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Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily increasing over the last few years. An MGMA Stat survey found that nearly seven in ten providers witnessed a jump in denials during 2021, although the trend took hold even before COVID-19 hit. If providers rely on outdated systems and tools to process the growing volume of claims, it's inevitable that denial rates will continue to climb. It's not surprising then that a new Experian Health survey revealed almost 3 in 4 providers stated that reducing claim denials takes precedence over other priorities. Getting claims right the first time is no easy task. Traditionally, the claims management process has been labor and time intensive. Claims teams spend hundreds of hours gathering documentation, preparing claims for submission, engaging with medical clearinghouses, and then monitoring claims adjudication while they await the payer's verdict. Should a claim be denied, more staff hours may be required to rework it for a second attempt at reimbursement. Even if administrative budgets and staffing numbers increased in line with demand, inefficient manual systems can no longer bear the burden of data to be managed. With more providers heading into the danger zone of claim denials, automated claims processing tools are growing in popularity. These enable more efficient claims management, boosting productivity, easing pressure on staff, and above all, minimizing denials. Experian Health's survey found that 78% of providers are open to replacing current technologies if they are presented with compelling ROI projections, reflecting the urgency of the situation. What is automated claims processing? Automating claims involves the use of digital technology, software, machine learning and advanced analytics to optimize healthcare claims management. This can include: pre-filling data into digital forms to avoid data input errors using intelligent document processing to pull unstructured information into a single, usable format comparing data from multiple sources and flagging inconsistencies providing real-time insights and status updates allowing multiple parties to work from interoperable data Tools such as robotic process automation (RPA) can be used to replace manual activities, using data, logic and business rules to make decisions within certain parameters. This eases pressure on busy staff and improves efficiency, for example, when prioritizing claims to be reworked. Imagine how much faster a software program can synthesize hundreds of current and historical data points, compared to a human trying to do the same job. There are opportunities to automate just about every stage of the claim lifecycle, from the patient's first interaction with their provider to reimbursement. For example, automation can be used to: Streamline patient onboarding and automate identity checks to avoid errors in patient information Verify insurance eligibility and run continuous coverage checks to see if the patient's status has changed Maintain a complete electronic health record that follows the patient throughout their healthcare journey, so claims contain correct information Track payer policy changes and apply custom edits so that coding information is correct Scrub claims to find and fix any errors before they are submitted Submit claims to payers and monitor the claims adjudication process Optimize the denials management workflow and prioritize denied claims for resubmission Verify reimbursements and initiate patient billing processes. Virtually any repetitive, process-driven, or paper-based task from claim creation to claim reimbursement is an opportunity for automation. As technology advances, so do the opportunities to streamline operations, reduce time to reimbursement, optimize decision-making, reduce costs and improve the patient experience. Here are the 5 benefits of automated claims processing: 1. Automated claims processing streamlines operations Automation's number one benefit is allowing providers to move away from inefficient and error-prone manual processes. Staff no longer need to sift through disparate and complex coding lists, medical records and payer edits looking for the correct information to attach to a claim. Together with electronic records management, automation allows for standardized workflows, so the entire claims cycle is more consistent, and decisions are based on real-time accurate data. It helps to eliminate time spent searching for missing information, reformatting data to meet payer requirements, and trying to figure out which claims are worth reworking. Multiple digital tools are available to optimize different tasks within the claims processing workflow. But for maximum efficiency, providers should look for solutions that work together within an integrated system. Using a single vendor makes it easier to manage data consistently and simplifies system-to-system interactions. A comprehensive claims management solution also creates a smoother user experience, for example, by allowing staff to check real-time insights within one dashboard, using one log-in. Experian Health's suite of healthcare claims management solutions connects each step in the claims workflow to speed up claims processing. For example, ClaimSource manages the entire claim cycle in a single, scalable online application that serves individual hospitals and physician practices through to large multi-facility health systems. It creates custom work queues and integrates electronic remittance data directly, to allow staff to prioritize high-impact claims and speed up reimbursement. 2. It saves staff time and resources Outdated and clumsy processes can contribute to staff burnout, poor performance and difficulties attracting and retaining top talent, even more so as patient volumes return to pre-pandemic levels. By removing many time-wasting manual tasks, automated claims processing allows staff to use their time more productively. It's particularly important amidst ongoing staffing shortages, which put additional strain on existing staff. Some of the most time-consuming manual activities occur in the prior authorization workflow. Prior authorizations are also a common cause of claim denials. Because payer requirements around prior authorizations change frequently, staff must painstakingly check each payer's website before submitting authorization requests to ensure that the necessary documentation is in place. Once submitted, they must log in to different payer portals to track progress. According to the American Medical Association, some physician practices spend more than two full days processing prior authorizations each week. But with automated prior authorizations, staff can prevent delays and denials. Online prior authorizations automate inquiries and submissions without the need for user intervention, instead drawing on payer data that are already updated and stored in the system. It auto-fills the necessary information and flags where manual intervention is required. It can initiate more authorizations in less time, and guide staff to the highest-priority tasks using dynamic, exception-based work queues. By reducing the error rate, automation also facilitates faster claims processing, which means payments can be processed and issued more quickly. 3. Automation generates more accurate and actionable insights Automation doesn't just save time; it also gives staff greater clarity and control over the claims process. Automated digital solutions facilitate more reliable data management to reduce errors, and generate real-time insights based on accurate information. A large proportion of claims are denied because patient information doesn't match the payer's records. This can be easily avoided using robust electronic medical records that hold data in standardized formats and automatically populate forms with the correct information. Electronic data management also gives staff richer and more reliable insights, by pulling together all the information they need into a single, accessible interface. Using an automated tracker such as Denial Workflow Manager makes it easy for staff to monitor claims, denials and remittances in one place. Not only does it track denials, holds, suspends, zero pays and appeals, but it also provides detailed analysis to help root out the causes of denials, so they can be avoided in the future. Staff can immediately see which claims need attention and resolve them much more quickly, as opposed to using manual processes. Enhanced Claim Status complements Denial Workflow Manager by automatically generating work lists for staff, complete with actionable data to help them check off the tasks quickly and accurately. The software sends automated status requests based on each payer's claims adjudication timeline, to see if claims are pending, denied, returned-to-provider or zero-pay transactions. This takes place before the Electronic Remittance Advice and Explanation of Benefits are processed, so staff can respond quickly and avoid unnecessary denials or delays. 4. Faster claims processing equals faster payment According to the Council for Affordable Quality Healthcare (CAQH), the time saved by switching from manual to electronic claims processing could save the medical industry up to $1.7 billion each year. The increase in accuracy leads to more first-time pass-through rates and optimized decision-making around which claims to rework. While automation requires some upfront investment, the output tips the balance in favor of faster, higher reimbursements. Experian Health's Claim Scrubber solution is one example of how automated claims processing can reduce undercharges and denials, optimize staff time and improve cash flow. This program reviews each pre-billed claim, line-by-line, to check that coding details are accurate. It then applies general and payer-specific edits and verifies that the claim is free of errors before it's submitted to the payer or clearinghouse. As a result, more claims are correct – and therefore paid – the first time, and staff can spend less time chasing old accounts receivable. Case study: Read how Summit Medical Group Oregon – Bend Memorial Clinic reduced A/R days and volume by 15%, and achieved a 92% clean claims rate with Claim Scrubber and Enhanced Claim Status. 5. Automation can transform the patient experience Getting claims right the first time starts at the beginning of the patient journey. A digital patient access experience is more convenient and satisfying for patients and helps prevent errors that can lead to denied claims later. Patient contact information can be automatically pre-filled so the patient can check for errors. If a patient adds new data when they're scheduling or registering for care, that information can be automatically checked against the data already on file, and flagged if there are inconsistencies. Further along, the efficiencies afforded by claim process automation mean patients don't have to wait so long for confirmation that their medical expenses have been handled. Or, if they have an out-of-pocket amount to pay, they'll get clarity about their financial responsibility much sooner. Patient portals are a great tool for helping patients track claims when and where it suits them, rather than having to wait to speak to a call center agent. And by making the claims process more efficient, automation also releases staff from time-consuming repetitive administrative tasks so they're free to support patients with more complex queries. Automation can elevate the customer experience with personalized communications and simplified transactions, from patient access to patient payments. Transitioning to automated claims management As the volume and complexity of claims to be processed increases, providers need to find ways to manage the workload, alleviate pressure on staff and prevent unnecessary revenue leakage. Working with a trusted vendor can ease the transition to automation and maximize potential cost savings. Experian Health provides industry-leading software solutions to improve healthcare claims and denials management so that more claims are clean the first time. In fact, Experian Health was voted as the top claims vendor for hospitals in the 2022 Black Book vendor survey, for the second year in a row. Find out more about how Experian Health's suite of healthcare claims management products can help providers reduce denials, rebilling and drive up reimbursements with automated, clean and data-driven claims processing.

New data reveals that the number of healthcare data breaches continues to climb, causing financial and reputational damage to healthcare providers. HIPAA Journal reported 692 large healthcare data breaches between July 2021 and June 2022 that exposed the records of over 42 million individuals. The number of records breached in June 2022 was more than 65% higher than the monthly average over the previous year, highlighting the need for providers to stay on top of their game when it comes to protecting patient data. In a recent conversation with PYMNTS, Chris Wild, Experian Health’s Vice President of Adjacent Markets and Consumer Engagement, discussed the consequences of healthcare data breaches and set out the key steps providers should take to prevent and resolve security incidents. Compromised patient records send financial and reputational costs soaring IBM reports that financial damages resulting from data breaches have reached a 12-year high, with the average breach in healthcare costing $10.1 million, up nearly $1 million since 2020. Wild notes that this includes a huge range of costs, from HIPAA fines to operational costs to curb and resolve breaches: “The cost of dealing with a breach is enormous. There’s anything from penalties of $100 per incident to $1.5 million per year. You’ve got reconciliation costs – trying to patch the holes in technology stacks and things like that. You’ve also got inbound phone calls from concerned patients who’ve just heard about a breach and want to know if it impacts them.” But Wild says that beyond HIPAA fines and operational expenses, the greatest cost is repairing the reputational damage of breaching patient trust: “the reputational cost is enormous because once you lose a patient, you lose a patient.” Wild suggests a two-pronged approach to mitigate the risk and impact of a healthcare data breach that focuses on prevention and preparation. Protecting patient identities to deliver a satisfying and secure consumer experience  An unfortunate side effect of the accelerated adoption of digital health solutions during the pandemic was that it opened the door to new methods of medical crime and fraud. Patients interact with their data electronically more often, thus increasing their vulnerability to cyber-criminal attacks. Preventing infiltration by bad actors before they occur should be the priority. In the past, efforts to secure a patient’s identity have relied on personal security questions, considered unanswerable by anyone but the patient. However, Wild says that asking for past addresses and details of previous living arrangements may no longer be the gold standard: “We’re finding that this is a little bit passé now. There’s a lot more that goes into identifying somebody, and that goes along with improving security, but it also improves the patient experience. There’s always been a balance between trying to make sure that data is secure on the one hand, but also make sure that it’s easy to access on the other.” To this end, providers should look for patient engagement solutions that deliver a flexible, convenient and consumer-friendly patient experience, while ensuring that patient data is secure. Wild suggests a few specific strategies, such as monitoring device ID and validating the identification documents used during patient registration: “When you have your cell phone or your tablet or your laptop, or your computer, or even your voice assistant devices, they all have a device ID. We keep track of those and see which ones are being naughty, which ones are being nice. We can start to ramp up when we see a naughty device acting naughty. But also think about things like document verification, validating that a driver’s license being shown to a registrar is actually a real driver’s license, or things of that nature.” A multi-layered approach to securing patient portals and other digital patient access tools will ensure there is no single point of vulnerability. Experian Health’s patient portal security solutions with Precise ID include a range of protections, including two-factor sign-in authentication, device intelligence and additional checks on risky requests to proactively secure patient identities. Each element protects against a specific type of threat, building up defensive depth to thwart attempts to breach patient data. Responding quickly in the event of a healthcare data breach Prevention only goes so far, though. Evidence suggests that most healthcare providers will be hit by a data breach at some point. Wild suggests that regular “fire drills” can help ensure that everyone in the organization knows how to respond, should the worst happen: “For a healthcare data breach or any sort of misappropriation of patient or member data, you want to make sure you’re keeping things safe, keeping things secure, and make sure that all of the associated people know what to do.” Wild says this must include front desk staff who will be answering phones from worried patients, through to marketing teams who will need to put out proactive messages about what happened and how it will be dealt with. How a provider responds may have an even greater impact on their reputation and patient loyalty than the breach itself. All of this can be pulled together in a data breach response plan, which sets out exactly what needs to be done and by whom, to help organizations avoid missteps in the aftermath of a breach. Experian Health’s Reserved ResponseTM program can help healthcare organizations put together a data breach preparedness plan in as little as three days. The program is based on 17 years of real-world experience dealing with data breaches and has evolved as security threats and consequences have increased. The program offers providers guides, templates, checklists and service-level agreements to guarantee manpower, infrastructure and response readiness at the most crucial moments. As the uptake of patient portals and other digital patient access solutions accelerates, finding the right data security partner to help navigate the unprecedented threats and consequences will be essential. Watch the full interview with Chris Wild and find out more about how Experian Health helps healthcare providers protect patient identities to prevent healthcare data breaches.

As the COVID-19 pandemic collides with another winter flu season, patient volumes are likely to climb – which could leave traditional patient registration processes crumbling under the pressure. Healthcare providers should identify opportunities to improve the patient registration process and guard against bottlenecks in patient access over the coming months. Streamlined patient intake isn’t just about alleviating pressure – it lays the foundations for the entire patient journey. The question for providers is whether this first touchpoint signals efficiency, compassion and convenience, or hints at errors and delays to come. The answer to that question will most likely depend on the organization’s success in delivering a digital patient access experience. Patients don’t want a stack of papers to fill out by hand in the waiting room. They don’t want to make lengthy phone calls at inflexible times. They want frictionless processes, user-friendly tools, and quick, accurate information. Pre-registration should demand as little of their attention as possible. For this reason, automated and digital patient registration solutions are likely to be differentiators for healthcare providers. Here are 5 ways to improve the patient registration process before flu season hits: 1. Offer patients convenience and choice with virtual registration options More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s 2021 State of Patient Access 2.0 survey. In a more recent study, Experian Health and PYMNTS found that a third of patients filled out registration forms at home. It’s no wonder: completing forms in the waiting room is time-consuming, inconvenient, and exposes patients to the risk of infection. With Registration Accelerator, providers can offer a simple text-to-mobile experience so patients can begin registration with a single click. Registration forms can be filled out from the comfort and convenience of home, where patients are more likely to have insurance details to hand. Alternatively, some patients may choose to do this in their car before their appointment, which reduces waiting room traffic. Not only does this meet the expectations of Gen C healthcare consumers, but it also helps patients prepare for their appointments, so they’re more likely to remain actively engaged in their care. 2. Increase efficiency and reduce delays with streamlined workflows Automated patient intake also alleviates the administrative burden for busy staff. Manual patient registration incurs high labor costs, and as patient numbers increase, patient access staff cannot afford to lose time to inefficient paper-based systems. Self-service options such as patient portals allow patients to take care of more of these tasks themselves, freeing staff to focus their efforts on patients who need extra help. Automated reminders to complete forms and schedule appointments also help to reduce delays, in turn creating more efficient workflows. An added benefit of software-based processes is the ability to generate detailed insights and performance reports, which eliminates redundant tasks and flags up opportunities for further improvement. 3. Avoid costly errors with integrated data management systems One of the biggest advantages of an automated registration solution is that it can be integrated with other data management systems, including hospital information systems, electronic medical records, and project management systems. This means that staff no longer need to input the same data multiple times into different systems. It saves time and avoids errors that lead to delayed reimbursement. When patient data is pre-filled and checked automatically against information on file, there’s a far lower risk of error than in situations where a patient or staff member writes it out by hand or communicates it verbally across a noisy reception desk. Reimbursement need not be delayed while errors are found and fixed. This is the thinking behind eCare NEXT®, which integrates and automates patient access activities within a single platform. When Martin Luther King Jr Community Hospital integrated eCare NEXT® with Cerner, they saw a huge improvement in their registration processes, saving two to three minutes on more than half of their registrations. For healthcare organizations grappling with increasing registrations this winter, those minutes add up. 4. Accelerate payments from patients and payers to improve the patient registration process According to the State of Patient Access 2.0 survey, 88% of providers said they were planning to invest in patient intake capabilities in 2021, up 15% on the previous year. While the shift to online and virtual patient registration was undoubtedly motivated by the pandemic, the opportunity to accelerate reimbursements and reinforce the revenue cycle was another major driver. Registration Accelerator works alongside Patient Financial Advisor so patients can get accurate, personalized pre-service price estimates and payment management options through a single unified experience. Providers may also consider running repeated coverage checks from the moment a patient registers, to find any missing or forgotten coverage. If coverage is found, claims can be submitted promptly to payers, further increasing the options and likelihood for reimbursement. 5. Reduce no-shows and increase bookings with automated scheduling Finally, as service utilization increases over the winter months, providers will want to ensure that every possible appointment slot is filled. Integrating registration solutions with digital patient scheduling tools can help to reduce no-shows and improve the patient registration process. Patient Scheduling is a multi-channel platform for guided search and allows 24/7 access to scheduling options, which makes it easier for patients to book appointments. Automated reminders can be sent to patients so they don’t miss their appointments, with easy links to reschedule if they can no longer attend. These tools can be customized to meet the specific needs of the organization’s workflows, to increase the number of bookings and reduce the number of patients lost to follow-up. Find out more about how Experian Health’s digital patient access solutions can help improve the patient registration process ahead of the busy winter period.

As inflation puts the squeeze on families and individuals, healthcare providers have an opportunity to reimagine the patient financial experience so that medical bills put less stress on a household’s finances. Consumer-friendly changes might include providing estimates, clarifying benefits statements, offering payment plans, providing digital tools to make payments more convenient and offering more payment options. Not only would this help patients manage their medical bills so they feel more in control of their finances, but it would also help ensure that healthcare providers get paid faster and more reliably. Treating patients more like customers might actually boost the bottom line. In fact, a recent study from Experian and PYMNTS revealed that 6 out of 10 patients who paid out-of-pocket healthcare costs and received either an inaccurate cost estimate or an unexpected bill would switch healthcare providers for a better payment experience. “The Healthcare Conundrum: The Impact of Unexpected Patient Costs on Care,” a new report by Experian Health and PYMNTS, surveyed 2,483 consumers to learn about the effects of rising healthcare costs and unexpected medical bills on patient care and satisfaction. The financial challenges for patients Patients have been forced to assume a greater financial burden for healthcare payments through the prevalence of high-deductible healthcare plans. One benefits survey found that 58% of covered workers have at least a $1,000 deductible for single coverage. And due to limited payment options for managing medical costs, many consumers get strapped with large medical debt. More than half of Americans have at least $1,000 in medical debt and more than two-thirds of Americans under 65 report that they struggle with the cost of healthcare. Some consumers even opt to delay or forego medical care because of the cost. The healthcare industry has invested billions of dollars in technology and services that empower patients to play a more active role in the clinical side of their health journeys. Now, providers have an opportunity to do the same with the financial side of healthcare, so patients are empowered to better manage their health costs. 3 investments for a better patient financial experience Experian Health’s State of Patient Access 2.0 survey showed that patients want transparent healthcare pricing, payment plans and support, and faster and more convenient ways to pay their medical bills. “Giving patients transparency and payment options can improve the patient experience,” says Liz Serie, Senior Director of Product Management at Experian Health. She explains that it’s important for providers to improve the financial experience because it will benefit each patient’s overall health journey, increase the likelihood that patients will pay their medical bills, and help build patient loyalty as consumers prefer providers that offer convenient financial tools for patient payments. Experian Health has a suite of tools and services that can help providers improve these aspects of the financial side of healthcare. If providers make these strategic investments in the patient financial experience, they can both grow revenue and increase patient satisfaction. Investment 1: Price transparency Financial transparency is a major issue in healthcare, which results in unexpected or unexpectedly large medical bills. Data from Experian and PYMNTS revealed that in the past 12 months, 43% of patients who received inaccurate cost estimates and 40% of those who received an unexpected bill spent more than they could afford. If providers can offer more price transparency, it will help patients avoid getting stuck with inaccurate, confusing, or nonexistent estimates for their health costs. Tools like Patient Payment Estimates and Patient Financial Advisor can deliver clear estimates to a patient’s mobile device so they can be better informed about their health costs – and be better prepared to manage them. Patient Estimates uses real-time insurance status, contract rates, and provider pricing so the patient gets an accurate breakdown of a pricing estimate on the front-end of their care. This will allow patients to focus on the care they need instead of stressing about price uncertainty. These tools also offer convenient ways for patients to pay their medical bills so they can manage their financial obligations. Investment 2: Customized payment options Consumers expect financing options for larger purchases like cars and appliances, so healthcare providers should consider offering the same.  Personalized payment plans can help patients manage and pay their health bills. PatientSimple identifies the best financial pathway for each individual patient and offers an easy-to-use, self-service portal that helps them navigate that path. Patients can also use this tool to store payment information, set up payment plans, and apply for charity care. Consumers also want digital payment options that give them a fast, flexible, and secure way to make payments. Many consumers report that the pandemic has changed how they prefer to pay for goods and services. They want more contactless options, online portals, and mobile-friendly systems. Experian’s Patient Payment Solutions modernize patient payments through mobile-optimized, self-service options that make it easier and simpler for patients to pay their health bills in whichever way they prefer. Investment 3: Data-driven financial insights Healthcare providers can use data-driven tools like Patient Financial Clearance and Collections Optimization Manager to determine which patients have the financial capacity to pay their medical bills – and which patients might need financial assistance. By tailoring payment plans to each individual patient, providers can improve the financial experience and increase the efficiency and productivity of collections. Consumers have shown that they want convenient and customized payment options for all their purchases – healthcare included. To meet that expectation, providers can leverage technology, data, and analytics, creating the best possible patient payment experiences and improving their own bottom lines. Learn more about Experian Health can help healthcare organizations reimagine the patient financial experience with digital tools and solutions.

Nearly a quarter of patients have received a surprise medical bill, according to new data from Experian Health and PYMNTS. 4 in 10 patients said they ended up spending more on healthcare than they could afford, with the average surprise bill amounting to $675. Even insurance-savvy patients fall foul of surprise billing: 31% of patients who were familiar with the coverage landscape ended up paying more than their estimates suggested. Healthcare providers will need to implement solutions that can generate accurate price estimates before patients seek care, and prevent surprise billing. Without accurate cost estimates, patients are more likely to cancel appointments, which could cause their health conditions to get worse and eventually cost more to treat. This also creates avoidable and expensive administrative work for providers, who must chase payments from growing numbers of anxious, self-pay patients. To prevent surprise billing, healthcare organizations can look to data and digital tools. Advanced analytics provide greater clarity about each patient's financial situation, generate more accurate estimates and improve the patient payment experience. Inaccurate estimates persist despite the No Surprises Act Consumer demand and legislative action on surprise billing have led to an escalation in the push for more accurate estimates. But estimating patient liability is far from simple. It requires complicated calculations based on the patient's coverage, provider charges, payer contracts and potential discounts. Undertaking this manually can be time-consuming and error-prone, so many providers are turning to automated solutions. In a recent conversation with Healthcare Finance News, Jason Considine, Experian Health's Chief Commercial Officer, notes that providers expect to invest more in digital patient estimates solutions, particularly as the regulations expand. Those investments are likely to include technology to deliver accurate estimates and patient-friendly payment methods, and increased use of advanced data analytics to optimize collections. Surprise billing is at odds with a high-quality patient payment experience Beyond compliance, accurate estimates are essential for a positive patient experience. A poor financial experience can leave a bad taste in the patient's mouth, even if the clinical care was outstanding. So, what does that positive experience look like? The key is to think like a consumer: make the billing process as clear, convenient and compassionate as possible. Patients are looking for accurate and up-to-date pricing to be available before they receive care. And clear, and communication around the billing process can help eliminate the shock factor and improve patient collections. For example, providers could integrate a tool such as Patient Estimates, to give patients an accessible, personalized cost breakdown based on real-time pricing and benefit information. Patient Financial Clearance assesses a patient's individual financial circumstances to provide accurate estimates and recommend appropriate payment plans. And pricing information, payment plans and links to secure payment methods can be offered via a range of self-service, mobile-optimized patient payment solutions. El Camino Hospital in California used Patient Estimates to improve price transparency. The Senior Director (Revenue Cycle) said: “We decided to do a soft launch of a patient estimator tool, and the very next day, even without advertising it yet, our patients found the tool on the website and started using it. The feedback was excellent. We're providing a lot more estimates than we could before because it's 24/7 and patients can use it on their mobile device, their laptop or their desktop. Some advice I'd give other hospitals is to think of the patient when you're deciding what to do to best communicate your prices. What would the patient want?” Data-driven technology can prevent surprise billing Tom Cox, President at Experian Health, is optimistic about how the patient payment experience might evolve in the second half of 2022, as shared in a recent PYMNTS publication. He believes improvements come down to having the right data in place: “Payment options are increasingly digital and more convenient, payment plans are more common, and price estimates have become less of a rarity. There is also greater use of non-clinical data to get a broader view of patients and their unique financial solutions. Data, coupled with the right technology, can help providers make sense of it all and enhance the patient journey.” Data-driven technology can help simplify the payment process for patients, from accurate estimates to convenient payment methods. With PatientSimple, providers can leverage Experian's unmatched data and advanced analytics to identify the optimal financial pathway for consumers. It then guides patients toward that pathway through a user-friendly self-service portal. Patient Financial Advisor offers a similar experience via mobile. Patients can avoid the stress of surprise medical billing and plan for upcoming expenses. With tools that allow them to pay medical bills from anywhere, at any time, many patients will pay upfront, speeding up the collections process. Working with a partner such as Experian Health lets providers combine what they already know about their patients with industry-leading technical expertise and payment tools. With support to implement the right data-driven technology, providers can prevent surprise billing, resulting in regulatory compliance, greater revenue opportunities and customer loyalty.

The U.S. is currently struggling with a critical healthcare labor shortage that is impacting every part of the revenue cycle. In fact, the American Hospital Association has deemed this challenge a “national emergency” that is only expected to worsen. Staffing shortages leave healthcare providers vulnerable to reimbursement delays, low morale and negative patient experiences.  As a result, many healthcare providers are leveraging automation to tackle this staffing crisis. Revenue cycle management (RCM) software and analytics can help providers navigate labor shortages by relieving staff of repetitive, process-driven manual tasks and improving operational efficiency. As healthcare labor shortages continue, how can providers maximize the return on their investment in automation? The snowball effect of healthcare labor shortages The first quarter of 2022 ended with a peak of 11.9 million open vacancies in the United States. Just about every industry is feeling the impact of the Great Resignation, driven largely by the fact that more people are reaching retirement age than are entering the labor market. In healthcare, the challenge of attracting and retaining top talent is felt even more acutely - in May 2022, the healthcare vacancy rate was 8.8%, second only to hospitality services. While the pandemic created greater pressures on healthcare staff, chronic understaffing and burnout were already a problem. Now, healthcare workers are contending with the snowball effect of increasing stress, sickness absences, lack of time to train new staff and loss of morale. Potential recruits may be tempted away to industries touting fewer COVID regulations, competitive pay, and more flexible and remote positions. Healthcare providers need smart and creative staffing strategies to close the gaps. Automation should be at the heart of HR contingency planning Providers may look to traditional market forces to solve the staffing challenge. Reducing services, increasing wages, improving working conditions and partnering with local education facilities to attract new staff are all on the table. But tight margins and inflationary pressures limit the options available, and policy changes can take time to be implemented. Automation can help mitigate healthcare labor shortages in three main ways. It can reduce the workload and increase staff capacity, improve operational performance and free up resources that can be reinvested in the workforce, and create better experiences for staff (and patients). Using automation to increase staff capacity Repetitive tasks that follow the same process every time are perfect for automated programs. Shifting the load from staff to software means that fewer team members are needed for those activities, and available staff can focus on more complex issues. Patient access is a good place to start. Many hospitals have already started to scale back care due to severe staffing shortages. Online scheduling and automated registration can ease the burden as patient volumes increase. These self-service tools cut down call center queues and eliminate labor-intensive data entry. With automated pre-registration, the correct information for each patient can be pre-filled and follow them throughout their healthcare journey, so staff no longer lose entire days spent resolving data input errors. Automation can improve operational efficiency, even with labor shortages Automation is more than replacing human effort with software programs: it also strengthens operational performance. Automated revenue cycle tools can complete tasks such as data entry, coverage checks, pre-authorizations and eligibility verifications much faster – and with fewer errors – than staff. If data-driven tasks can be completed with greater accuracy and efficiency, then the entire revenue cycle will move more quickly, leading to faster reimbursement. This is especially obvious when using automation to streamline collections. It doesn’t make sense for staff to pursue all past-due accounts, but with automation and advanced analytics, they can identify the patients most likely to pay and focus their efforts accordingly. Collections Optimization Manager uses multiple data sources to automatically screen and segment accounts, so staff doesn’t waste time chasing the wrong ones. Accounts are then distributed to appropriate collections channels using specific routing and recall rules. With a better understanding of each patient’s financial situation, staff can engage with patients in a more compassionate way and resolve issues without repeated calls and emails. Alongside this, automated patient outreach can provide personalized and convenient communications about patient collections. PatientDial frees up staff from time-consuming calls by providing automated inbound, outbound and blended calls with live agents or automated interactive voice response (IVR) services. “Queue callback” automatically calls patients back when a suitable agent becomes available, maximizing staff time while improving the patient experience. PatientDial also monitors agent performance so managers can make strategic decisions to improve workflow. Using automation to create better user experiences Existing staff may worry that increasing the use of automation could lead to their jobs becoming redundant. This isn’t really the case: while automation and artificial intelligence (AI) allow RCM teams to “do more with less” and reduce the need to recruit additional staff, they should be seen as complementary to rather than replacing staff. By removing time-consuming and tedious tasks, automation creates a better experience for staff. User-friendly interfaces give patient access, claims and billing teams all the information they need to help patients quickly and accurately. And as prior authorizations and payer policy changes change ever more frequently, staff will be relieved to hand over the task of checking each payer’s website to a software program that can complete the job quickly and accurately. Shifting to online and mobile options gives patients a more convenient and satisfying user experience, too. For example, automated self-service tools can be used to give patients upfront estimates about their expected cost of care, and link to convenient payment methods. It’s a quick win for providers who will find it easier to comply with new price transparency rules and makes it easier for patients to clear their bills faster. And the result? A happier workforce, a better patient experience and a healthier revenue cycle. Find out more about how Experian Health’s automated revenue cycle management solutions can help healthcare organizations build resilience and thrive in the face of healthcare labor shortages.

COVID-19 provided an unexpected use case for patient portals. In a matter of weeks, the benefits of remote patient access were undeniable. Patient portals allowed patients to schedule, register and pay for care from the comfort and safety of home. Now, as the latest omicron sub-variant triggers another surge in case numbers, providers are again reminded of the value in making digital channels available to minimize face-to-face interaction. With staffing shortages continuing and patient numbers rising, it’s worth recapping the benefits of patient portals. Why should healthcare providers prioritize patient portals? Here are 7 reasons: 1. Patient portals can be used to communicate safely with patients as Covid-19 cases rise Health officials may be cautious about reinstating extreme measures in response to the latest wave of infections. However, they can’t afford to be complacent about an uptick in hospital admissions. Patient portals can mitigate the risks associated with increasing foot traffic by allowing patients to schedule and register for care without attending in person. Completing paperwork from home eliminates the need for patients to share clipboards or sit in stuffy waiting rooms, while online scheduling platforms enable staff to manage the flow of patients safely and efficiently. Remote patient monitoring, secure messaging and online prescription refill requests can also be managed via portals, further reducing the need for in-person visits. 2. They can ease pressure on understaffed teams Providers need to find efficient ways to handle the administrative workload that comes with higher patient volumes. It’s even tougher given increasing retirement and resignation figures. More nurses are embracing the occupational benefits of remote and virtual care and are opting to switch from high-stress facilities to telehealth positions. While this speaks to the growth and impact of remote healthcare, it leaves a gap to be filled in hospitals. Patient portals can alleviate some of the burdens by reducing the need for staff input at various points in the patient journey. For example, online scheduling reduces the number of calls to call centers. Pre-filled data and automated registration can reduce the risk of errors during patient intake, which are time-consuming to fix. Portals can also be used to help patients navigate the payments process, speeding up collections and reducing the time staff spend chasing payments. 3. Patient portals can address inefficient patient access workflows Because patient portals are tethered to the patient’s electronic health record (EHR), they provide a hub for every piece of data relating to the patient. Patients can access that golden record at any time. They get an engaging and transparent experience, and are less likely to call up to ask questions – they already have the answers. They can also check data to make sure that it's accurate, which helps avoid the delays and misunderstandings that cause friction for patient access teams. It's important to ensure that the portal itself doesn’t introduce friction. Patients need to be able to enroll in the portal without too much trouble. Automating the patient enrollment process and implementing a multi-layered identity-proofing solution can create a secure and efficient way for patients to get the most out of their portal, without compromising safety or efficiency. 4. To improve patient engagement and meet consumer expectations One of the biggest reasons to invest in patient portals is because patients say they want them. Research from Experian Health and PYMNTS found that 44.1% of patients have obtained test results through patient portals, while 18% used patient portals to fill out forms for their most recent healthcare visit. Overall, two-thirds said they use patient portals. Beyond offering a convenient patient experience, this is also a matter of patient loyalty and retention: 61% of patients say they’d consider switching providers to one that offered a patient portal, which could have a significant impact on revenue. 5. They can boost revenue by offering easy ways to pay Experian and PYMNTS research shows that around a fifth of patients uses their portal to make payments. Unfortunately, 16% of those patients said they’d faced difficulty viewing invoices, setting up payment plans and making payments through their portal, which suggests some room for improvement. Experian Health’s Patient Payment Solutions solves these challenges. A range of self-service, mobile-optimized tools simplify the patient financial journey by giving patients upfront pricing estimates, personalized payment plans and easy ways to pay. 6. Using patient portals can improve health outcomes (especially for “frequent flyers”) Patient portals also play an important role in promoting better health outcomes for patients. Research shows that when patients have access to their medical information, they feel empowered and prepared to speak to their doctor and adhere to care strategies. Multiple providers can engage with the patient through the same platform, and see what other treatments are being prescribed. This helps improve communication between the patient and provider and helps improve care management. It’s especially useful for older patients and those with chronic conditions. In this way, portals support effective care coordination, helping value-based care providers achieve their goals of reducing healthcare costs, promoting population health and closing the gaps in care that have widened over the last few years. 7. Patient portals can support compliance with price transparency regulations Finally, portals offer a route to ensuring compliance with new regulatory requirements around price transparency. The No Surprises Act and hospital price transparency rule call on providers to give patients accurate, upfront cost estimates so they can plan for their financial responsibility more easily. Patient Payment Estimates can be delivered in several ways, including through patient portals. And as noted, once the patient has their estimate, they can also be directed to easy and convenient payment methods, including through their portal. Whether it’s a surge in COVID-19 cases, rising inflation, or labor shortages, providers must find ways to build resilience, stay competitive, and continue to offer patients the flexible and transparent healthcare experience they desire. Patient portals should be part of the plan to open the digital front door. Contact us to find out how Experian Health helps healthcare organizations deliver a reliable and secure patient portal experience.

According to the most recent figures from the Centers for Disease Control and Prevention, around 8.8% of Americans are without health insurance. While this has dipped since the pandemic high of 10.3% towards the end of 2020, it still leaves nearly 30 million people facing the often-difficult decision of what to do when they need healthcare. A further 40 million underinsured individuals could find themselves in the same position.  Do they pay for it themselves, avoid care altogether or seek financial assistance? With inflation on the rise and government pandemic support coming to an end, even those with coverage may need additional charity care support. Several regulatory efforts have been made to address healthcare affordability and increase transparency around charity care, particularly at the state level. For providers, the challenge is to find efficient ways to screen for charity care eligibility as more patients become eligible for support, and remain compliant as these new regulations come into effect. Why screen for presumptive charity? Eligibility for charity care depends on a hospital's financial assistance policy and relevant state regulations. Uninsured patients may be offered a full or partial discount on their medical bill, while insured patients may be awarded a discount on the cost of care. Without charity care, these unpaid bills would be tagged as bad debt, which could lead to patients being chased for payments they're unable to make and affect the provider's cash flow. To qualify for charity care, patients are often asked to share their household size and income, among other details. Often a provider will ask patients if they'd like to fill out financial assistance forms during patient intake, but many patients decline or are unable to provide the necessary information. Some may feel embarrassed about needing support or worry about how the information will be used. There may be language or literacy barriers. Some may assume they're not entitled to support and decline the forms. To get around this, providers use automated screening software to identify patients who may be eligible for charity care. This pulls together credit information, demographic data and financial details to determine whether the patient qualifies. Patients get the support – and thus the care – they need, and providers can focus their collections efforts on those who are most likely to be able to pay. Regulation 501(r) permits this type of presumptive screening by a reputable third party. What does the legislation say about charity care? As the use of presumptive eligibility screening has grown, several federal and state regulations have been introduced to encourage clarity, consistency and best practice. Providers must keep pace with changes to charity care policy or risk civil penalties or the loss of tax-exempt status. Under the Affordable Care Act, Regulation 501(r) requires hospitals that offer charity care to have a written financial assistance policy, specify maximum amounts that eligible patients can be charged, and determine a patient's eligibility before sending their bill to collections. Again, it allows for this process to be automated using a third-party vendor. Individual states also have their own requirements around eligibility screening, for example: In Washington, the legislature has recently voted to expand charity care eligibility as of July 1 2022 for patients who meet federal poverty level thresholds and have exhausted third-party coverage options. The new rules require hospitals to identify patients that might be eligible for retroactive Medicaid support and support them in applying for coverage. In California, the AB 1020 rule raises the income level for charity care eligibility to 400% of the federal poverty level. Hospitals must display online notices explaining their policy for financially qualified and self-pay patients. They must also wait 180 days before assigning unpaid patient bills to collections, and provide information to patients before doing so. AB 532 requires hospitals to give patients written details of patient charity care and discount policies at the time of service or at least before they are discharged. How can providers streamline the presumptive screening process? Automated presumptive screening can help providers comply with these new rules and implement their own financial assistance policies in the most efficient way. For example, Experian Health's Patient Financial Clearance uses current financial data to screen patients for Medicaid, charity care and other financial assistance programs in line with the provider's unique charity policies. It incorporates customizable logic that helps providers adhere to regulatory requirements and internal rules around charity care and billing. Screening happens automatically prior to or at the point of service, generating an estimated Federal Poverty Level (FPL) percentage for each guarantor.  A healthcare-based propensity to pay score can also be calculated, giving providers a further data point to work best with patients. This makes it easy for patient advocates to connect patients with the most appropriate financial assistance program, and even auto-enroll them. If the patient does have an amount to pay, they can be guided to the optimal payment plan for their individual circumstances. Patients can get direct access to screening qualification tools too, with solutions like Patient Financial Clearance. They can check their qualification status and upload documentation to qualify for discounted or free care via text to their mobile device. In addition to helping providers ensure regulatory compliance and document charitable services, this tool helps maximize collections and deliver a patient-centered financial experience. Providers should also check that their collections partners are aware of their obligations under charity care law, and ensure they're compliant, too. Keeping patients in the loop during charity care eligibility screening Clear communication is at the heart of a compassionate patient experience, fostering loyalty and trust. In the context of charity care screening, this means making sure that patients know that financial assistance may be available (now also a requirement under charity care regulations). In the past, some patients were not informed about how to apply for financial assistance and struggled with bills they couldn't afford. Others were assigned to charity care without their knowledge and spent months worrying unnecessarily about bills that would never arrive. Automated charity care checks solve both situations, by ensuring that no patient misses out on support to which they're entitled and by making it easy for providers to notify them. Patient Financial Clearance generates scripts for patient advocates to use during financial counseling discussions, to help patients navigate the financial process with greater ease. And with mobile text charity screening, the patient gets the information they need, right in the palm of their hand, so they can engage with the process more easily. Patient Outreach solutions can complement these activities by providing timely and personalized prompts and reminders through the patients' preferred communication channels. Not only will this enhance the patient experience and support compliance with charity screening rules, but it also helps improve patient outcomes by keeping patients on track with their care plans and driving down unnecessary readmissions. And for patients who do have an amount to pay, a payment experience that's tailored to their financial circumstances will further boost patient satisfaction and collections. The ROI on these tools can be significant. Let's say a hospital treats 1,460 uninsured patients per month. If just 10% of those patients qualify for Medicaid, at an average reimbursement rate of $1000, the hospital could claim $146,000 per month by ensuring those patients are enrolled – and avoid writing off nearly $1.8 million per year. As economic uncertainty continues to weigh on providers and patients alike, the pressure's on to streamline patient collections and prevent avoidable missteps such as non-compliance with charity care rules. Find out how using an automated financial assistance process with Patient Financial Clearance can create a safety net for providers and patients, increase collections and reduce bad debt as patient financial responsibility increases.

Experian is one of three credit bureaus to remove cleared medical debt from consumer credit scores, as of July 1, 2022. Previously, debts that were sent to collections would remain on patients’ credit scores for up to seven years after they’d been paid, making it harder to secure credit cards, loans and housing. Patients will also have double the time to manage unpaid medical debt before it appears on credit scores (up from six months to one year). Unpaid bills under $500 will no longer appear at all. It’s great news for the millions of Americans burdened by medical debt and financial stress and is one step to improving patient payments. The measures are expected to remove nearly 70% of medical collection debt from consumer credit reports. In a joint statement, Experian, TransUnion and Equifax said: “Medical collections debt often arises from unforeseen medical circumstances. These changes are another step we’re taking together to help people across the United States focus on their financial and personal wellbeing. As an industry we remain committed to helping drive fair and affordable access to credit for all consumers.” Healthcare providers can support efforts to ease financial pressures on consumers (and protect their own profit margins) in two major ways: by introducing transparent pricing and improving the patient payment experience. Help patients plan and understand medical bills with price transparency tools  July 1 also saw the implementation of the new Transparency in Coverage Final Rule, which places new responsibilities on health insurers to share negotiated rates for covered items and services. In theory, providing upfront estimates of the cost of care allows patients to make more informed decisions about their healthcare and plan for forthcoming bills with more confidence. In practice, it’s easier said than done. A report from August 2022 found that only 16% of hospitals are compliant with the earlier Hospital Price Transparency Rule. Non-compliance penalties aside, it makes good financial sense to help patients understand and plan for their medical bills: 9 out of 10 providers recognize that when patients have upfront estimates, they’re more likely to pay in full and on time. Digital and automated tools can make this easier to deliver. With Patient Payment Estimates, patients get a simple breakdown of their expected costs delivered straight to their mobile device, so they can plan – and even pay – in advance of treatment. Of course, estimates are only useful if they’re accurate, so this solution pulls from real-time price lists, payer contracts and benefits data so that estimates are as close as possible to the final bill. Provide an “Amazon-inspired” patient payments experience When it comes to patient payments, consumers want the “Amazon experience” – personalized payment options, easy-access digital payment methods, and above all, choice about when and where to pay. These three trends quickly gathered ground during the pandemic, and are set to outlast it. Providers looking to up-level the patient payments experience can’t afford to omit digital and contactless payment options. To help deliver this, Experian Health offers a menu of self-service, mobile-optimized payment solutions. For example, with Patient Financial Advisor, providers can help patients take control of their financial journey through a simple text-to-mobile experience. Patients get a text message with a secure link to details of their estimated financial responsibility and links to user-friendly payment tools. They can also be advised on appropriate personalized payment plans. Support patients to manage healthcare payments  For some patients, pricing estimates may influence their decision to access care in the first place. A new collaborative report by Experian Health and PYMNTS, released in July 2022, found that nearly 50% of consumers have canceled a healthcare appointment or procedure due to the high cost of medical treatment. The study also found that three-quarters of millennials canceled a healthcare appointment after receiving a high-cost estimate, as have 60% of consumers living paycheck to paycheck. Providers can use digital tools to identify patients who may need more assistance when it comes to paying for care and assign them to the appropriate pathway. Patient Financial Clearance screens patients automatically prior to or at the point of service to see if they qualify for financial assistance or charity support. It determines how likely a patient is to pay out-of-pocket expenses, and can calculate the optimal payment plan based on the patient’s specific circumstances. Another option is PatientSimple, which offers a user-friendly self-service portal to help patients apply for charity care and keep track of balances and payment plans. Of course, a huge amount of financial worry can be eliminated by simply tracking down missing or forgotten coverage, so the patient can relax knowing their bills will be covered. Coverage Discovery runs automated coverage checks across the entire patient journey to minimize accounts sent to collections and charity. In 2021, Coverage Discovery tracked down billable coverage in nearly 3 out of 10 self-pay accounts, amounting to more than $66 billion in additional revenue. Providers that create a patient-centered payments experience will not only deliver a better service to those needing care, but will be better placed to meet changing legislative requirements and strengthen their own revenue cycles. Find out how Experian Health’s digital patient payments solutions can help healthcare organizations transform the patient financial journey from a maze of dead ends and obstacles to one that’s clearly mapped out and simple to navigate.