All posts by Experian Health

Collecting payments from patients has always been tough. Confusing bills, missed reminders and affordability concerns often lead to delays. Billing teams get bogged down in follow-up calls and paperwork, leaving little time for complex cases and a big question mark over whether they're using their time efficiently. As patients shoulder a greater share of their healthcare costs, there's increased pressure to make billing more accessible, transparent and manageable. Could automation be the answer? This article looks at how automation can simplify patient collections for everyone. With faster reminders, more accurate estimates, tailored payment plans and efficient collections management, providers can improve the patient experience and increase collections simultaneously. The importance of automation in patient collections One of the biggest frustrations for billing staff is seeing patients struggle to pay their bills. Medical costs can be daunting, and as patients are confronted with rising prices at the gas pumps and grocery stores, they may feel forced to delay healthcare payments or forego care altogether. Complicated bills with unclear charges and terminology only compound the problem: Experian Health's 2024 State of Patient Access (SOPA) survey found that 69% of providers see patients postpone services when they don't understand the financial impact. Many patients are able to pay their bills, but need clearer and more flexible payment options. In their attempts to support patients, billing teams spend a lot of time managing routine tasks like sending reminders, setting up payment plans and fielding questions about bills and unresolved insurance issues. What if these tasks could be handled automatically? There are opportunities to take advantage of automation, advanced data analytics and artificial intelligence in just about every corner of the collections process. Providers integrating automation in patient collections find it easier to help patients keep up with payments and maintain a steady cash flow — without draining staff resources. The benefits of automation for patient collections Here is a run-down of a few key automation benefits for patient collections: 1. Clearer billing, which boosts better cash flow In the SOPA survey, 88% of providers recognized that upfront price estimates contribute to collections success. Automation makes it easier to calculate accurate estimates based on the provider's current prices and the patient's specific insurance benefits. With user-friendly bills, patients can quickly grasp what they owe without needing to ask their provider for clarification. Automated systems can also issue friendly reminders to patients via text or email so they don't miss payment deadlines. Including quick payment links allows patients to click and pay in an instant. 2. Personalized payment options, which create a compassionate and convenient patient experience A survey by Experian Health and PYMNTs found that patients welcome tailored payment plans that allow them to pay their bills in stages. This is backed up by SOPA findings, which show that 40% of providers have seen reduced friction in patient intake thanks to payment plans. Automation can be used to calculate customized options that fit different budgets. Aligning payment plans to the patients' ability to pay improves the consumer experience and minimizes bad debt. Today's consumers want to choose how they pay for care, yet many providers lack the online and mobile-enabled payment options to support fast and convenient payments. With automation, healthcare organizations can enable multiple secure payment methods across their services and departments, giving patients more hassle-free ways to pay. 3. Increased efficiency, which reduces the admin burden for staff With automation handling routine billing tasks, staff can spend less time on paperwork and more time on patient care, leading to a more efficient and patient-focused service. Overall, automation creates a smoother billing experience. Patients appreciate clear information, convenient payment options, and timely reminders, which makes them more satisfied with their care. Key tools and technologies for automating patient collections When building a toolkit for automated patient collections, providers can choose from a growing range of technologies. For example: 1. Analytics-based collections optimization One way to simplify patient collections is to use data analytics to screen, segment and prioritize self-pay accounts so that each one can be handled in the most efficient way. Collections Optimization Manager screens patient accounts for bankruptcy, deceased status, Medicaid, and charity so staff can focus on higher-yield accounts. After screening, accounts are given a score based on the patient's propensity to pay and then routed to the most appropriate servicing channel. Users can access real-time dashboards and expert consultancy support to monitor and improve collections strategies. This improves the experience for patients, reduces repetitive manual work for staff, and maximizes collections while reducing the overall cost to collect. See it in action: How Wooster Community Hospital collected $3.8M in patient balances with Collections Optimization Manager 2. Financial aid automation Many patients with high out-of-pocket costs and co-pays are unaware that they might be eligible for financial assistance. By using Experian’s comprehensive data, Patient Financial Clearance automatically determines which patients may qualify for financial assistance and even auto-enrolls them in relevant programs. To make this process as easy as possible for patients, the tool prompts them to complete applications whenever it is convenient, either online or through their smartphones. This releases staff from time-consuming manual work and accelerates approvals and payments. In addition, the tool creates individualized payment plans that account for what the patient is likely to be able to afford, thus helping providers collect from patients who do not qualify for charity support, too. See it in action: How Eskenazi Health boosted Medicaid approvals by 111% with financial aid automation 3. Automated upfront, accurate estimates For patients with out-of-pocket bills, getting ahead of any surprise charges with accurate pre-service estimates is essential. Patient Estimates is a web-based pricing tool that pulls together every last detail about chargemaster pricing, payer contracts, insurance benefits and financial assistance policies to generate an accurate estimate for patients. It applies any prompt-pay discounts or payment plans so the patient knows what to expect. Helping patients understand and prepare for forthcoming bills smooths out the payment process and leads to more revenue being collected, sooner. 4. Digitally enabled payment technology The patient-friendly collections experience can be rounded out by offering a choice of digital-first payment methods. PaymentSafe® allows providers to securely accept patient payments at any time, expanding the number of collection points available to patients. The tool automatically integrates data from across the payments ecosystem to pre-populate fields in the patients' accounts, allowing them to pay multiple bills at once, and automatically settles and remits payments. Making it easy for patients to pay accelerates payments, including before and at the point of service. The future of patient collections through automation Bringing together automation and patient collections will continue to simplify and make these processes more patient-friendly. Automation and digital tools will enable more self-service options, making it easy for patients to manage bills, choose payment plans, and make payments at their convenience. Moving toward greater transparency and personalization will also give patients more control. Emerging technologies such as predictive analytics, machine learning and artificial intelligence will give providers greater insights into their patients' financial needs, so they can offer proactive and compassionate support to navigate the process. As these trends gather steam, patient collections will become faster, more adaptable and better aligned with the needs of today's healthcare consumers. Find out more about how simplifying patient collections with automation can improve patient experiences and increase collections. Learn more Contact us

As economists offer up their best guesses for the US economy over the coming year, healthcare leaders know one thing for sure: no matter what happens, they need solid revenue cycle management (RCM) processes to remain financially sound and deliver high-quality care. Revenue cycle management connects the financial and clinical aspects of care by ensuring that providers are properly reimbursed for their services, through accurate and efficient billing and claims management processes. Keeping the financial scales tipped in the right direction is a growing challenge: data from the American Hospital Association shows that payer delays and denials are driving up operational costs while slowing revenue. Many providers are turning to artificial intelligence (AI), automation and data analytics to eliminate inefficiencies and maximize reimbursement. Factors that affect healthcare revenue cycle management While revenue cycle math is pretty simple – money in versus money out – the reality is more complex. A tight grip on delivery costs is just one part of the equation. Most RCM efforts center around determining who owes what and collating the necessary documentation to secure prompt payment from each party. A few factors to consider include: Are there reliable processes for capturing accurate patient information? How quickly can coverage and pre-authorizations be verified? Are claims and denials managed efficiently? How easy is it for patients to understand and pay their bills? Can RCM leaders monitor and analyze staff and agency performance? Changing payer policies, patients' financial status and data management demands add to the challenge. The goal of revenue cycle management To achieve the primary aim of getting reimbursed in full and on time, organizations must reduce billing errors, submit clean claims and refine operational efficiency so staff can stay laser-focused on high-value tasks. But it's important to look beyond the spreadsheets: selecting the right tools to deliver a transparent and compassionate patient experience will boost the bottom line, too. History and evolution of RCM RCM has shifted from largely paper-based processes to sophisticated software-based systems in just a few decades. Few could have imagined how those early healthcare information systems of the 1970s would evolve as electronic health records, standardized coding frameworks and digital data processing came to the fore. Changes in regulation and reimbursement models furthered the need for advanced analytics. And now, the rise of healthcare consumerism drives demand for the industry to open its digital front door. Organizations that commit to digital transformation will be in a stronger position to navigate today's RCM challenges and meet the needs of digitally native consumers. Relationship between patient experience and RCM Experian Health's recently published State of Patient Access Survey 2024 reveals the extent to which the patient experience affects revenue. Integrating patient-centered principles into RCM processes improves patient satisfaction, makes it easier for patients to understand and pay their bills, and leads to better financial performance overall. Steps in the healthcare revenue cycle A typical revenue cycle management workflow in healthcare follows the patient’s journey. Each touchpoint in the patient's journey is an opportunity to check that patients, payers and back-off teams have the information they need to expedite payment: Scheduling – When the patient books an appointment, administrative staff verify the patient's insurance eligibility. This is a chance to make sure pricing is transparent and give the patient an estimate for the cost of care. Registration – Next, the provider captures the patients' medical history, insurance coverage and other demographics. Correct patient information on the front end reduces the errors that cause rework in the back office. Prior authorization – Front-end staff check whether the patient's insurance provider requires prior authorization for the procedure or service they need. Skipping this step can lead to costly denials and rework. Treatment and follow-up – After treatment, the back office collates billable charges and assigns a medical billing code to the claim. Accuracy is paramount, as reworking claim rejections can drain resources. Claim submission – Then, the claim must be submitted to the payer. Accurate and timely submissions prevent rejections and reimbursement delays. If a claim is denied, it must be resubmitted as quickly as possible to avoid lost revenue. Collections – Once the payer approves the claim, the patient's out-of-pocket costs are calculated and billed. Providing a range of convenient payment methods will increase the likelihood of prompt payment. Regulatory and compliance considerations At each stage in the process, staff must stay mindful of the regulatory and compliance frameworks governing revenue cycle management. These are primarily patient-centered. For example, the Health Insurance Portability and Accountability Act (HIPAA) safeguards patient privacy and sensitive health information, while the No Surprises Act seeks to make pricing more transparent. Failure to adhere brings severe reputational and financial risks, as made painfully clear by recent headlines about the cost of cyberattacks within the industry. Common challenges in healthcare RCM For most providers, avoiding the cycle of claim denials and rework is the biggest challenge. A survey of 1300 hospitals found that denials by commercial payers had increased by 20.2%, while Medicare Advantage denials had increased by 55.7% between January 2022 and July 2023. Reliance on inefficient manual processes to track and monitor claims does little to help. A 2023 CAQH report shows that switching from manual to electronic claim status inquiries could reduce the time spent on each transaction by 17 minutes, saving the medical industry more than $3.2 billion overall. Providers are also collecting increasing sums from self-pay patients. Financial pressures and uncertainty around coverage mean many patients cannot fully cover their medical expenses. Improving their financial journey with accurate upfront estimates, clear and compassionate communications, and convenient payment methods will accelerate payments. Unfortunately, there's still some way to go: the State of Patient Access Survey 2024 found that 64% of patients had not received a cost estimate before care, and of those that did, 14% reported final costs that were much higher than expected. Financial impact analysis To track the financial effects of these challenges, healthcare organizations should identify key performance indicators (KPIs) aligned to their specific priorities. Conducting real-time monitoring and analysis of patient access, collections, claims and contract management metrics can flag up opportunities to prevent revenue leakage and maximize income. Read more about how to identify the right KPIs for your revenue cycle dashboard. 4 ways to improve revenue cycle management in healthcare When it comes to implementing specific revenue cycle management solutions, the following four tactics are likely to yield the greatest return on investment: Automate AccessA healthy revenue cycle begins with quick, accurate and efficient patient access systems. Automated, data-driven workflows reduce the errors that lead to denials and rework. Online scheduling allows patients to easily book appointments, while solutions like Patient Access Curator use AI to capture all patient data at registration with a single click. Increase collectionsMaximizing patient collections while fostering a positive patient experience can be a delicate balance. Patient access staff must be the patient's advocate, while ensuring the organization collects what’s owed. Giving patients upfront estimates of their financial responsibility and offering appropriate financial plans makes it as easy as possible for them to pay. Collections Optimization Manager allows providers to focus their efforts on the right accounts, through highly predictive patient segmentation. Streamline claimsAutomating claims management is another way to use technology to accelerate reimbursement. Claims management software verifies that each claim is coded properly before being submitted. Encounters can be processed in real-time with automatic alerts to flag any issues before the claim is submitted. Experian Health's flagship AI Advantage™ solution helps predict and prevent denials by checking claims before they are submitted and calculating the probability of denial. It evaluates and segments denials that occur based on the likelihood of reimbursement following resubmission, and prioritizes the work queue so staff make the best use of time. Increase reimbursementHealthcare organizations that don't stay current on payer policy and procedure changes risk payment delays and lost revenue. Providers and payers must be on the same page to quickly resolve mismatches between expected and actual reimbursement amounts. Automated payer policy and procedure change notifications help providers strengthen relationships with payers and avoid payment delays. How healthy is your revenue cycle? Our revenue cycle management checklist helps healthcare organizations catch inefficiencies and find opportunities to boost cash flow. Case studies See how automated revenue cycle solutions helped Stanford Health optimize their patient collections strategy. See how Schneck Medical Center prevents claim denials with AI AdvantageTM Hear how UC San Diego Health used automation to improve patient billing and drive collections. Getting the most out of revenue cycle management software These case studies demonstrate that a successful revenue management strategy has three essential ingredients: data, software and training. Experian Health's “Best in KLAS” revenue cycle management solutions are built on proven technology and proprietary databases, to help staff find new opportunities to bring in revenue. Experienced consultants are on hand to guide staff and ensure workflows are set up for the best results. The future of RCM Whatever the economic outlook, technology’s defining role in the future of revenue cycle management is undisputed. Payers are already leveraging AI to their advantage, and patients have come to expect convenient digital transactions—any providers that fail to embrace AI and automation-based RCM solutions will fall behind the competition. Learn more about how Experian Health's revenue cycle management solutions generate more revenue for healthcare organizations.

Many healthcare providers believe pairing “revenue cycle” with a qualifier like “predictable” is an oxymoron. From healthcare staffing shortages that slow down reimbursement tasks to increasing payer denials, financial regularity can seem like an unattainable goal for these organizations.  The American Hospital Association (AHA) reports over one-half of U.S. hospitals had financial losses in 2022. Another AHA survey shows that 84% of these organizations say the cost of complying with complicated payer policies is climbing. Providers throw an excessive amount of time and staff at chasing revenue, but reimbursement complexities make for anything but smooth financial sailing. How can healthcare providers even out the ebbs and flows of the revenue cycle? Experian Health's suite of revenue cycle management (RCM) solutions can help. Revenue cycle predictability during the life of a claim When it comes to finances, U.S. healthcare providers rarely have an easy go of it. Today, the average life of a claim is anything but average. From registration to collections, hospitals established a new normal over the past decade: Widening gaps between service delivery and reimbursement. How can providers tackle this untenable situation? The answer is two-fold: with technology and at each stage of the life of a claim. Here are three ways healthcare providers can use technology to create reimbursement predictability at each stage of a claim's life. 1. Establish payment accountability at patient registration with price transparency Reimbursement problems begin at patient registration. Healthcare price transparency demands patients understand the cost of care. According to Experian Health's State of Patient Access survey, 81% of patients agreed that an accurate estimate helps them better prepare to pay for their care costs. However, only 31% of patients received a cost estimate before care. There are three significant impacts of this troubling trend: Nearly 40% of patients say they put off needed care due to cost. The number rises to 61% if the patient is uninsured. Patients can't afford to pay for needed care. Currently, 41% of U.S. adults have medical debt. An Experian Health study showed four in 10 patients spend more than they can afford on healthcare treatment. Uncompensated care causes a significant drop in healthcare provider income, which has amounted to almost $745 billion, according to the AHA. Experian Health offers several data-driven solutions to improve price transparency. These tools make it easier for patients to handle their financial responsibilities while helping providers find solutions to help ease their burdens.Patient Financial Advisor creates more accurate service estimates for patients before their procedure. The mobile-first platform offers patients a detailed cost breakdown on their preferred digital device. Patient Estimates is a web-based platform offering real-time service estimates. Blessing Health System uses the tool to provide patient estimates that are up to 90% accurate. The provider increased collections by 58% and credits the software with a 1,200% return on their investment. Patient Access Curator automatically initiates communication with payers to improve coordination of benefits and maximize return. It also automatically identifies missing or incorrect Medicare Beneficiary Identifier (MBI) numbers or errors in patient contact details. This solution also helps providers understand the patient's ability and propensity to pay, allowing these organizations to predict revenue streams after service delivery. Behind the scenes, Experian Health also automates insurance eligibility verification to unlock hidden reimbursements. This software roadmaps the correct coverage, connects to more than 900 payers and verifies insurance coverage at the time of service to improve cash flow and ease patient payment burdens. 2. Reduce claim denials by decreasing manual paperwork errors Claim denials are one of the biggest impediments to revenue cycle predictability. Providers are stuck in an endless cycle of inaccurate payer submissions, rejected claims, and rebilling, creating a chaotic chase for payment long after the service. Today, 35% of healthcare organizations report $50 million or higher in lost revenue due to claims denials. Even worse, Experian Health's State of Claims 2022 report showed that 30% of providers say denials are increasing by up to 15%. According to that data, the top three reasons for claim denials are: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Coding inaccuracies. Experian Health's Claim Scrubber software levels out provider cash flow, creating predictability amidst the chaos. The solution reviews complete claims for errors, generating actionable edits before submission. Claim Scrubber also reviews approved reimbursement rates to prevent undercharging. Transactions process within three seconds and providers reduce the need to rework claims. Experian Health's AI Advantage solution uses the power of artificial intelligence (AI) to evaluate every claim for its propensity to turn into a denial. Instead of submitting claims and hoping the payer will accept them, this solution takes the guesswork out of reimbursement for a more rational, predictable process. The software automatically scans for payer updates to reimbursement requirements that significantly contribute to claims denials. Hospitals like Schneck Medical Center use this tool to streamline the revenue cycle by preventing denials. After just six months, the provider’s denied claims reduced by an average of 4.6% each month. Claim corrections that took up to 15 minutes manually are now processed in less than five. 3. Increase collections efficiency with automation Patients trust their healthcare providers to take care of them. Providers also rely on patients to pay their bills. It's a mutually beneficial arrangement. However, it's also a problem forcing providers to walk a delicate tightrope between caring for a sick patient while still chasing payment for their services. Unfortunately, the increasing cost of healthcare leaves patients on the hook for more than $88 billion in debt. The volume of healthcare payments in arrears is staggering, causing a substantial drain on provider cash on hand. However, technology offers healthcare providers a way to improve the patient collections process. For example, Coverage Discovery impacts the revenue cycle at every stage of the claim: Before providing care, the software scans patient data to determine reimbursement coverage options from Medicaid, Medicare, and commercial insurance. It scans for active insurance 30, 60, and 90 days after care delivery. The tool scans patient data before determining whether the account moves to bad debt collections. A more robust understanding of patient payment options at every stage of claims management allows healthcare providers to forecast reimbursements more accurately, increasing the predictability of the revenue cycle. Collections Optimization Manager provides organizations with actionable insights, so that providers can segment and prioritize accounts by proprensity to pay. This solution increases patient collections by leveraging Experian's data driven segmentation models, and helps providers screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility ahead of time. Experian Health's AI Advantage – Denial Triage prioritizes rejected claims based on their yield potential, automating workflows for claims managers so they focus first on the patients more likely to pay. This tool segments denials based on their potential value to help even out the revenue cycle with a faster rate of financial return. Denial Triage expedites A/R by increasing revenue collection per person per hour. Revenue cycles can be more predictable, but the complexities of reimbursement require technology to achieve this goal. Experian Health offers a comprehensive line of revenue cycle management solutions to help healthcare providers maximize collections and improve RCM. Find out why Experian Health ranks Best in KLAS for 2024 in the categories of Claims Management & Clearinghouse and Revenue Cycle: Contract Management, or contact us for a more predictable revenue cycle, better cash flow, and a healthier organization.

Artificial intelligence (AI) and computer automation are finally beginning to impact healthcare. Payers are implementing generative AI to improve the customer experience. Researchers at Stanford use AI to review X-rays and detect pathologies in seconds. Today, AI and automation can remind patients about appointments and even provide a portion of their treatment via robotic surgery devices. While groundbreaking AI and automation technologies are in the news, adoption by the majority of healthcare providers has been slow despite research showing these tools could eliminate up to $360 billion in spending. It's a startling statistic that illustrates the reality of AI and automation applied to the revenue cycle: These tools quite literally can pay for themselves. The case for applying artificial intelligence and automation in healthcare Successful revenue cycles depend on thousands of daily tasks, which means efficiency lies at the heart of these endeavors. However, there are a lot of improvement to be made. Experian Health's State of Claims Survey 2022 shows the current state of the average healthcare revenue cycle: Reimbursement cycles are running longer. Claim errors are on the rise. Denials are increasing. More than one-half of U.S. hospitals reported financial losses in 2022. A 2023 America Hospital Report (AHA) report showed: 84% of hospitals admit the cost of complying with payer reimbursement requirements is increasing. 95% report spending more time on pursuing prior authorization approval. Over 50% of hospitals and health systems have more than $100 million tied up in A/R for claims six months old. These challenges stem from the increasing complexities of working with third-party payers, but also the by-hand human workflows embedded within provider revenue cycles. The State of Claims Survey 2022 showed that 61% of providers say they rely too heavily on manual processes and lack the automation they need to streamline reimbursement. As costs rise and revenue cycles tighten, there is increasing pressure to do more with less—faster. However, chronic healthcare staffing shortages have only exacerbated how hard it is for providers to get paid. Technology solves many of the problems plaguing healthcare's revenue cycle. AI and automation offer better revenue cycle management tools with fewer errors, less manual work, and more streamlined processes. How AI and automation improves revenue cycles Increasingly complicated reimbursement processes are the perfect testing ground for new technologies. These tools can improve the revenue cycle from the first point of patient contact to collections long after the procedure is over. For example, AI and automation software can greatly reduce errors and increase the accuracy of claims information before submission. When billing becomes more accurate, it lessens the volume of rejected claims, which take up an inordinate amount of staff resources and lengthen the time from service delivery to reimbursement. But AI and automation also impact the backend of the patient encounter by helping collections teams prioritize accounts most likely to pay. Four applications for AI and automation in the revenue cycle include: 1. Applying automation to patient registration The revenue cycle begins at patient registration, and that's also where providers can begin to apply technology to increase cash flow downstream. Patient registration is often cumbersome, an in-person process tied to a clipboard, paper, and open office hours. Yet Experian Health's State of Patient Access 2023 report shows that 73% of patients want to handle these processes online. Self-scheduling offers patients more flexibility for scheduling appointments when they want and on their preferred digital device. It can remove the friction from a frustratingly manual paperwork process while decreasing no-shows with automated messaging by text and email. Experian Health's automated patient scheduling software reduces time spent on traditionally manual scheduling tasks by 50%. Providers that select these tools increase their patient show rate to nearly 90%. From a revenue cycle perspective, providers that implement online self-service scheduling can see up to 32% more patients each month—which is money in the bank. 2. Finding hidden financial resources to reduce bad debt Experian Health's Coverage Discovery® automates the insurance verification process to match patients' responsibility with the best financial resources possible given their policy limits. Coverage Discovery scans proprietary databases and historical information for primary, secondary, and tertiary coverage. The platform seeks to find all available financial resources to lower the volume of accounts that end up as write-offs or in collections. In 2022, Coverage Discovery found $64.6 billion in patient coverage. In 2023, this software discovered previously unknown financial options for 32.1% of patient accounts, giving these customers more options for reducing debt. 3. Preventing denials by improving data quality Many claims are rejected by payers each day simply due to human error. Some of the most common reasons for claims errors include missing or inaccurate information caused by manual processes. From eligibility verification errors to incorrect insurance details, when paperwork is still by hand and this complex, it's far more likely to make an error than not. Experian Health's Patient Access Curator software automatically verifies eligibility and coverage while scanning patient documentation for obsolete or inaccurate data. The software leverages artificial intelligence and robotic process automation (RPA) to apply computer rigor to previously manual workflows to reduce manual errors. Significantly, this new technology performs these tasks in seconds, freeing up staff time and improving the patient experience. 4. Using artificial intelligence to prevent and mitigate denials How much does the endless pursuit of denials management tie up potential revenue? One survey showed half of hospitals report more than $100 million in delayed or unpaid claims at least six months old. The good news is that 85% of the errors that lead to denied claims are preventable with the help of existing technology. Experian Health's AI Advantage™ solution works in two critical areas to prevent denials before they happen—and correct any denied claims quickly: At the front end of the claim, by correcting errors before submission. AI Advantage - Predictive Denials spots the submissions most likely to kick back from the payer. This early warning system reduces the volume of denials by flagging claims with errors stemming from human mistakes or payer requirements changes. At the back end of the claim, for those rejected by the payer. AI Advantage - Denial Triage takes the volume of claims rejections and prioritizes them by those with the highest ROI for the provider organization. Not all denials offer the same volume or potential for revenue collection. This solution helps prioritize the highest returns quickly to increase revenue collection. Benefits of applying AI and automation to healthcare's revenue cycle There is little argument across the healthcare industry that the strategies that once worked to create a healthy revenue cycle still apply. Fortunately, today's AI and automation software allow these organizations to modernize their approach to these complexities—and win the revenue cycle game. The benefits of applying modern AI and automation tools at every point of the revenue cycle are substantial: Faster and more accurate patient scheduling and registration. No more manual data searches that tie up staff time. Fewer data entry tasks that lead to errors. Fewer claim denials. Less time spent chasing claims. Fewer days in A/R. More cash on hand. A high-performing revenue cycle is possible with the latest technology tools. Experian Health offers a suite of technology solutions that utilize artificial intelligence and automation designed to get providers paid faster, free up staff time, and improve the patient experience. Improving the revenue cycle is a necessity, and Experian Health helps healthcare organizations achieve this goal.

Could common revenue cycle management (RCM) myths be preventing healthcare organizations from getting paid in full? Does what constituted best practice a few years back still apply to revenue cycle operations today? Many providers are embracing new technology to strengthen their RCM processes, using automations and software to create more accurate and efficient billing and claims management workflows. But if these processes are built on shaky assumptions, the results will be sub-optimal. As year-end financial reviews get under way, there is a prime opportunity to re-evaluate some long-standing beliefs about billing, collections and payments that, if not set straight, could limit financial performance in the year ahead. This article examines four of the most common revenue cycle myths and considers what providers can do to make financial growth a reality in 2024. Revenue Cycle Myth 1: All patients are equally likely to pay Reality: No two patients are alike – whether in their medical needs or financial circumstances. Providers know this, yet many rely on revenue cycle management solutions that lean toward a one-size-fits-all approach to patient payments. Instead, providers should consider RCM tools that use data and analytics to segment patients according to their individual financial situation, to create a more personalized and proactive approach to collections. This should take account of both the patient's ability to pay (i.e., whether they can afford their bills), and their likelihood to pay promptly, which may be enhanced by offering payment options that are convenient and aligned to their personal preferences. Collections Optimization Manager analyzes patients' individual payment history and demographic information so their accounts can be routed to the most appropriate collections pathway from the start. Patients that are likely to pay quickly can be sent billing information automatically and presented with self-service payment options. Alongside this, Patient Financial Clearance pulls together credit and non-credit data to help providers identify patients who may need a little more guidance and connect them to suitable payment plans. It catches any individuals who may be eligible for Medicaid or charity support. Staff get accurate, at-a-glance data to help them have sensitive financial conversations with patients, and can avoid losing time chasing collections from patients who would never have been able to pay. Case study: See how Stanford Health Care improved collections with a tailored, patient-focused approach to healthcare collections. Myth 2: It's hard to have meaningful pre-service financial conversations with patients Reality: Contrary to popular belief, most patients are receptive, and even eager, to have financial discussions with their provider as soon as possible. Doing so need not be challenging. In the past, providers may have worried that broaching the money question could deter patients from seeking necessary care, or simply not prioritized such discussions. Billing and insurance can also be highly complex, which may lead staff to assume that patients would find conversations about these issues to be confusing or overwhelming. But it is for these exact reasons that providers should have financial discussions with patients as early as possible. Experian Health's 2023 State of Patient Access survey found that almost 90% of patients wanted upfront pricing estimates so they could plan ahead for their financial obligations – yet less than a third received one. Tools like Patient Payment Estimates and Patient Financial Advisor can calculate cost estimates, taking account of the patient's claim history, deductibles and other insurance information, and automatically send these to patients before treatment so they know what to expect. These can also be combined with quick payment links so bills can be cleared before care. Giving patients consistent information through whichever digital channel they prefer means they will be better positioned to make informed decisions and discuss their situation with patient access staff if necessary. When patients are better informed and supported, they're also less likely to end up postponing care due to cost concerns. And with the same accurate data at their fingertips, patient access staff can serve as financial concierges, helping patients to understand coverage and copayments and check eligibility for relevant financial assistance programs. In addition to user-friendly data tools, providers should consider whether staff would benefit from additional training to bolster their confidence in leading compassionate financial conversations. Myth 3: It's impossible to know what patients owe across a system with a single look-up Reality: Thanks to data analytics and digital payment technology, it is now pretty straightforward to consolidate a patient's outstanding balance information from across an entire health system, and debunks common revenue cycle myths. Patient access staff can view a comprehensive summary of a patient's insurance status, estimated liability and open balances from multiple providers, enabling them to have meaningful financial conversations with patients. Even if these discussions do not lead to immediate payment, they can still act as a reminder to nudge the patient to act soon, thus accelerating the payment process. Selecting RCM tools from a single vendor makes it easier to integrate data from multiple workflows and generate a unified view of what a patient owes. When systems talk to each other, it's possible for a single tool to leverage the data and create a better experience for patients and staff. For example, PaymentSafe® automatically brings together data gathered throughout the revenue cycle to streamline what was previously a disjointed and time-consuming process. With point-to-point encryption, it accepts secure payments at any point in the patient's journey, using cash, check, card payments and recurring billing, through a single web-based application. Myth 4: Revenue cycle management is “set-and-forget” Reality: Revenue cycle managers may dream of setting up a system once and then forgetting about it, but the reality is that managing billing, claims and collections is an ongoing and evolving process that needs constant attention. Healthcare organizations must regularly review and adjust their RCM strategies to prevent missed revenue opportunities, manage compliance risks and promote operational efficiencies. That said, data analytics and automated revenue cycle management tools do make it far easier for providers to stay on top of RCM demands. These tools help providers with everything from monitoring payer policy changes and identifying billing errors to personalizing patient communications and generating monitoring reports. Artificial intelligence takes it a step further, for example, by preventing and predicting claim denials. In this way, these tools reduce the need for extensive staff input, so staff can spend more time focusing on the issues that need more human attention. With up-to-the-minute reports covering multiple RCM processes, staff also have the information they need to optimize performance and find opportunities to boost reimbursement that may have been previously overlooked. So, while RCM is not quite a “set-and-forget” process, automations and analytics can simplify it significantly, so it's less labor-intensive for staff and more efficient overall. Debunk revenue cycle myths and proactively challenge assumptions to increase profitability Debunking these revenue cycle myths is simple and achievable with tools that integrate a patient's clinical and financial data for a fuller picture of what that patient needs. This is crucial as changing consumer expectations, economic drivers, and new technology reshape how patients, providers and payers interact with one another. Checking underlying assumptions in any RCM process is essential to root out potential misunderstandings and outdated thinking. Not doing so leaves providers vulnerable to inaccurate financial projections, mismatched strategies and poor patient experiences. See how Experian Health's industry-leading Revenue Cycle Management Solutions make streamlined billing and collections a reality.

Artificial intelligence (AI) is cropping up everywhere. But it's about to make an even bigger splash by revolutionizing how providers handle HCM (healthcare claims management). In healthcare, the claims process is a real source of frustration. Thirty-five percent of healthcare providers say they lose more than $50 million annually in denied claims. That's a lot of money lost for healthcare providers after care is delivered to their patients. As industry costs rise, healthcare claims management becomes an unsustainable financial drain for providers, who have no choice but to push these costs back to the patients they're trying to serve. Using AI for claims management has numerous benefits - and with denied claims on the rise, healthcare providers will need to incorporate this technology or risk leaving millions on the table. AI Advantage™, Experian Health's innovative predictive analytics software, uses AI in claims processing to help providers expedite reimbursement and improve cash flow. This software takes the unsolvable Gordian Knot that is U.S. claims reimbursement and untangles it for faster reimbursement, better cash flow, and less wasted time. Understanding AI in Healthcare Claims Management The odds are stacked against providers before the patient ever visits their practice. One patient claim can go through 20 or more checkpoints before the payer approves reimbursement. Denied claims are much less likely to be paid, and 89% of hospitals say denial rates are rising. An Experian Health survey said the three most common reasons for medical claim denials include: Missing or incomplete prior authorizations Failure to verify provider eligibility Inaccurate medical coding Without question, healthcare claims denial management must include better training for staff to file claims without error. Providers need accurate patient data upfront, with standardized verification processes at each step in the process.However, healthcare providers can reduce or completely avoid many common reasons for medical claim denials by using AI in claims processing. AI claims management software provides “teachable moments” for staff by sharing claims management errors at the front-end of processing before submission and possible rejection by the payer. Tom Bonner, Principal Product Manager at Experian Health, says, “Healthcare providers everywhere ask themselves: How can we reduce claims denials? But we have the technology to go even further. By using AI in claims processing, providers can avoid claims denials altogether by proactively spotting and correcting the human errors that slow down reimbursement before the claim is submitted to the payer.” Top Benefit of Using AI in Claims Processing - Providers Avoid Claims Denials AI and automation are the one-two punch providers need to improve healthcare claims processing. Using AI healthcare claims management software helps organizations avoid claim denials far upstream — before it occurs. AI Advantage - Predictive Denials is a preventative tool that proactively stops bad claims before they turn into costly denials. This AI-driven healthcare claims management software works in two key ways: By proactively identifying undocumented payer adjudication rules potentially resulting in denials. By identifying claims with a high likelihood of denial based on an organization's historical payment data. Schneck Medical Center improved their claims management processing by using AI Advantage - Predictive Denials to first identify error-prone claims. When the automated system spots the probability of a denial, it triggers an alert that routes the claim to an investigative biller. The AI carefully scrubs the claim, checking coding errors, authorization status, insurance eligibility, and more. Once the agent resolves these errors, they can successfully submit the claim to the payer. Using AI in claims processing leads to improved accuracy and fewer rejections for better revenue cycle management. After leveraging these tools for six months, Schneck Medical Center reduced denials by 4.6% on average per month. Benefit #2 - Healthcare Claims Management Software Speeds Denials Mitigation But what if a claim makes it through to the payer and they deny it? Denial management is a tedious, time-consuming process that impedes cash flow. AI Advantage - Denial Triage uses advanced algorithms to segment denials based on their potential value, allowing billers to focus first on high-value claims to maximize the revenue cycle and quickly reduce the denials queue. AI in reimbursement processing increases the speed of healthcare claims management to help staff identify and target the claims that need attention as quickly as possible without wasting time on low-value denials. By using automation and AI, healthcare providers gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. Benefit #3 - AI Software Automates Reimbursement for Faster Payment Experian Health offers a streamlined series of standardized, automated tools to help with claims management. From registration, quality assurance, and eligibility on the front-end to claims processing and denials management on the back-end, Experian Health has full lifecycle solutions to prevent and mitigate reimbursement denials. The Experian Health intelligent ecosystem is a comprehensive solution to the untenable healthcare claims denials management process. These tools include: ClaimSource: Voted Best in KLAS Claims Management Clearinghouse 2023, this healthcare claims management software gives providers reimbursement visibility in real-time from one intelligent hub. This software helps providers handle the entire reimbursement cycle. The tool allows end-users to create custom work queues to manage claims more efficiently. It also automates claims, allowing the software to clean submissions before they send. Flagging features let billers know exactly what's wrong with a claim, so staff can repair the error. Ensuring clean claims lessens denials and improves cash flow. Claim Scrubber spots claim errors within 3 seconds, flagging the claim with an explanation of why it needs reworking. Intelligent algorithms identify undercharging to maximize payer-allowed amounts. For medical billers and coders, this tool quickly spots the root causes of claims denial, faster and more accurately than doing it by hand. Enhanced Claim Status connects billers quickly to denied, pending, returned-to-provider, or zero-pay transactions well before the EOB or Electronic Remittance Advice forms process. Instead of waiting 30- or 45 days to review a denied claim, this software lets teams see the problems online in real time. It's an immediacy that's been missing from both front- and back-end claims management processes, allowing real teaching moments for revenue cycle teams. Denials Workflow Manager: Eliminates manual processes and allows providers to optimize the claims process. Providers no longer review claims manually, instead using computer automation to optimize follow-up activities. Claims management teams can quickly identify and target the claims needing attention quickly. Powerful features leverage root cause analysis to identify trends leading to claims denials. These platforms easily integrate with existing practice management and electronic health record software. They work well together or ala carte to increase the accuracy of claims documentation to eliminate denials. A successful strategy for reducing claims denials starts with AI and automation software. Healthcare organizations can reduce the time spent processing rejections and improve A/R by flagging at-risk claims. Ultimately, healthcare claims management software solves the complexities inherent in these processes. Higher patient satisfaction and greater provider revenues are possible. Talk to Experian Health today to see AI in claims processing at work.

After a brief hiatus, the COVID-19 virus is reemerging, just in time for cold and flu season. According to the Centers for Disease Control and Prevention (CDC) July numbers show COVID-related hospitalizations are ticking upward. A spokesperson from the agency said this is the first notable acceleration of the illness in 2023. In these challenging times, healthcare providers prepare for the next COVID-19 surge. While the American healthcare system struggled just three years ago to cope with COVID-19 as a black swan event, these organizations now have the perspective that comes from hard-earned experience. They also have the potential benefit of time. It makes sense to take the lessons learned from the 2020 crisis and apply best practices to prepare for a COVID-19 resurgence. A new survey shows healthcare teams still struggling with burnout from the last COVID uptick. By leveraging technology and implementing best practices, providers can streamline processes, improve patient access, and alleviate burdens on healthcare staff. Let's explore how digital solutions such as online self-service scheduling, mobile-first registration, and patient portals can help healthcare organizations prepare for the next wave of COVID-19. COVID lesson #1: Online self-service scheduling offers key benefits for patients and staff During the previous COVID-19 outbreak, online self-service scheduling proved to be crucial in mitigating the spread of the virus. Not only did it improve the experience for patients and healthcare staff, but it also reduced the volume of visitors to emergency rooms and prevented sick individuals from congregating in waiting rooms. While self-service patient registration isn't just for a pandemic, COVID-19 clearly illustrated the critical need for digital patient intake solutions. A recent Experian Health survey showed seven of ten patients prefer self-service appointment scheduling. Forbes says, “Scheduling options are now a must-have feature for hospital and health systems…Health systems that do not offer online patient scheduling will not only be left behind but will be left out.” With the potential for an additional COVID upsurge in the future, health providers must also consider the benefits for staff of offering online patient scheduling options. They include: Fewer manual tasks associated with patient registration Real-time scheduling information that streamlines workflows Reduced patient no-shows Improves team communication and closes care gaps Automates unnecessary administrative functions COVID lesson #2: Mobile-first registration increases patient access and satisfaction The Experian Health State of Patient Access 2023 shows increasing the convenience of patient access is the quickest way to improve customer satisfaction scores. The survey showed access to provider care is challenging post-pandemic; four in ten say access has worsened because of scheduling. These challenges are always more daunting during high utilization—such as during the COVID-19 pandemic. As healthcare providers prepare for a COVID surge during flu season, adopting a mobile-centric registration accelerator solution can empower patients and streamline the registration process. Patients can complete registration safely and conveniently in their homes without spending time in a waiting room. Providers benefit from this online solution with reduced paperwork, automation of manual tasks such as appointment reminders, and a lightened workload. Implementing mobile-first registration not only improves patient satisfaction but also eases the burden on healthcare staff. Patients that use these solutions reduce practice call volumes by 50%. COVID lesson #3: Patient portals streamline communication and engage patients Harnessing technology to streamline processes and alleviate burdensome tasks is crucial. Patient portals are revolutionizing healthcare by empowering patients and lightening the load on the system. The pandemic accelerated the use of patient portals. In 2020, the National Institute of Health (NIH) found less than half of insured adults used these tools. Today, the usage of online patient portals such as PatientSimple is much higher—and on the rise. A recent national survey shows even seniors are getting into online patient portals to access healthcare information; 78% of people aged 50 to 80 now use at least one of these online hubs. Five years ago, researchers say just 51% of this population used these tools. Leveraging a patient portal now before cold and flu season makes sense. Patients can use patient portals to manage common tasks such as: Pay balances up front with an on-file credit card Set up payment plans View test results Generate price estimates View statements and test results online Apply for charity care Communicate with providers The latest research from Experian Health and PYMNTS says two out of three consumers use patient portals to “streamline the medical journey,” while the remainder say they'd use these tools if their provider offered them. Online patient portals increase access and convenience for healthcare customers. However, there are just as many arguments in favor of providers investing in patient portals to benefit their staff.As COVID-19 cases rise, patient portals serve as critical information hubs, streamlining communication between providers and the patients they serve. Self-service portals ease pressure on overburdened care teams and upfront administrative staff. They also integrate with electronic health records (EHRs), streamlining the flow of personal health information (PHI) between providers and patients. It's a more engaging and effective experience for patients that lightens providers' workloads. As we move toward increasing COVID cases this fall, patient portals will be vitally important for everyone involved in the patient journey—including the patients themselves. Learn how Experian Health is helping care providers streamline their efficiencies with digital software and prepare for the next COVID surge.

Finding previously unidentified insurance coverage is a high-stakes treasure hunt for healthcare providers. If patients are unaware of active coverage or eligibility for Medicare and Medicaid, they will be left footing a bill that could have been covered by a payer. If they can't afford it, their account may end up being written off to bad debt, and providers will miss out on reimbursement opportunities, leaving millions of revenue dollars on the table. Hunting down missing or forgotten coverage on the spot is a challenge for providers, particularly if the patient does not have a Social Security Numbers (SSN) or the payers in question do not use SSNs to verify eligibility. It's a problem worth solving though and can improve the patient financial experience while preventing avoidable revenue loss. The shift away from Social Security Numbers Historically, providers have used demographic information like Social Security Numbers (SSN) to verify patient identities and locate coverage information. Without a unique patient identifier, SSNs were a stable way to link a person's health information across multiple health systems and payers. However, the use of SSNs for identification and verification purposes has dropped in recent years due to concerns about patient privacy and the risk of identity theft: SSNs give identity thieves a mechanism to assume a person's identity and access financial information and health records illegally. Moreover, SSNs are unreliable identifiers, as it is possible for more than one person to use the same number. Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. In 2018, the Centers for Medicare & Medicaid Services began the process to remove SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards, replacing them with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person's identity for Medicare transactions like billing, eligibility status and claim status. Similarly, many health plans also shifted away from using SSNs as primary identifiers, instead opting for member IDs or other secure identifiers to verify and track coverage for their members. Find billable coverage with historical data With demographic searches on the decline, providers need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage. Combining search best practices, multiple proprietary databases and historical information, Experian Health's Coverage Discovery® locates patients' billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process. In 2022, Coverage Discovery tracked down billable coverage in almost 30% of self-pay accounts and found more than $64.6 billion in corresponding charges. Closing the coverage gap caused by Medicaid disenrollment Coverage Discovery offers another important benefit: helping providers offer additional support to patients on lower incomes who find themselves without Medicaid, at least for a short time, following the end of continuous enrollment. As of July 2023, more than 1.6 million Medicaid enrollees were disenrolled. Providers can use the tool to confirm whether Medicaid coverage remains in place, or to uncover any additional billable government or commercial insurance that could give patients peace of mind. Patient Financial Clearance can also help screen patients for Medicaid eligibility before or at the point of service, then route them to the Medicaid Enrollment team or auto-enroll them in charity care if appropriate. Case study: Read the case study to find out how Luminis Health used Coverage Discovery to locate $240k in billable coverage each month. Leverage technology to locate unidentified coverage Thanks to advanced tools like Coverage Discovery and Patient Financial Clearance, it's much easier for providers to locate alternative coverage options for patients, using multiple sources of data. These tools leverage secure identifiers and comprehensive searches across databases, allowing providers to reclaim revenue that may otherwise go unclaimed, and reassuring patients that they won't be left holding an unexpected bill. Find out more about how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

  “The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.”   This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior authorizations requirements were particularly messy, and as more patients return to care, there’s a risk they’ll become even more chaotic.   During 2020, many in-person healthcare services were canceled, delayed, or avoided for fear of infection. Now, patients feel more comfortable about returning for care. When we first surveyed consumers in November 2020, 58% said they’d wait until COVID-19 subsides before rescheduling. In June 2021, only 19% said they’d wait. Canceled procedures have dropped by half, and while the opportunity to recoup lost revenue is a relief for providers, processing prior authorizations for the sudden influx of patients is a worry.   Two thirds of providers say they find it difficult to keep track of changing pre-authorization requirements. Two in three also expect to face issues in securing authorizations for scheduled elective procedures, up from just over half last year. Embedding accurate and efficient workflows will be paramount as patient volumes rise, which means it’s time to rethink the archaic manual processes that often result in delays, errors, and non-compliance. Could automation offer a mess-free way to manage the growing challenge of prior authorizations?   Manually managed prior authorizations cost time, money, and quality of care   Even before the pandemic, prior authorizations were a thorny issue for healthcare organizations who wanted to offer the best possible care to patients, without risking denied claims. According to the Medical Group Management Association (MGMA), 80%-90% of medical groups say prior authorization requirements have grown year over year.   In an ideal world, prior authorizations protect patients from undergoing therapies that are overpriced, ineffective or unnecessary. They assure providers that they’ll be reimbursed for the services they deliver, and confirm that treatments are high-quality, evidence-based, and safe.   In reality, while prior authorizations can help incentivize value-based care, the admin and financial burden for providers is growing exponentially. Frequent changes, increasing denials, and lengthy negotiations with payers mean many providers need to employ additional full-time staff to handle prior authorizations. As the cost of drugs soars, they’re forced to lay out huge sums and cross their fingers as they wait to recoup the costs.   There was a hint of respite at the peak of the pandemic, when payers lifted many requirements, or extended authorizations already held on file. But these changes took time to filter through, and some providers continued to lose up to two entire business days per week to prior authorizations work during the pandemic.   Now, as the pandemic starts to settle, those requirements are back (and growing), and providers are scrambling to re-join the dots using their old, manual processes. As patient numbers surge, traditional manual methods for such an admin-heavy process are straining under the pressure. With so many accounts to authorize, the need for an automated solution is even more apparent.   Leveraging automated solutions for speedy, accurate prior authorizations To ensure patients get the care they need and to keep a lid on further revenue loss, hospitals and medical groups should consider tapping into automated authorizations engines. With an integrated Authorizations management system, you can initiate more authorizations in less time, run automated status checks to avoid rescheduling care, keep abreast of changing payer rules, and avoid unnecessary reworking of claims.   Users are guided through the workflow, which auto-fills essential real-time payer information. Patient information is populated by the SmartAgent feature, so pre-certification can be progressed quickly behind the scenes. Users only need to step in when clinical questions pop up. Notice of Care (NOC) generates a worklist of all pending patient encounters, to ensure that no payer notification requirements for notice of admission, observation or discharge are missed. Staff can escape the time-suck of repeatedly checking payer websites or calling up payers to verify yet again whether a patient encounter qualifies.   Say goodbye to Excel spreadsheets and lengthy calls to payers For organizations worried about rising patient numbers choking their existing manual workflows, switching to an automated system could be a timely move. Chasing paperwork is never a good use of resources, and with the lingering possibility of pandemic flare-ups, automated authorization inquiries could help minimize time spent on tedious manual tasks and running checks with payers.   Find out more about how Experian Health’s Prior Authorization software could help your organization minimize the risk of missed reimbursements, and give your team the breathing space needed to focus on maximizing support for patients returning to care.