for real-time eligibility checks and data validation. Experian Health also delivered staff training to support the transition to the new system. Watch the video: See how Experian Health's Patient Access Curator streamlines patient access and billing, addressing claim denials, data quality and real-time corrections to boost your business's bottom line. Outcome Thanks to Patient Access Curator, Exact Sciences achieved the following results: 15% increase in revenue per test due to accurate eligibility and fewer denials 4x business volume without increasing headcount 50% reduction in denials and major improvement in timely filings $100 million added to the bottom line in 6 months Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors and more. Overall, Kubisty credits Experian Health's Patient Access Curator for helping Exact Sciences overcome critical pain points resulting from data errors and eligibility issues. Solving for bad data quality with real-time data correction freed staff from tedious manual work, ensuring faster, more accurate claims processing – all without growing headcount. After implementing Patient Access Curator, the company is ready to scale and handle growing volumes efficiently, say goodbye to late filing denials and scale smarter. For Kubisty, this highlights how technology drives efficiency and sustainable growth. Learn more about how Patient Access Curator helps patient access teams prevent claim denials by solving for bad data quality with real-time data correction. Learn more Contact us