Data and Analytics

A positive patient experience can quickly sour when difficult financial conversations enter the picture. High out-of-pocket costs and confusing medical bills make payments a sensitive issue for many patients. For providers, the challenge is clear: how to improve patient collections while delivering compassionate care. This article considers proven strategies and best practices to simplify patient collections, maximize revenue, and keep the focus on patient-centered care. The importance of optimizing patient collections for healthcare providers For many patients, an unforeseen medical emergency can quickly become a financial one. According to a 2024 report by the Consumer Financial Protection Bureau, medical debt rose from an average of $2,000 per person to over $3,100 in a year, while 15 million Americans carry medical collections on their credit reports. Such financial strain erodes the patient experience, with one in five patients experiencing distress over healthcare costs they can't afford. Experian Health's State of Patient Access 2024 survey found that both patients and providers agree that understanding coverage helps patients manage their healthcare costs. Still, unpaid bills and aging accounts are a persistent concern for providers. Hospitals' operating margins may have rebounded, but remain extremely tight. Remaining alert to risks and opportunities in patient collections is essential for long-term financial health. As patients shoulder a greater share of their medical costs—and those costs continue to rise—efficient collections are critical for patient trust and financial resilience. Breaking down the patient collections process The patient collections process involves determining how much of the cost of care falls to the patient, and then billing and collecting the correct amounts. During registration, providers verify insurance coverage and eligibility to estimate what the insurer will cover. Accurate cost estimates can then be provided to patients upfront, giving them the option to make payments before or at the time of service. The bulk of billing and collections activities take place post-visit, sometimes involving third-party agencies. However, collections can be thwarted by several challenges. Staff must keep up with frequent changes in insurance policies to prevent errors in billing or cost calculations. Patients may worry about affordability, leading to late payments. Billing teams often lack information about patients' financial circumstances, making it hard to predict how likely they are to pay. On top of this, many patients expect more convenient payment options, such as online or mobile payment methods, and will express frustration if the process feels inconvenient. Proven strategies to collect more revenue, sooner Three ways to create a patient-friendly billing experience and ensure prompt payment include the following: 1. Reduce stress with clear pricing and flexible payment plans Patients want collections processes to be clearer and more transparent. The State of Patient Access survey found that more than four in ten patients say they would be more likely to cancel or postpone care without an accurate estimate. Six in ten say they'd be more confident in their ability to pay for care if they were offered a payment plan that took account of their financial situation. Automated patient estimates arm patients with accurate information about the expected cost of care in advance. They have more time to make their financial arrangements and are less likely to be surprised by a surprise bill. Providers can offer additional clarity and flexibility through tailored payment plans. Experian Health's Patient Financial Clearance software uses advanced analytics and data to analyze individual patient accounts and determine their ability to pay. This allows front desk personnel to quickly choose the most appropriate financial pathway for each patient. It also supports more compassionate financial conversations, as staff can adjust their approach to suit each patient's financial situation. 2. Help patients find and understand coverage Relying on manual processes can slow down registration and miss potential payment sources. Since 2000, unidentified coverage opportunities have landed hospitals with more than $745 billion in uncompensated care. Given that patients are asking for help understanding coverage, it makes sense to build coverage discovery into the collections process. Experian Health's Coverage Discovery® automatically scans patient accounts throughout their care journey to uncover alternative payment methods and reduce financial strain. This has helped healthcare organizations like Luminis Health identify over $240k in active coverage per month, greatly reducing the financial risk for patients and providers. 3. Make payments easier to prevent delays Improving patient collections processes will be fruitless if patients can't easily make payments. Digital and mobile payment options are non-negotiable for today's digital-first consumers. Accepting payments at multiple collection points, including mobile devices, kiosks and patient portals, gives patients the convenience and choice they need to pay promptly. Best practices for patient collections management Aside from automation and digital tools, the strongest strategies for improving patient collections rest on one key ingredient: robust data. Collections software is only as good as the data behind it. With a tool like Collections Optimization Manager, providers can deploy advanced analytics to segment patient accounts so they can be handled appropriately. Using credit, behavior and demographic data, it applies a proprietary propensity-to-pay score to each account, so staff know which accounts to prioritize, write off or refer out. This approach has helped organizations like Novant Health and Cone Health bring in millions of dollars with personalized, patient-centric collections. On-demand webinar: Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager. Tracking patient collections success By monitoring key performance indicators like collection rates, accounts receivable days and patient feedback, providers can continue to fine-tune their processes. Collections Optimization Manager captures this data in user-friendly dashboards and reports, so staff can assess their performance against their own history and industry trends. Users also benefit from expert support from Experian Health consultants, who help teams evaluate reports and recommend the right collections strategies every step of the way. How to build a patient collection strategy that gets results For millions of Americans, medical debt isn't just a financial burden: it's a barrier to care. To overcome this challenge, providers need proactive collections strategies that prioritize patient well-being and financial stability. By incorporating automation, analytics, and digital tools, healthcare organizations can create patient collections processes that are clear, compassionate and effective, delivering better outcomes for both patients and providers. Find out more about how Experian Health's suite of healthcare collections products helps providers boost collections, cash flow and patient satisfaction. Learn more Contact us

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.

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.

As the saying goes, “what gets measured gets managed.” For healthcare providers, this is a reminder that optimizing the revenue cycle relies on monitoring and reporting on the right metrics. Claims, billing and collections teams will struggle to know which of their activities lead to improvements if they don't track key performance indicators (KPIs). The question, then, is how to choose the right KPIs. How can providers gain more visibility into their financial performance? Where are the pitfalls that limit the usefulness of the data? This article looks at how revenue cycle managers may find more opportunities to prevent revenue leakage by building a healthcare revenue cycle KPI dashboard populated with the right medical billing metrics. What is a revenue cycle KPI dashboard? A revenue cycle or medical billing KPI dashboard is part of a revenue cycle management (RCM) platform. It enables real-time visibility into metrics regarding billing and revenue and is customizable based on the KPIs that matter to each healthcare organization. It centralizes critical information related to patient access, healthcare collections, claims management and payer contract management. Challenges and pain points in revenue cycle management The first step in selecting the most relevant KPIs for a revenue cycle dashboard is to identify and understand the thorniest RCM challenges that could be causing dollars to slip through the net. Here is a run-down of some of the biggest obstacles to effective RCM and possible performance measures that may help track improvements: 1. Inefficient patient access for scheduling and registration Revenue cycle management begins in patient access. Unfortunately, so do many of the errors and inefficiencies that lead to claim denials and missed payment opportunities. Confusing and disjointed scheduling systems can lead to underutilization of services and no-shows, as well as falling short of consumer expectations for online booking methods.Online self-scheduling tools make it easier for patients to book appointments so they can start their healthcare journey quickly and conveniently. Cancelled appointment slots can be offered to other patients, to maximize clinician time. Here, it would be useful to track the percentage of unfilled appointments: an increase over time would suggest that patients are finding it easier to book appointments, and confirm better use of doctors' hours.Similarly, digital registration options can quell the frustrations that many patients feel when trying to fill out forms ahead of treatment. No-show rates, percentage of patients using online tools, registration error rates and patient satisfaction scores would all be relevant KPIs. 2. Claims and denial management processes that rely too heavily on manual work From checking payer updates to poring over billing codes, claims management workflows often involve manual tasks that put unwelcome pressure on already-overwhelmed staff. There are many opportunities for errors, which drive up denials and put the brakes on the organization's cash flow. An increase in clean claim rate and a reduction in the rate of denials would be KPIs to look for on the revenue cycle dashboard. An end-to-end claims management solution that uses automation and artificial intelligence (AI) to improve accuracy and lift the load on staff can alleviate these challenges. For example, AI Advantage™, leverages AI to predict and prevent denials using the organization's own historical claims data. 3. Patient collections practices are often inconsistent Patient responsibility for healthcare costs is higher than ever, so the consequences of poor billing practices are severe. Experian Health's State of Patient Access 2023 report found that 63% of providers believe patients frequently postpone care because they're worried about costs. If patients are unsure about what they owe, unable to find financial assistance, or unclear about how and when to pay, the provider is likely to see their accounts receivable metrics and collection rates heading in the wrong direction. Clear bills and convenient ways to pay are key to optimizing patient collections. Collections Optimization Manager supports better financial decision-making for both patients and providers by screening, segmenting and routing accounts based on payment probability. Users get tailored support from an experienced optimization consultant to select the right KPIs and turn insights into effective action. 4. Actionable insights are often out of reach RCM analysts may have a wealth of information to interrogate, but they are often tripped up by disparate systems and legacy processes. Critical information in patient access, collections, claims management and payer contract management may be held in different systems and formats, which makes it much harder to see connections. With revenue cycle analytics tools, providers can make sense of the information they hold, rather than drowning in data. A revenue cycle or medical billing dashboard can enable real-time visibility into the KPIs that matter most while tracking changes over time. What are KPIs for RCM?  Revenue cycle KPIs are quantifiable measures that illustrate the financial viability of an organization's revenue cycle. These metrics indicate if healthcare organizations are achieving their financial goals and are effectively managing revenue inflows and outflows. Specific KPIs will be tailored to the organization's particular goals, challenges and processes. The quality and availability of relevant data will also play into the selection process, to maximize visibility and insights into the revenue cycle. In addition to the suggested metrics discussed above, other common KPIs to feature in a revenue cycle dashboard include: Days in account receivable Aged accounts receivable rate Adjusted collection rate Clean claim rate Claim denial rate Claim appeal rate Bad debt rate Gross collection rate Net collection rate Importance of healthcare revenue cycle KPI dashboards A  revenue cycle KPI dashboard is more than just a handy way to present data. Monitoring an organization's financial health is critical to its ability to serve patients and attract and retain high-performing employees. A healthcare revenue cycle dashboard can enable providers to: Identify if revenue levels are sufficient to keep the organization afloat and know in advance if new strategies are needed to maintain cash flow Locate glaring operational efficiencies in RCM that are costing the organization time and money Forecast future revenue projections to determine the organization's ability to expand and invest Improve all financial decision-making through better use of data that is already being collected Boost patient satisfaction by highlighting opportunities to create a more convenient and transparent financial experience. Driving efficiency and success through RCM solutions Once the revenue cycle KPI dashboard is built, RCM teams can get to work on implementing the specific actions needed to tackle those thorny issues discussed above. With Experian Health's integrated RCM solutions, providers can bring together metrics such as financial performance, billing efficiency and collections rates into one place, to allocate resources more strategically, drive targeted improvements, and accelerate reimbursement. And with these insights, providers are not just managing revenue – they are optimizing for future financial stability. See how Experian Health's revenue cycle management solutions, dashboards and drill-down reports can uncover opportunities to prevent revenue loss and boost profitability.

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.

With the ability to be applied across many different areas – from disease prediction to claims management and administrative tasks – data and analytics in healthcare is booming. In fact, according to a Grand View Research report, the global market for data analytics was valued in 2022 at $35 billion and is expected to increase at a compound annual growth rate of 21.4% until 2027. So, why the rapid growth? How can healthcare data analytics be used across the healthcare revenue cycle? The role of data and analytics in healthcare Historically, there has been a large amount of healthcare data being generated, but the industry has struggled to properly leverage this data into useful insights that improve patient outcomes, operations, or revenue. Today, with increasingly advanced data analytics, healthcare providers are using real-time data-driven forecasts to stay nimble and pivot quickly in rapidly changing healthcare and economic environments. And there is more data collaboration between healthcare organizations to convert analytics-ready data into business-ready information, thanks to the ability to automate low-impact data management tasks. Data-derived intelligence is also now easier to share with colleagues, third parties and the public. Types of healthcare data analytics methodologies and tools Healthcare data analytics involves several different types of methodologies and tools – all of which can be applied to various aspects of revenue cycle management. For example, descriptive analytics allows organizations to review data from the past to gain insights about previous trends or benchmarks. Predictive analytics, on the other hand, uses modeling and forecasting to help predict future results. When a strategic course of action is needed based on certain data inputs, prescriptive analytics is used. If a provider wants to take a deep dive into raw data to uncover patterns, outliers, and interconnection, they may employ discovery analytics. There are also generally three categories of technology-driven tools that can help collect and convert raw data into usable insights during the revenue cycle, including: Solutions that gather data from a wide variety of sources, such as patient case files, machine-to-machine data transfers, and patient surveys Programs designed to scrub, validate, and analyze data in response to a specific question being researched Software created to leverage the results produced by the analysis into actionable suggestions that be applied to meet specific goals Applying data analytics to maximize revenue “There are many things driving near-constant change in the healthcare revenue cycle, including shifting reimbursement, evolving value-based payment models, growing regulatory pressures, and increasing provider risk and patient responsibility,” says John Menard, VP of Product, Analytics, at Experian Health. “Healthcare organizations are also adapting to value versus volume reimbursement models, requiring revenue cycle leaders to lean into leveraging data analytics to improve not just operational efficiency, but patient financial experience and quality outcomes as well." Here's a closer look at how data analytics can help with revenue cycle management: Assessing patient finances From registration to collections, data analytics can play a key role at every step of the patient journey – and revenue cycle. Not only can the right data analytics tools help healthcare organizations better assess a patient's individual financial circumstances, but they can also help providers create accurate estimates and payment plan recommendations. Data-driven technology can help providers reduce surprise billing through more transparent pricing, helping patients navigate the cost of care and providing more timely patient communication. Digital solutions can help improve the patient financial journey by: Providing a self-service patient portal – With a solution like PatientSimple, patients get convenient 24/7 access to self-service account management tools. They can use the online portal to log into their healthcare account to securely process payments, request or review payment estimates, and schedule appointments. The portal also provides patient access to pricing information, plus the ability to apply for financial assistance or set up payment plans. With easy-to-use patient online tools, patients are more likely to meet their self-pay responsibilities and providers get paid more quickly as a result. Offering payment solutions – To collect payments with confidence, healthcare providers can utilize comprehensive data collection and advanced analytics through a digital solution like Patient Financial Clearance. With this solution, providers use a patient's financial data to quickly assess a patient's propensity and likelihood to pay prior to treatment. When appropriate, providers can then offer empathetic financial counseling and connect those that potentially qualify to financial assistance programs. By applying data analytics to this payment solution, healthcare organizations can increase point-of-service collections while reducing bad debt—in real-time. Providing patients with more accurate estimates – A recent Experian Health study found that 4 in 10 patients said they spent more on healthcare than they could afford. However, when patients know the expected cost of their care up front, they feel more empowered and make better decisions. Patient Estimates lets providers create more accurate estimates, eliminate manual tasks and improve patient satisfaction. Plus, it allows providers to automate and standardize their price transparency practices, which can help healthcare organizations meet regulatory requirements, create a more positive patient experience and increase revenue at the point of service. Reduce denied claims According to Experian Health's 2022 State of Claims survey, denied claims are on the rise with 42% of providers reporting that denials increased in the past year. 47% of respondents also said improving clean claims rates was a top pain point. Digital solutions can help providers reduce denied claims and increase revenue by: Automating claims management – With a solution like ClaimSource®, providers can automate their claims management systems – helping to ensure claims are clean before they are submitted to a government or commercial payer. Using an automated solution also allows providers to streamline the claims management process from a single web application. With ClaimSource, providers can easily analyze claims, payer compliance and insurance eligibility. Plus, it allows staff to prioritize their workload and focus on high-impact accounts – resulting in claims denial rates of just 4% compared to the industry average of more than 10%+. Optimizing efficiencies through artificial intelligence – Incorporating artificial intelligence (AI) into an automated claims management solution enhances the claims process in two key moments: before claim submission and after claim denial. AI Advantage™ integrates seamlessly with ClaimSource to continuously learn and adapt to ever-changing payer rules. The solution features two AI offerings, AI Advantage – Predictive Denials and Denial Triage, which can be customized to prioritization thresholds. Verify insurance and patient information Missing patient healthcare data can be a headache for providers to hunt down but looking for active coverage is often necessary. Providers must contend with a range of factors impacting patient coverage – including forgotten coverage, inadequate coverage, patients being misclassified as self-pay and regulatory changes, particularly with Medicaid and Medicare coverage. Implementing digital solutions can help providers use data to verify and find missing patient health insurance coverage, optimize patient collections, and boost revenue by: Utilizing automated, real-time insurance verification – Verifying patient coverage prior to service using a digital solution, such as Experian Health's Insurance Eligibility Verification. This tool can help providers experience fewer payment delays and claim denials. Plus, verifying insurance with automated insurance eligibility and benefits data improves cash flow, reduces claims denials and speeds up payments, including Medicare reimbursements. Patients also feel empowered with accurate payment estimates and accelerated registration, leading to a better patient experience overall. Improving collections with better data – With Collections Optimization Manager, providers can screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility ahead of time. Through targeted collection strategies, providers can leverage actionable insights to focus on high-value accounts. Plus, predictive algorithms and data-driven rules help providers route and distribute accounts to the right collectors and agencies, controlling overall collection costs. This solution also connects providers to live support from an experienced optimization consultant that will help develop a tailored collection strategy through data evaluation and industry knowledge. Finding unidentified coverage – In 2022, Coverage Discovery tracked down previously unknown billable coverage in 28.1% of self-pay accounts, finding more than $64.6 billion in corresponding charges. Providers can use Experian Health's Coverage Discovery solution at any point in the revenue cycle to look for previously unidentified coverage – maximizing insurance reimbursement revenue and reducing accounts sent to collections, charity, or bad debt. Coverage Discovery also automates self-pay scrubbing and proactively identifies billable Medicare, Medicaid, and private insurance options, using a mix of search, historical information, proprietary data sources and demographic validation. See how the right data and analytics can help providers better understand their patients, streamline operations, and improve revenue.

The healthcare staffing crisis was one of the biggest challenges facing healthcare providers pre-pandemic, only to be exacerbated by the pressures of dealing with the COVID-19 crisis. Almost a fifth of healthcare workers resigned between February 2020 and September 2021. Unfortunately, the problem isn't in the rearview mirror yet – a new study from McKinsey reveals that worker shortages persist, with 31% of nurses declaring their intent to leave their jobs in the next year. These shortages put pressure on remaining staff, compromise hiring efforts and make high-quality services difficult to maintain. Without a thriving, vibrant workforce, how can healthcare providers meet the needs of their patients? Can automation help address the healthcare staffing crisis? Stubborn staff turnover levels aren't unique to healthcare, but addressing them is even more critical, given the detrimental effect on patients. As the staffing crisis shows no signs of letting up, providers should consider how technologies that leverage automation and AI can help. Tom Cox, President at Experian Health, says, “Automation has transformed many aspects of healthcare, from driving down appeals and denials to improving the digital front door. We're now seeing AI starting to make waves, too. These technologies are the future and are changing healthcare for the better.” Opening healthcare's digital front door is a good place to start. By eliminating repetitive and time-consuming tasks like data entry, manual patient registration and prior authorizations, staff will be freed up to focus on what matters most: delivering high-quality patient care. Here, we look at three areas where automation can simultaneously alleviate the burden of staff shortages and create a better patient experience. Use case 1: automate patient access to manage the growing demand for services Manual and repetitive processes eat up valuable time and create greater workloads that contribute to staff burnout. This is especially true in patient access, which is a typically admin-heavy process. Allowing patients to complete more of their registration and scheduling tasks themselves can reduce the workload in understaffed teams. Many patients prefer not to book appointments through call centers, and high call volumes are a major pressure point for staff. Similarly, manual patient registration is labor-intensive and error-prone, eating up staff time and creating bottlenecks for patients. Automated registration and self-scheduling solutions help patients access care without waiting in phone queues. Patients can book, cancel and reschedule appointments through their mobile devices. On the back end, data can be leveraged to predict and manage demand, while digitized scheduling means agents can spend less time checking referrals against scheduling rules. Automated prior authorizations mean staff no longer need to spend hours poring over payer policies and checking individual payer websites to check for changes – the software updates automatically in real-time. Simplifying these processes with automation not only minimizes operational strain but also reduces friction for patients who want to see the right specialist in the least amount of time. Use case 2: automate personalized patient outreach to reduce call volumes Another way to reduce the administrative burden is with automated patient outreach. Reducing no-shows is an important strategy to promote better health outcomes and boost financial performance. Instead of burying staff with a list of patients to follow up with, providers should utilize automated patient reminders. Automated patient outreach solutions allow providers to segment patients according to their individual needs and preferences, so patients get relevant information through the most appropriate channel. This allows patients to proactively and conveniently manage their own healthcare journey. Automated messages can also be sent to remind patients of outstanding bills and link them to payment options. This means patient collections teams can spend less time on calls and focus instead on meaningful conversations with patients who need extra guidance or support. Use case 3: automate patient collections for faster payments and a better patient experience With fewer staff, patient collections teams must figure out which accounts to prioritize, while navigating increasingly complex payer policies. Advanced data analytics and automation can be used to make these processes more efficient. Similarly, automated patient collections software can screen and segment patient accounts to allow staff to quickly prioritize those with the highest probability of being paid. Collections Optimization Manager offers convenience and clarity to staff with an easy-to-use interface, while targeted collections strategies facilitate conversations with patients based on accurate information and fewer calls and emails. Speed and accessibility create a better experience all around for both patients and staff. Using automated solutions to reduce the pressure of the healthcare staffing crisis Cox says, “Over the last few years, Experian Health has focused on helping providers and payers solve the immediate challenges associated with a remote workforce and staffing constraints while scaling services in response to surging demand. Integrating automation with self-service tools is just the beginning. Our vision is to continue driving innovative and automated solutions that will improve care outcomes and transform our clients' healthcare operations.” These are just a few examples of how automation can create new opportunities for healthcare providers. Digital processes that were once considered merely “nice to have” are now critical components to alleviate the healthcare staffing crisis and deliver positive patient experiences. Contact us to find out more about how Experian Health can help your organization use automation to alleviate the healthcare staffing crisis.

Healthcare data is mushrooming. Each patient generates hundreds of megabytes of data each year, from electronic medical records to activity logs on fitness trackers. The volume of data and diversity of sources is growing exponentially, churning out a wealth of information about patients' medical histories, socio-economic circumstances, consumer preferences and lifestyles. This is a gold mine for healthcare leaders and clinicians who want to improve clinical care and treatment. It reveals opportunities to reduce healthcare costs and address population health challenges. But with the rush to focus on fresh insights, there's a mountain of historical data piling up in the background. Is this “old” healthcare data still useful? How can healthcare organizations ensure that their decisions and strategies are based only on the most relevant data? Determining the relevance of healthcare data Value-based care and efficient workflows rely on up-to-the-minute healthcare data. After all, what use is a diagnosis that fails to take account of a patient's new medications? Why risk delayed payments by failing to check a patient's current billing address? When providers have a full understanding of a patient's current circumstances, they can deliver the best possible patient experience. Providers are right to focus on box-fresh data (such as Experian's unmatched, originally sourced healthcare, marketing and credit bureau data), but historical data shouldn't be overlooked. What matters is how the data correlates with other data points. Can it be relied upon to fill in gaps in a patient's profile? To answer these questions, providers should look at the source, format and content of their datasets. Can the original sources be verified? If historical data was recorded manually and stored in paper files, is it compatible with today's digital systems? How can historical healthcare data be used?   While clinical decisions shouldn't be made solely based on historical data, such data can help enrich patient profiles and build a fuller picture of the patient's life. For example, data that reveals a patient's past behaviors and habits may help to explain current symptoms. This can lead to improved health outcomes and a better patient experience. When used in conjunction with more recent data, historical data can help providers create robust patient profiles and promote stronger patient engagement, better allocation of resources and more equitable access to services. Fortunately, multiple tools exist to help providers make sense of all their data to draw accurate, timely and actionable insights. For example: 1. Unique patient identifiers help eliminate erroneous patient data Utilizing more data points means there's a higher chance of duplicate data creeping into patient profiles. Providers need to watch out for information that shouldn't be there, information that's missing, or information that's associated with the wrong person. Inaccurate and incomplete patient information can lead to medical errors, reduced quality of care and suboptimal patient experiences. A unique patient identifier helps eliminate identification errors and create a single source of truth for each patient. Universal Identity Manager protects each patient record, allowing both new and old data to be combined in a standardized format. The unique patient identifier makes it easier for providers to verify patient information at each touchpoint in the patient journey, so that new information can be checked against existing records to maintain a clean patient database. 2. Consumer marketing data helps create personalized patient experiences Older data offers additional insights into patients' behavior, lifestyles and consumer preferences, which can be combined with new information to create a personalized healthcare experience. For example, by leveraging third-party data from a reliable source such as Experian, a provider might discover that a patient has a preferred language that's different to the one being offered. Being able to refer the patient to a physician who speaks their language will create a much better patient experience and avoid potential misunderstandings. Experian now offers nearly 200 language codes, making it easier for providers to communicate effectively with individual patients. A consumer marketing tool such as ConsumerView also enables providers to tailor the content, method and timing of marketing communications. This supports value-based care by making it easier for patients to engage with healthcare communications and access the support they need. 3. Improved revenue cycle analytics can increase reimbursements Of course, being able to access increasing volumes of current and historical data is only useful if that data can be turned into actionable insights. The more accurate the data points, the more reliable the analysis will be. This is particularly true of revenue cycle analytics, which encompasses everything from patient access and billing to reimbursements and payer performance. Experian Health's web-based business intelligence tool gathers together multiple data streams into a single analysis, so providers can make better decisions across the entire revenue cycle. User-friendly dashboards give staff at-a-glance summaries of what's happening across the revenue cycle, while allowing them to drill down to see detailed trends analysis for specific key performance indicators. A reliable data partner can help providers harness vast datasets Harnessing these ever-growing datasets to generate the most relevant insights is no mean feat. By partnering with Experian Health, providers can enrich patient profiles with originally sourced, reliable data and secure the greatest ROI from Experian's unmatched suite of analytical tools. Providers can tap into thousands of healthcare, credit, marketing and lifestyle data points to get a 360-degree view of their patients. They can validate the source, standardize the format and interrogate the content of new and historical data with Experian Health's user-friendly software. With clean, comprehensive data presented in a timely and accessible way, providers can future-proof their workflows and capitalize on the transformative power of big data – old and new. Discover how Experian Health's data and analytics tools can help healthcare organizations build robust patient profiles by leveraging both old and new datasets.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.