Patient Access

“Reducing denials upfront would improve our revenue, which could be channeled into current and future investments that support our mission.” —Joshua Gayman, Revenue Cycle Manager at UT Medical Center Challenge The University of Tennessee Medical Center (UT Medical Center) is a leading 710-bed acute care hospital with a rich history of exceptional patient care and award-winning services. During the pandemic, the hospital faced revenue losses of around $45 million that put serious strain on its capacity to invest in bigger and better facilities. UT Medical Center needed to find a strategy to recover some of this revenue by reducing claim denials at the point of patient registration. UT Medical Center relied on eligibility checks that often missed errors in patient registration, resulting in increased claims denials, costly reworks, and wasted staff time. The hospital urgently needed a solution to help staff identify and resolve potential patient registration errors in real time to prevent denials before they occur. Finding a more efficient way to capture accurate patient and benefits data would be essential. Proactively preventing claim denials would provide the hospital with a much-needed boost in cash collections and free up staff to focus on patient care. Solution To address its claims denials challenge, UT Medical Center partnered with Experian Health and implemented Registration QA, a solution designed to find and fix registration errors upfront. Now, when patients first arrive, front-end staff enter their data to verify insurance. If Registration QA finds an error, it alerts staff in real-time so they can resolve it within 72 hours. Alongside more than 400 alert rules curated by Experian Health, UT Medical Center also built custom alerts based on the organization's specific requirements, using demographics and benefits data. The tool easily integrates with existing workflows, and its configurable dashboard gives UT Medical Center Management detailed insights into department performance and allows staff to track trends and identify areas for improvement. This proactive approach to correcting errors significantly reduces the risk of downstream denials and helps patient registration staff take proper corrective actions for their errors without management intervention. More accurate patient registration is also better for patients, as fewer errors make for a smoother intake experience. Outcome UT Medical Center successfully optimized patient registration by using Registration QA to identify registration errors before and at the point of service, reducing denials and boosting revenue. In the 12 months after implementing Registration QA, UT Medical Center saw the following results: Now that registration errors can be identified before and at the point of service, UT Medical Center has seen initial denials drop from an average of $5 million per month in 2022 to just $1.7 million in 2023, representing a 66% decrease in average monthly initial denials value. Cash write-offs also decreased, dropping 57% from an average of $1 million to just over $400K, helping the organization keep bad debt low. Gayman notes that UT Medical Center's partnership with Experian Health was central to its success. Experian Health shared the organization's vision and provided weekly support to help realize it. They developed a customized curriculum to make sure staff were confident using Registration QA and offered insights into what was happening more widely in the industry, so UT Medical Center's team could benchmark their performance against similar organizations. Thanks to these savings, the hospital can increase its capacity to invest in new projects and deliver operational excellence, while improving patient satisfaction. Find out more about how Registration QA helps healthcare organizations minimize denials and increase cash flow through accurate patient registration. Learn more Contact us

Missed payments, delayed reimbursements and rising debt are often symptoms of a struggling financial clearance process. According to Experian Health's State of Patient Access survey, more than six in ten patients say they'd feel more confident about covering their portion of healthcare costs if offered a payment plan. Still, many remain unaware of financial assistance that could further ease their financial burden. Automating financial clearance helps get patients on the right financial pathway as quickly as possible, resulting in streamlined collections and a better patient experience. In a recent on-demand webinar, Brandon Burnett, VP, Revenue Cycle at Community Health System, shared how his organization is using Patient Financial Clearance (PFC) for financial assistance automation, and to increase efficiency throughout the revenue cycle. By using Experian Health's data to quickly identify charity care eligibility and generate appropriate payment plans, they've been able to increase the amount covered by charity care by 30% and reduce bad debt without any additional staff. This article summarizes the key takeaways. Why automate patient financial clearance? Kim Berg, Director of Product Consulting and Optimization at Experian Health, set the scene by explaining how Patient Financial Clearance helps healthcare organizations assess patients' financial capacity and guide them accordingly. Using data like estimated income, spending habits and household size, the tool calculates Federal Poverty Level (FPL) percentages and assigns propensity-to-pay scores, so providers have a more realistic idea about what patients can afford. “We're not collecting pay stubs or tax returns,” Berg said. “We're using aggregated consumer data to estimate income and figure out the patient's ability and propensity to pay.” With this, health systems can quickly identify charity care eligibility and offer customized, affordable payment plans. “It's about understanding a patient's ability to pay and guiding them down the right financial path.” Using data to support state regulation compliance and automate financial clearance processes Rising healthcare costs and uncompensated care are the main motivations for improving presumptive charity screening. Berg noted that changes in state regulations add pressure, introducing additional checks for charity care eligibility before patients are sent to collections. “We're seeing more states passing legislation that introduces some kind of charity requirement,” she said. “We can provide the data to help prioritize those patients sooner in the process and work with you one-on-one to understand how the data can help you comply with state requirements.” Burnett said that automating presumptive charity screening with Patient Financial Clearance has helped his organization manage these changes, including California AB-1020. “We're using Experian's data to automate the decisions when patients apply. It means we don’t require any additional documentation or information.” It helps “move eligible patients out of accounts receivable and into charity approval faster.” Automating charity approvals to reduce manual work and bad debt Sharing a look inside Community Health System's financial clearance workflow, Burnett described how Patient Financial Clearance had led to a 30% increase in the amount approved in charity care compared to 2023, with no increase in bad debt. They comfortably handle an average of 1,400 applications each month, with only one to two full-time equivalent staff. “We've automated about 80-85% of our charity approvals,” he said. By integrating PFC data with Epic, the system automatically identifies charity-eligible patients and processes adjustments without staff intervention. “The adjustments happen automatically, the letters are generated, and nobody has to touch it. That's a huge efficiency gain for our charity team, because it's exception-based now,” he said. Finding additional efficiencies throughout the revenue cycle While Community Health System is also using Experian Health's Collections Optimization Manager to automate collections, they've also integrated PFC data into their broader collections workflow. “Using Collections Optimization Manager, we can identify patients through their propensity to pay, their presumptive FPL, and if they look like they would be approved for one of our financial assistance programs,” said Burnett. “We're also screening for bankruptcy and scrubbing to see if patients are deceased. So beyond PFC, Collections Optimization Manager is a great way to continue to leverage that data throughout your collection cycle.” He highlighted that Experian's support had helped them get even more out of automation. “Experian will come on-site and walk through the workflows. You don't always know what other organizations are doing or what's possible, so having that consultative approach has been so helpful.” These reviews helped uncover further opportunities to use PFC data, resulting in hundreds of staff hours saved. “We weren't even looking at these extra benefits at first,” Burnett said. “Experian pointed out that we could use the same data to automate more processes, and it ended up saving us hundreds of hours of staff time. That wasn't something we expected, but it's already paid for itself.” Using Patient Financial Clearance to improve patient experiences with self-service For Berg, two particular benefits of Patient Financial Clearance are worth highlighting for their impact on the patient experience. Firstly, it paves the way for more compassionate payment discussions with patients, by giving financial counselors a more complete picture of the patient's financial situation. “You can prioritize financial counselors' work queues to focus on certain patients first, because they're most likely to qualify for Medicaid or charity. You can offer estimates, and make sure patients understand their responsibility and their options,” she says. “If you understand your self-pay population sooner, you can guide them to the right path and free up more time. There's a lot of cost savings and resource savings downstream.” Secondly, Berg points out that many patients prefer to manage their financial assistance applications digitally, without recourse to a financial counsellor. “A lot of people want to handle everything on their mobile device or through a website,” she says. The recent State of Patient Access survey found that 56% of patients want more digital options for managing healthcare, while 67% want to be able to apply for financial assistance online. To support this, many Experian Health clients are using PFC's self-service options to allow patients to complete applications on their own, whenever and wherever it is most convenient. These include: Mobile links are sent via text message, with the option to submit an application through eCare NEXT® Websites and patient portals, where patients can apply and upload documents online. Offering these digital options meets patients' demand for more control over their financial journey, while reducing manual work for staff. “A great way to leverage data throughout the collections cycle” Community Health System's experience shows how automating financial assistance delivers value throughout the revenue cycle. Patient Financial Clearance helped accelerate and increase charity care approvals, reduce the administrative load for staff and lower bad debt, while ensuring patients receive the support they need. With a clearer understanding of each patient's financial capacity, Community Health System can proactively guide patients to the right pathway, making financial assistance more accessible and reducing friction when it comes to payments. The hidden benefits of using the same data to streamline collections are a strategic advantage for efficiency-conscious providers. As costs and complexities continue to trend upwards, data-driven automation is an increasingly useful way to improve financial health for both providers and patients. Learn more about how Patient Financial Clearance uses data to help healthcare organizations implement financial assistance automation, to improve patient satisfaction and increase collections. Learn more Watch the webinar

Finding missing health insurance is critical to keeping revenue cycles on track. Insurance eligibility verification is an important process providers use to confirm active coverage, including additional coverage a patient may have forgotten. According to Experian Health's State of Claims 2024 survey, almost a fifth of providers say missing coverage is a top reason for claim denials. It helps providers determine what insurance a patient has and what's covered and plays a key role in billing. When a patient has more than one type of active coverage, providers use insurance eligibility verification checks to determine how much should be billed to the correct payer and in what order. However, searching for missing coverage is often time-consuming and error-prone thanks to manual systems, disjointed databases and ever-changing payer regulations. When mistakes are made in the early stages of patient intake, it affects every step of the patient journey and revenue cycle. The struggles to confirm patient coverage are likely to worsen as patient volumes increase, medical needs get more complex and staffing shortages continue. Despite these mounting obstacles, insurance eligibility verification checks remain a critical first step to reducing claims denials, improving patient outcomes and minimizing lost revenue. This article explores why insurance eligibility verification checks matter and how providers can adopt new strategies and digital tools to find missing health insurance and prevent revenue from slipping through the cracks. The hidden costs of missing health insurance Today, more Americans are struggling to afford their medical bills — even with insurance. A KFF study reports that 48% of U.S. adults find affording healthcare difficult, while 25% say they or someone in their household had issues covering medical costs in the past twelve months. About half of those surveyed say paying an unexpected $500 medical bill would put them into debt. Insured patients aren't immune from the burden of high healthcare costs, though. Thanks to rising deductibles, co-pays and premiums, patients are taking on more financial responsibility, and 74% are worried about covering out-of-pocket costs. Nearly half of U.S. adults expressed concerns about affording their monthly insurance premiums. When medical bills go unpaid, provider revenue can take a serious hit. Uncompensated care is a huge financial burden for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. Patients often have additional insurance coverage that could help close the gaps, but they've either forgotten about it or are unaware of their eligibility. Finding missing coverage is a top priority for providers who want to ensure revenue streams stay in check — especially as healthcare costs continue to rise. Benefits of resolving missing health insurance issues Resolving missing health insurance issues has many benefits for both providers and patients, beyond verifying that services are covered and medical bills are paid. These include: Reduces claim denials: Claims denials are on the rise, and missing coverage is a top reason, according to Experian Health data. Incorrect or incomplete information can result in errors on claim forms or providers sending claims to the wrong payer. Finding missing coverage before claims submission reduces errors, denials, delays and rework. Minimizes wasted staff time: An eligibility recheck is needed when providers discover an incomplete claim, due to a change in active benefits after claims submission. With 43% of providers reporting that eligibility rechecks add at least 10 additional minutes per claim, finding missing coverage in advance is critical to freeing up valuable staff time. Improves the patient experience: Patients are often confused about what insurance covers and what they'll be on the hook for out-of-pocket. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care. When providers are able to find missing coverage during insurance discovery, patients are more likely to receive accurate upfront estimates. Complete and transparent pricing allows patients to prepare for the cost and avoid any surprises, while accelerating collections for providers. Tools and strategies to find missing health insurance Insurance eligibility checks help providers verify insurance status, coverage details and benefits in advance. However, performing insurance checks isn't always straightforward, and often requires searching for missing coverage. Patients sometimes forget to let providers know about secondary coverage or insurance changes. Or, coverage can be forgotten because a patient has moved to a new house, changed states, switched employers or signed up for a different policy. In some cases, patients may be misclassified as self-pay or have only one form of insurance. Providers can improve their insurance eligibility verification process and discover missing health insurance at every stage of the revenue cycle with the following strategies: Implement digital insurance discovery solutions Outdated manual systems are often error-prone and make finding missing coverage a labor-intensive task for already overburdened staff. Automated eligibility verification solutions offer a more streamlined approach to finding missing coverage faster with more accurate results. Tools like Experian Health's Coverage Discovery work across the entire revenue cycle and search government and commercial payers to find previously unknown insurance coverage. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Streamline patient intake and updates Matching patient information to payer databases starts at registration. However, patient information, including insurance coverage details, can change anytime. Patients may switch insurers, move states or change their contact information. Catching errors before a claim is submitted is key to keeping the revenue cycle moving and collections. Providers often can't keep up with changes or may struggle with tool overload, with nearly 60% of providers reporting using at least two different tools to gather the necessary patient information for claim submission. Digital tools, like Experian Health's Patient Access Curator, can help solve for bad data quality with real-time correction. This solution uses artificial intelligence (AI) and performs eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, to ensure that all data is correct on the front end. Patient Access Curator also interrogates 271 responses to indicate any secondary or tertiary coverage data. Other tools, like Registration Accelerator, puts the patient in control of inputting and updating information. Using an automated link, patients can enter their personal details and insurance information from their mobile phone or the web-based app, with no login required. Providers can prompt patients to complete registration details during the initial intake process and send reminders to update information that may have changed, like an address or insurance policy, when follow-up appointments are scheduled. Provide accurate upfront estimates The lack of accurate care estimates is an ongoing challenge for both providers and patients. According to Experian Health data, four in 10 patients report spending more on healthcare than they could afford. When providers don't have access to the most up-to-date patient insurance information, or coverage is missing, estimates are often incorrect and patients end up with surprise bills. Inaccurate estimates create a negative patient experience, resulting in unpaid bills and extra work for staff to resubmit claims or chase down collections. However, tools like Eligibility Verification can help providers easily confirm coverage, co-pays and deductibles at the time of service. When armed with real-time coverage data, providers can build more accurate estimates and help patients prepare for the cost of care. How technology makes finding missing health insurance easier 43% of Experian Health's State of Claims survey respondents say that eligibility checks take 10 to more than 20 minutes to complete. Eligibility checks are taking longer, are filled with more errors, and only 54% of providers feel their claims technology can handle current revenue cycle demands. Using technology at every step of the revenue cycle helps providers bridge the gap between front-end eligibility checks and back-end claims management. Digital tools, like Coverage Discovery, fit anywhere into the revenue cycle, allowing providers to easily check for health insurance through the patient journey, not just at registration. Emerging AI and automation tools also help providers find missing health insurance faster. Automated eligibility verification solutions, like Experian Health's Eligibility Verification, seamlessly check insurance benefits across 900 payers using advanced patient matching tools. Patient Access Curator uses AI-based data capture technology to return real-time data in a single click from hundreds of payer responses, allowing providers to quickly verify active coverage, billing information, plan level details, and more. Case studies: See health insurance discovery in practice 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 How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Learn more about how automated health insurance discovery helps providers find missing health insurance, reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

For five years straight, patients responding to the State of Patient Access survey have ranked “seeing a doctor quickly” as a top priority. Unfortunately, 94% of patients are still waiting more than two weeks for an appointment. Too many find themselves stuck in scheduling dead-ends, with unanswered calls, endless hold times and limited options when they finally get through. Providers are working hard to cut wait times, but an aging population, rising rates of chronic conditions and elevated levels of seasonal flu are driving up demand. Failure to manage spikes in patient volumes isn't just a scheduling problem; it has wide-reaching financial and operational consequences. Providers must find more efficient ways to help patients move through the healthcare system more quickly without compromising the quality of care. Could online self-scheduling be the answer? This article looks at how opening the digital front door with patient appointment scheduling software gives patients more control over their health journey, while easing operational strain. Challenges in patient appointment scheduling for healthcare providers Efficient scheduling is the only way to help patients see the right physician at the right time. So, what's getting in the way? Demand outstrips supply — Growing demand for specialists, increasing numbers of older patients, and more people with complex chronic diseases mean there are more patients than available appointments. In some “medical deserts,” there are too few medical providers to support local populations with basic primary care. Staffing pressures — Heavy workloads, seasonal illness spikes and lingering burnout (improving, but still affecting nearly half of physicians) affect staff availability and scheduling operations. Administrative complexity — Specialist care often requires longer visits, specific equipment, or multi-provider coordination, making scheduling more complicated. Poor management leads to bottlenecks and inefficiencies, while reliance on manual scheduling increases errors, double-bookings and delays. Rising patient expectations — When patient volumes are high, keeping patient access running smoothly is challenging. Patients now expect healthcare to function like other service industries, with digital scheduling, same-day appointments and clear communication. Appointment scheduling software is key to delivering on those expectations while maintaining operational efficiency. No-shows and cancellations — Missed appointments create inefficiencies, disrupt workflows and lead to revenue loss, while last-minute cancellations create costly gaps in the schedule. They're a drain on resources that providers can't afford. Without an effective waitlist or rebooking system, providers miss opportunities to help patients and bring in more revenue. Benefits of patient appointment scheduling software in healthcare Self-service patient scheduling tools address many of these challenges by allowing patients to book, cancel and reschedule appointments online and on their schedule. It's convenient for patients, while alleviating the burden on staff. Patient Schedule, Experian Health's online scheduling platform, takes a two-pronged approach. With Patient Schedule – Online Scheduling, new and returning patients can book appointments at any time, from any device. Automated integration with provider calendars and business rules prevents patients from booking the wrong appointment type. It updates immediately when a cancellation occurs, so patients are shown real-time availability and can see their doctor sooner. And for those that need more assistance or prefer to speak to an agent, Patient Schedule – Call Center Scheduling uses sophisticated decision technology to help call center staff schedule faster and more accurately. Automated prompts guide staff through the conversation, so teams can easily find the right providers based on an organization's business rules. Together, these tools allow providers to increase their capacity and improve patient engagement. Discover how IU Health used guided scheduling to transform operations, which resulted in a 114% increase in patient utilization within one year. Patient Schedule by the numbers: Up to 50% reduction in scheduling time, thanks to fast and efficient guided search Staff training is completed in just one hour, so they can start taking calls the same day 89% patient show rate as a result of automated reminders 32% more patients scheduled monthly, as self-scheduling attracts patients and increases market share. The growing importance of patient appointment scheduling software With 89% of patients saying they value the opportunity to book appointments anytime, via online or mobile tools, patient appointment scheduling software is fast becoming a competitive advantage. As more healthcare organizations adopt these automated scheduling tools to streamline booking, reduce no-shows and improve access, those relying on outdated manual systems risk losing patients to other providers and falling behind. Streamlining administrative tasks with digital patient intake solutions The State of Patient Access survey found that 63% of providers offered self-scheduling in 2024, up from 40% in 2022. With a further 16% planning to onboard self-scheduling software, the future looks bright for patients who want to call time on slow and outdated booking systems. However, patient scheduling software is only one piece of the patient access puzzle. When integrated with other automated registration and intake tools, scheduling software reduces paperwork, minimizes errors and accelerates check-in. For example, Registration Accelerator allows patients to complete forms, verify insurance and update their contact information before arrival, while Patient Payment Estimates cut the confusion around medical costs. This means that from the moment an appointment is scheduled, staff can focus on patient care, rather than administrative tasks. With the right digital solutions, patients can take control of these processes themselves – wherever and whenever is most convenient. Find out more about how Experian Health's patient appointment scheduling software can simplify and accelerate patient access. Learn more Contact us

“You know when the Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” —Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences Challenge Exact Sciences is a prominent cancer diagnostics laboratory with an annual net revenue of around $2.6 billion, that's best known for its flagship cancer screening test, Cologuard. After a period of rapid growth demand for its test, Exact Sciences faced the difficult task of collecting accurate patient data and verifying insurance eligibility at scale. Anticipating a 25% growth in annual testing volumes, Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences, says the organization “needed an automated, real-time solution" to capture accurate data from the start. The company had four specific objectives: Improve the accuracy of patient insurance data to reduce errors and denials. Streamline processes to handle rising testing volumes without increasing headcount. Reduce claim denials to bring in more revenue (especially those related to eligibility and timely filing). Ensure accurate identity verification in lab settings, where patient, physician and lab data aren't unified within a single data management system. Watch the webinar: Hear our pre-recorded session from our annual Experian Health High-Performance Summit 2024 (HPS), featuring Exact Sciences and Trinity Health, as they reveal how Patient Access Curator helped their organizations automate eligibility, reduce denials, and more, all with a single click. Solution In need of a single solution to solve multiple challenges, Exact Sciences turned to Experian Health's Patient Access Curator. This new product provided the team with a way to run inquiries for eligibility, Medicare beneficiary identifiers, coordination of benefits, insurance discovery and demographic data with a single click. Instead of juggling multiple products and vendors, registrars would be able to capture and verify patient data in a single transaction. Through automation and machine learning, Patient Access Curator could deliver results in less than 30 seconds and help submit clean claims the first time – reducing the risk of denials even as volumes increased. Experian Health's implementation experts configured the tool to Exact Sciences' needs, integrating over 4,000 payer plans nationwide and customizing parameters for real-time eligibility checks and data validation. Experian Health also delivered staff training to support the transition to the new system. Watch the video: See how Experian Health's Patient Access Curator streamlines patient access and billing, addressing claim denials, data quality and real-time corrections to boost your business's bottom line. Outcome Thanks to Patient Access Curator, Exact Sciences achieved the following results: 15% increase in revenue per test due to accurate eligibility and fewer denials 4x business volume without increasing headcount 50% reduction in denials and major improvement in timely filings $100 million added to the bottom line in 6 months Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors and more. Overall, Kubisty credits Experian Health's Patient Access Curator for helping Exact Sciences overcome critical pain points resulting from data errors and eligibility issues. Solving for bad data quality with real-time data correction freed staff from tedious manual work, ensuring faster, more accurate claims processing – all without growing headcount. After implementing Patient Access Curator, the company is ready to scale and handle growing volumes efficiently, say goodbye to late filing denials and scale smarter. For Kubisty, this highlights how technology drives efficiency and sustainable growth. Learn more about how Patient Access Curator helps patient access teams prevent claim denials by solving for bad data quality with real-time data correction. Learn more Contact us

Ask any healthcare revenue cycle manager how they feel about using artificial intelligence (AI), and the response is likely to be “hopeful, but wary.” The potential is clear — fewer denials, faster reimbursements and more efficient workflows. However, with adoption slowing, it seems many have lingering concerns about implementation. According to Experian Health's State of Claims survey, the number of providers using automation and AI in revenue cycle management has halved from 62% in 2022 to 31% in 2024. Despite these reservations, there are bright spots. From preventing claim denials to automating patient billing, AI and automation are already helping many healthcare organizations improve operations, boost financial performance and deliver a better patient experience. This article examines what providers need to know about bringing AI technology into their revenue cycle. Understanding the role of AI in revenue cycle management AI regularly hits the headlines for its clinical applications, like medical imaging analysis, drug discovery and surgical robotics. But behind the scenes, it's also quietly transforming revenue cycle management (RCM). Non-clinical processes like medical billing, claims management and patient payments are complex. Trying to manage these manually results in slow reimbursement and strained resources. AI offers efficient solutions to reshape how providers manage these pressing issues, giving them a head start in coping with increasing costs, workforce challenges and ever-increasing volumes of data. Benefits of AI in healthcare RCM  For most providers, AI's main draw is its ability to deliver significant financial savings. The most recent CAQH index report suggests that switching from manual to electronic administrative transactions could save the industry at least $18 billion. That's a compelling prospect for revenue cycle leaders looking to do more, and faster, with fewer resources. These financial savings aren't just the result of direct cost-cutting – they stem from the broader operational benefits AI brings to the table. These include: Streamlined billing processes: Automating repetitive tasks and minimizing human error reduces costly mistakes that lead to payment delays Fewer claim denials: Predictive analytics help staff identify claims that may be at risk of denial so that issues can be tackled upfront Real-time eligibility verification: AI tools can check a patient's insurance details in an instant, to catch outdated information and prevent billing mistakes and denials Better data insights: AI has the power to analyze vast datasets and find patterns and bottlenecks to help teams improve decision-making Productivity boost: With reduced admin overhead, staff can focus on higher-priority tasks and improve overall performance, with less stress and burnout. The benefits extend to patients, too. Behind every denied claim or billing error is a patient caught in administrative confusion. By automating processes, eliminating errors and increasing transparency, AI and automation help providers give patients financial clarity throughout their healthcare journey. How AI is revolutionizing healthcare RCM  Here are some examples of what this looks like in practice: Using AI to manage complex billing procedures Medical billing errors cost healthcare organizations millions of dollars each week, and the problem is only getting worse. Experian Health's State of Patient Access survey 2024 found that 49% of providers say patient information errors are a primary cause of claim denials, while in the State of Claims survey, 55% of providers said claim errors were increasing. Manual processes make managing the complexity of insurance plans, billing codes and patient payments near impossible. AI simplifies the task. For example, Patient Access Curator uses AI-powered data capture technology, robotic process automation, and machine learning to verify coverage and eligibility accurately with one click. This ensures accuracy throughout the billing cycle, reducing denials and accelerating collections. On-demand webinar: Watch our recorded session to hear how revenue cycle leaders from Exact Sciences and Trinity Health share their strategies and success stories with the Patient Access Curator. Using AI to prevent claim denials Claims can be denied for many reasons, but poor data consistently tops the list. Even so, around half of providers are still using manual systems to manage claims. AI helps providers buck the trend by improving data quality and using that data to improve claims management. Experian Health's AI AdvantageTM, available to those using the ClaimSource® automated claims management system, analyzes patterns and flags issues before claims are submitted, using providers' historical payment data together with Experian Health's payer datasets. It continuously learns and adapts, so results continue to improve over time. Read the case study: AI Advantage helped Schneck achieve a 4.6% average monthly decrease in denials in the first six months. Using AI to reduce patient payment delays The rise in high-deductible health plans is associated with a greater risk of missed patient payments. According to SOPA, 81% of patients said accurate estimates help them prepare for the cost of care, and 96% are looking for their provider to help them make sense of their insurance coverage. AI is vital for providers looking to help patients understand their financial responsibility early and avoid payment delays. With solutions like Patient Access Curator, staff no longer need to sift through piles of patient data and payer websites to verify eligibility and get a clear picture of a patient's insurance coverage. Instead, they can quickly gather the information they need to give the patient a prompt and accurate breakdown of how the cost of care will be split. "Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly." Ken Kubisty, VP of Revenue Cycle, Exact Sciences Key AI technologies driving RCM transformation Healthcare revenue cycle managers have long trusted automation to handle repetitive tasks. Hesitancy around AI may stem from a lack of familiarity with its more advanced capabilities. Findings from the State of Claims survey reveal a widening comfort gap, with the number of respondents feeling confident in their understanding of AI dropping from 68% in 2022 to 28% in 2024. So, what are some of the key technologies providers should understand to help bridge the gap? While automation relies on straightforward, rule-based processes to handle repetitive tasks, AI tools are capable of learning, adapting and making decisions. A few examples to be aware of include: Machine learning: Analyses historical data to predict trends like claim denials and payment delays, and use this knowledge to prevent future issues Natural language processing: Extracts actionable insights from unstructured data, such as clinical notes and patient communications, giving staff consistently formatted data to use in RCM activities AI-powered robotic process automation: Goes beyond basic automation to handle decision-based workflows with precision, for example, in evaluating claims information to make predictions about the likelihood of reimbursement. Challenges and considerations in implementing AI in RCM Getting to grips with what AI technologies offer is an important first step for healthcare revenue cycle managers. However, successful implementation also calls for consideration of the practical challenges. Can AI solutions be successfully integrated with existing legacy systems? Will the data available be of high enough quality to drive meaningful insights? Are the costs of implementation within budget, especially for smaller providers? Is the workforce ready to buy into AI, or will extensive training be needed? With careful planning and a trusted vendor, these challenges are manageable. Embracing AI for a smarter, more efficient RCM The benefits of AI in revenue cycle management are clear: more innovative, faster processes that free up staff time and reduce errors, resulting in much-needed financial gains. To maximize AI, providers should begin by reviewing their organization's key performance indicators and identifying areas where AI can add the most value. This should focus on points in the revenue cycle where large volumes of data are being processed, such as claims submissions or patient billing, which are common areas for inefficiencies and errors. By taking a strategic, targeted approach, providers can find the right AI solutions to make the biggest impact – whether it's through curating patient insurance information, improving claim accuracy or predicting denials. A trusted vendor like Experian Health can guide teams through the AI setup and make sure it meets their needs. Find out more about how Experian Health helps healthcare providers use AI to solve the most pressing issues in revenue cycle management. Learn more Contact us

No matter how much the healthcare industry evolves — whether through new legislative priorities or advances in AI and automation — one thing remains constant: the patient experience matters. Patients expect quality care, quickly. For five years running, timely access has been a top priority for patients, according to Experian Health's State of Patient Access surveys. But efficiency is just the start. In an uncertain world, patients also need reassurance, reliability and compassion. For revenue cycle leaders, meeting these expectations isn't just about good service. It's a competitive advantage. A patient experience built on empathy, convenience and personalization fosters loyalty and trust, driving both satisfaction and financial performance. With the right digital tools, providers can take meaningful steps toward improving the patient experience. What is patient experience and why does it matter? The patient experience encompasses every step the patient takes while seeking and receiving medical care. It goes beyond the clinical aspects of care and includes all the systems and strategies that determine a patient's access to care. From the moment they book their appointment through their clinical care and final bill payments, each interaction is an opportunity to make or break a patient's satisfaction with their provider. The patient experience can be a major driver of health outcomes. Inefficient systems lead to missed appointments, while confusing billing practices cause patients to postpone care. Adherence to care plans is more likely when patients are engaged and informed. And when patients feel positive about their healthcare experience, there are trickle-down effects for staff, who have more time to focus on priority tasks. It's also vitally important for an organization's financial outcomes. A positive patient experience increases patient retention, reduces billing disputes and accelerates payments. Research shows this goes both ways: well-implemented revenue cycle management improves the patient experience, too. What does a quality patient experience look like? Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says that a high-quality patient experience should encompass three things: “Choice, flexibility and convenience are themes that have come through strongly in our patient surveys. Patients are more mobile and more digitally active, so they expect services to be available on demand. They have a diverse range of schedules, responsibilities and preferences, and providers need to accommodate these variations so accessing care feels easy and convenient. Providers that leverage digital technology to deliver a patient-centered experience will see higher levels of patient engagement, better health outcomes, and a healthier bottom line.” Key strategies for improving the patient experience For healthcare providers, there's always a new delivery challenge around the corner. But it's also getting easier to improve the patient experience, thanks to digital technology. Here are five practical ways to make an immediate difference: 1. Reduce wait times Long wait times frustrate patients and lead to last-minute cancellations, which hurt revenue. Online self-scheduling, pre-visit digital check-ins and automated appointment reminders help keep schedules on track and reduce no-shows. According to the State of Patient Access 2024, these tools are also a smart way to meet patient expectations: 89% of patients want the ability to schedule appointments anytime, via online or mobile tools. 2. Streamline administrative processes with technology Manual data entry slows everything down. Patients dislike repetitive paperwork, while human error is a frustratingly common cause of denied claims, especially when that paperwork starts to pile up. Digital tools eliminate much of the hassle and allow staff to work more efficiently. Automated patient intake accelerates the admin tasks, so patients get the care they need without delay, and providers can keep revenue flowing without unnecessary roadblocks. 3. Improve communication between patients and providers Confusing communications are a major pain point for patients, and billing is a prime example. With 43% of patients saying they may postpone or cancel care if they don't get an accurate cost estimate, providers have an opportunity to stand out from the competition by offering clear and compassionate financial communications. Upfront estimates, proactive financial counseling, and digital payment options ease patients' anxiety, prevent disputes, build trust and increase collections. 4. Increase healthcare access with automation and AI Insurance hurdles are another source of frustration for patients. Uncertainty over coverage, eligibility and out-of-pocket costs can impede access, lead to billing disputes and increase the risk of claim denials. Manual verification is time-consuming for staff and often leaves patients waiting for answers. Automation and AI can eliminate these bottlenecks. For example, Patient Access Curator uses machine learning to verify and update all patient information with a single click. Watch the webinar: Revenue cycle leaders from Exact Sciences and Trinity Health share how they use Patient Access Curator to redefine patient access 5. Personalize patient care A key point to remember is that patients only care about what's relevant to them: a one-size-fits-all approach is not going to increase patient satisfaction scores. Using data to anticipate patient needs, like flexible payment plans, personalized reminders, or a choice of payment methods, improves the patient's experience and reassures them that they're with the right provider. How technology is revolutionizing the patient journey Here are a few examples of how healthcare organizations are using digital tools to put these strategies into practice: Indiana University Health used Experian Health's Call Center Scheduling solution to increase call center capacity and boost provider, staff and patient satisfaction by improving efficiency and reducing appointment-type scheduling errors. Guided scheduling led to a 114% increase in patient utilization in just one year. UCHealth helped more patients qualify for financial assistance using Patient Financial Clearance, which automates presumptive charity screening. The tool disbursed $26 million in charity care and covered more than 1,700 patients. On-demand webinar: Learn how Community Health System used Experian Data to drive financial assistance automation. Prioritizing patient-centered healthcare The way the patient experience is delivered may change, but its role as a driver of trust, loyalty and financial stability does not. As patients become more mobile and digitally active, they expect care that fits into their busy lives — available on demand and tailored to their needs. By using digital technology to offer choice, flexibility, and convenience, providers can make care easier to access, strengthen relationships and improve both health outcomes and financial performance.  Find out more about how Experian Health's digital solutions help healthcare organizations improve the patient experience. 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Revenue cycle management (RCM) challenges exist at every stage of the patient journey – from patient intake and registration to insurance eligibility, claims processing and collections. Creating administrative efficiencies, reducing claims denials, improving the patient experience and remaining compliant with payer requirements and industry regulations all play a role in successfully managing revenue cycles and avoiding uncompensated care. This article takes a closer look at some of the top challenges in revenue cycle management, their root causes and strategies that leaders can use to tackle RCM issues head-on. Common challenges in revenue cycle management Staying on top of current RCM challenges helps healthcare organizations keep revenue cycles on track. Some of the key roadblocks in revenue cycle management include: Complex billing processes Health payer requirements change often and vary widely among the hundreds of providers operating in the U.S. To avoid delays and lost revenue, claims must be coded and billed correctly – the first time. However, a streamlined approach for error-free insurance eligibility verification, prior authorization and claims processing isn't always simple for healthcare organizations to implement and maintain. This leads to mistakes, wasted staff time and revenue loss. Rising claim denials Claims denials are rising, leaving healthcare organizations to face potential hits to the bottom from delayed or unpaid claims. Denials often occur when claims with incorrect patient information and billing codes are submitted. However, outdated manual processes, overburdened administrative staff and rapidly changing payer requirements can make it tricky for providers to manage the claims process efficiently and error-free consistently. Collections delays Collecting payments continues to be a major bottleneck in the revenue cycle, wasting valuable staff time and hurting provider bottom lines. With rising healthcare costs, a growing number of patients are struggling to pay their medical bills—especially when they don't know the cost of care up front or are self-paying. Estimates created with inaccurate benefits information or missing coverage add to patient and provider frustration and collection delays. Check out this guide to choosing the right key performance indicators for your revenue cycle dashboard to ensure the effective implementation of RCM strategies. Why these obstacles persist: Root causes of RCM issues Current roadblocks in revenue cycle management often persist due to the following root causes: Strained resources: Labor shortages continue to plague the healthcare industry – leaving revenue cycle managers tasked with figuring out how to “do more with less.” With staffing shortages expected through 2030, according to American Hospital Association data, maximizing staff time and administrative efficiencies must remain a top priority for the revenue cycle Lack of patient access: Some patients think patient access has improved, but there's still a long way to go. Data from Experian Health's State of Patient Access survey shows that 51% of patients feel patient access has remained static, despite 28% reporting an improvement since the previous year. High healthcare costs: Many patients struggle to afford healthcare thanks to climbing out-of-pocket costs, higher premiums and more complicated medical issues. As the cost of care and health insurance continue to rise, patients may be more likely to delay or default on payments. Medical expenses aren't likely to go down, leaving providers to help patients understand their financial responsibility and provide a simple path to payment. Frequent regulation changes: Legislation, like the No Surprises Act, plus ever-changing payer requirements, are time-consuming for busy administrative teams to monitor. Outdated patient intake processes and verification systems further contribute to compliance issues and resulting claims delays and denials. How healthy is your revenue cycle? Our revenue cycle management checklist helps healthcare organizations catch inefficiencies and find opportunities to boost cash flow. How to overcome revenue cycle management challenges The following strategies can help busy RCM leaders take steps toward creating a successful revenue cycle. Boost patient access Healthy revenue cycles begin with efficient and streamlined patient access. According to Experian Health data, 60% of patients say they want more digital options to engage with their provider and are willing to switch providers to get more digital access. Patients want it to be simple to book an appointment and complete intake paperwork – on their own time. They want to see their provider quickly, understand the cost of care and have the option to pay bills online or set up a payment plan. Adopting patient engagement solutions that improve access helps healthcare organizations foster more positive experiences, deliver better outcomes, collect more accurate patient data and increase their bottom lines. Providers can put patients in the driver's seat with tools that streamline scheduling, registration, estimates and payments. Staff is freed up from repetitive administrative tasks, patient no-shows decline, claims denials are reduced and collections are expedited. Improve claims management processes Processing claims is a significant contributing factor toward “wasted” healthcare dollars. According to Experian Health survey data, 73% of respondents agreed that claim denials are increasing, compared to 42% in 2022. Bad data is to blame, with providers saying incorrect information and authorization are driving the uptick in denials. 67% of respondents also agreed that reimbursement times were longer, indicating a broad issue with payer policy changes and claims errors. Revenue cycle managers who want to prevent denials, rather than just manage them, can reduce denials with automated claims management solutions. Tools like Experian Health's award-winning ClaimSource® make the claims editing and submission process effective and efficient. Other solutions, such as Claims Scrubber, help providers submit complete and accurate claims, resulting in more timely reimbursement and a healthier bottom line. In the case of denials, AI AdvantageTM - Denial Triage, uses artificial intelligence (AI) to identify denials with the highest potential for reimbursement, so that teams can focus on remits that have the most impact. Learn how Indiana University Health processed $632 million in claims transmissions in one week after a halt to operations. Keep pace with changing payer policies and healthcare regulatory and compliance standards According to Experian Health survey data, more than 75% of providers agree that payer policy changes are increasing. Staying up to speed on the ever-evolving compliance landscape is critical for RCM leaders who want to reduce claim denials, payment delays, and administrative backlogs. Digital regulatory solutions, like Insurance Eligibility Verification, can help providers keep up with evolving payer policies. Experian Health's price transparency solutions, like Patient Estimates and Patient Financial Advisor, allow healthcare organizations to remain compliant with regulatory requirements. Price transparency solutions provide proactive pricing information and make it easier for patients to pay, all while improving patient satisfaction. Nicole Ready, Revenue Cycle Systems Manager, at South Shore Health and Michael DiCarlo, Sr. Advisor, Revenue Cycle Operations at Northwell Health, discuss how they deliver better patient experiences with Experian Health's Price Transparency solutions. Preparing for new and evolving RCM hurdles Technology will continue to play a defining role in the future of revenue cycle management, for patients, providers and payers. Healthcare organizations can stay competitive by embracing AI and automation-based RCM solutions. From claims processing, verifying COB, MBI, and demographics in one click, prior authorizations to data analytics, RCM leaders can rely on AI and automation tools to optimize every stage of the revenue management cycle. Turning RCM roadblocks into opportunities for growth Revenue cycle management challenges are among the greatest obstacles facing today's healthcare organizations. However, improvements in digital tools and analytics can help providers keep revenue flowing while maintaining compliance and the patient experience in focus. With the right technology partner, RCM leaders can turn obstacles into growth opportunities. Experian Health's Revenue Cycle Management solutions can help your organization optimize revenue cycle management from patient intake to reimbursement. Learn more about how Experian Health's revenue cycle management solutions help healthcare organizations generate more revenue and increase their bottom lines. Learn more Contact us

As margins tighten, traditional revenue cycle management strategies are on shaky ground. Many healthcare providers are turning to automation and AI to simplify payments, prevent revenue loss and protect profits. This article breaks down some of the most common revenue cycle management (RCM) challenges facing healthcare leaders and offers a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Common challenges in revenue cycle management Revenue cycle management is how healthcare organizations handle the financial side of patient care, from patient billing to claims management. Healthcare providers rely on RCM to ensure they are properly paid, so they can keep the lights on, pay their staff and deliver quality patient care. Are traditional RCM strategies still fit for purpose? Consider some of the current challenges: Patients are responsible for a larger share of costs due to high-deductible health plans. How can providers help them understand their financial obligations and make it easier to pay without hurting their experience? Minimizing claim denials is a daily focus, thanks to constantly changing policies and regulatory updates. How do revenue cycle teams keep up with payers? Staffing shortages remain on the agenda. How can providers ease pressure on staff to maintain productivity and morale? There's also the question of how to turn mountains of data into actionable insights. How do teams interpret it correctly to identify bottlenecks and opportunities for improvement? Automation and AI offer a way through. When implemented thoughtfully, these tools can speed up processes, reduce errors and clear operational roadblocks for a more resilient revenue cycle. The following revenue cycle management checklist includes some of the key questions to consider along the way. Checklist for improving revenue cycle management Automating patient access Can patients book appointments online? Does the online scheduler automate business rules to guide patients to the right provider? Are patient identities verified at registration and point of service? A healthy revenue cycle starts with efficient patient access. According to the State of Patient Access 2024, 60% of patients want more digital options for scheduling appointments, managing bills and communicating with providers. Providers who see improvements in patient access also credit automation, which speeds up intake and improves accuracy. A good first step is to replace paper-based processes with online self-scheduling and self-service registration. These tools make life easier for patients, boosting satisfaction, retention and engagement. Behind the scenes, Experian Health's new AI-powered tool, Patient Access Curator, helps providers get paid faster by verifying and updating patient information with a single click – accelerating registration and paving the way for faster reimbursement. Register now: Exact Sciences and Trinity Health will share how Patient Access Curator is redefining patient access in this upcoming webinar. Optimize patient collections with data and analytics Are patient estimates provided upfront? Are notice of care requirements being addressed? Are patients offered appropriate financial plans and easy ways to pay? With more financial responsibility resting on patients' shoulders, patient collections are under the spotlight. The State of Patient Access report shows that upfront estimates and clarity about coverage are top priorities for patients, because when they know what they owe, they're more likely to pay on time. Implementing tools to promote price transparency and easy payment methods should feature in any RCM checklist. With Coverage Discovery, healthcare organizations can run checks across the entire revenue cycle to find billable commercial and government coverage that may have been forgotten, to maximize the chance of reimbursement. Meanwhile, Patient Payment Estimates offers patients clear, accessible estimates of their financial responsibility before treatment, so that hose who need financial assistance can be directed automatically to payment plans and charity options. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery® Improve claims management to reduce denials Are high-impact accounts prioritized? Are remittances reconciled with payments received? Does claims management software generate real-time insights and reports? With 73% of healthcare leaders agreeing that denial increased in 2024, and 67% saying it takes longer to get reimbursed, claims management is a great use case for automation. ClaimSource®, ranked Best in KLAS in 2024 for claims management, automates the entire claims cycle in a single application. It integrates national and local payer edits with custom provider edits to verify that each claim is properly coded before submission. By focusing on high-priority accounts, providers can target resources in the most effective way to ensure a higher first-pass payment rate. A major advantage for ClaimSource users is access to AI Advantage™. This tool utilizes AI to “learn” from an organization's historical claims data and trends in payer behavior to predict the probability of denial. It also segments denials so staff can prioritize those that are most likely to be reimbursed, reducing the time and cost of manual appeals and rework. Case study: After using AI Advantage for just six months, Schneck Medical Center reduced denials by an average of 4.6% each month, and cut rework time from 12 to 15 minutes per correction to under 5 minutes. Benefits of implementing a revenue cycle management checklist The key to choosing the right RCM tools and technologies is to build the strategy around what patients need most. A clear, transparent and compassionate billing experience is more manageable for patients and helps providers get paid faster. An RCM checklist helps teams stay focused on the tasks that matter. Providers can build on the suggestions above by choosing the key performance indicators (KPIs) that align with their specific goals. Metrics like financial performance, billing efficiency and collections rates can be combined to guide resource allocation, drive improvements and speed up reimbursement. With a well-designed checklist informed by clear KPIs, revenue cycle leaders can keep their teams on track and take their organizations from “surviving” to “thriving.” Learn more about how Experian Health's revenue cycle management tools can help healthcare providers meet current challenges, improve the patient experience and increase cash flow. Learn more Contact us