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Medical excellence is a given when it comes to improving the patient experience, but what about the non-clinical side of care? Long waits, confusing processes and financial uncertainty can overshadow even the best medical treatment. As many as one in four patients delay care because of hidden administrative obstacles. As providers look to improve the patient experience in 2025, tackling these frustrations is top of mind. How easy is it for the patient to schedule their appointment? How quickly can they complete registration? Do they understand their insurance coverage, and do they have the right support to manage and pay their bills? Clear and straightforward patient access processes give patients support, convenience and control, and allow providers to focus on delivering care. This article looks at the challenges and opportunities that may affect patient access over the next year and highlights three ways to use digital tools to improve the patient experience. The patient experience in 2025: a rollercoaster of risks and opportunities Over the next year, patients' shifting needs and attitudes will change how they access care. Informed, tech-savvy patients armed with wearables and health-tracking apps want streamlined access and contact with their providers, and expect efficiency and personalization when they do seek care. At the same time, an aging population and increasing numbers of people with multiple chronic conditions drive demand for more complex and ongoing support. On the provider side, challenges like staffing shortages and remote work demands will continue to strain patient access teams. Payers' rapid adoption of artificial intelligence (AI) will continue to widen the denials gap. Rising costs will persist. Amidst this uncertainty, the forthcoming change of government may bring additional regulatory and legislative changes, so providers must be ready to adapt. Opening the digital front door is a way to elevate the patient experience to meet changing consumer expectations, while simplifying and streamlining processes so they can respond to whatever's in store. How can digital tools help improve the patient experience? Digital tools take the patient journey from a series of disjointed encounters to a coordinated and personalized experience. Building on innovations that gained momentum during COVID-19, like telehealth and virtual care, these tools keep patients and providers connected throughout the care process. By tailoring experiences to individual needs in real time, digital tools integrate into daily life and meet the rising demand for convenient, tech-driven options. Three ways to improve the patient experience Experian Health's latest State of Patient Access survey offers some pointers as to what providers should prioritize: 1. Expedite scheduling so patients can see their practitioner quickly Patients measure the patient experience by how quickly they can see their doctor. In the State of Patient Access survey, both those who think patient access has improved and those who think it has worsened give this as their reason. As patients' top priority, efficient scheduling is an obvious focus for providers who want to improve the patient experience. Online scheduling, mobile registration and self-service portals can simplify how patients book and check in for appointments. Patient Schedule lets patients book appointments anytime they like without needing to call. It only offers specific types of appointments with the right provider and makes it easy to cancel and reschedule, so no-shows are less likely. This also increases providers' capacity, giving patients more options so they can see their doctor sooner. Mobile registration complements digital scheduling by allowing patients to complete registration forms anytime, anywhere. Automated registration prefills information held on file to minimize paperwork, which is good news for the 85% of patients who do not want to fill out paperwork if they've already provided the information. Reducing manual errors also reduces delays so that patients can get on with their visit. 2. Help patients understand their insurance coverage and bills Patients and providers both cite financial challenges among their top priorities for improving patient access. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care, while more than half say they need their provider's help to understand what their insurance covers. Providers should consider digital tools that support transparent pricing and billing to improve patients' financial experiences. Experian Health's Patient Payment Estimates generates accurate, upfront estimates of what a patient will owe, incorporating real-time pricing information, benefits and discounts. Estimates and secure payment links can be sent to patients via text or through the web-based app for a convenient and user-friendly payment experience. Additional tools can help patients find missing coverage and identify suitable payment plans, empowering patients and accelerating collections for providers. 3. Explore how automation and AI can support a better patient experience The growing use of AI will continue to reshape all aspects of care. By processing vast amounts of information at an unprecedented rate, AI presents exciting opportunities in patient access: keeping patients informed, generating performance insights and reducing the errors, delays and bottlenecks that come with manual processes. One of the highest-ranking challenges for providers in the State of Patient Access survey was the difficulty of managing multiple solutions to run patient eligibility and coverage checks. Patient Access Curator uses AI to address this with a single-click solution that captures all patient data at registration. It checks and verifies eligibility, Medicare Beneficiary Identifiers, coordination of benefits and demographics, delivering results in just 30 seconds. This prevents denials on the front end and takes the pain out of registration and scheduling for patients. Read the blog: How Patient Access Curator uses real-time, automated discovery to prevent denials and improve patient access Put patients in the driver's seat in 2025 As competition intensifies with new providers and disruptive technologies entering the market, patient satisfaction will no longer be optional — it will define success in 2025. Investing in digital patient access tools gives patients the autonomy, choice and convenience they crave as modern digital consumers. Simplifying and streamlining access will not only help meet and exceed patient expectations, but will help providers future-proof their operations and build a sustainable revenue cycle for the years ahead. Find out more about how Experian Health's patient engagement solutions will help providers improve the patient experience in 2025. Patient Engagement solutions Contact us

The growing shift from inpatient to outpatient care continues. The U.S. ambulatory services market was estimated at USD 289.5 billion in 2023 and is projected to grow at a CAGR of 5.38% from 2024 to 2030. A Deloitte study notes that the gap between inpatient and outpatient revenue has been closing for two decades. But what's driving this boom? Clinical advances, patient demand for lower-risk and lower-cost options and payer pressure all play a role. New technologies, like advances in orthopedics, allow more procedures to be performed at outpatient service centers instead of costly hospital settings. Free-standing ambulatory surgery sites are expected to see a 14% volume boost over the next decade as more service lines, like cardiovascular and neurosciences, begin to shift procedures from inpatient to outpatient facilities. The ongoing growth in outpatient services presents a unique opportunity for revenue cycle leaders to use technology to improve outpatient revenue—and the overall patient experience. Grow outpatient revenue with more digital care Patients want a better experience at every step of the patient journey. They want to see their doctor faster, manage appointments online and understand how much it costs—with as little red tape as possible. A lack of streamlined patient access and transparency often results in no-shows, a rise in claims denials, wasted staff time and patient complaints. However, by opening the digital front door, providers can give patients the self-service tools they crave, improve the care experience, keep outpatient schedules full and increase revenue. Additionally, providers can use technology like artificial intelligence (AI) to lower claim denial rates. Here are five strategies to increase outpatient revenue in 2025. 1. Make patient access simple Patients want to see their doctor faster. In Experian Health's latest State of Patient Access survey, eight in ten patients who reported being unhappy with their provider experience cited waiting for an appointment as a top complaint. When trying to schedule, patients are also frustrated by the friction that comes with complex processes, clunky technology systems and sparse provider communication. Outdated manual workflows, staffing shortages and lack of staff training often result in challenges for both patients and providers. Improved patient access is at the heart of patient-centered healthcare. Technology designed to put the patient in control, like online patient scheduling and digital patient intake tools, offer continuous patient engagement, optimized scheduling, and streamlined administrative processes. By leveraging modern patient access solutions, providers can improve patient experiences and alleviate the impact of staffing shortages. 2. Reduce appointment no-shows Missed appointments cause headaches for patients, providers, and revenue cycle managers. Online scheduling and mobile registration are also top of mind for patients. In Experian Health's State of Patient Access 2024 survey, 89% of patients said they wanted self-service scheduling and 85% reported a dislike for filling out repetitive intake paperwork. Online patient scheduling software puts patients in the driver's seat, providing convenient and secure 24/7 access to book, reschedule, and cancel appointments on their own time. Solutions like Patient Schedule sync seamlessly to an organization's scheduling rules, and patients receive automated appointment reminders by text or IVR. On average, providers that use Experian Health's scheduling solution experience an 89% show rate, a 50% reduction in scheduling time, and a 32% increase in patients per month. Patient intake tools like Registration Accelerator simplify mobile registration with a streamlined text-to-mobile experience. Once registration is complete, automated returns of forms, patient-check-ins and demographic information ease the burden on staff. 3. Help patients prepare for outpatient costs Patients need a clear breakdown of their financial responsibility before receiving care. Without it, they may be unable to prepare for care costs appropriately. While hospitals are now required to share detailed pricing for at least 300 common procedures, confusion around a patient's actual financial responsibility still persists. More than half of patients report turning to their provider for help understanding what insurance covers. Digital solutions that provide accurate, upfront estimates empower patients. More than eight in ten patients say pre-service estimates help them prepare for the cost of care. Patient Payment Estimates provide upfront, real-time estimates of what a patient will owe. Providers can offer convenient and secure payment links, and allow patients to pay their bills online or see customized payment plans. Outpatient providers can further maximize the chance of reimbursement by running health insurance coverage checks across the entire revenue cycle. This can help find billable coverage that may have been forgotten and give patients greater certainty about what they'll owe. 4. Automate healthcare collections Collections are often a major challenge in the outpatient revenue cycle. Outpatient procedures can be costly, even with insurance, leaving patients responsible for potentially large bills. Automating healthcare collections allows for faster, more efficient, and more compassionate collections. Tools like Collections Optimization Manager helped Novant Health achieve an overall recovery rate of 6.5% and increase revenue and cost savings to a rolling average return on investment of 8.5:1. With automated tools like Patient Financial Clearance, providers can assess patients' ability to pay and assign them to an appropriate financial pathway. This allows patients to quickly get the assistance they need while freeing up valuable staff time. 5. Streamline claims to increase outpatient revenue Denied claims continue to be problematic for providers. In Experian Health's State of Claims 2024 report, which surveyed 210 healthcare revenue cycle leaders, nearly three-quarters of providers feel claims denials are increasing, while 67% feel getting paid is taking longer. Claims management software can help end the cycle of denials. However, around half of providers still use a manual claims review process, and only 28% feel confident in their understanding of automation, machine learning and AI. Adopting automated and integrated healthcare claims management solutions can reduce errors, prevent undercharges, and ensure a higher first-pass payment rate. Tools like Experian Health's ClaimsSource® simplify the entire claims process, while Claim Scrubber helps providers submit more accurate claims. Digital solutions can also automate claim status monitoring and eliminate manual denial processes. Implementing AI tools to interpret past claims data and recommend next steps can improve outpatient claim denial statistics. Tools like AI AdvantageTM look at past payer behavior and historical claims data to predict and prevent denials. AI Advantage's two components, Predict Denials and Denial Triage, help providers respond to growing denial challenges by identifying claims with a high likelihood of denial before submission, and focus on remits that have the most impact. See how: Find out more about how Experian Health's revenue cycle management solutions can help healthcare organizations increase outpatient revenue, keep pace with growing patient volumes, improve patient satisfaction and boost their bottom lines. Learn more Contact us

Lines at the desk, phones ringing off the hook and a stack of insurance questions waiting to be resolved — this is the daily reality for many patient access teams. Today's patients find these "front door" bottlenecks in healthcare particularly frustrating, especially since they can envision how much smoother the process could be with the digital apps and tools they rely on in other areas of their lives. Despite improvements in patient access, Experian Health's latest State of Patient Access survey suggests that the digital front door in healthcare is still only partially open. Drawing on these survey findings, this article examines how opening the digital front door in healthcare can address common pain points in patient access, improve operational efficiency and better meet the needs of modern healthcare consumers. What is the digital front door in healthcare? Scheduling a doctor's appointment should be as easy as using a food delivery or ride-sharing app. That's the idea behind the digital front door in healthcare. Giving patients secure digital options to book, register and pay for care puts control in their hands so they can manage their care anywhere, anytime. It's part of a larger digital transformation in healthcare, making it easier for patients to connect with services quickly and conveniently. At the same time, it improves efficiency and profitability for providers. From websites and portals to mobile apps, this approach creates a friendly, accessible entry point that focuses on what patients need: simplicity, convenience, and transparency in their healthcare journey. Top pain points in the healthcare digital experience While previous State of Patient Access reports exposed frustrations with patient access, the 2024 survey shows a glimmer of hope. Self-scheduling options are on the rise and telehealth is reducing friction. Patients and providers agree that access is getting better and credit digital tools for many of the improvements. That said, challenges remain. Top 3 pain points for patients Seeing their doctor quickly (27%) Understanding how much their care will cost (17%) Trying to schedule appointments (14%) Top 3 pain points for providers Maintaining staffing levels (45% vs. 55% in 2022) Efficient and timely management of prior authorizations (39%) Improving speed and accuracy of resolving patient information prior to claims submission (31%) When it comes to future priorities, patients and providers agree that accurate pre-service price estimates and clarity around insurance coverage are the top two. Providers believe they're getting better at providing accurate estimates, and while 74% of patients say they did receive accurate estimates, this is down from 78% the previous year. It's a good reminder that the digital front door isn't just about online scheduling: using digital tools to help patients understand and prepare for their bills is a key component. Patients and doctors want more — not fewer digital services The 2024 report reaffirms previous findings that patients want more digital options for managing their healthcare: six in ten say this is important. And among providers, it's clear that digital front door technology is seen as a critical driver of improvement in patient access. Here are just a few ways providers say they're using digital tools to reduce friction: Expanding telehealth services Introducing digital/mobile patient communications Launching patient portal services Enabling online and mobile payment tools Implementing digital self-service registration and online/mobile self-scheduling Mitigating staffing shortages is a major benefit. Staffing issues have lessened since the peak of the pandemic, but remain an obstacle to effective scheduling and registration for 72% of providers. Automation and self-service patient access tools help alleviate these pressures. How digital solutions improve patient access and satisfaction “These digital tools make healthcare more accessible by eliminating barriers and simplifying patient-provider interactions,” says Alex Harwitz, VP, Digital Front Door, at Experian Health. “Automation can take care of repetitive tasks that take up staff time, so staff can focus on helping patients directly. Real-time scheduling, accurate cost estimates and streamlined mobile options meet patients where they are and give them the control and flexibility they want.” Bottlenecks, wait times and costly errors go down, while patient satisfaction is higher. 3 solutions to improve the digital front door Harwitz suggests three ways to use the digital front door to eliminate friction in the patient journey: 1. Simplify patient scheduling Patients' litmus test for patient access is how quickly they can see their doctor. To help patients quickly find and book the earliest available appointment, healthcare organizations turn to Experian Health's Patient Schedule software. This 24/7 digital scheduling platform guides patients to the right appointment and provider in line with scheduling and business rules. Patients can easily cancel and reschedule if necessary, and no log-in is required, so new patients can get started instantly. Automation optimizes scheduling capacity, so no appointment slots are wasted, improving call center efficiency. There's also the option to incorporate automated text, interactive voice response and email reminders so patients don't forget their appointments, which will increase completion rates and reduce gaps in care. 2. Speed up registration times Patients don't want to sit in waiting rooms and fill out manual paperwork, and healthcare staff have limited bandwidth to handle high patient volumes. Tools like Registration Accelerator can streamline the registration process, by reducing manual efforts and paperwork for patients and staff. This patient intake solution sends an automated link that allows patients to register anywhere, and at any time. Patient Access Curator uses AI-powered data capture technology to collect and verify patient information at registration, reducing the need for manual input. In a single click, the tool runs simultaneous inquiries to capture: Eligibility verification Coordination of benefits Medicare Beneficiary Identifiers Coverage discovery and patient financial status Patient demographics Not only does this accelerate the registration process for patients, but it also gathers clean, accurate data for downstream claim submissions. This technology has prevented over $1 billion in denials since 2020. Watch the webinar: How Patient Access Curator is transforming claims management from the front end of the revenue cycle. 3. Provide more accurate estimates With 96% of patients looking to their provider to help them understand their insurance coverage, the demand for better financial communications is clear. More than 80% of patients say accurate upfront estimates help them plan for costs. If they feel they can't afford to pay, 43% say they would consider postponing or canceling care. Lack of clarity is a health risk as much as a financial one. Experian Health created Patient Financial Advisor and Patient Estimates to help providers improve price transparency. Healthcare providers can use these tools to generate precise cost estimates based on real-time pricing information and offer convenient online payment options to expedite collections. Patients can get a personal estimate, customized payment plan and submit a payment in a few clicks. This addresses patient concerns about affordability and transparency, while ensuring providers remain compliant. See it in action: the digital front door in the real world How IU Health used guided scheduling to boost patient satisfaction and improve operational efficiency even as patient volumes increased. How Banner Medical Group uses Patient Estimates to boost patient satisfaction and meet compliance requirements. The evolving digital front door in healthcare The digital front door in healthcare isn't just a single entry point — it's a constantly evolving way to connect with patients, bridging digital and real-life interactions. By tackling common challenges like outdated booking systems, unclear financial statements, lengthy waits and limited payment options, healthcare organizations can create a smooth, patient-friendly experience that boosts satisfaction, builds trust and improves results for everyone involved. Learn more about how Experian Health's digital front door solutions tackle the most common pain points in patient access and deliver convenience, clarity and control. Learn more Contact us

As more Americans feel the squeeze on their household budgets, paying for healthcare is a growing concern. A 2024 survey by Pew Research Center found that the number of Americans who rate their personal finances positively has dropped from 50% to 40% over the last three years, with nearly 60% of Americans now saying their financial situation is "fair" or "poor." A West Health-Gallup poll revealed that 35% of US adults would struggle to afford care, with some cutting back on essentials like utilities or food to pay for medical expenses. To address and mitigate these financial pressures, healthcare providers must take proactive steps to support patients and avoid a shortfall in collections. Patient payment plans can help patients manage costs without delaying or skipping necessary care. Providers that go the extra mile to improve the patient experience will boost patient attraction and retention rates, reduce collection costs and support the financial health of their patients and their organizations. The growing importance of healthcare payment plans Cost concerns often influence patients' perceptions of their providers. In Experian Health's State of Patient Access 2024 survey, 54% of patients who thought patient access had deteriorated over the previous twelve months said it was because they were less able to afford care. On the flip side, 32% of those who thought patient access was better said it was because payment plans made care more manageable. Healthcare payment plans allow patients to spread out the cost of their medical expenses into smaller, more manageable chunks, instead of paying the full amount at once. Previous research by Experian Health and PYMNTS confirms that patients welcome the flexibility, convenience and reassurance that this offers. This is particularly true of patients who would struggle to pay an unexpected bill: up to a fifth of these patients would switch providers based on the payment experience alone. The clear message for providers is that patients who struggle to pay bills—especially unexpected bills—are more likely to need healthcare payment plans and to seek out a provider that offers them. How flexible patient payment plans improve satisfaction By letting patients pay at a pace that works for them and their budget, payment plans reduce stress and create a more supportive and compassionate financial experience. When patients know they have options, they're more likely to stay on track with payments and feel more satisfied with their overall care. A major advantage is that these plans can be tailored to each patient's unique situation. For example, with PatientSimple®, patients can use a self-service portal to generate pricing estimates and explore suitable payment plans to make a more informed decision about how they'll pay for care. They can break down bills into smaller and more affordable payments, rather than facing the daunting prospect of a single large bill. Using Experian Health's unmatched data and advanced analytics, PatientSimple offers a richer understanding of each patient's propensity to pay, helping providers make better decisions about the optimal financial pathway for each patient. Patients can access their bills and statements online at any time. This is more convenient for them and frees up staff to give more attention to patients with more complex circumstances. Key benefits of healthcare payment plans for patients and providers Improving the patient experience with healthcare payment plans also translates into financial and operational benefits for providers. Helping patients navigate their financial responsibilities more easily — especially through automation and software-based tools — increases cash flow, reduces admin burdens and boosts overall efficiency. Here are a few examples of how payment plans and other financial tools can benefit patients and providers: 1. Patient Financial Clearance automatically screens patients to determine eligibility for Medicaid or other financial assistance programs. Calculating the optimal payment plan based on the patient's ability to pay gives patients more affordable options and providers more predictable revenue streams. Increasing access to financial assistance also increases access to care, as patients are more likely to follow care plans, leading to better health outcomes. Case study: How UCHealth wrote off $26 million in charity care with Patient Financial Clearance 2. Patient Financial Advisor and Patient Estimates give patients a pre-service, personalized breakdown of what their bill is likely to be, using accurate chargemaster data, payer rates and real-time benefits information. This upfront clarity makes it easier for patients to plan for payments, while providers benefit from fewer payment defaults and improved patient trust. And with fewer bills ending up in accounts receivable, providers can reduce the manual effort needed to manage outstanding balances. 3. Helping patients reduce out-of-pocket expenses is another way to achieve a better financial experience, boosting loyalty and retention. Coverage Discovery® finds any forgotten or overlooked commercial and government coverage, so no costs that should be covered elsewhere fall to the patient. The tool scans for potential coverage from pre-service through the entire accounts receivable file, and automates self-pay scrubbing to detect discrepancies that can be quickly corrected. Accounts that were previously destined for collections, charity or bad debt are instead submitted for payment. Case study: How Luminis Health found $240k in billable coverage each month with Coverage Discovery 4. Finally, removing friction from the payment process will always be a win with patients and providers. Consumers increasingly rely on mobile and contactless payment tools, so it makes sense to offer similar options in healthcare. PaymentSafe® allows providers to collect any payment securely and quickly. Patients can pay anytime and anywhere, while providers benefit from faster, more reliable revenue collection. Maximizing patient experience with effective healthcare payment plans Payment plans aren't just a financial lifeline for patients. They can make or break the whole patient experience. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, explains the importance of healthcare payment plans and why offering flexible payment options is at the heart of improving the patient experience: “Our most recent State of Patient Access report confirms that many consumers are concerned about how they'll handle their healthcare bills. Having a plan to make costs more manageable can immediately alleviate some of that stress. Providers have an opportunity to step up and help them figure out the best financial pathway.” He says, “At Experian Health, we use data and automated technology to help providers identify patients who need extra assistance and direct them toward appropriate support. Providers that don't offer payment plans, estimates and other financial solutions will struggle to attract and retain patients who can't pay upfront and risk more patient accounts being written off as bad debt.” Paying bills will never be an enjoyable part of the patient journey, but clear and compassionate healthcare payment plans make it easier. With the right technology, providers can simplify and accelerate the collections process, foster patient trust, and most importantly, allow patients to focus on their health instead of their bills. Prescribe the right financial pathway for your patients with Experian Health's industry-leading patient collections technology. Learn more Contact us

Self-pay collections are challenging for healthcare organizations of all shapes and sizes, but particularly for mid-size providers. Caught in an awkward middle ground, these organizations are often too large to operate with the agility and personal touch of small clinics, but too small to leverage the economies of scale available to large health systems. Revenue cycle managers must find the balance between operational efficiency, patient-centered services and financial constraints. With limited staff and resources, many mid-size hospitals feel like they're fighting an uphill battle to maintain cash flow and patient satisfaction as they contend with increasingly complex billing and insurance protocols. Implementing self-pay collections strategies tailored to mid-sized healthcare organizations can boost efficiency, reduce bad debt and create smoother patient billing processes. This article looks at practical strategies to help bring more dollars in the door without compromising the patient experience. Importance of effective self-pay collections in the mid-sized market Like other markets, mid-size providers are squeezed by self-pay collections on two fronts – the hospital's financial health and patient satisfaction. Finding the right collections strategy is vital to protect this “double bottom line.” Financially, failure to collect on bills seriously hurts cash flow. Unlike larger hospitals that might have more resources or smaller practices with fewer expenses, mid-size facilities often operate on tighter margins. Inefficient collections processes lead providers to risk revenue loss, which leads to cuts in services, staff and the ability to invest in new tech. At the same time, the way hospitals handle billing and collections plays a major role in how patients feel about their overall healthcare experience. Confusing bills or aggressive collections tactics can damage trust. An effective self-pay collections strategy that makes payments easy, straightforward and flexible contributes to a positive patient experience and will pay dividends in the long run. How to improve self-pay patient collections for mid-size hospitals and facilities Here is a breakdown of some key approaches and tools that can be adapted to suit the specific needs of mid-size providers and make billing and collections more efficient, patient-friendly and cost-effective: 1. Automate as much as possible One of the fastest ways to make better use of resources is with automation. Why have staff spend hours sending out bills and payment reminders by hand when this can be done automatically? Automated collections tools can also send email and text reminders to patients, set up auto-pay options, and guide patients to appropriate payment plans. Automatic alerts for overdue accounts can be used to help staff focus their limited time on high-value activities. This saves time, reduces errors and creates seamless patient experiences. Read more: Maximize patient collections with automated technology 2. Segment and conquer collections Every patient's financial situation is different, so why handle their accounts in the same way? Segmentation divides patients into groups based on their payment behaviors, financial situations and balance size so that providers can tailor their approach. Collections Optimization Manager screens and segments self-pay accounts to scrub accounts that need special handling (like bankruptcy, deceased status, Medicaid and charity) and focus on patients most likely to pay. Accounts are given a segment code based on the patient's propensity to pay, which then informs how the account is managed. For example, those who typically pay on time can get a simple text reminder, while those with larger balances or financial difficulties may need a more flexible payment plan. This solution can also be used with Patient Financial Clearance to create individualized payment plans for patients who may not qualify for charity care. A targeted approach to self-pay billing strategies for mid-sized healthcare facilities increases the chances of successful payments. 3. Implement interactive voice response (IVR) IVR systems allow patients to get important payment information through an automated phone system, without needing to talk to someone. Patients can receive automated voice messages or call in and follow prompts to pay their bills over the phone. Not only does this give patients far more flexibility to pay when convenient for them, but it also reduces the workload on staff, who don't have to handle so many incoming calls. Experian Health's cloud-based dialing platform, PatientDial, helps patients clear their bills quickly and conveniently, with minimal input from staff. In a single year, this tool helped clients collect over $50 million in self-pay collections and save 900,000 labor hours that would have been spent dialing manually. 4. Work with a dedicated collections consultant Bringing in a collections expert gives patient finance teams targeted support to improve collections rates while maintaining a positive patient experience. Clients who use Collections Optimization Manager get dedicated support from experienced revenue cycle consultants who can recommend the most appropriate collections strategies, evaluate opportunities to improve performance, and oversee scenarios to test and adopt new approaches. Some providers may find it more efficient to manage collections in-house, while others benefit from outsourcing to a specialist third party. Experian Health offers collections solutions to both, enabling mid-sized providers to choose the best fit. Collections Optimization consultants provide personalized attention and customized workflows tailored to the organization's needs, whether they're using Epic, Oracle, Meditech or other electronic health record platforms. Integrating patient-friendly billing practices Whatever the strategy, maintaining a positive patient-provider relationship through patient-friendly billing is essential. For example: Simplifying billing statements and using clear language reduces confusion and helps patients understand what they owe Running coverage discovery checks and offering upfront patient payment estimates gives patients greater clarity about their financial obligations Setting up automated reminders nudges patients to pay on time Highlighting available payment plans gives patients manageable options to reduce the risk of unpaid balances. Experian Health's data insights allow providers to better understand patients and develop strategies for proactive outreach before debts become unmanageable. Collection Optimization Manager's segmentation model draws together credit, behavior and demographic data, incorporating socio-economic modeling and income estimations to build a complete picture of each patient. Unlike traditional segmentation models that rely solely on payment history, the CO model includes estimated household size, income and federal poverty line analytics to generate a meaningful score without needing additional data. Automated communications such as PatientText and PatientDial make the billing and payment process less intrusive. Combining convenience and personalization builds trust and improves collections while supporting a more compassionate patient experience. Enhancing revenue for mid-sized medical groups with improved self-pay collections Going back to that “double bottom line,” Judy Wirtz, Senior Analytics Consultant at Experian Health, explains how Experian's collections toolkit helps mid-sized organizations boost financial performance while maintaining a positive patient experience: “Boosting self-pay collections for mid-size healthcare organizations doesn't have to be daunting,” she says. “Our goal is to simplify collections while keeping the patient experience front and center. We use industry-leading data, smart segmentation and dedicated support to help organizations customize their strategies based on their unique patient mix and resources. Other tools fill in different pieces of the collections puzzle, but Collections Optimization Manager is the only one to give providers the full picture. Our clients have seen an impressive 9:1 return on investment, so we're confident this approach makes a real difference.” Wirtz suggests that those who'd like to learn more about Collections Optimization Manager should watch Experian Health's recent webinar with Wooster Community Hospital. The hospital used CO to collect $3.8 million in patient balances. Find out more about how Collections Optimization Manager boosts self-pay collections for mid-size healthcare organizations. Learn more Contact us

According to Experian Health's State of Claims 2024 survey, missing coverage is the top reason for healthcare claim denials for almost a fifth of providers. However, the issue isn't just about whether a patient is insured — four in ten providers worry about insurance companies paying out even where patients have active coverage. Constantly changing payer policies can result in altered or expired benefits, leaving providers scrambling to secure alternative sources of payment. That's why many providers are turning to automated health insurance discovery to find missing coverage and catch outdated policies early. This article looks at how coverage discovery software helps healthcare organizations address some of the most stubborn pain points in the revenue cycle. What is health insurance discovery? When a patient comes in for care, one of the first jobs is to figure out exactly what insurance they have — if any — and what it covers. Health insurance discovery is the process of checking whether the patient has active insurance and confirming details of that coverage, such as payer name and plan type, to ensure the cost of care is billed to the correct payer. If a patient has multiple active plans, the provider must also determine how much should be billed to each payer and in what order. How does it work? Ideally, coverage discovery occurs pre-service, but it can occur later if a claim is denied, and alternative coverage sources must be found. The main steps in the process include: Collecting insurance details when patients schedule or check in Checking with insurance companies to confirm that coverage is active and will cover planned services Cross-checking payer databases to ensure no coverage is missed Considering a patient's eligibility for Medicaid or other charity support Coordinating benefits for accurate billing Benefits of automated health insurance discovery for providers While respondents to the State of Claims survey are reasonably confident about their coverage discovery processes, the actual outcomes are less robust. Eligibility checks are taking longer and errors are on the rise. Only 54% of providers believe their claims technology can meet current revenue cycle demands. Automation offers a reliable and adaptable solution to bridge the gap between front-end checks and back-end claims management. Here are a few ways automated health insurance discovery sets the stage for smoother claims submissions and revenue cycle performance: 1. Maximize reimbursement by finding missing coverage quickly Challenge: Patients don't always provide complete insurance information, which can cause providers to miss out on opportunities for reimbursement. How automation helps: Automated health insurance discovery digs deeper than manual processes to find any coverage that may have been missed or forgotten. Experian Health's Coverage Discovery® solution combs through multiple proprietary databases, including employer information, historical search information, registration history and demographic validation to proactively identify billable Medicare, Medicaid, and commercial coverage. With minimal patient details, it finds additional sources of primary, secondary and tertiary insurance instantly. In 2023, Coverage Discovery tracked down previously unknown billable coverage in a third of patient accounts, resulting in more than $25 million in found coverage. 2. Reduce the manual workload Challenge: Staff spend too much time calling payers, logging into portals and manually entering patient data. This is time-consuming and error-prone, especially when one in four resubmissions are worked on by a different person than the one who originally processed it. How automation helps: Automation eases the admin burden by handling repetitive aspects of insurance verification behind the scenes, freeing staff to focus on more complex tasks. Coverage Discovery saves staff time by continuing to check for health insurance throughout the patient journey, and not just at registration. This final post-service check is vital to detect discrepancies that could lead to denied claims. Staff can also automate the self-pay scrubbing process to further reduce the risk of errors. As providers continue to feel the squeeze from staffing shortages and rising operating expenses, any move to reduce costs while bringing in more revenue is to be welcomed. 3. Prevent eligibility issues Challenge: Providers often only discover that active benefits have changed after the claim has been submitted. That's too late. For 43% of providers, it takes at least 10 more minutes to check eligibility when initial checks are incomplete. How automation helps: With automation, providers can run real-time eligibility checks, ensuring that changes to the patient's benefits are caught early so claims aren't denied due to outdated information. Experian Health's new Patient Access Curator uses artificial intelligence-based data capture technology to return accurate information from multiple sources with a single click. It automatically interrogates data from more than 270 payer responses, including active and billable coverage, plan level detail, chaining and primacy, so providers can verify eligibility and more in an instant. 4. Reduce claim denials and rejections Challenge: Incorrect or incomplete insurance information results in errors on claims forms or claims sent to the wrong payer, which causes denials, delays and rework. How automation helps: Automated discovery ensures that the correct payer and coverage information is attached to claims, reducing the likelihood of denial. This solves one of the most frustrating parts of coverage discovery, making the process faster, more accurate and less reliant on manual effort. Read more: How to leverage AI and automation to minimize healthcare claim denials 5. Improves the patient experience Challenge: Patients are often confused about their coverage status and worried about whether their healthcare costs will be met by their insurance provider. Medicare beneficiaries, in particular, report difficulty understanding and comparing plan options, leading to potential gaps in coverage. When healthcare providers fail to catch errors or gaps in their information, this erodes trust and negatively impacts how they feel about their experience. How automation helps: By correctly identifying coverage and verifying benefits eligibility, automation allows providers to give their patients early certainty about how their healthcare costs will be covered. Patients are less likely to receive unexpected or incorrect bills, which prevents delays and disputes. Automated tools can go a step further to improve the patient experience by guiding patients toward additional support and payment plans. For example, Patient Financial Clearance identifies patients who may be eligible for Medicaid or charity assistance, and identifies appropriate payment plans for anyone with an unmanageable self-pay balance. Case studies: See health insurance discovery in practice How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month Learn more about how automated health insurance discovery helps providers reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

Outdated scheduling systems, endless phone calls and clunky user digital interfaces cause friction – for both patients and staff. The result? Frustrated patients, no-shows, unused appointment time slots and a hit to bottom lines. Patients want to see their provider quickly, and they don't want to jump through hoops to make an appointment. Online patient scheduling software may be the solution. In Experian Health's 2024 State of Patient Access survey, nearly 8 in 10 patients who reported being unhappy with their provider experience blamed waiting for an appointment as a top frustration. And 89% of patients said they want to schedule their appointments online or using a mobile device. Unsurprisingly, 61% of patients would consider switching to a healthcare provider that offers a patient portal or a digital front door. Now, 63% of providers report offering self-scheduling tools and another 16% plan to implement online patient scheduling in the next six months. But getting patients to use them is still a challenge. With online patient scheduling software, patients get the 24/7 access they crave, and healthcare organizations benefit from increased patient volume, improved staff efficiencies and revenue growth. Understanding online patient scheduling software To enable online patient self-scheduling, organizations need a platform that translates a provider's scheduling rules into an intuitive experience, guiding patients to the appropriate provider and appointment while keeping the provider in control of their calendar. This is achieved with Experian Health's Patient Schedule solution, through decision support and automated business rules that uphold best practices, regardless of how the appointment is booked. The platform then digitizes the scheduling workflow, handles various scheduling scenarios, and includes necessary pre-registration information for the right appointment. It streamlines the process, ensuring patients can easily communicate their needs and be routed to the correct provider. Providers can automate their scheduling protocols, ensuring patients only see available options. Online patient scheduling software puts patients in charge of managing appointments—on their own time. Tools like Patient Schedule integrate with practice systems, making it easy to coordinate care seamlessly. The software is customizable to an organization's scheduling rules, so patients only see the calendars and appointment types providers want them to see. New and returning patients can access systems in real time and find the appointment slots and providers they need easily. Patients can book, reschedule and cancel appointments, making no-shows less likely. Physician time is used wisely, schedule gaps are lessened and staff no longer has to waste valuable time confirming appointments. Instead, text messages, with their 98% open rate, facilitate fast and direct patient communication. Benefits of patient schedule software to hospitals More than 62% of healthcare workers consider patient scheduling to be one of the areas hit hardest by staff shortages. However, when patients have convenient, 24/7 access to patient scheduling software, it eases the burden on overburdened call center staff, administrative resources and operational costs. Patient scheduling software boosts retention of existing patients and makes it easier to acquire new patients. On average, providers using Experian Health's scheduling solution see 32% more patients per month, reduce scheduling time by 50% and enjoy an 89% patient show rate. Key features to look for in online patient scheduling software Patient scheduling software features should facilitate convenient and flexible patient scheduling while increasing care access, streamlining staff productivity and boosting operational efficiency. Here's a breakdown of key features to consider in online patient scheduling software. 1. User-friendly interface Old habits are hard to break. Experian Health data reports that more than half of providers (55%) find getting patients to use digital services to be one of their greatest challenges. Why? Some research indicates that 89% of patients are reluctant to use an online scheduler because they're either not aware of the service or feel they don’t have the computer skills to use it. Easy-to-use online scheduling is common for everyday tasks like booking dinner reservations. However, in healthcare, that's not always the case. Patients struggle to use slow systems and hard-to-navigate interfaces. To encourage widespread adoption, online patient scheduling software needs to be simple to set up, deploy, and use—for providers and patients. Tools like Patient Schedule easily automate scheduling workflows, allowing providers to define appointment criteria and sync with existing calendars. A platform with no login required, unique patient identification and mobile access makes it easy—and secure—for patients to find providers and schedule appointments. 2. Appointment reminders Relying on appointment reminder phone calls can drain your staff and the bottom line. Patients might miss calls, forget to return messages, lose reminder cards or forget about their appointments entirely. This leads to no-shows, time wasted on rescheduling and juggling physician calendars, decreased patient outcomes and reduced revenue. Automating appointment reminders by text or IVR with Patient Schedule makes it simple to send patients updates, confirm appointments, and maximize staff and physician time. Patients can book, reschedule, or cancel appointments in real time—even after business hours. When patients are in charge of their own schedule, no-shows decrease, and revenue goes up, not to mention improved patient outcomes and satisfaction. 3. Integration capabilities Seamless integration is key. Online patient scheduling software works best when it dovetails with practice management systems, electronic medical record (EMR) platforms and other operational technology. This ensures efficient scheduling, fewer gaps in physician schedules and the ability for providers and practice management to communicate effectively with patients throughout the entire patient journey. With the appropriate integration, patients are in control of their scheduling. Status updates are communicated in real time over text when a patient books, reschedules or cancels online – keeping everyone in the know. Patient Schedule's template rules allow providers to optimize their calendars to ensure patients schedule into the right time slots. Practice managers benefit from coordinated workflows and a holistic view of the entire schedule, making it easier to identify gaps. 4. Customization options There's no one-size-fits-all approach to online patient scheduling software. Whether integrating self-schedule into an existing online system or starting from scratch, the software solution should be tailored to every organization's requirements, goals and budget. When selecting a partner, it's important to consider the organization's needs carefully. What's the scope of use? Is it a small practice or a large hospital network? What existing systems will the online patient scheduling software need to integrate with? Is the online patient scheduling software replacing a large call center or a small support staff? For best results, look for flexible solutions that allow room to scale while accommodating changing healthcare environments and privacy needs. Factors to consider when choosing a solution To ensure a successful implementation of an online patient scheduling software solution, consider these additional factors: Accessibility features Staff training and onboarding requirements HIPAA compliance Privacy protection features Time to launch Cost to implement Ongoing technical support Case studies: Successful implementation stories Curious how Experian Health's Patient Schedule solution benefits healthcare organizations? Here's what two clients had to say: In practice: When Indiana University (IU) Health implemented Patient Schedule, they found that “the platform is very new patient-focused with new patients accounting for over 59% of Self Scheduling bookings.” Of those bookings, they saw an 87% show rate and found “around 64% of our patients self-scheduled during non-business hours.” Watch the webinar: See how IU Health used self-scheduling to manage increasing patient volumes with less staff – and gain insights on using digital scheduling to scale operations. In practice: CareMount Medical, a patient-centered organization, implemented online patient scheduling as part of a 24/7 access initiative, enabling real-time scheduling access across all of their providers and specialties. Read the case study: See how CareMount Medical used Patient Schedule to make it easier for patients to get in to see their provider, improve patient satisfaction and boost financial visibility. By adopting online patient scheduling, healthcare providers can streamline operations, improve patient satisfaction and deliver high-quality care. This solution speeds up staff training, streamlines scheduling time, improves patient no-show rates and increases patient volumes and retention. Ready to make the move to online patient scheduling? Contact Experian Health to get started. Learn more Contact us

Patients expect clear information about their insurance coverage when they visit their healthcare provider, but too many leave feeling confused and financially underprepared. Experian Health's State of Patient Access 2024 survey reveals that 56% of patients struggle to make sense of their insurance coverage without provider assistance, while 61% say improving coverage explanations is the most urgent challenge in patient access. For providers, the financial fallout from missed insurance eligibility checks is even more pressing, with 15% of providers citing eligibility issues as one of their top three reasons for denials. Accurate eligibility checks are crucial to keep the revenue cycle on track. This article highlights common challenges and current best practices for improving eligibility verification. Could automated insurance eligibility checks give patients and providers the financial clarity they're looking for? What are insurance eligibility checks? Insurance eligibility checks are carried out pre-service to confirm that a patient has active insurance that will cover their planned treatment and care. Verifying insurance status, coverage details and benefits in advance ensures that the proper claims and bills are sent to the right recipient. Patients and providers get early warnings of coverage limitations and potential out-of-pocket costs, which helps patients access care without any financial surprises. Without these checks, healthcare organizations may deliver services to patients without active coverage — and with no clear path to payment. Therefore, a reliable eligibility verification process is essential to minimize the claim denials, rework and billing errors that often stem from inaccurate insurance information. How do insurance eligibility checks impact revenue cycle management? In the healthcare revenue cycle—which revolves around who pays, when and how—insurance eligibility checks are a first line of defense against revenue leakage. They're a proactive step toward establishing smooth claims and collections processes so no dollar goes uncollected or is lost to avoidable admin overhead. Prioritizing robust eligibility verification systems, as patient survey respondents advocate, is not just an operational necessity; it's a strategic safeguard against slow payments, patient dissatisfaction and financial instability. The insurance eligibility check process The eligibility verification process typically begins by confirming the patient's contact information to match their insurance card and electronic health record details. Staff then initiate an eligibility request to confirm active coverage. Once confirmed, they check that the plan covers proposed services, including any pre-authorization requirements, and review coverage limits to ensure the patient hasn't exceeded annual or lifetime caps. If applicable, providers also cross-check for Medicare eligibility using the Medicare Beneficiary Identifier (MBI) to identify any additional coverage. Common challenges with insurance eligibility checks Findings from Experian Health's State of Patient Access and State of Claims surveys illustrate the extent of the eligibility challenge, pointing to three main areas for improvement: Outdated or incomplete insurance information Sometimes, the insurance details in the provider's system don't match the payer's record. Patients may change jobs, switch insurance plans, or have secondary coverage they didn't know about or forgot to mention. If these changes aren't caught up front, it can lead to claim rejections and billing delays. Besides the obvious problem of lost revenue, this challenge incurs extra work: 43% of providers report that incomplete checks add at least 10 minutes per eligibility check. Changing payer policies and pre-authorization requirements Keeping up with each insurance provider's prior authorization requirements is challenging, especially if the patient's treatment is urgent. Missing a necessary authorization can lead to a denial, delayed payment and extra work. More than three-quarters of providers say payer policy changes are increasing, but only 10% are using automated tracking as part of their denial management strategy. Is there an opportunity to automate prior authorizations and eligibility verification to tackle denials? Inadequate tools to verify eligibility More than 7 in 10 providers say their organization runs eligibility checks quickly and accurately, but significantly fewer think their revenue cycle management technology is as good as it could be. 59% of providers are using at least two different solutions to collect all the necessary patient info for a claim submission. Tool overload is a real problem, as staff must wrestle with different platforms, processes and logins to get the eligibility information they need. Best practices for effective insurance eligibility checks  To tackle these challenges, providers can use automation to streamline their verification workflows. Some key practices for more reliable and efficient insurance eligibility checks include: Automate real-time eligibility checks for faster, more precise verification: For example, Eligibility Verification automatically verifies insurance coverage and plan-specific benefits information before and at the time of service. This not only speeds up registration, but also catches any potential coverage gaps before services are provided. Automation also helps minimize manual work and reduces the risk of human errors that can lead to claim denials. Track payer policy changes automatically: Insurance verification software helps providers keep up with ever-changing payer requirements. Eligibility Verification connects to more than 900 payers with advanced search, to maximize the likelihood of matching patient information. This can be used alongside Experian Health's automated pre-authorization tool, which dynamically updates national payer prior authorization requirements and flags when something is missing. Give patients upfront, automated price estimates: More than 80% of patients say upfront pricing estimates help them prepare for costs. Automating eligibility checks and patient payment estimates help patients understand their coverage, co-pays and deductibles, so they know what to expect when their bill arrives. This improves transparency, boosts patient satisfaction and accelerates collections. Implementing these best practices helps ensure smooth claim submissions and reduces denials due to eligibility issues, ultimately supporting a healthier revenue cycle. Case study: How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Within just five months of implementing Eligibility Verification, Providence Health had saved $18 million in potential denials. Read the case study to see how automated insurance eligibility checks reduced denials, increased staff productivity and boosted patient satisfaction. How Experian Health can help healthcare organizations improve eligibility checks While healthcare affordability remains a pressing concern for patients and providers, quickly and accurately verifying insurance eligibility will remain among the top priorities for both groups. Experian Health aims to simplify the process with automated Eligibility Verification. In addition to reducing payment delays and denials, its streamlined workflows support higher patient volumes, especially as patients have more complex insurance arrangements and take on greater financial responsibility. One significant advantage is the ability to provide extra support for the growing number of patients who may be eligible for Medicare. Medicare eligibility checks can be complicated, particularly if patients don't know which component they qualify for. Eligibility Verification includes an optional MBI lookup service to find and validate the patient's MBI number without requiring a manual search. Find out more about how automating insurance eligibility checks verifies coverage quickly and accurately — giving patients and providers early clarity about how the cost of care will be covered. Learn more Contact us

Experian Health's State of Claims 2024 report reveals a worrying trend in healthcare claim denials, with nearly three-quarters of survey respondents reporting a rise. Around four in ten say claims are denied 10% of the time, with one in ten seeing denial rates above 15%. Denials at this scale, driven by various claim denial reasons, represent billions of dollars in lost or delayed reimbursements, so it's no wonder that reducing health insurance claim denials tops healthcare providers' “must-fix” list. However, despite being highly motivated to resolve the challenge, many organizations need more support to overcome operational roadblocks. Prior authorizations are taking longer to come through. Payer policy changes are more frequent. Patient information is increasingly inaccurate. For 65% of respondents, submitting clean claims is more complex than before the pandemic. With some wrangling more than three technological solutions and others lacking confidence about using automation and AI, providers seem to be struggling to find the sweet spot when tackling denials. This article looks at the reasons for increased claim denials, as well as how automation and artificial intelligence (AI) can help healthcare providers overcome these obstacles to increase operational efficiency and improve cash flow. Major operational challenges leading to increased claim denials Clarissa Riggins, Chief Product Officer at Experian Health, says that many providers are increasingly concerned that payers won't reimburse costs as denial rates increase, when discussing the State of Claims 2024 report. These concerns reflect operational challenges, including difficulty keeping track of pre-authorization requirements, inability to keep up with rapidly changing payer policies and inadequate front-end data collection. While staffing shortages are not among the top three claim denial reasons as they were last year, they are a continuing drag on efficiency for 43% of providers. Burdened by limited resources, these revenue cycle teams are more likely to make avoidable errors during claim submission—a problem that is affecting the four in ten providers who say they have limited resources to cross-check claims for errors. Riggins suggests that healthcare organizations look to technology to close the claims gap: “We had hoped to see a decrease in claim denials from our previous survey, but it's clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes. This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology to navigate this volatility.” Top reasons for healthcare claim denials Here are the top three claim denial reasons and how automation and AI can solve them: 1. Missing or inaccurate claims data Missing or inaccurate claims data is the number one operational challenge responsible for the increase in medical billing claim denials – among the top three challenges for 46% of respondents in the State of Claims 2024 survey. Submitting clean claims relies on getting data right the first time. It calls for speed and efficiency, which is impossible with slow, error-prone manual systems. Yet almost half of the respondents say their organizations are reviewing claims manually. While 54% of respondents believe their technology is sufficient to meet claims management demands, increasing errors and rising denials tell a different story. Revenue cycle leaders who embrace automation in their claims submission and denial prevention strategy set themselves up for smoother operations and a boost to the bottom line. Without the right automation to increase the speed and accuracy of claim submissions, valuable staff time and effort are wasted on manually processing error-prone claims, increasing the likelihood of denial. The lack of automation also places unnecessary strain on staff, diverting their attention from more complex claims issues. 2. Prior authorizations Claim denials often stem from poor communication between payer and provider systems, with the prior authorization process as a prime example. The process requires providers to seek agreement from the payer to cover a service or item before it is administered to the patient. Failure to do so results in the claim for that treatment being denied. Unfortunately, obtaining prior authorizations is not always straightforward; sometimes, the patient's treatment must begin before the authorization process is concluded. Other times, the authorization only covers certain aspects of the treatment. Not only is the prior authorization process complex, but it is also costly, laborious, and time-consuming to navigate successfully. According to the 2023 AMA Prior Authorization Physician Survey, physicians and their staff spend 12 hours per week completing prior authorizations, with almost all reporting physician burnout as a result. Providers must stay on top of frequent changes to payer policies, and staff must use multiple payer portals to track authorization requests. Unsurprisingly, authorizations are among the top three claim denial reasons for 36% of respondents in the State of Claims survey. As with any challenge involving digital systems “talking” to one another, authorizations are a great use case for automation. Automation can be used to check payer policy changes, alert staff when prior authorization is needed, gather relevant documentation, and review authorization requests for accuracy. This significantly reduces the burden on staff and minimizes the risk of claims being submitted without the necessary authorizations in place. Experian Health's Prior Authorizations technology automates authorization inquiries and checks requirements in real time. It uses AI to help users find and access the appropriate payer portal to speed up the authorization workflow. Users will have confidence that they're looking at the same account information and policy details as the payer, which means lengthy negotiations can be avoided. Staff also get accurate status updates on pending and denied submissions so they can take appropriate action and maximize reimbursement. 3. Inaccurate or incomplete patient data Even the slightest mistake or mismatch in a patient's name, address or insurance details can result in a denial, leading to payment delays and extra work for the staff. These denials are particularly frustrating because they should be avoidable. Automation can be used to pre-fill the patient's information before they arrive to avoid the errors that occur with manual input. This has the added benefit of accelerating registration. These solutions can also check for duplicate charges, missing fields and coding inaccuracies. For example, Claim Scrubber helps providers prepare error-free claims for processing by reviewing each line of the claim before it's submitted. ClaimSource® helps providers manage the entire claims cycle by creating custom work queues and automating claims processing to ensure that claims are clean the first time. Implementing technology to prevent claim denials The report details some of the strategies providers are using to try to reduce denials. These include upgrading existing claims process technology, automating or expanding patient portal claims reviews, and automating tracking of payer policy changes. More than half are motivated to adopt new technology to reduce manual input. This is exactly what Denial Workflow Manager is designed to do. It enables providers to track claim status and appeals and quickly identify those that need to be followed up on. It eliminates the need for manual review, while analysis and reporting give staff insights into the root causes of denials to optimize performance. This solution can be integrated with tools like Enhanced Claim Status, which sends automatic status requests based on the type of claim and specific payer timeframes. It generates accurate adjudication reports within 24-72 hours to accelerate the revenue cycle. The output is viewable in ClaimSource to streamline workflows and manage the claims process in a single online application. Automation and digital technology are also valuable counterweights to the shortage of qualified staff. While staffing shortages aren't as high on the list of concerns as in previous years, they remain a stubborn problem. By reducing the need for manual input, claims management can be accelerated while freeing staff to focus their attention where it matters most. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more AI solutions for reducing claim denials Healthcare organizations can get more bang for their buck from automation by integrating these solutions alongside AI. Interestingly, the survey suggests that providers have mixed feelings towards AI: 35% of providers say they want solutions that leverage more AI and machine learning, yet only 8% are actually using them. Current ClaimSource users might consider AI Advantage™, which uses AI and automation to generate real-time insights for a proactive approach to denial management. It helps providers combat claim denials from two angles: AI Advantage – Predictive Denials uses AI to identify undocumented payer adjudication rules that result in new denials. It identifies claims with a high likelihood of denial based on an organization's historical payment data and allows them to intervene before claim submission. AI Advantage – Denial Triage comes into play if a claim has been denied. This component uses advanced algorithms to identify and intelligently segment denials based on potential value so that organizations can focus on resubmissions that most impact their bottom line. Doing so removes the guesswork, alleviates staff burdens, and eliminates time spent on low-value denials. This solution complements existing claims management workflows to help providers expedite claims processing, reduce denials, and maximize revenue. Another AI-powered solution helps prevent denials on the front end: Patient Access Curator allows patient access teams to capture multiple data points in seconds. This solution solves the “bad data” problem, using AI and robotic process automation to run checks for eligibility, coordination of benefits, Medicare Beneficiary Identifier, demographics and coverage discovery with a single click. The financial impact of denials and the ROI of technology Another paradoxical finding in the report is that while 47% of respondents see having AI technology as a competitive advantage, less than half say they'd be up for fully replacing their existing claims processing technology, even if presented with compelling ROI projections. Automation and AI can meaningfully impact the claims metrics that keep revenue cycle leaders awake at night – denial rates and clean claim rates being the top two. Patients also want to see improved performance when it comes to reducing denials. If healthcare organizations cannot offer a reliable, error-free system, they risk losing patients' trust and loyalty. Providers who demonstrate a well-managed claims system with swift and accurate results will inspire confidence and improve patient engagement. It's essential to assess how existing solutions perform against these metrics and implement upgraded solutions to deliver a more substantial ROI. AI and automation in practice How are Experian Health's clients using AI and automation to reduce claim denials? Here are a few examples: In only six months of adopting AI Advantage for claims processing and reducing claims denial, Schneck Medical Center saw denials fall by an average of 4.6% each month. In addition, the time needed to correct claims dropped from 15 to less than five minutes. The ambulatory clinic Summit Medical Group Oregon implemented Experian Health's claims management solutions, including Enhanced Claim Status and Claim Scrubber, to improve its registration and coding processes. These two solutions helped the team submit cleaner claims, resulting in a decrease in denials. As a result, the company now maintains a 92% primary clean claims rate. Another compelling example of the positive impact of technology on healthcare claims management is IU Health's experience with the all-in-one claim cycle management platform ClaimSource. With ClaimSource, IU Health managed the transmission of $632 million in claims in five days and processed $1.1 billion of claims backlog. Clients who have implemented Experian Health's Patient Access Curator have saved over $1 billion in denied claims, significantly boosting their bottom lines. Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system – for the second consecutive year.  Learn more Enhancing revenue cycles by addressing claim denial reasons By pinpointing the most common health insurance claim denial reasons and adopting automation and AI-driven solutions, providers can increase the first-pass clean claim rate, ramp up the likelihood of reimbursement, and reduce the overhead of reworking and resubmitting claims. Inevitably, hospitals will witness a surge in their financial performance. Contact us today to learn how data-driven claims management technology can help your organization reduce denied claims in healthcare and increase ROI. Improve claims management Contact us