All posts by Kelly Nguyen

Convenience, speed, and control are the triad of better patient experiences. Experian Health's 2024 State of Patient Access survey showed that 89% of patients want to schedule their appointments online or on a mobile device. Today, patients expect provider scheduling, registration, and other administrative tasks to match the convenience of their typical online shopping experience. However, too many patients face obstacles when booking appointments and accessing care. With more than 6 out of 10 patients saying they would switch to a provider that offers a patient portal, making digital channels available is now a baseline requirement for providers seeking to improve care delivery. Patients want a digital front door that circumvents the inconvenience of traditional call center booking systems. Self-service patient scheduling software helps providers keep pace with patients' digital demands. But the case for scheduling software goes beyond these expectations, offering real benefits for patients and their doctors. Here are 8 reasons to use online scheduling to benefit both patients and providers: The benefits for patients 1. Patients enjoy the convenience and accessibility of online scheduling Online appointment scheduling provides unparalleled convenience and accessibility for patients. These solutions allow them to schedule their appointments anytime, without being constrained by office hours. This flexibility benefits individuals with demanding work schedules, family responsibilities, or other commitments. The user-friendly interface of online scheduling platforms enables patients to quickly navigate the system, select their desired service, and book an appointment without any hassle. Additionally, remote access means that patients can schedule their appointments from any device with internet connectivity, whether at home, work, or on the go, eliminating the need for physical visits or phone calls. 2. Patients can experience reduced wait times and greater access to care Nearly 8 in 10 patients who say they're unhappy with their provider experience cite the speed at which they see their doctor as a big frustration. By using online appointment scheduling, patients can significantly reduce their wait times. They have immediate access to the real-time availability of appointment slots, allowing them to choose the most convenient times without waiting for a receptionist to check the calendar. The streamlined booking process minimizes the back-and-forth communication typically required when scheduling via phone, leading to quicker confirmation and less time spent coordinating. Patients who need to reschedule can easily do so online, viewing available slots and selecting a new time without delays. 3. Patients can schedule anytime and from anywhere One of the most significant advantages of online appointment scheduling is its 24/7 availability. Patients can book appointments anytime, including evenings, weekends, and holidays. This flexibility primarily benefits those who find making calls during standard office hours challenging. With the ability to address their scheduling needs instantly, patients can book or change appointments whenever it is most convenient for them. Additionally, for practices serving patients in multiple time zones, online scheduling ensures everyone can book appointments at a time that suits them best. 4. Online scheduling provides immediate confirmation, reducing uncertainty and the need for follow-up Online scheduling provides patients with instant confirmation of their appointments, offering real-time updates that reduce uncertainty. Once an appointment is booked, patients receive immediate confirmation, often via email or SMS, which helps to alleviate anxiety and ensure they know their appointment is secured. Many online scheduling systems also offer automated reminders via email, SMS, or app notifications to help patients remember their appointments and reduce the likelihood of missed visits. This instant confirmation and reminder system also reduces the need for administrative staff to follow up with patients to confirm appointments, freeing up their time for other tasks. The benefits for providers 5. 24/7 self-scheduling increases appointment bookings and reduces no-shows One of the major challenges healthcare providers face is the issue of patient no-shows. According to the Medical Group Management Association (MGMA), the average provider no-show rate is 5% to 7%. The cost to healthcare providers is around $150 billion annually. Yet there is growing evidence that allowing patients to conveniently and quickly schedule, cancel and reschedule appointments decreases no-shows, which is money in the bank for providers. Studies at the Mayo Clinic and Johns Hopkins showed that the percentage of appointments kept increased when patients scheduled their visits online. Automated reminders and confirmations are integral features of online scheduling systems that help mitigate this problem. By sending reminders via email, SMS or app notifications, these systems ensure that patients know about their upcoming appointments. These reminders reduce the likelihood of patients forgetting their scheduled visits, decreasing missed appointments. Fewer no-shows translate to more consistent patient flow and better utilization of the provider's time and resources. 6. Digital scheduling reduces pressure on staff The convenience factor extends beyond patients. Self-scheduling platforms also improve efficiency and ease the burden on call center staff. Experian Health's “Short-staffed for the long term” report showed that 73% of providers say finding staff is challenging. As the chronic staffing crisis continues, providers should look to automated solutions to remove bottlenecks, increase capacity and improve the experience for call center staff. After partnering with Experian Health, Indiana University (IU) Health found that automated self-scheduling helped them do more with fewer staff while engaging patients. They stated, “Self-scheduling does the work of two full-time schedulers.” Of the patients who used the online scheduling tool, 87% arrived for their visit. Patient appointment scheduling software offloads call volumes and cuts call times in half. It also gives providers control over their calendars while integrating seamlessly with electronic medical records and practice management systems. Providers can also use these solutions in parallel to patient intake software to help accelerate registration, saving even more valuable time and resources. 7. Embracing digital scheduling gives providers a competitive edge Getting patient scheduling right is crucial to patient acquisition and retention strategies and is increasingly vital as patient volumes fluctuate. Making a strong first impression with easy self-scheduling is more likely to attract new patients and gives providers a competitive edge. Online appointment scheduling systems allow healthcare providers to manage their schedules more effectively. Providers can easily view and optimize appointment slots, ensuring effective time utilization. These features improve workflows and productivity as providers can balance their schedules to avoid overbooking or underutilization. Additionally, the ability to analyze scheduling data can help providers identify peak times and adjust their staffing and resources accordingly, further enhancing operational efficiency. In a competitive healthcare market, staying ahead of the curve with advanced technology solutions like online scheduling is crucial. Providers who embrace digital scheduling not only improve their operational efficiency and patient satisfaction but also position themselves as leaders in the industry, attracting tech-savvy patients who seek modern and convenient healthcare services. 8. Patient scheduling software can protect against the unexpected A final reason to embrace patient scheduling software is to future-proof scheduling capacity against unforeseen events. During the COVID-19 pandemic, flexible self-scheduling tools helped providers maintain operational stability as patient numbers surged with each new wave of infections. In a climate of chronic staff shortages, augmenting employee numbers is challenging and can be impractical to manage during periods when patient volumes subside. Patient self-service software is a DIY solution patients want, and providers need to stretch staff efficiency and work smarter. Today, these tools continue to improve, and providers increasingly rely on them to meet patient needs. A 2024 survey showed that 60% of patients want more digital tools to manage their health. Patient scheduling software gives patients the self-service experience they're accustomed to with 24/7/365 online appointment scheduling. New uncertainties will always be on the horizon, but with the right digital patient scheduling software, providers will be well-positioned to face whatever's next. Learn how Experian Health's patient scheduling software can help healthcare organizations meet patient expectations, improve operational efficiency and prepare for future patient scheduling demands.

“For too many, coverage is either unavailable or insufficient.” This is the harsh reality the American Hospital Association highlighted in a recent statement to the US Senate, urging action to address growing medical debt. Despite efforts to expand insurance coverage, hospitals continue to lose billions of dollars through unpaid bills. The statement notes that hospitals provided over $42 billion in uncompensated care in 2020 alone. Guiding low-income patients to appropriate charity care programs can mitigate a significant portion of this uncompensated care. Unfortunately, many eligible patients are either unaware of these options or choose not to apply, causing hospitals to waste time and money chasing bills from people who cannot afford to pay. Helping those patients find and apply for financial support is critical to reducing bad debt. But that's a challenging prospect without automation. Presumptive screening with Patient Financial Clearance offers a faster route to reliable charity care classifications and a reduction in uncompensated care. What is charity care? Charity care programs provide free or discounted healthcare to patients who can't afford to pay their bills, covering medically necessary inpatient and emergency room services. Typically, programs offer full or partial discounts to uninsured patients, but those with insurance may be entitled to assistance if their plan doesn't cover their care. Eligibility depends on the hospital's financial assistance policies and relevant state regulations. Hospitals do not expect to be reimbursed for charity care, though tax exemptions and government funding may offset some of the cost. In this way, charity care is distinct from “bad debt,” which refers to unpaid patient bills that hospitals expect to collect. Frustratingly, too many accounts that could have been eligible for charity care are written off to bad debt—perhaps because patients don't realize they're eligible, don't know how to fill out the application, or feel embarrassed to seek help. The problem is further exacerbated by the growth in high-deductible and “skinny” health plans, as patients without sufficient coverage assume support is only for the uninsured. Several states are tackling medical debt by bolstering charity care programs. For example, North Carolina plans to boost federal payouts to hospitals that agree to waive medical debt for low-and middle-income patients. In Milwaukee, County Supervisors are taking a preventive approach, using income data to automatically enroll at-risk patients into charity care programs to stave off bad debt before it takes root, in a process known as presumptive charity. What is presumptive charity? Checking eligibility and helping patients apply for charity care is predictably form-heavy. Patients must provide tax returns, pay stubs, and bank statements to confirm their household income and financial status. Manual reviews are time-consuming for providers, while the overall experience can feel intrusive or confusing to patients. Presumptive charity screening expedites charity care checks by automatically screening patients for financial assistance eligibility. It uses automation and data analytics to quickly evaluate the patient's credit information, financial data and demographic details to make a 'presumptive' determination of eligibility for charity care, regardless of coverage status. Better charity care classifications reduce bad debt Automated charity care checks mean more patients will be classified correctly so hospitals can confidently seek reimbursement from the appropriate source. This offers several advantages, such as: Reducing bad debt: Presumptive charity screening results in fewer eligible patients missing out on financial support, so they're less likely to be sent bills they can't pay. Increasing efficiency: More accurate screening allows staff to cut time spent on administrative tasks and stop chasing collections from patients who are unlikely to be able to pay. Expediting classification decisions: Automation means eligible patients don't have to wait for long periods to find out if they'll get financial support, which is especially important in urgent and high-volume services, such as emergency departments and large hospital systems. Improving the patient experience: Speedy systems with fewer forms reduce the patient's involvement to a minimum, contributing to a more convenient and compassionate financial journey. Maintaining compliance: Hospitals comply and maintain their non-profit status by providing charity care to their community. Supporting patients: Providing accessible healthcare to those who are low-income and are most vulnerable. How can Patient Financial Clearance help providers improve charity care classifications? Patient Financial Clearance (PFC) is a presumptive screening tool designed to help providers quickly determine which patients may be eligible for financial assistance. It then connects those patients with relevant charity care programs and automatically enrolls them, or establishes tailored payment plans for the amount they owe based on their financial situation. First, Patient Financial Clearance triggers automatic checks before or at the point of service to rapidly assess whether the patient qualifies for Medicaid, charity care or other financial assistance programs. It uses Experian Health's superior data and analytics to accurately estimate the patient's income, household size and Federal Poverty Line (FPL) percentage, and it calculates a Healthcare Payment Risk Score to predict their propensity to pay. Unlike alternative models which are built to estimate incomes for consumers with higher incomes, PFC's income estimates are optimized to predict incomes below 400% of the FPL. Then, if patients are likely to be eligible for charity care, the tool pre-populates application forms and initiates auto-enrollment to reduce staff manual input and the risk of errors. There needs to be a prompt process to help patients who do not qualify for charity care manage their bills. For patients who do not qualify for charity care, there also needs to be a prompt process to help. Patient Financial Clearance recommends optimal payment plan amounts per the organization's terms and policies. Staff can pull up summarized and detailed views of the patient's credit history and custom scripts to guide financial counseling discussions. Alex Liao, Product Manager for Patient Financial Clearance at Experian Health, explains how better charity classifications help reduce bad debt and increase collections: “The obvious benefit is that clients can accelerate the charity care application process and ensure eligible patients get assistance quickly. However, having a more accurate picture of patients' financial needs offers wider benefits across the revenue cycle: it ensures each patient account is handled appropriately to increase upfront collections and reduce bad debt. Those with a low ability to pay receive a payment plan they can afford, while those with a greater capacity to pay are not just paying the minimums.” Patient Financial Clearance in practice See how UCHealth used PFC to create a more streamlined approach to charity care classifications, resulting in: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). To hear more about how automating charity care classifications with Patient Financial Clearance could help your organization reduce bad debt, contact us today for a demo. Patient Financial Clearance Contact us

The fine line between getting paid what they're owed and delivering compassionate care puts patient collections among the top challenges for providers. Improvements to collections processes feature prominently in Experian Health's most recent State of Patient Access survey: 94% of providers pointed to the need for more accurate patient estimates, while equally many want faster, more comprehensive insights into what patients' insurance actually covers so they can make the billing process easier for everyone. The challenge is even starker when the patient's perspective is considered. More than four in ten patients are so worried about the bill that will later land on their doorstep that they’d avoid care altogether. Even those who have insurance are struggling: 53% of total bad debt write-offs in 2023 came from patients with some form of insurance. As healthcare becomes more expensive, insurance becomes more complex, and patients become more cost-conscious, providers must find ways to improve the patient collections processes. This article looks at how technology can bridge these competing demands. What are patient collections in healthcare? Patient collection processes cover all the steps involved in calculating, invoicing and obtaining payment for the amount the patient owes for their healthcare treatment. Figuring out the patient's financial responsibility starts when the patient registers for care and when the provider can check for active insurance coverage. Once verification and eligibility processes are complete and the provider knows how much of the total cost will be covered by an insurer (if any), they can estimate the patient's responsibility. The earlier this happens, the better. What makes the process so complex is the number of moving parts: Payer policies change regularly, and staff must keep up to date or there will be gaps and errors in claims submissions and patient estimates Healthcare costs are increasing, leaving providers with tighter margins and less room to maneuver Patients are increasingly worried about whether they can afford healthcare, as household bills continue to increase despite economic improvements Patients expect a wider range of payment options, with 72% of patients emphasizing the need for online and mobile payments to enhance their health experience. Billing staff cannot tell which patients are able and likely to pay due to insufficient data on patients' economic and credit history. Part of the problem for healthcare providers is that their systems are geared more toward traditional collections from government or private payers. Still, the average patient's responsibility is at an all-time high. For healthcare providers to increase the volume of revenues they collect from patients, they must invest in technologies that provide consumers with a frictionless payment experience. How can patient billing and collections be improved? One way to think about improving patient collections is to break it down into its parts: How to calculate and communicate more accurate, upfront estimates to patients How to figure out a patient's propensity to pay based on segmentation data How to compile and share clear and comprehensive bills and financial statements How to offer patients various digital and mobile options to make prompt payments. Advanced technology offers solutions for each step, while creating a seamless experience overall. In a recent byline, Clarissa Riggins, Chief Product Officer at Experian Health, says that manual systems can't cut it any longer: “It's time to move away from the notion of collections as a one-off, manual and labor-intensive process. Instead, let's view it as a part of an ecosystem that begins before patients receive treatment, starting with upfront, self-service payment options and early screening of patients for potential coverage. In this way, we can transform collections from a destination into a process—and perhaps, by doing so, we can even put our traditional collections departments out of business.” How does technology improve patient collections? Prompt and accurate patient estimates Almost nine in ten providers agree that providing accurate, up-front estimates improves patient collections success. Patient Payment Estimates give patients the expected cost of care ahead of time, so they're in a stronger position to plan – and providers get paid faster. Automated estimates increase revenue and help providers stay on the right side of compliance with rules and regulations. Analytics-based collections optimization When compiling accurate bills to patients and payers, providers have a wealth of technical options at their disposal. For example, Collections Optimization Manager uses in-depth data and advanced analytics so providers can identify patients most likely to pay and ensure patient accounts are handled most efficiently. Patients are segmented by propensity-to-pay scores based on behavioral, demographic and credit data. This supports tailored billing and collections strategies and improves financial outcomes by identifying patients most likely to pay and ensuring patient accounts are handled most efficiently. Case study: See how St Luke's University Health Network used Collections Optimization Manager to improve patient engagement and boost cash collections by 22%. Quick and convenient ways to pay Riggins says that improving payment processes is a significant step toward maximizing patient collections in healthcare. Previous research has shown that while credit and debit cards are the most popular payment methods, patients would use them less often if their preferred digital options were available. Providers should consider digital tools such as PaymentSafe® to offer patients fast, frictionless and secure payment options across multiple collection points, including interactive voice response, mobile, kiosks and patient portals. Automating patient outreach to increase collections Another use case for patient access technology is in facilitating direct and efficient communications with patients while reducing the workload for staff. Automated patient outreach tools such as PatientDial and PatientText send patients timely bill reminders and self-pay options via voice or text message to increase collections without the need for agent interaction. These tools bring more dollars in the door while reducing operational costs: PatientDial helped Experian Health's clients collect over $50 million in one year via automated call campaigns, saving many thousands of labor hours compared to manual outreach. Personalizing payment plans for every individual From the patient's point of view, a winning strategy calls for transparency and personalized support. Creating a collections process that accommodates patients' individual circumstances will increase revenue while improving the patient's financial experience. For example, Patient Financial Clearance analyzes each patient's financial situation and creates a personalized payment path that fits their needs. It screens self-pay patients to identify those who need extra support and reroutes them to the proper channels. Where relevant, providers can then offer the option to pay in more affordable installments or connect the patient to financial assistance programs. Together, these tools improve collections by streamlining how patients pay – and how providers get paid. Maximize patient collections with Experian Health Walking the patient collections tightrope demands that providers take bold action and experiment with new approaches. That might feel risky when the stakes are so high, but working with a trusted vendor with experience in delivering leading patient collections solutions should ease concerns. Experian Health's suite of collections management and secure, reliable payment solutions integrate easily with existing systems and processes for a seamless end-to-end collections experience. Contact us today to learn more about maximizing patient collections in healthcare with Experian Health's leading collections management technology.

Maintaining a healthy cash flow is the only way to deliver quality patient care, invest in state-of-the-art technologies and keep daily operations running smoothly. But that's easier said than done: data errors, delayed payments, denials and staffing disruptions leave providers vulnerable to escalating admin costs and revenue leakage, with little left over to reinvest. By adopting a few key revenue cycle management (RCM) strategies, providers can sidestep these challenges and bring in more dollars. This guide summarizes five revenue cycle management best practices healthcare leaders should follow to optimize RCM workflows and promote financial stability. Key challenges in revenue cycle management Common issues that can get in the way of a healthy revenue flow include: Inaccurate patient data leading to coding errors, claim denials and billing delays Increasing numbers of denied claims generate costly rework and wasted time Payer compliance issues that are constantly changing and time-consuming to monitor Growing numbers of self-pay patients struggling to pay their bills Labor shortages increase pressure on staff and leave the door open to sub-par performance Inadequate data insights hindering management's ability to spot opportunities for improvement Rapid technological changes leave providers on the back foot if they fail to keep pace with new developments. The dream scenario would be to avoid all these potential obstacles before they do too much damage. In reality, providers will need to choose a few priority areas to troubleshoot. Check out this guide to choosing the right key performance indicators for your revenue cycle dashboard to ensure the effective implementation of RCM strategies. Revenue cycle management best practices What does a successful revenue cycle look like? For busy RCM leaders, deciding what to tackle first can be overwhelming. While there's no one-size-fits-all RCM strategy, there are a few key issues that all organizations must pay attention to. Here are five areas of best practice to factor in: 1. Streamline patient registration and insurance verification Accurate patient data is the number one factor in building a robust revenue cycle. It doesn't matter how efficient claims management and collections processes are if the data they use is flawed. Automated registration and verification tools reduce the chances of manual errors entering the system to ensure correct billing, reduce denials, and speed up reimbursement. One pitfall to watch out for is the fact that some digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility. Experian Health's latest patient access solution, Patient Access Curator, avoids this by using AI-driven technology to collect and verify patient information with a single click. 2. Automate claims submission and management According to Experian Health's State of Claims 2022 report, 62% of providers feel they lack the necessary data and analytics to identify issues in claims submission processes. A similar number believe the absence of automation prevents improvement. The CAQH Index backs this up, with the latest estimates suggesting the healthcare industry could save $18.3 billion by switching to electronic transactions. As with patient intake, there's an opportunity to leverage automation in claims management to prevent errors and delays so the organization gets paid faster. Experian Health's claims management products—ranked #1 in 2024 surveys by both KLAS and Black Book—automate each step of the claims workflow so providers can submit clean claims quickly and cut the need for time-consuming manual work. 3. Optimize denials management and appeals with AI Despite best efforts, claims denials remain a burden for many RCM teams. However, proactively understanding and addressing the root causes can help keep denials under control. There's an opportunity to go a step beyond automation and see how artificial intelligence and machine learning can help combat the denials challenge. AI AdvantageTM evaluates individual claims in real time to flag those with a high likelihood of denials based on historical payment data, so staff can intervene quickly before submission. Denials are then triaged using advanced algorithms so staff can focus on reworking denials with the greatest chance of payment, rather than wasting time on those that are never going to be approved. Eric Eckhart, Director of Patient Financial Services at Community Medical Centers in California, says that since implementing AI Advantage, “Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in-house and save money. The savings have snowballed. That's really been the biggest financial impact.” Watch the webinar: Hear how Community Medical Centers and Schneck Medical Center are using AI AdvantageTM to prevent and triage denials. 4. Choose the right technology and tools for enhanced RCM The three previous revenue cycle management best practices emphasize the importance of selecting the right tools for the task. Two things to look out for when adopting a new RCM product are how well it integrates with existing tools and systems, and whether it offers meaningful insights to drive ongoing improvements. Experian Health's integrated RCM solutions are designed to fit together seamlessly, often allowing staff to view information from multiple workflows within the same dashboard. By bringing together metrics such as financial performance, billing efficiency and collections rates into one place, these tools help staff make strategic decisions about resource allocation and operational improvements. 5. Keep up with regulatory compliance Finally, ensuring compliance with regulatory requirements cannot be overlooked. The reputational and financial risks are too great. Regular training for staff on compliance issues and maintaining up-to-date knowledge of government and payer requirements will minimize the risk of penalties. Choosing RCM tools that automatically check for relevant updates can help providers stay current. Price transparency is a topical example. While the Hospital Price Transparency Rule is designed to help healthcare consumers understand healthcare costs and make more informed decisions about their care, implementation has proven tricky for providers. With the right technology and third-party support, it's much easier to stay compliant. Watch the webinar: See how Experian Health and Cleverley & Associates have partnered to help healthcare organizations navigate price transparency in 2024. Looking for more insights into revenue cycle management best practices? Contact Experian Health today to discover how our RCM solutions can transform your revenue cycle and increase cash flow year over year. Revenue cycle management solutions Contact us

While the healthcare industry remains hesitant about automation, there's one area where digital tools have already proven their worth: patient intake. According to Experian Health's State of Patient Access survey, almost 90% of patients say they welcome digital patient registration, reflecting the growing demand for efficiency and convenience. Staff frustration with mounting paperwork and poorly coordinated manual systems also points to an urgent need for a better way of working. The case for switching from traditional to digital patient intake systems is pretty compelling, even before factoring in potential cost savings. For providers still taking a “wait-and-see” approach, it may be worth considering how digital patient intake could address some of the most common challenges associated with traditional registration methods, such as the following: 1. Online registration can prevent missed opportunities for patient bookings Patients' number one patient access challenge is seeing their doctor quickly. Too many are stopped in their tracks by slow and inflexible intake processes. Inconvenient booking protocols – often requiring phone calls during limited office hours – deter patents, resulting in sluggish scheduling rates and avoidable gaps in physician calendars. Moreover, traditional systems that treat scheduling and registration as two distinct activities miss the chance to accelerate intake because patients have to fill out the same information multiple times. Digital patient intake streamlines scheduling and registration so patients can book and manage appointments anytime, anywhere. With a mobile-first automated platform, patients can provide essential demographic and insurance information at the point of booking, and fill out remaining registration forms whenever it suits with a single click. When intake is easy, bookings increase. 2. Digital patient access can reduce high no-show rates Quick and convenient intake addresses the related challenge of no-shows, which lead to underutilization of services and delayed patient care. If canceling or rescheduling an appointment is easy, patients are more likely to make that little bit of effort to click the link instead of simply not turning up. With accurate patient data coming in at the start, providers can send automated appointment reminders and tailored messages to coordinate follow-ups, so patients are less likely to forget appointments or misremember referral instructions. 3. Digital patient intake can prevent payment delays and claim denials Inefficient registration means patient information passes through multiple hands, resulting in data entry errors that trickle through the revenue cycle. In a recent Q&A, Barb Terry, Product Manager for Registration Accelerator at Experian Health, talked about the importance of ensuring accurate data from the start: “Waiting until the patient's appointment to collect insurance information doesn’t give providers much time to verify insurance, or to determine the patient’s financial responsibility for copays, deductibles, and out-of-pocket expenses… In previous surveys, 40% of providers have said registration errors are a primary cause of denied claims. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.” With Registration Accelerator, patients receive a text to scan their identity and insurance cards, validating the data in real-time and automatically uploading it into eCare NEXT®. Experian Health's Eligibility Verification and Registration QA tools can then use the same verified data, reducing the risk of manual errors that lead to claim denials. 4. Reduce patient stress caused by unclear costs One of the clearest messages from patients in this year's State of Patient Access survey is the need for upfront, transparent information about costs. A disappointing 64% of patients did not get price estimates before care, and of those that did 14% said their estimates were inaccurate. It's extremely challenging for staff to compile all the data points necessary to calculate patient responsibility using traditional systems. Digital tools that automate patient data capture, insurance eligibility verification, coverage discovery and prior authorizations provide financial clarity quickly and accurately, giving patients peace of mind and reducing the burden on staff. By improving the patient billing and payment experience, providers can reduce financial stress for patients and get paid more promptly. 5. Digital patient intake reduces high operational costs and poor use of staff time Traditional registration systems are full of hidden costs, from the hefty price tags associated with paper forms, storage and printing to the time required of admin staff. These expenses are compounded over time by revenue leakage caused by errors in claim submissions and scheduling delays. Staffing shortages mean many providers simply don't have the human power to handle these challenges using manual systems alone. Again, automation comes out on top. Registration Accelerator eliminates the need to scan, fax and file forms and automatically handles patient check-ins, form returns and demographic updates. It is one of a suite of tools that feed into eCare NEXT®, automating up to 80% of the pre-registration process. A digital helping hand for faster, smarter, more accurate patient intake As patient intake challenges continue to grow, digital patient intake stands out as a practical and proven solution to streamline access to care and stabilize cash flow. With Registration Accelerator, staff can focus on critical tasks that drive revenue and make a positive first impression on patients who are looking for a convenient and compassionate healthcare experience. Find out more about how Registration Accelerator expedites patient intake and solves the operational and financial challenges that come with traditional systems. Learn more Contact us

Healthcare claim denials persist as a significant challenge, impacting the efficiency, affordability and timeliness of healthcare delivery and hospitals' financial well-being. They contribute a substantial portion of the staggering $265 billion annual in waste attributed to administrative complexities. On average, hospitals face a yearly loss of $5 million due to healthcare claim denials, amounting to 5% of their net patient revenue, according to the Journal of AHIMA. Yet it appears that the rise in claim denial rates continues unabated. Experian Health's State of Claims 2022 report revealed that 30% of respondents experience medical claims being denied in 10-15% of cases, and 42% confirm an increasing trend in denial rates from one year to the next. There is no question that the claims denial process is ripe for innovation, and that's where reducing healthcare claim denials with artificial intelligence (AI) comes in. Like many other sectors, healthcare providers are slowly but increasingly turning to automation and AI for more accurate data and better insights. The Experian Health survey shows over one-half of healthcare providers turn to AI-driven healthcare claims management software to reduce claim denials. "Adding AI in claims processing cuts denials significantly," Tom Bonner, Principal Product Manager at Experian Health, explains. AI automation quickly flags errors, allowing claims editing before payer submission. It's not science fiction—AI is the tool hospitals need for better healthcare claims denial prevention and management." The current challenges in claims management High patient volumes and complex payer policies Experian Health's 2022 State of Claims survey revealed that reducing denials was a top priority for almost three-quarters of healthcare leaders. Why? High patient volumes mean there are more claims to process, and changing payer policies and insurance coverage compound an already overwhelming problem. An Sg2 report predicts that patient volume issues will continue over the next decade, with inpatient hospital volumes growing by 2%. This rise in patient numbers will require more data for claims management processing. Hospitals, often short-staffed, will have to allocate more resources to ensure claim approval and increase efforts to address claims denial. In addition to managing increasing patient volumes, keeping track of changing payer coverage and requirements has always been challenging for providers. The inconsistency of these payer rules and communication problems exacerbate the situation. Healthcare providers may need efficient solutions to keep up with these rule changes or allocate more time and resources to addressing and revising claims. Labor shortages and financial pressures According to a data brief from the American Hospital Association, the increasing rate of clinician burnout, the enduring effects of COVID-19, and ongoing strains on the healthcare workforce are compelling hospitals to recognize and tackle chronic labor shortages. Notably, 80% of healthcare leaders acknowledge that chronic staffing shortages present significant risks for their organizations. Increasing denial rates is one way these risks manifest. As the State of Claims 2022 report confirms, 30% of respondents mentioned staffing shortages significantly contribute to healthcare claim denials. Additionally, Experian Health's recent survey, Short Staffed for the Long-Term, which investigated the impact of healthcare staffing shortages, found that 70% of respondents facing staff shortages also experienced increasing denial rates. Labor shortages mean fewer hands on deck to deal with the claims processing workload, while financial pressures on hospitals mean the stakes are higher than ever to solve the problem of claim denials. Limitations and costs of manual claims processes Health payers deny hospital systems about $260 billion worth of inpatient claims annually. According to Experian Health's survey, manual processing and a lack of automation are the primary reasons for these medical claim denials. The State of Claims 2022 report found that 61% of respondents do not automate claims submission and denial prevention processes, leaving them to rely on manually processing claims. However, manual claims management tools simply cannot keep up with the complexities and data-intensive nature of claims processing. When claims processes are handled manually, healthcare workers are burdened with cumbersome tasks that could have been automated, there is a higher risk of errors that lead to claims denial, and there'll be more need to dedicate extra time and effort to appeal denied claims. These intensive steps necessary for manual claims processing drain staff resources and create opportunities for money and time waste that are eventually detrimental to the hospital's financial circumstances. How AI and automation address healthcare claim denials Automation and AI can ease the pressure by processing more claims in less time. They give providers better insights into their claims and denial data so they can make evidence-based operational improvements. AI tools achieve this by using machine learning and natural language processing (NLP) to identify and learn from data patterns and synthesize huge data swathes to predict future outcomes. While AI is ideal for solving problems in a data-rich environment, automation in claims processing can complete rules-based, repetitive tasks with incredible speed and reliability that a person might not achieve. By using automation and AI in claims processing, healthcare providers can gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. Tom Bonner says, "AI in healthcare claims processing maximizes the benefits of automation for better claims processing, better customer experiences and a better bottom line for healthcare providers." However, the pace of AI adoption is somewhat slower in healthcare due to legacy data management systems and data silos. As efforts to improve interoperability progress, providers will have more opportunities to deploy AI-based technology. This prediction is already evident in claims management, where executives are keeping an ear to the ground to learn of new use cases for reducing claim denials with AI to help maximize reimbursements. Key benefits of AI in healthcare claims management Healthcare claims management upgraded with the inception of AI-driven healthcare claims management software exponentially benefits claims management through its predictive, accuracy, and error-reduction capabilities. Predictive Analytics and Pattern Recognition: The benefits of AI in healthcare claims processing lie in the ability of AI-driven solutions to predict potential issues before they occur by analyzing claims and providing a probability of denial that allows the end user to intervene and determine the appropriate collection. AI can analyze patterns in historical claims data to predict future volumes and costs, so providers can plan accordingly without simply guessing at what’s to come. Error Reduction and Clean Claim Submissions: AI can also assist in identifying inaccurate claims and improve claims processing accuracy to ensure clean claim submission and efficient revenue cycle management. Case studies and real-world applications AI and automation in claims processing are helping healthcare providers overcome the challenges contributing to increasing claim denial rates. Experian Health's AI-driven and automation solutions, like AI Advantage™, enable clients to benefit from the full potential of AI and automation to minimize claim denials. How Community Medical Centers uses AI Advantage to predict and prevent healthcare claim denials Community Medical Centers (CMC), a non-profit health system in California, uses Experian Health's new solution, AI Advantage, which uses AI to prevent and reduce claim denials. Eric Eckhart, Director of Patient Financial Services, says they became early adopters to help staff keep up with the increasing rate of denials, which could no longer be managed through overtime alone. "We were looking for something technology-based to help us bring down denials and stay ahead of staff expenses. We're very happy with the results we're seeing now." AI Advantage reviews claims before they are submitted and alerts staff to any likely to be denied based on patterns in the organization's historical payment data and previous payer adjudication decisions. CMC finds this particularly useful for addressing two of the most common types of denials: those denied due to lack of prior authorization and those denied because the service is not covered. Billers need up-to-date knowledge of which services will and will not be covered, which is challenging with high staff turnover. AI Advantage eases the pressure by automatically detecting changes in how payers handle claims and flagging those at risk of denial so staff can intervene. This reduces the number of denials while facilitating more efficient use of staff time. Eckhart says that within six months of using AI Advantage, they saw 'missing prior authorization' denials decrease by 22% and 'service not covered' denials decrease by 18% without additional hires. Overall, he estimates that AI Advantage has helped his team save more than 30 hours a month in collector time: "Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in-house and save money. The savings have snowballed. That's really been the biggest financial impact." How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Providence Health is a prominent health system with 56 hospitals and over 1,000 physician clinics, serving an annual patient volume of over 28 million. This magnitude of patient volume created greater issues with slow and manual payer eligibility processes and increased eligibility denials. Furthermore, in response to Epic's growing payer plan table, Providence Health sought an effective solution to merge and organize data on insurance plans, contracts, and reimbursement details and automate eligibility tracking within the system. Their search led them to Experian Health's Insurance Eligibility Verification solution. According to Emily Brown, Director of Operation Excellence, "Our search for a solution that seamlessly integrates with Epic led us to choose Experian as our preferred vendor, given their proven track record of working with Epic." Providence Health implemented Experian's Eligibility solution, including a Bad Plan Code Detection tool to catch coding errors before submission. The solution also allowed them to stay connected to over 900 payers and provide backup connectivity to over 300 additional payers for uninterrupted service. The solution's automated work queues also helped staff work more efficiently. Providence reduced denial rates, saving $18 million in potential denials in 5 months of implementing Experian's Eligibility solution. The tool also helped them find $30 million in coverage annually while reducing staff workload. How Schneck Medical Center prevents and triages denials with AI Advantage™ Schneck Medical Center delivers care to four counties in Indiana, supported by a team of over 1,000 employees, 125 volunteers, and close to 200 physicians. According to Skylar Earley, Director of Patient Financial Services, "The challenge we (Schneck Medical Center) sought to overcome by leveraging AI Advantage at our organization was just gaining more insight into how denials originate and what actions we can take to prevent those from happening." Schneck Medical Center collaborated with Experian Health to implement: AI Advantage™ — Predictive Denials and AI Advantage™ — Denial Triage. They aimed to use these tools to identify claims that were more likely to be denied so that the appropriate personnel could address them and clean them before sending them to payers. They also wanted to be able to identify and prioritize denials with the potential for revenue reimbursement that will impact their bottom lines. AI Advantage™ — Predictive Denials enabled team members to make informed and timely decisions before submitting claims. In the first six months of using the tool, Schneck achieved a 4.6% average monthly decrease in denials. The time spent on denials decreased by 4x, and flagged claims were resolved in 3–5 minutes rather than the previous 12–15 minutes per correction. With AI Advantage — Denial Triage, billers were able to redirect their effort on denials more likely to be reimbursed. This prioritization enables them to avoid wasting time on high-dollar claims that are unlikely to be paid. "We had no insight into whether we were performing value-added work when we followed up and worked denials. Now we see those percentages," says Skylar Earley, Director of Patient Financial Services Steps to implementing AI in claims management AI Advantage works in two stages in claims management, reducing claims denial and addressing denied claims to prioritize those with the best value for reimbursement. Stage One: Predictive Denials Stage one is Predictive Denials, which uses machine learning to look for patterns in payer adjudications and identify undocumented rules that could result in new denials. As demonstrated by CMC and Schneck Medical Center, this helps providers prevent denials before they occur. Stage Two: Denial Triage Stage two is Denial Triage, which comes into play when a claim has been denied. This component uses advanced algorithms to identify and segment denials based on their potential value so staff can focus on reworking the denials that will impact their bottom line. Enhancing revenue cycle management with AI Embracing integrated workflows uncovers novel applications for reducing healthcare claim denials with AI and automation. AI Advantage seamlessly works within ClaimSource®, which means staff can view data from multiple claims management tools in one place. These integrations amplify the benefits of each tool, giving healthcare providers better insights into their claims and denial data. With richer data, organizations will find new ways to leverage AI to increase efficiency, reduce costs and boost revenue. Key differentiators In addition to its AI solutions, Experian Health offers solutions that automate claims processing to facilitate claims management and increase efficiency. ClaimSource® helps providers manage the entire revenue cycle by creating custom work queues and automating reimbursement processing. This intelligent healthcare claims management software ensures clean claims before they're submitted, helping to optimize the revenue cycle. The software generates accurate adjudication reports within 24 to 72 hours to speed up reimbursement. ClaimSource ranked #1 in Best in KLAS 2024, for its success in helping providers submit complete and accurate claims. This tool prevents errors and helps prepare claims for processing. Because the claims are error-free, providers can optimize the reimbursement processes and get their money even faster. Another Experian Health solution, Enhanced Claim Status, improves cash flow by responding early and accurately to denied transactions. This solution gives healthcare providers a leg up on denied, pending, return-to-provider, and zero-pay transactions. The benefits include: Provides information on exactly why the claim was denied Speeds up the denials process Automates manual claims follow-ups Integrates with HIS/PMS or ClaimSource Automation frees up staff to focus on more complex claims Denials Workflow Manager integrates with the Enhanced Claim Status solution to help eliminate manual processes, allowing providers to optimize claims submission and maximize cash flow. Using AI and automated solutions to prevent healthcare claim denials There's no question that healthcare claims denials management is an unwieldy, time-consuming, and ever-changing process. Reimbursement is complex, but human error plays a large part in missed opportunities and lost revenue. The revenue cycle becomes seamless with AI and automation in healthcare claims management. Any healthcare provider seeking faster reimbursement and a better bottom line knows that improving claims management is critical to better cash flow. AI and automation-driven claims management software offers healthcare organizations a way to achieve these goals. Contact Experian Health today to prevent healthcare claim denials and improve your claims management process with AI Advantage and other denial management solutions.

Patients increasingly expect convenience and efficiency in all aspects of their lives, including healthcare. A study by Experian Health shows that 89% want the ability to schedule appointments anytime via online or mobile tools. The same survey showed providers are listening, with 63% offering self-scheduling and another 16% planning to go live with these tools in six months. That's good news for everyone, and not just because patients say they want more digital tools to manage their healthcare. Online scheduling addresses patient expectations by offering a range of benefits that traditional scheduling methods cannot match. However, these benefits aren't just for patients; healthcare providers that deploy online patient scheduling software experience four impressive benefits with a direct impact on their revenue cycle. What is online patient scheduling software? Online patient scheduling software is a digital tool designed to facilitate the appointment booking process for healthcare providers and their patients. This patient access technology replaces traditional over-the-phone scheduling methods with an efficient and user-friendly online system. The key features of patient digital scheduling platforms include: 24/7 appointment booking: Patients can schedule appointments at any time, day or night, providing flexibility and convenience that traditional methods cannot offer. Automated reminders: The software sends automatic reminders via email or SMS to reduce the likelihood of missed appointments. Real-time availability: Patients can view and select available time slots in real-time, ensuring they can find appointments that fit their schedules. Calendar integration: The software integrates with the provider's existing calendar systems to ensure that all appointments are accurately tracked and managed. Customizable scheduling: Healthcare providers can customize the software to reflect their specific scheduling rules, such as appointment types, durations, and provider availability. Manual scheduling frustrates patients and providers. Online patient scheduling allows patients to regain control while increasing their engagement in managing their health. Why do patients prefer online scheduling? Patients want online scheduling software because it aligns with their desire for convenience, efficiency, and control over their healthcare experience. One of the primary reasons to use online scheduling software is its round-the-clock availability. Patients can book appointments without office-hour restrictions. Online scheduling software allows patients to select time slots best suited to their schedules, minimizing the time spent waiting on hold during phone calls or in busy waiting rooms. Patients can easily see and compare availability, making planning their visits easier around personal and professional commitments. It also makes canceling or rescheduling appointments less of a hassle. One common issue patients face is forgetting about their appointments. Online scheduling software often includes automated reminders and confirmations via email or SMS, helping patients remember their upcoming visits. Some patients may also feel uncomfortable discussing their medical issues over the phone or in person at the front desk. Online scheduling offers a more private and discreet way to book appointments, allowing patients to select services without disclosing personal information to multiple people. Bringing digital efficiencies to healthcare scheduling leads to a more positive patient experience. One study showed that 28% of patients say care access has improved over the past year, even as more providers adopt these new technologies. But it's not just patients who benefit from online patient scheduling software. There are plenty of incentives for healthcare providers to adopt these tools. Healthcare providers benefit from online patient scheduling By adopting this technology, healthcare providers can streamline operations, improve patient satisfaction, and ultimately deliver higher-quality care. Experian Health offers online patient scheduling software that meets the needs of patients while benefiting providers. For example, Indiana University Health (IU Health) deployed the software across 16 hospitals and the largest network of physicians in the state. The organization leveraged the solution to increase patient volumes with minimal staff training, improving patient utilization by 114% within the first year. Today, four employees can handle patient scheduling for up to eight service lines. An unexpected benefit was the increase in referral management; the software enabled 600 monthly referral appointments, helping to generate new revenue for the system. These results are typical; most providers find the benefits of online patient scheduling software include: Reduced staff training time Improves the scheduling process for patients and providers Decreases patient no-shows Increases patient volumes and revenue Speeds up staff training One of the most significant challenges in any healthcare setting is training new staff quickly and effectively. Getting new staff up to speed rapidly is essential when severe staffing shortages are the norm. Experian Health's online patient scheduling software simplifies training. Its user-friendly interface and intuitive design reduce the learning curve for new employees to about an hour. The software provides guided workflows and real-time assistance, translating to less time spent on training and more time focused on patient care. Streamlines scheduling time Traditional scheduling methods can be time-consuming and prone to errors; 62% of providers say chronic staffing shortages exacerbate the problem. Online scheduling streamlines the entire process, cutting scheduling time in half over traditional methods. By allowing patients to book appointments online, the software reduces the back-and-forth communication typically required for scheduling. Automated reminders and confirmations ensure efficient appointment management. The calendar integration feature allows real-time updates and availability checks, providing a convenient booking process that enhances the patient experience. Improves patient no-show rates Patient no-shows can be a significant issue for healthcare providers, leading to lost revenue and wasted time. Experian Health's online scheduling software tackles this problem head-on. The software includes automated email or SMS appointment reminders, significantly reducing the likelihood of patients forgetting their appointments. Additionally, the ease of rescheduling allows patients to adjust their appointments without the hassle, further decreasing no-show rates. By keeping patients informed and engaged, the software helps ensure they attend their scheduled appointments, improving the clinic's efficiency and patient satisfaction. Josh Brown, Program Manager for Provider Match at IU Health, stated, “We've seen a reduction in no-shows and an increase in patient engagement. By leveraging technology and data analysis, the guided scheduling platform has helped deliver better care more efficiently and effectively.” Increases patient volumes and revenue Online patient scheduling directly contributes to increased patient volumes by improving scheduling efficiency and reducing no-show rates. More patients can schedule in less time, and the reduction in no-shows means fewer appointment slots go unused. The convenience of online scheduling can attract new patients who prefer digital interactions over traditional phone calls. These benefits lead to higher patient volumes and increased revenue for the healthcare practice. Today's digitally-savvy healthcare consumers require a different approach to scheduling services. Online patient scheduling offers them the convenience of DIY appointment setting and has some surprising benefits for healthcare providers, too, making these solutions a win for everyone. Ready to make the move to online scheduling? Contact Experian Health to get started! Improve patient scheduling Contact us

With over $220 billion in medical debt, patients in the U.S. are burdened by substantial financial obligations. These numbers also distress healthcare providers, who face cash flow and other operational challenges stemming from unpaid patient bills—and debt collection can further strain the relationship between care providers and patients. An efficient financial clearance process at the beginning of each patient encounter can benefit the entire system. But what is healthcare financial clearance and how can providers achieve it? What is financial clearance in healthcare? Financial clearance in healthcare is an administrative process that ensures patients understand their financial obligations before service delivery. It's often a manual workflow that involves verifying insurance coverage, estimating out-of-pocket costs, and discussing payment options or plans. The main objectives of financial clearance in healthcare are to prevent unexpected financial burdens for the patient, reduce the risk of unpaid medical bills for the provider, and streamline billing and payment. Common challenges with healthcare financial clearance Complex insurance policies, inaccurate or incomplete patient information, and lack of patient understanding of their own policy requirements are just a few of the challenges healthcare providers face in financial clearance. Not all healthcare providers have access to advanced technology or automated systems to streamline financial clearance, leading to reliance on manual processes that are prone to errors. Determining eligibility for financial assistance involves navigating complex criteria, which include assessing individual income, household size, savings, and medical requirements. When patients need help understanding their policy requirements, the educational burden often rests on the healthcare provider. Traditional manual methods of collecting and analyzing this data are prone to inefficiencies and inaccuracies, leading to missed opportunities to provide necessary financial support to patients. This makes the financial clearance process even more time-consuming, requiring significant administrative effort to verify insurance details, secure authorizations, and communicate with patients and insurers. Verifying a patient's insurance details during financial clearance ensures that the provider has the correct information about the patient's coverage, reducing the risk of denials due to eligibility issues. Financial clearance involves confirming that the patient is eligible for the services under their insurance plan. If eligibility is not verified beforehand, providers may deliver services that are not covered, leading to denials. Financial clearance also involves estimating the patient's out-of-pocket costs and ensuring the patient understands their financial responsibility. This process helps reduce denials related to unmet deductibles or co-payments, as patients are informed about their financial obligations upfront. Enhancing the healthcare financial clearance process improves revenue cycle management and significantly boosts patient satisfaction. As reimbursement denials continue to rise, healthcare providers have a vested financial interest in minimizing the financial uncertainties patients face early on in their healthcare journey. The use of technology to automate many of these manual processes allows healthcare providers to focus on minimizing financial uncertainty for patients, thereby enhancing their overall experience. Improve revenue cycle with automated healthcare financial clearance Healthcare providers can use technology to understand patient payment challenges and recommend the best financial pathway during the registration process. Providers like UC Health in Colorado leveraged Experian Health's Patient Financial Clearance software to write off $26 million in charity care. The technology integrates cleanly with the provider's electronic health record (EHR) to lessen the back-and-forth between systems during patient registration. Identifying the patients who need financial assistance upfront lessens the time spent pursuing bad debt and connects those who qualify for financial assistance with the right programs. Experian Health's Patient Financial Clearance solution fosters clear communication between the healthcare provider and the patient regarding coverage, costs, and payment expectations. This transparency helps in addressing potential issues that could lead to denials before they occur. Automation reduces bad debt and improves the patient experience Technology answers the question of 'what is financial clearance in healthcare?' with outcomes that include higher patient satisfaction and a better bottom line. Patient Financial Clearance automates screening to determine financial and clinical eligibility for each person at the first point of service. It answers critical questions such as: Does the patient qualify for financial assistance? What constitutes a realistic patient payment plan? Notably, the software helps set the tone for the patient intake specialist, approaching payment terms proactively and empowering everyone to take on their financial responsibilities early in the care delivery process. Patient Financial Clearance automates and streamlines manual workflows to optimize the revenue cycle. For example, this software can: Automate screening prior to service or at the point-of-service to determine if patients qualify for financial assistance, Medicaid, or other assistance programs, without relying on patients for information Leverage Experian’s comprehensive data and analytics capabilities to calculate the patient’s optimal payment plan amount based on the patient’s unique financial situation Predict propensity to pay using Experian’s proprietary Healthcare Payment Risk Score The benefits of Patient Financial Clearance for providers include: Improved point-of-service collections Lowered bad debt write-offs Increased staff productivity IRS 501(r) compliance Improved patient and staff experience For patients, Experian Health’s Self-Service Patient Financial Clearance option enables patients to conveniently complete eligibility checks at their own pace. Through a mobile and web-based platform, patients can submit screening forms and upload necessary documents, receiving real-time updates without the need to contact their healthcare providers. All information is securely stored, allowing staff to access application statuses as required. Automating financial clearance in healthcare transforms an unwieldy process into an efficient way to manage the delicate relationship between providers and patients. Technology can free up intake specialists to concentrate on creating a better patient experience and eliminate the frustrations surrounding collecting payment after the service is complete. Learn more about how Patient Financial Clearance can help healthcare organizations reduce bad debt by automating the patient financial assistance process.

The Price Transparency Rule, effective January 1, 2021, requires hospitals to provide clear and accessible pricing information about their items and services online. Although the rule is simple in theory, hospitals are finding it challenging to implement. Under the rule, hospitals can make their pricing information clear and accessible by publishing it online as a comprehensive machine-readable file (MRF) with all items and services and in a display of shoppable services in a consumer-friendly format for at least 300 shoppable services. The Centers for Medicare & Medicaid Services (CMS) states that the rule aims to "help Americans know the cost of a hospital item or service before receiving it." This rule represents a giant stride towards delivering much-needed and long-awaited benefits associated with price transparency. These include empowering consumers to make informed healthcare purchasing decisions based on the costs and benefits involved, enabling cost predictability and closing the information gap between providers and patients. It is also an eye-opener for consumers, preventing them from falling victim to wide price discrepancies prevalent in an opaque pricing system. As Tricia Ibrahim-Zafari, Director of Product Management at Experian Health, states, "The requirements are meant to help patients become true consumers of healthcare." However, the success of the concept of price transparency hinges on hospitals adhering to and implementing the rule. Unfortunately, reports have found that hospitals have struggled with compliance since the rule was enacted. One of the reports, published in February 2024 by the Patient Rights Advocate, found that three years after the Hospital Price Transparency Rule took effect, only 34.5% (689) of the 2,000 U.S. hospital websites analyzed fully complied with the rule's requirements. One of the barriers to the adherence to and successful implementation of this rule is its constant and frequent evolution, making it challenging for hospitals without efficient price transparency solutions to keep up. Stricter penalties due to low compliance rates, increased public access to pricing and the challenging financial environment prohibiting flexible price changes exacerbate existing pressure on hospitals, Ibrahim-Zafari explained. The good news is that hospitals looking to meet the transparency requirements, including the Price Transparency 2024 updates while delivering high-quality care for all, can explore Experian Health and Cleverley & Associates solutions for Price Transparency compliance. These price transparency tools in healthcare help providers comply with the Price Transparency Rule, improve price defensibility and create financial opportunities, as affirmed by Ibrahim-Zafari. Price Transparency 2024 updates: the latest in the price transparency regulatory environment Jamie Cleverley, President of Cleverley & Associates, emphasized that the earlier language of the Price Transparency rule is grounded in provisions of the Affordable Care Act (ACA) and displays noteworthy similarities. Both require making consumer-relevant information easily accessible for easier comparison shopping and providing insights into negotiated rates between clinicians and insurers in a machine-readable format. However, the Price Transparency rule has evolved ever since. Since its introduction in 2021, the Price Transparency Rule has been continuously updated to better align with its intent, to adapt to the changing healthcare landscape and to encourage compliance. For example, Ibrahim-Zafari noted that in 2022, CMS increased the penalty for non-compliance with price transparency requirements from $110,000 to over $2 million a year. Additionally,  the agency imposed stricter timelines for hospitals to address pricing data issues and streamlined the enforcement process. The Price Transparency 2024 updates required to be implemented by hospitals on January 1, 2024, July 1, 2024 and January 1, 2025, fall under five broad categories: new definitions, good faith estimate and machine-readable file (MRF) attestation, ​​standardization of the MRF format and data elements, improving access to hospital MRFs and enhancing enforcement and compliance. Put simply, CMS established definitions for specific terms in regard to the new definitions category. Let's delve into the remaining categories under the price transparency 2024 updates. Good faith estimate and machine-readable file (MRF) attestation The good faith estimate and MRF update emphasize hospital leadership's obligation to verify the MRF content's comprehensiveness and accuracy. Good faith effort - Starting January 1, 2024, CMS requires every hospital to make a good faith effort to ensure that the standard charge information stored in the MRF is accurate and complete. MRF Attestation - Starting July 1, 2024, hospitals must attest to the completeness and accuracy of the applicable standard charge information in their MRF. Cleverley explains that the good faith effort update does not require hospitals to include any attestation on their website or in their machine-readable file. However, beginning July 1, hospitals will be required to use the CMS template for the MRF, which includes an attestation comment, where they must select true or false. Standardization of the MRF format and data elements CMS also introduced updates that ensure the standardization of the MRF formats and data elements across the board. Starting on July 1, 2024, hospitals must format the contents of the MRF into a specific template. This template can be in either .JSON or .CSV format. According to Cleverley, the .JSON format is digital-friendly, making it the preferred option for hospitals. The .CSV format, on the other hand, is more consumer-friendly. Furthermore, the Price Transparency 2024 updates introduced additional required data elements, including five types of standard charges. Some of the new data elements, including "Estimated Allowed Amount," "Drug Unit of Measurement," "Drug Type of Measurement," and "Modifiers," have been stated to be implemented on January 1, 2025. Improving access to hospital MRFs To make hospital MRFs more accessible, CMS requires that from January 1, 2024, hospital websites must include a .txt file in the root folder containing their MRF and contact information. In addition, hospitals are required to include a "footer" at the bottom of their homepage, linking to the webpage that hosts the MRF. Enhancing enforcement Considering that hospitals have been slow to comply with the price transparency requirements, it's not surprising that CMS is ramping up its enforcement efforts through four measures. Increasing scrutiny of hospital compliance efforts - CMS is increasing scrutiny by authorizing comprehensive compliance reviews. Under the Price Transparency 2024 updates, they can also request hospitals to have an authorized official certify the accuracy and completeness of MRF data and submit additional documentation, including payer contracts, to evaluate compliance. Acknowledging warning notices - Hospitals must confirm receiving warning notices from CMS whenever they receive such notice. Addressing system-wide non-compliance - If CMS finds a hospital part of a health system to be non-compliant, they can notify the health system's leadership to address potential defaults from other hospitals within the health system. Publicizing actions and outcomes - CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. Experian Health and Cleverley + Associates solutions for price transparency compliance Compliance with the Hospital Price Transparency Rule is indispensable to achieving price transparency. To support providers in adhering to these rules in the best and most efficient way possible, Experian Health and Cleverley & Associates solutions to provide solutions that ensure maximum compliance while improving price defensibility and creating revenue opportunities. Experian Health's Patient Payment Estimates help providers compile a consumer-friendly list of shoppable service items. Cleverley & Associates provides fully compliant and comprehensive machine-readable files for the hospital's "items and services." The price transparency tools in healthcare are available in two options to cater to the specific needs of healthcare organizations: Machine-Readable File - Standard: This solution provides machine-readable files only in the standardized payer-specific negotiated charge format. Machine-Readable File - Premium: This package provides a price transparency machine-readable file and includes consulting services to assist with price changes. Navigating price transparency requirements in the ever-changing healthcare landscape can be daunting. However, the task becomes seamless with solutions from Experian Health and Cleverley & Associates for price transparency compliance. Healthcare organizations can now stay up to date with and meet evolving transparency rules while also improving profitability. Watch the on-demand webinar, featuring experts from Experian Health and Cleverley & Associates, to learn more about the new updates and explore the latest developments and strategies to navigate price transparency in 2024.