All posts by Kelly Nguyen

Staffing shortages are the new normal in healthcare. Most news headlines focus on gaps between the supply of providers and the growing demand for care. However, a recent survey by Experian Health, released in November 2023. shows the massive impact staffing shortages have on back office revenue cycle where these functions intersect with front-of-house patient engagement. Strikingly, the healthcare staffing shortage statistics in the survey show revenue cycle executives are 100% in agreement—staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees. Experian Health's report, Short-staffed for the long term, surveyed 200 healthcare executives responsible for revenue cycle functions. The goal was to gauge the impact of worker shortages on revenue cycle management and patient engagement. While the pandemic brought these shortages into the public purview, this new data shows most providers believe healthcare staffing gaps are chronic and here to stay. These results reinforce The State of Patient Access 2023 survey, where 87% of providers blamed staffing shortages for declining access to care. As the healthcare industry continues to struggle with an ever-increasing staffing shortage, it has become increasingly evident that if left unresolved, this situation can wreak havoc on revenue cycle management (RCM). The latest survey illustrates the need for new strategies to alleviate healthcare worker shortfalls. This article explores the most recent healthcare staffing shortage statistics and some key findings from the study to help determine how healthcare providers can turn these challenges into opportunities. Experian Health surveyed 200 revenue cycle executives to determine the impact of staffing shortages on reimbursement and patient engagement. Download the report to get the full results. Finding 1: Most revenue cycle leaders believe staffing shortfalls negatively affect payer reimbursements and collections. 96% of survey respondents indicated a lack of qualified workers has a detrimental impact on organizational revenue channels. 80% say turnover in their department ranges from 11 to 40%, much higher than the national average of 3.8%. When healthcare organizations lack revenue cycle talent, they risk missing performance goals. High turnover and the departure of experienced staff create information deserts within healthcare organizations. It forces new team members to train faster, handle bigger caseloads before they're ready, and potentially burnout from stress. The pressure to do more faster creates a higher volume of preventable claims errors that lead to denials. The survey showed all these factors at play, and their negative impact on reimbursement, collections, and the patient experience. While the traditional way to alleviate staffing shortages is to increase recruiting and retention efforts, these approaches no longer work when there simply isn't enough available staff to hire and train. Healthcare organizations must consider new partnerships with technology providers who offer automation tools to streamline human workflows. Revenue cycle management software eliminates repetitive tasks and lessens errors that lead to rejected claims. Digital technology can help solve labor shortages by reducing staff workloads and improving operational performance. Automation can streamline collections by prioritizing the accounts most likely to pay. These tools help existing revenue cycle teams work more efficiently while enhancing patient encounters. Finding 2: Healthcare staffing shortages roadblock a positive patient experience. 8 of 10 survey respondents say patient experience suffers due to gaps in staffing coverage. 55% report the patient experience is most heavily affected at intake, and 50% say at appointment scheduling. Staffing shortages and turnover cause an undue burden on the healthcare workers left behind. The survey asked respondents to indicate the top pain points experienced by revenue cycle professionals, and one of the major challenges was staff burnout. Stress has a detrimental effect on patient interactions throughout the revenue cycle. The survey shows staffing shortages impede patient satisfaction in critical areas within revenue cycle functions, including: Scheduling appointments Patient registration Prior authorization Insurance coverage confirmation Patient estimates Revenue cycle interactions can be delicate, requiring extreme patience and clear communication. Healthcare organizations must provide the support their revenue cycle teams need to handle these crucial conversations appropriately. To improve the patient experience, organizations must first improve the workflows and workloads of these critical back-office teams. When healthcare organizations have the right tools to eliminate manual tasks that bog down revenue cycle staff, these professionals can spend more time on the compassionate handling of patients and their accounts. Providers have the opportunity to solve these challenges with digital patient engagement solutions that improve workflow efficiencies at every level of the revenue cycle. Patient scheduling software creates a self-service environment that 73% of healthcare customers prefer. Patient intake improves with online software that automates the tedious paperwork that tie up staff. Better technology can create price transparency without manual effort, ensuring patients understand their responsibilities up front instead of facing surprises during or after care delivery. Finally, a frictionless online payment platform allows patients to handle their obligations seamlessly without staff intervention. Finding 3: Errors arise when healthcare providers are short staffed, leading to claims denials. 70% of survey respondents say staff shortages exacerbate denial rates. 92% of survey respondents said new staff members make errors that negatively impact claims processing. Some of the most common reasons for healthcare claim denials include: Incomplete collection of claims data Coding errors Billing errors Eligibility verification errors Missed insurance verification Healthcare operations and revenue cycles are full of manual processes. RevCycleIntelligence reports one-third of prior authorizations are completed manually, and two-thirds of hospitals haven't automated any part of their denials management processes. Yet technology has made significant strides toward reducing these error-prone manual tasks. Leveraging artificial intelligence (AI), with solutions like AI Advantage™, within the complexities of claims processing could cut provider spending by up to 10% annually. Eliminating repetitive tasks with automated claims management solutions improves the lives of staff, cuts manual errors that tie up cash flow in reimbursement wrangling, and creates a better, less stressful environment for customers. Reducing the impact of healthcare staffing shortages with revenue cycle automation and technology Sometimes, 100% agreement isn't the desired outcome. In this case, the healthcare staffing shortage statistics found in the survey shows healthcare providers agree unanimously that chronic staffing shortages create a problematic environment for employees that costs revenue and patient engagement. While technology exists that can maximize revenue staff workflows to extend the reach of overburdened employees; survey participants suggest that healthcare organizations continue to approach solving these issues by adding staff.  But healthcare's staffing challenges are not new. While organizations have historically invested revenue in higher salaries and sign-on bonuses to attract staff, technology offers a new opportunity for history to avoid repeating itself. It's time for healthcare organizations to support their teams with automation. These tools alleviate mundane, error-prone tasks that tie up staff. Experian Health offers these organizations a way to improve the lives of everyone within the revenue cycle by allowing back and front-office teams to focus on patient care, rather than filling in forms. It's a more humane way to handle a very human staffing crisis. Download the survey or connect with an Experian Health expert today to learn how we can help your healthcare organization combat staffing shortages.

Hospital admissions for COVID-19 increased by almost 92% between the last week in July 2023 and the last week in August 2023, according to figures published by the Centers for Disease Control and Prevention (CDC). It is worth noting that this time last year, the numbers were double what they are now. However, it is important to acknowledge that the virus is still evolving. Demand for services may be unpredictable over the coming months, so providers will need to position their teams to adapt to changing patient volumes and staff absences. Additionally, seasonal flu vaccination programs are underway, putting extra pressure on patient access. Now is the perfect opportunity for healthcare providers to reassess and streamline patient intake processses. This article looks specifically at how online scheduling for patients can help providers prepare for the unexpected this fall. Rethinking patient intake Online scheduling helps providers create a more efficient patient access experience by allowing patients to schedule appointments from home, instead of by phone or in person. It's more convenient for patients, limits exposure to infection and reduces the administrative burden on front office staff. Understandably, some providers without online scheduling software in place may worry about implementing new tools during the busiest time of year. They may see it as a “nice to have” to deploy when demand is more stable. But this is a false economy: any time saved by postponing the switch to online scheduling will be lost to costly inefficiencies over the hectic winter period. It's crucial to start the process now, before the stress hits. In a 2022 evaluation of self-scheduling processes at the Mayo Clinic, the authors describe themselves as “fortunate to have the self-triage and self-schedule process in place during the unanticipated surge of COVID variant omicron in the winter of 2021-2022.” The organization saw utilization of self-scheduling for COVID-19 tests increase from 4% of appointments booked in December 2020 to 44% in January 2022, saving thousands of hours of staff time, reducing no-shows and streamlining the patient experience. Get more benefits from online scheduling with a tailored approach Switching to online scheduling doesn't have to be complicated. To simplify implementation, providers should focus on how online scheduling can support their organization's specific operational challenges and goals. Choosing a solution that integrates with existing practice management and hospital information systems will also ensure implementation is as frictionless as possible. Here are a few examples of ways to maximize the benefits of online scheduling for their organization: 1. Create screening questionnaires to manage demand Screening questionnaires can be given to patients as soon as the log in to book appointments for specific services. Their answers can then be used to determine the appropriate appointment type and guide patients to their next step quickly and efficiently. Clinical needs, billing requirements, and patient preferences (such as the need for an accessible location or interpreter), can all be managed automatically.It's an effective strategy to manage demand for high throughput and routine services that are less likely to need staff assessment, such as COVID-19 testing or flu vaccinations. In the Mayo Clinic example, self-scheduling took just 3.1 minutes for asymptomatic patients, increasing to just 5.8 minutes for symptomatic patients who self-triaged with a screening questionnaire. 2. Use guided search to direct patients to virtual services Online scheduling can also guide patients to appropriate and convenient services they may not otherwise have considered, such as virtual care. Virtual care proved its value at the height of the pandemic, and while utilization has levelled off, providers should not see this as a lack of appetite for digitally-enabled care among patients. In Experian Health's State of Patient Access survey 2023, 56% of patients said they wanted more digital options for managing healthcare. Respondents (particularly younger patients) listed mobile scheduling for telehealth appointments among their expectations of the digital front door.The recent explosion in digital health companies offering at-home care solutions also speaks to patient demand for virtual services. Established providers should look to expand and promote their digital offerings, or risk losing their competitive edge. Leveraging the incumbent advantage is a move to make now, while new players are still finding their feet. One effective method to achieve this is by directing patients to existing virtual services through an online scheduling platform. 3. Eliminate walk-in traffic at urgent care centers Urgent care centers are the 'doctor of choice' for many patients, with patient volumes increasing by 60% since 2019, according to the Urgent Care Association. If COVID-19 and seasonal flu cases collide over the winter, urgent care centers may become overwhelmed by patients with both infections. Urgent care center managers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This helps reduce the number of in-person visits and walk-in traffic, which will not only help prevent spread of infection, but also contribute to a better patient experience.Online self-scheduling also eases pressure on urgent care centers in another important way. Allowing patients to book their own appointments reduces the risk of cancellations and no-shows. This proactive approach prevents delays in care, effectively bridging gaps that can potentially escalate into costlier and riskier emergency situations. 4. Extend staffing capacity with real-time resource allocation Experian Health's data shows that between June 2022 and June 2023, providers that used Patient Schedule saw an average of 40% of patients book appointments after hours, saving hours of administrative time. Efficiencies on this scale will be invaluable, should COVID-19 or seasonal flu cases trigger a rise in patient volumes and staff absences.Patient Schedule automatically optimizes patient and provider capacity in real-time. Scheduling rules based on providers' calendars, appointment types and business needs are built into the platform, so that patients only see the available appointments based on those rules. The tool gathers calendar inventory from across multiple providers for a comprehensive view of network capacity, to make even better use of available staff time. The calendar inventory can cover an entire care team, such as a physician, physician assistant and nurse practitioners. This frees up staff to focus on other administrative tasks and assist patients with additional needs. Get ahead of winter pressure points with online self-scheduling These are just a few examples of how providers can use online patient scheduling to zero in on their own operational priorities, make life easier for schedulers and patients, and ease pressure on services over the coming months. Contact Experian Health today to explore self-scheduling options and immediately boost your service capacity.

The phrase “it's complicated” resonates well in the realm of prior authorizations in healthcare. Initially devised as a cost control strategy by insurance payers, the concept of prior authorization holds merit. However, the reality unfolds as a different tale, with 94% of doctors attributing care delays and diminished clinical outcomes to prior authorization hurdles. Furthermore, one in three doctors  connect these authorizations to escalated healthcare resource utilization, manifested through patient hospitalizations and life-threatening clinical events. There is a shimmer of hope as some insurers are retracting prior authorization prerequisites for certain conditions and procedures. However, this move might produce more complexities, given the distinct protocols of each payer. The traditional manual handling of prior authorizations by most providers leaves ample room for errors amidst these changes. A viable solution lies in leveraging technology. Experian Health's electronic prior authorization software can expedite and streamline pre-certification workflows, keeping providers updated with the ever-evolving payer requirements. What are prior authorizations?  Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. This process can be time-consuming, burdensome, and can lead to delays in patient care. Kaiser Family Foundation (KFF) says, “Prior authorization, or pre-certification, emerged decades ago to deter physicians from prescribing costly tests or procedures unjustifiably, aiming at delivering cost-effective care.” Initially, the focus was on high-cost care like chronic condition treatments. However, the spectrum has broadened, encompassing mundane clinical encounters like basic imaging or medication refills. Since 2020, a whopping 80% of providers have witnessed a surge in prior authorization volumes, stirring discussions on their necessity. The American Medical Association (AMA) critiques the overuse of prior authorization, emphasizing the administrative and clinical issues it spawns. The lack of uniform documentation requirements across payers often culminates in unwarranted care denials and treatment delays. The administrative overhead is hefty; an average doctor processes 45 pre-authorizations weekly, a task primarily manual, time-consuming, and error prone. Some insurers lifting prior authorization requirements  The scrutiny over the years has prompted some payers to relax prior authorization mandates:  UnitedHealth is reducing nearly 20% of their prior authorization requisites for a variety of treatments from spine surgery and breast reconstruction to outpatient therapies and durable medical equipment Humana has eliminated prior authorizations for cataract surgery for Georgia Medicare Advantage beneficiaries.  Following suit, Aetna has waived pre-certification for certain cataract surgeries, albeit excluding Medicare Advantage beneficiaries in Georgia and Florida. They have also ceased prior authorization for physical therapy in five states. Currently, 30 state bills aiming to rectify the prior authorization problem are in the pipeline. Washington is on the verge of introducing new mandates for both private and public payers. However, the diverse new rules from payers and legislative attempts to address the issue might create new challenges.  How to keep track of prior authorization changes  The traditional reliance on manual paperwork for prior authorizations remains predominant. Over half of the providers find the process daunting to organize and maintain. Experian Health's electronic prior authorization solution stands to help automate this process, enhancing operational efficiency and curbing costly denials. The solution auto-updates with the latest payer rules, offering real-time tracking of authorization status and allowing manual look-up by CPT code or service description. This significantly reduces the time spent hunting for updated information. Furthermore, the software can add actionable alerts, creating flags when payers change their requirements. For example, the Prior Authorization Knowledgebase, a proprietary repository for more than 160 national payers and their pre-certification rules, allows quick check functionality to see if a procedure requires appropriate use criteria adherence. Users can create service work queues when CMS requires adherence to Appropriate Use Criteria (AUC). Two supporting tools to aid these processes include the Medical Necessity tool, which validates clinical orders against CMS and private payer rules for fewer denials, and Claims Scrubber, which helps healthcare organizations prevent denials by improving claims accuracy.  Neeraj Joshi, Director of Product Management, at Experian Health, says, “Technology has the potential to significantly reduce the need for pre-authorization in healthcare by improving efficiency, streamlining processes, and enhancing decision-making. Automating prior authorizations eliminates the burden of tracking these constantly changing requirements. Following these changes by hand, scrolling back and forth between websites, then manually adding them to a rules list leaves room for error that no one can afford.”   Using technology to streamline prior authorizations Today, a mere 21% of providers have adopted electronic prior authorization software. The Council for Affordable Quality Healthcare (CAQH) projects that automation of service preapproval could slash healthcare's administrative encumbrances by $437 million annually. More crucially, it would expedite patient decision timelines and care delivery. The impact on patient outcomes could be significantly positive over time. The utilization of electronic prior authorization software promises to alleviate the anxiety doctors and patients endure while awaiting treatment approval. The AMA reports that 8 in 10 doctors acknowledge patient experience unwarranted care delays, sometimes leading to treatment abandonment due to prolonged prior authorization procedures. The technology to expedite prior authorizations is at our disposal, and progressively, healthcare organizations are transitioning towards it, mending the broken pieces of care delivery and reimbursement. Joshi says, “While technology can reduce the need for pre-authorization in healthcare, it's essential to strike a balance between ensuring the appropriate use of medical services and avoiding unnecessary delays in patient care. Healthcare providers can use technology to design more efficient workflows that minimize administrative burdens. For example, automating data entry and documentation can free up healthcare staff to focus on patient care. We have the tools available that can speed up these processes.”   Today, better health requires reducing the complexities of the healthcare paradigm. Experian Health offers provider organizations improved options for delivering care with robust technological solutions that improve the lives of clinicians, staff, and patients. We specialize in offering digital tools to improve every stage of the patient journey. Contact Experian Health today to improve your pre-approval processes with electronic prior authorization software. 

AI and automation could cut US healthcare spending by up to 10% – a promising figure for hospitals operating on razor-thin margins. Despite the potential for cost savings and revenue growth, investing in AI can seem risky while the technology feels relatively new. But as denial rates increase, staff shortages persist, and payers race ahead with their own AI-led efficiencies, investing in AI and automation could help healthcare providers increase efficiency and reduce manual workloads, while improving the patient experience. In a recent podcast interview, Johnathan Menard, VP of Analytics at Experian Health, talked to Andrew Brosnan of Omdia about how providers can use AI and automation in healthcare to reduce admin costs and tackle staff burnout, while maximizing the ROI on new technology. This article sums up the key takeaways. “AI and automation are gaining momentum in the healthcare revenue cycle, but there remains untapped potential” For healthcare leaders, maintaining the financial health of their organization is critical to serving their communities. Menard sees untapped potential to use AI to improve financial prospects by automating and eliminating administrative tasks within the revenue cycle: “There are many repetitive, tedious tasks involving large amounts of data that's already collected, and mostly structured and standardized. That can be organized and analyzed with AI to help improve efficiency and accuracy.” Automation is a well-established route to lowering manual workloads, increasing efficiencies and generating data for better decision-making. AI takes this a step further. For example, Experian Health's flagship AI platform, AI Advantage™, can parse an organization's data to identify and predict patterns in payer behavior. It translates this data into insights that help providers boost profitability and improve the staff and patient experience. Menard explains why claims management is a prime use case for AI: “Last year, the average denial rate was already above 11%. That's 1 in 10 patients potentially having to deal with uncertainty about who will pay the bill, when they should be focusing wellness. That's where we see Experian Health being able to lean in and drive value and change in the healthcare industry with AI.” “Cost is the biggest barrier to AI and automation adoption in healthcare – but can be offset with the right data” Despite the potential upside, healthcare still lags other industries when it comes to implementing AI. Menard says that workforce costs are the biggest barrier to adoption: “In healthcare, it's not just a matter of implementing the technology or solution, but also maintaining it on a yearly basis with talent. Organizations are going to have to recruit an AI-competent workforce.” He says that providers may struggle to offer competitive salaries to attract staff with this skillset, but there are other ways to offset cost concerns. One example is working with a trusted third-party vendor to choose the best-fit AI solution for their organization. These vendors can leverage economy of scale, data and lessons learned in other markets to help providers deliver new models of care: “At Experian Health, we have health data spanning eligibility and benefits, address, identity, claims remittance payments. We have insights on 300+ million consumers and 126 million households. We're able to offer providers one of the most holistic views of today's health care consumer. It gets really exciting when you think about partnering with providers to augment their capacity to deliver a different style of care.” “Providers need to make sure staff see the benefits of AI and automation” Menard notes that successful implementation of AI needs staff buy-in: “Providers need to make sure staff see the benefits of what this technology can bring. They must also make sure they give them the proper training on how to embrace these capabilities. They do not replace your job; they augment you to do more, or they allow you to focus on doing the right thing, not the right thing that needs their specific level of expertise.” AI Advantage is a prime example, reducing the admin burden for staff, who can then focus on higher priority tasks. The solution takes a two-pronged approach to help staff reduce claim denials and maximize reimbursement: AI Advantage – Predictive Denials synthesizes historical and real-time claims data and payer decisions to flag claims that are likely to be denied. This allows staff to intervene and make necessary amendments prior to submission. AI Advantage – Denial Triage performs a similar function for claims that do end up being denied. It helps staff eliminate time spent on low-value denials by guiding them resubmissions that are most likely to be reimbursed. Schneck Medical Center and Community Regional Medical Center (Fresno) are seeing the benefits of AI Advantage. Watch the on-demand webinar to hear about their results. Moving beyond proof of concept Menard acknowledges that providers need to feel confident in a tool's ability to deliver before they make an investment, especially if they are operating on single-digit margins: “You can't do that without the proof of concept. There are too many competing priorities, especially in the revenue cycle, and healthcare leaders need to be laser-focused and very confident in their decision-making.” In part, this is what Experian Health is looking to do with AI Advantage. By demonstrating the power of AI to reduce costs and alleviate staff pressures within claims management, it can act as a springboard for smarter automation across other revenue cycle operations. Menard believes that as AI adoption expands, it will become faster, easier and cheaper to develop solutions at scale: “That's why we built the AI Advantage platform – to launch other products in the future and solve other issues throughout the healthcare journey. We talked about automation, adoption and healthcare. To me, the best way to automate a process is to eliminate the need for it in the first place.” Find out more about how AI and automation in healthcare can reduce costs, prevent staff burnout and help providers prepare for future challenges.

In July this year, the Centers for Medicare & Medicaid Services (CMS) reported that a data breach in a contractor's network may have compromised the data of more than 600,000 current Medicare beneficiaries. The breach, which occurred in May 2023, involved a vulnerability in file transfer software that enabled an unauthorized party to access beneficiaries' personally identifiable information (PII) and protected health information (PHI). Some patients were issued with new Medicare Beneficiary Identifiers (MBIs) following the incident. The contractor also offered two years of Experian credit monitoring at no cost to those affected. However, providers may see an increase in patients who are confused or concerned about using their MBI card. Experian Health's MBI Lookup service can help providers ensure that Medicare eligibility verification remains as efficient as possible. Thousands of beneficiaries issued new MBI numbers In response to the breach, CMS announced that 47,000 individuals would be mailed new MBI cards with new MBI numbers. However, as 612,000 patients were affected by the breach, there may be a significant number of people whose MBIs may change without notice. Since these individuals will not be able to use their old MBIs when trying to find Medicare coverage and benefits, there could be confusion among patients and providers who rely on MBIs to confirm a patient's eligibility for Medicare coverage. It could also affect billing processes and claim status inquiries. Experian Health reached out to CMS for clarification and received the following guidance: If a Medicare beneficiary's MBI number has changed, then their old (now inactive) MBI will return an AAA72 error when attempts are made to confirm coverage using the HIPAA Eligibility Transaction System (HETS). The HETS 270/271 platform will accept historical 270 requests that use the patient's new MBI. Old MBI numbers will only be accepted if that number was active during the Date(s) of Service noted on the request. Providers should note that some patients may inadvertently use invalid MBI numbers and review processes for verifying Medicare eligibility accordingly. Verifying Medicare eligibility with Experian Health's MBI Lookup tool Verifying active coverage can be a painstaking process, but it's a vital step to confirm that planned services will be covered by the patient's insurance provider. If a patient is unaware or cannot demonstrate eligibility for Medicare, then the provider cannot make a claim for reimbursement, and the patient may be left to pay a bill they cannot afford. Finding active coverage helps providers reduce the risk of bad debt. Experian Health's Insurance Eligibility Verification speeds up this process by accurately confirming coverage at the time of service. The process comes with an optional MBI Lookup feature, which checks transactions against MBI databases to see if the patient may be eligible for Medicare. If the patient has forgotten their MBI card, the tool will check to see if they're included in the database, using their name, date of birth, and Social Security Number (SSN) or Health Insurance Claim Number (HICN). The MBI Lookup service triggers on 270/271 transactions in the following cases: Where the transaction fails because the subscriber is not found or their MBI number or other identification is missing or invalid (a “Traditional Medicare Failure”) Where a commercial 270 inquiry returns a “Medicare Advantage Plan” or “Managed Care Plan” indication on the “Other Payer” or “Other Coverage” section of the 271 response Where a commercial 270 transaction returns a failed response and the patient is aged 65 or older. If the provider's system attempts to use a patient's old number, and the patient does not realize that they have a new number or card, MBI Lookup will find and verify their new MBI. When the tool is triggered, it finds active and verified MBI numbers in 60% of cases on average. Find coverage faster with automated discovery tools Kate Ankumah, Principal Product Manager of Eligibility Verification and Alerts at Experian Health, says the automated MBI Lookup service has proven especially useful during times of change: “Providers relied on this service to verify Medicare coverage quickly when the pandemic hit, just as the industry was adjusting to the use of MBIs instead of their legacy HICN. Now, MBI Lookup can help providers smooth out the impact of data breaches involving Medicare beneficiaries with minimal fuss. It's a reliable way to give patients clarity without placing any undue burden on staff.” Insurance Eligibility Verification can be used alongside other automated coverage identification tools, such as Coverage Discovery®. Coverage Discovery scans government and commercial payer databases throughout the patient journey to find any previously unknown or forgotten coverage, eliminating the need for manual inquiries. Using multiple sources of data and tried-and-tested algorithms, these tools work together to locate coverage for patients, giving patients peace of mind and helping providers avoid uncompensated care. Both tools can be accessed via the eCareNext® platform, so staff can view eligibility responses and manage work queues through a single interface. And of course, this recent breach is a stark reminder of the need to protect patient data. Using a single vendor with integrated software and data solutions can help reduce the risk of data getting into the wrong hands. Find out more about how Experian Health's Eligibility Verification solution and MBI Lookup tool can help providers verify active coverage and give patients peace of mind following a data breach.

Humans increasingly benefit from the convenience of a self-service world. Thanks to the internet and companies like Amazon, online digital interactions yield an almost immediate result. It's a standard consumers have adapted to and unconsciously expect from every service provider, whether it's same-day grocery delivery or scheduling the next doctor's appointment. Today's gold standard for most services is a few clicks with a favorite handheld digital device. But when it comes to healthcare, sometimes expectations don't meet reality. Healthcare providers must accommodate patient expectations by opening a digital front door. Despite the complexities inherent in American healthcare, patients increasingly demand a frictionless online experience where they manage their care at their leisure. Clarissa Riggins, Chief Product Officer at Experian Health, says, “Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services. They seek convenient self-scheduling options, accurate cost estimates, and the ability to pre-register through their smartphones.” Understanding the need for a digital front door in healthcare Healthcare's digital front door is a set of online tools that enable patients to manage their care. These tools began growing in popularity during COVID, when the necessity of limiting physical interactions drove many patients to online healthcare alternatives. These digital encounters further increased patient expectations of a seamless healthcare experience from scheduling to service delivery to payment. Meeting patient demand for digital services Increasingly, the level of control that stems from online scheduling is what healthcare customers demand. Digital tools used to book appointments, register for care, and make payments are becoming a norm across the healthcare continuum. Survey results from the State of Patient Access 2023 found that some of the most important digital services for patients that drive a positive experience include being able to schedule appointments online or via a mobile device (76%), having an online/mobile option for payments (72%), and more digital options for managing healthcare (56%). Clarissa Riggins points out the gap between these expectations and the reality of most patient experiences, stating, “In general, findings seem to show progress has stalled when it comes to making patient access functions like scheduling, registration, coverage verification, and cost estimates more efficient.” Yet providers seem aware of their patient's interest in seeing more, not fewer, digital front door tools in healthcare delivery. The State of Patient Access 2023 report shows 86% of healthcare providers want their organizations to improve by adopting digital front door software. Riggins says, “But provider's motivation is not necessarily generating action.” Patients are growing frustrated; nearly half say they can't find appointments to fit their schedule, and 40% complain that even trying to schedule with a doctor is challenging. Today, 87% of patients perceive the across-the-board accessibility of their healthcare practitioners as a problem. Digital front door software is healthcare's solution to provider shortages, decreasing access, and our patient's on-demand scheduling requirements. Patients and doctors want digital front door software to increase access to care Patients are turning to providers who use automated solutions. Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, and 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. A prior study showed 44% of patients say they prefer to receive test results via a secure online hub. While staffing shortages certainly impact the ability to schedule care, Riggins points out, “Since patients associate 'access' with their ability to see a provider quickly, it makes sense that, without technology in place, staffing shortages will negatively impact the consumer experience.” It's a good point; nearly 40% of healthcare providers say technology solutions like digital front door software offset staffing shortages. Healthcare patients demand digital front door access and their doctors agree. But healthcare organizations are lagging in implementing these tools. Where is the disconnect? Eliminating the tedious human tasks that accompany manual patient registration, automating accurate price estimates, or offering patients one-click, convenient payment options, will free up staff to focus on key initiatives. Not to mention that these digital innovations will give patients and providers what they want. Perhaps the lag in implementing healthcare digital front doors occurs because these organizations find digital transformation daunting. But healthcare providers can work with a third-party trusted advisor with the right expertise to make the transition to digital front door software. Utilize mobile and self-service scheduling Experian Health specializes in opening healthcare's digital front door, beginning at the front door of any practice. Automated patient scheduling gives patients 24/7 control over when they visit doctors. Easy one-click functionality in a comfortable user interface allows patients to reach the right doctor at the best time for everyone. For providers, this kind of digital front door software alleviates the pressure on overburdened scheduling staff by moving these processes to a self-service online environment. Provide a better registration experience Experian Health's registration software also takes the next step, inviting patients through the digital front door by simplifying and streamlining intake. Healthcare organizations can create a better registration experience and increase patient booking with text-to-mobile registration. Two-way automated communications with patients decrease no-shows and engage patients at every step of their journey. For new and existing patients, automated cost estimates with easy payment options let them know their obligations to a healthcare practice, increasing co-pay collections while lessening burdens on providers and staff. Communicate costs upfront Communicating the costs associated with healthcare delivery is a critically important step toward improving patient experience. Experian Health's State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. That's why Experian Health expanded their digital front door software to include tools like Patient Estimates and Patient Financial Advisor. These tools creates true price transparency between healthcare providers and their patients. Providing a patient with an on-demand, clear, accurate cost estimate for healthcare should be a standard part of the care delivery paradigm. These solutions automate this process so that every customer understands the costs associated with receiving care. The bottom line There is evidence now that patients want a digital front door to improve access to care. They want to retake control of their health and do it from their preferred digital device. Experian Health has a set of digital front door tools that brings healthcare consumers exactly what they want while lowering provider staffing costs. Adopting innovative digital solutions is no longer an “if” proposition; healthcare customers have shown they will seek out new providers if their scheduling, registration, and payment processes are not seamless. This shift in the consumerism of our healthcare services means that healthcare organizations face a strategic imperative to open the digital front door—or lose patients to the competition.  Contact Experian Health to learn we help organizations open their digital front door with automated patient access solutions.

Is streamlining patient access with technology the key to improving revenue cycle management? Technology is already making intake, insurance verification, patient estimates, and other elements of patient access simpler. The same technology can also speed up and smooth out the healthcare revenue cycle: a goal many providers can get behind. Victoria Dames, Vice President of Product Management at Experian Health, says, "Patient access is the first step in simplifying healthcare and revenue cycle processes. Trading in manual processes and disjointed systems for integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle. For providers trying to choose between prioritizing revenue and patient experience, patient access technology can deliver on both.” The digital transformation journey starts with patient access technology Starting at the beginning with patient access makes perfect sense for providers who want to embark on their digital transformation journey. The early touchpoints in the patient experience, like patient intake and scheduling, not only set the tone but also lay the foundation for successful claims and collections in the future. Patient access technology can help streamline patient access processes, making it easier for patients to receive accurate cost estimates, understand insurance eligibility and coverage, and work out payment strategies. Integrated patient access solutions—including automated registration and financial clearance with eCareNext®, and accurate patient estimates and mobile payment options with Patient Financial Advisor —deliver convenience to the patient while requiring less manual work and reducing data errors that can cause problems with billing and collections. Dames says, "Patient access is where providers begin collecting data, confirming insurance eligibility, and providing accurate patient estimates. Completing these actions successfully at the beginning of the patient journey can facilitate payment and collections downstream. As providers continue their digital transformation journeys, improvements made in patient access enable further improvements in later stages of the revenue cycle: collections, claims management, and payer contracts.” Streamlining patient access affects revenue cycle management Efficiency in patient access has a direct impact on revenue cycle management. Here are three key areas where streamlining patient access can bring real improvements: Efficient revenue management begins with good data Up to 50% of denied claims originate in patient access. Manual intake processes are time-consuming for staff and carry the risk of human error. Staffing shortages put increased demands on workers, leading to an even larger potential for problems. To add to the mix, patients may be increasingly likely to have incorrect information. Medicaid redetermination following the end of the COVID-19 pandemic is ending coverage—and creating confusion—for millions of patients. Job and coverage changes can translate to confusion over coverage and eligibility. “Automation virtually eliminates human error, so providers get accurate patient information and standardized data they can use throughout an integrated revenue cycle,” says Dames. Nearly 90% of patients want an accurate estimate; only 29% get one Experian Health's 2023 State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. Although estimates are a requirement under price transparency laws, delivering an accurate estimate is difficult without the help of automated systems. Dames says, “Patients are anxious about the cost of care, and they can't estimate their own out-of-pocket costs. Accurate, transparent pre-treatment estimates are an important tool for building trust with patients. When providers offer real-time insurance verification and coverage information, they proactively help patients understand their own financial obligations. From there, providers can collect copays at the point of service and suggest options like payment plans or charity care, if appropriate.” Automated processes and tools like Patient Estimates improve staff productivity and speed up collections. As staffing shortages continue, streamlining back-office tasks improves efficiency and reduces frustration. Valuable staff members have more time to do the complex human work of talking with patients and solving problems. Real-world success story: Blessing Health Systems oversees two hospitals, a college of nursing, and a charitable foundation with nearly 3,000 total employees. Like many healthcare providers, Blessing faced challenges, including registration errors, inaccurate patient estimates, and collection difficulties. Blessing implemented an integrated suite of solutions including eCareNext®, Patient Estimates, Patient Self Service, Patient Statements, Payer Alerts, PaymentSafe®, Registration QA, and several financial clearance products. The results: Point of service collections increased by more than 80%. Clean claim rate increased from 63% to 90%. Denials decreased by 27%. Gross A/R decreased by an average of 28 days. “[Blessing now has the tools needed] to be successful in one, user friendly application,” says Jill Stroot, Director of Patient Access at Blessing. An integrated patient access solution allows Blessing to capture and verify important insurance information and catch registration errors in real time, resulting in less manual work, less rework, and a faster, better revenue management process overall. Best practices for implementing patient access technology Most providers are looking to improve and accelerate the revenue cycle. Many, too, are looking toward digital transformation as a long-term goal. But that means many are balancing the need for system-wide transformation against current realities. Incremental change allows providers to advance the ball now while preparing for further opportunities in the future. While providers weigh their options, here are a few best practices to help guide their thinking. Prioritize If doing everything at once isn't possible, providers can start with the processes that will have the greatest impact. Identify areas of greatest need. Look for the greatest ROI. Find quick wins that can be implemented with little change or investment. Choose solutions that integrate now Blessing Health Systems chose Experian Health solutions in part for their easy integration with Cerner. Finding solutions that integrate with existing systems is critical. Ultimately, solutions should also integrate throughout the healthcare revenue cycle. Choose a partner for the long haul Finding a technology partner that offers a full range of revenue cycle solutions—extending beyond patient access—helps ensure providers can continue their digital transformation journeys. Technology isn't the only factor to consider: Support and consultation along the way can help providers make the right decisions and maximize the value of new solutions as they're added. How to improve the healthcare revenue cycle Recent years have brought many new challenges to the healthcare space, but also new technology that can smooth out kinks in the revenue cycle. Providers that leverage patient access technology to deliver convenience and transparency to patients, and greater efficiency and cost savings internally, can look forward to better revenue cycle management while laying the groundwork for continued evolution. Learn more about how Experian Health's integrated suite of solutions can help with streamlining patient access.

Nearly three out of four healthcare leaders said reducing claims denials was their highest priority in  Experian Health's State of Claims Report. But knowing how to reduce claim denials is difficult. According to the survey, 62% of providers said they had insufficient access to data and analytics, and 61% lacked automation to meet the challenges of healthcare claims management. New and emerging artificial intelligence (AI) tools aim to help providers overcome these hurdles. Makenzie Smith, Product Manager at Experian Health, shares her thoughts on how providers can harness AI tools to predict, prevent, and prioritize claim denials for better results—and why preventing claim denials is so critical now. Q1: What is the challenge for revenue cycle teams, specifically when it comes to managing claims denials? “Revenue cycle teams that want to optimize claims processing have to respond to shifting payer behaviors, including major changes in the volume of denials,” says Smith. “Payers have been able to outpace providers in adopting new technologies, including AI. Payers are able process claims in a matter of seconds. For revenue cycle teams, that means receiving a large volume of denials all at once, which can be overwhelming.” At the same time, keeping up with policy changes is more than a full-time job. “You may have 20 different payers, each with multiple plans and policies that each have their own reimbursement or clinical guidelines,” says Smith. None of these policies are static: “They're constantly changing, which creates a huge challenge for providers.” Finally, maintaining enough staff to manage increased volume is an uphill battle. “The number of team members handling denials has not grown in a proportional way. Quite the opposite: They're being asked to do more with less. As providers continue to struggle with staffing imbalances, the challenge is not only having somebody to actually sit in these seats, but also managing the constant training and retraining that goes along with it.” Q2: Why is effective denial management so critical for providers' success?  “By one estimate, half of our country's hospitals are operating in the red,” says Smith. “Healthcare finance professionals are under incredible pressure to maintain or increase their operating margins. Meanwhile, Experian Health data shows that most organizations operate with an initial denial rate of 10% to 15%, and that rate is increasing year over year. “Effective denials prevention and management allow providers to get paid appropriately for services they've already provided,” Smith continues. “Optimizing revenue, improving cash flow, and maintaining expenses all stack up to provide meaningful financial resources providers can use on essential investments in staffing, physician recruitment and retention; capital equipment; and the expansion of services or service areas.” Providers that can't maintain healthy margins may be at risk for acquisition. “[Providers' viability is] put at risk daily because they must fight for every dollar from payers,” says Smith. Q3: How is Experian Health helping providers leverage AI tools and technology to start leveling up their denial management strategies? “Healthcare claims management technology solutions should be helping to bring providers up to speed,” Smith says. “Experian Health has released two products powered by a machine learning technical enablement layer to the market this year. Providers that use ClaimSource® to manage their claims can add AI Advantage™ tools to improve the way they manage claim denials. “AI Advantage - Predictive Denials uses AI and the provider's historical claim and remit data on the most probable reasons for medical claim denials to predict when claims will deny, in real-time, prior to claim submission. Billing teams can review denial predictions within their existing claim review workflows,” says Smith. “The design is incredible, allowing teams a seamless workflow integration with almost zero additional training.” “When denials do occur,” Smith continues, “AI Advantage - Denial Triage provides a predictive score based on the likelihood of recovery. Many denial follow-up teams prioritize working denials based on the highest charge amount. While that seems like a logical approach, there's a better way: segmenting by likelihood of recovery to drive priority and accelerate cash flow and recovery rates.” Q4: How is AI Advantage different from using human intelligence to predict and triage claim denials? “In some ways, it's quite similar,” Smith explains. “I was a director of billing for several years before I came to Experian Health. Often, one of the more senior billers would come to me and say, 'Hey, we're starting to see a trend with this payer, or with this denial reason code. We probably need to talk to our payer representative about this.' AI Advantage uses machine learning to identify these trends with greater speed and effectiveness, system-wide and in real-time. “Without this tool, one biller could see a denial happening twice and think nothing of it, while the biller sitting next to them is experiencing the same thing. This technology compiles all of this information together and identifies the holistic picture, so everyone benefits and trends don't go undetected.” Using AI in claims processing can make human teams more productive; it may help them feel empowered as well. Schneck Medical Center saw an average 4.6% monthly reduction in denials after six months of using AI Advantage. “Our people spend hours and hours on the phone with insurance companies fighting for dollars on claims we believe [are payable],” says Skylar Earley, Director of Patient Financial Services at Schneck. “Any leg up we can give our team members is a big, big deal.” Watch the webinar to hear from Eric Eckhart of Community Regional Medical (Fresno) and Skylar Earley of Schneck Medical Center as they discuss how their organizations use AI tools for claims management. Q5: What types of denials can providers expect to prevent, versus those that will continue to be denied? “Overall, the answer depends on a few things: an organization's healthcare claims denial management processes and ability to change on the one hand, and payer requirements on the other,” Smith says. “Too often, providers say they're just playing the game that payers put forward, simply so they can get paid what they are contractually owed.  As an industry, we cannot continue to accept this as the status quo. We'll find ourselves and our communities in a worse position to access healthcare.” Organizations that are willing to adopt new technology and be agile with their denial strategies can reduce their denial rates, even in a constantly changing environment. “I've seen the most success in denial prevention with eligibility, authorization, and technical billing categories,” says Smith. “But AI and machine learning are opening the door for new potential strategies that are more effective, more efficient, and more productive.” Q6: Clearly, claim denials affect providers, but patients also have a stake here. How do denied claims interfere with a positive patient experience? “There's definitely a patient impact,” says Smith. “Medical billing is already confusing, and a lot of people just don't understand their insurance to begin with. Add in potential denials and bills that seem to keep coming for months and months before getting resolved, and patients are bound to feel frustrated. Getting claims right on the first submission solves many of these issues up front. It reduces anxiety and makes for a much better patient experience overall.” Adding AI to the claims management toolkit Understanding how to avoid claim denials is a priority with good reason: Minimizing denials can improve revenue, lighten the burden on staff, and even help maintain a positive patient experience. Marginal changes make a difference: Smith notes that an increase in denied claims from 10% to 12% at an organization with $500 million in gross patient revenue represents a $2 million impact. Adding AI tools doesn't eliminate all the challenges of managing healthcare claims, but it does help equip providers for the current environment—and the future. Learn more about how AI Advantage can help providers prevent denials, improve the likelihood of reimbursements, and prioritize denied claims for reworking more efficiently and effectively.

Too often, resource pressures force providers to treat revenue cycle management as a reactive process. But with avoidable denials leaving thousands of dollars on the table, fixing problems after the fact is often a more expensive strategy. Investing in prevention on the front end can help providers minimize the risk of future revenue loss. This article looks at how providers can use automated prior authorizations to drive front-end revenue cycle growth, and fix revenue leaks before the denial dam bursts. Understanding the front-end of the revenue cycle Revenue cycle management includes all the activities involved in making sure hospitals and health systems get paid for their services. The front end of the revenue cycle includes the non-clinical processes that take place before a patient receives care, broadly referred to as 'patient access.' This can be broken into four stages: Scheduling and registering for care, including checking all patient information is current and correct Verification of insurance eligibility and benefits, to ensure planned services will be covered by the patient's plan Obtaining prior authorizations, to prevent claim denials Collection of co-pays and deductibles from patients before or at the point of service. Billing and claims management workflows must be set up so patients, payers and front- and back-office teams can share the information needed to expedite reimbursement. Accuracy and efficiency are essential at each stage of the front-end of the revenue cycle to prevent bottlenecks, errors and delays down the line. The longer errors lurk in the workflow, the more opportunities they have to damage the health system's financials. Front-end errors lead to denied claims later and more work for back-end staff Prior authorizations are a prime example: failure to secure the correct authorizations for treatment or services ahead of time can result in claims being rejected by payers. Time-consuming rework compounds the loss with hefty staffing and outsourcing bills. By the time the provider gets the amended paperwork in order, they've lost all leverage with the payer. It's a major concern as denial rates increase. Here are a few common prior authorization pitfalls to watch out for: The patient provides incorrect insurance information, which means the provider may fail to seek authorization from the right payer Inefficient operations and poorly defined processes allow inconsistencies and admin errors, such as wrong billing codes or misspelled names, to pass through the system undetected Frequent changes to payer requirements can be missed, so providers are working with outdated information Authorizations aren't obtained for the patient's entire treatment plan, leading to rework and treatment delays. A survey by the Association for Clinical Oncology found that 96% of respondents had seen a patient's care delayed because of prior authorization issues. Beyond these worrying harms to patients, the survey also revealed that 47% of practices spent more than 40 hours a week dealing with authorizations. Exploring solutions that will speed up prior authorizations can mitigate or eliminate these errors and delays. Front-end revenue growth starts with efficient prior authorizations As one of the top three reasons for denials given by providers in the State of Claims 2022 survey, prior authorizations are a logical target for front-end improvements. Prior authorization software helps providers get ahead of the above pitfalls by flagging authorization requirements early. Patient access teams can detect and resolve potential errors before they escalate, reducing the risk of rejected claims and appeals. Neeraj Joshi, Director of Product Management, at Experian Health, says that one of the big struggles for healthcare providers is that the prior authorization process is often still manual: “Automation has gained traction in many tasks within the revenue cycle, from patient access to claims management, but shifting to automated prior authorizations could offer one of the biggest returns on investment. Manual authorizations are time-consuming, error-prone and, all too often, a source of miscommunication. Shifting to automated authorization management can eliminate these obstacles and fuel revenue growth.” Experian Health's online prior authorizations solution automates 100% of inquiries, saving valuable staff time. Status checks happen without user intervention. Patient and payer data is auto-filled automatically, and users are guided through the workflow and prompted to make manual interventions only when absolutely necessary. Users can have confidence in the accuracy of the pre-filled data because the tool taps into Experian Health's Knowledgebase, which stores and updates national payer requirements in real-time. Users can also customize local and community rules, so no requirements slip through the net. By reducing costly denials and lowering labor costs, these set the stage for sustainable growth throughout the rest of the revenue cycle. How online prior authorizations can improve end-to-end revenue management Obtaining prior authorizations more efficiently is just the first step toward building a thriving revenue cycle. The promise of fewer denials might steal the headlines, but the benefits of automation resonate throughout downstream processes. For example, an automated online system enhances wider pre-registration processes by giving staff real-time visibility into the likelihood of a treatment being authorized. Staff can verify approval instantly, rather than turning patients away at check-in. This also makes it easier to generate accurate, upfront estimates of what the patient will owe, so they can plan for their own financial obligations. A positive patient experience can lead to faster patient collections and higher retention rates, which both boost revenue growth in the long run. Another ripple effect comes from the early verification of patient and payer information. These processes can surface data errors that, if left unchecked, could impede effective claims and billing workflows. This shows how a single authorization can have an outsized effect on overall revenue management performance – and why it's so important to get authorizations right the first time. Front-end efficiencies lead to a more predictable revenue cycle Providers that choose to use prior authorization software can amplify the benefits by integrating it with other online and automated solutions. Experian Health's prior authorizations tool fits seamlessly with the eCare NEXT® revenue cycle suite, which automates the entire revenue cycle workflow from insurance eligibility verification to secure patient payments. The interoperability of these tools means data can be shared from one system to another with ease, and reports can be generated and viewed on a single dashboard. With better data and analytics, users can make better predictions about their revenue cycle performance and find opportunities for further improvements. Similarly, providers can leverage the predictive power of analytics with AI-based technology. Experian Health's new AI-driven claims management solution, AI Advantage™, uses AI to predict claims that are likely to be denied, based on historical payment patterns. It checks for any undocumented payer adjudication rules, including prior authorization requirements, to make sure no essential information is missing before the claim is submitted. In a recent webinar on the future of claims management, Skylar Earley from Schneck Medical Center shared his experience with the new technology. He attributes the tool's success to its ability to make increasingly accurate predictions: “Since implementing this technology, we're continuing to see AR days decrease at our organization. One result that we're really excited about is seeing the number of authorized outpatient visits increase by about 2.5%. For anyone that deals with prior authorizations and denials related to prior authorizations, this is incredibly promising.” As authorization requirements increase in volume and complexity, providers need to be proactive in their response. Automation and digital technology can arm providers with the data and tools they need to speed up prior authorizations and drive revenue growth from step one in the revenue cycle. Find out more about how prior authorization software can support efficient front-end revenue cycle processes by creating opportunities to maximize cash flow from the start.