Patient Experience

For many Americans, access to healthcare is increasingly a question of affordability. There's no room for error when it comes to determining a patient's medical bill. Helping patients understand and plan for medical bills starts with calculating patient responsibility quickly and accurately. Incorrect charges, unexpected costs and confusing payment processes create poor financial experiences for patients. According to research by Experian Health and PYMNTS, patients are increasingly worried about their healthcare costs. 46% of those surveyed had canceled care after receiving a high-cost estimate, while 60% of those with out-of-pocket expenses said inaccurate estimates or an unexpected bill would prompt them to consider switching providers. As the stakes get higher, providers must reexamine how to calculate patient responsibility in medical billing so all parties are clear about who will pay for what. Providing that clarity will improve the patient experience, streamline patient collections and protect the organization from bad debt. What is patient responsibility? Responsibility for paying medical bills is apportioned between the patient who receives care, their insurance provider (if they have one), and government payers like Medicare and Medicaid (if the patient is eligible). “Patient responsibility” refers to the portion of the bill that should be paid by the patient themselves. Getting these calculations right is critical to the provider's revenue cycle. Determining patient responsibility starts during patient registration. Here, providers have their first opportunity to check that insurance details are up to date and ensure that the patient has not overlooked any active coverage. If the patient does not have coverage, they'll be liable for the whole bill (or will have to find charity assistance). If they do have insurance, the provider will liaise with their payer to check that the proposed care is covered under the patient's plan and establish any prior authorization requirements. Then, the provider can estimate how much of the cost of care should be reimbursed by the payer, and how much will fall to the patient. The amount paid by patients includes the following categories: Co-payment – this is a fixed, flat fee the patient pays toward their medical care at the time of service. If providers do not have accurate co-pay information available at the time of the visit, they may need to bill or refund the difference later. Not all health plans include co-payments, and those that do often specify exceptions. Deductible – this the total amount the patient must pay toward medical care each year before the payer contributes. For example, if a patient has a $1000 deductible, they must pay the first $1000 of medical bills that year, and any eligible costs on top of that will be covered by their payer or shared between the patient and payer. High-deductible health plans are attractive to patients who don't think they're likely to need care, as these plans often come with lower monthly premiums. However, if the patient does need care, they'll be left footing a greater portion of the bill. Coinsurance – this is the patient's share of remaining medical costs after paying their deductible. Out-of-pocket maximum – some health plans set an annual limit to the amount a patient needs to pay toward care, including co-payments, deductibles and coinsurance. Once that limit is reached, the payer will cover the remaining eligible expenses for the remainder of the period. Clearly, this is a complicated formula. To bill correctly, providers need to know whether the proposed treatment is covered by the patient's plan, how much the payer has agreed to pay for specific services, and whether individual service providers involved in the patient's care are in-network or not. Claims will only be reimbursed if all necessary coding and payer policy requirements have been met. Revenue cycle management tools to calculate patient responsibility Traditionally, providers have relied on teams of hard-working coders and billers to manually compile and review each claim. But with so many moving parts – not to mention frequent payer policy changes and staffing shortages – manual processes are no longer viable. When determining how to calculate patient responsibility in medical billing, providers should turn to automation and digital tools. This can help them augment their staff's capacity to calculate patient responsibility more efficiently and accurately and optimize patient collections. Here are a few examples of how they might do that: Automate insurance eligibility verification - Without understanding exactly what the patient's active coverage includes, providers will remain one step behind in the medical billing and claims management process. Payers are already using automation and artificial intelligence to fulfil their side of the equation, and providers cannot risk being left behind. Automating the verification process allows providers to capture up-to-date eligibility and benefits data, including the patient's co-pay and deductible amounts, to calculate the patient's responsibility pre-services. Find missing and forgotten coverage - As more patients switch health plans, more payers join the Affordable Care Act marketplace, and employer-based insurance changes, it's increasingly likely that the patient may not be 100% sure of their active coverage. With Coverage Discovery, providers can run quick, automated and repeated checks to see if any active coverage has been overlooked. This could drastically reduce the patient's responsibility, leaving them with a more affordable bill. Automate prior authorization - Many health plans require specific services to be authorized by the payer before being administered. Providers must check these requirements pre-service, or face a denied claim which could affect the patient's bill. Obtaining authorization from health plans before administering services can be slow and expensive, and often delays care. The Council for Affordable Quality Healthcare (CAQH) states that automating prior authorizations could save the medical industry $449 million per year (or 11 minutes per transaction). Automated prior authorization software gives providers real-time insights into payer requirements, so they can speed up reimbursement and give patients clarity over what they'll owe. Why use a patient cost estimator? With the necessary insurance information at their digital fingertips, providers can then use a patient responsibility pricer to calculate the patient's co-pays, deductibles and other out-of-pocket expenses. For example, Patient Payment Estimates is a web-based price transparency tool that generates personalized estimates for patients before and at the point of service. Patients get a comprehensive breakdown of what they'll owe, so they can plan for upcoming bills or even pay upfront. Patient liability estimator tools give patients more financial clarity, saving staff time and encouraging prompter payments. They're also an important compliance tool, and are specifically recommended in CMS advice on compliance with the Hospital Price Transparency Final Rule. Accelerate and streamline patient collections Early financial clarity encourages patients to pay sooner. This means it's more likely that those bills are paid in full, instead of lingering on the aged receivables list. In addition to upfront estimates, providers should make the payment process itself as easy as possible. This might include directing patients to payment plans or charity assistance, and connecting patients to convenient payment tools at any point in their healthcare journey. Inevitably, there will be some patients who simply cannot pay their bills. Collections Optimization Manager shows staff which accounts, so they don't waste time chasing the wrong accounts. By scoring and segmenting patient accounts based on the likelihood of payment, and adjusting as the patient's situation changes, Collections Optimization Manager helps providers manage resources more efficiently, while supporting a more compassionate patient financial experience. It also enables more effective use of collections agencies to minimize the cost to collect, and incorporates reporting and benchmarking tools to identify improvement opportunities. Find out how Experian Health's revenue cycle management tools can help providers calculate patient responsibility in medical billing, for a more compassionate patient experience and streamlined collections process.

Today, U.S. healthcare providers struggle with three significant challenges affecting care delivery—each resulting from chronic healthcare workforce shortages. Ultimately, these challenges threaten the fiscal health of the country's most critical care safety nets. Over 80% of the healthcare C-suite say the chronic staffing shortage creates significant risk for their organizations. The effects of healthcare staffing shortages are severe - Experian Health's recent survey of revenue cycle leaders found these executives unanimously agreed that staffing shortages impact cash flow, patient engagement, and the work environment of their current staff. Experian Health’s new survey, Short Staffed for the Long-Term, polled 200 revenue cycle employees to determine the effects of healthcare staffing shortages on patients, the workforce, and their facilities. What did these teams say about the healthcare workforce shortage and the state of care delivery? Find out by downloading the full report. Healthcare providers experience a vicious cycle, and the effects of healthcare staffing shortages can be seen in many different areas. For example, it makes it harder for existing team members to register patients on the front end of the encounter. On the back end, revenue cycle staff face higher workloads and stress leading to preventable reimbursement claims errors and missed collections opportunities. Ultimately, that stress leads to staff turnover, exacerbating the healthcare workforce shortage. This article dives into three effects of healthcare staffing shortages and how providers can combat them. Result 1: Short-staffed providers struggle with reimbursement and cash flow. 70% of respondents who say staff shortages affect payer reimbursement also report escalating denial rates. 83% report it's harder to follow up on late payments or help patients struggling to pay their bills. Costs are up, and cash flow is down. Claims denials are increasing by 15% annually. Reimbursement rates continue to decline even as denials rise and patient debt increases. These are the revenue cycle challenges healthcare providers face on top of the chronic healthcare staffing shortage. Healthcare organizations must look for new ways to improve reimbursements while engaging patients and staff to benefit everyone involved. Experian Health's Short Staffed for the Long-Term report noted two of the most significant revenue channels for healthcare providers, claims reimbursement and collections, are experiencing significant challenges. Reimbursement denials tie up cash flow in an endless cat-and-mouse game of revenue collection. HealthLeaders termed 2023 as, “the year of reducing denials for revenue cycle.” Their statistics further reinforce Experian Health data correlating increasing denial rates with the healthcare staffing shortage. Simultaneously, healthcare providers find it harder to collect from patients. High self-pay costs lead to lower patient collection rates. One study showed patient collections declining from 76% in 2020 to 55% in 2021. Providers desperately need a more patient-centered collections process that helps these customers understand their cost obligations and payment options. Integrating automated collections solutions can also help providers do more with less. Healthcare stakeholders must collaborate to devise innovative solutions that prioritize workforce augmentation and streamline financial workflows. Technology can solve these problems by automating manual revenue cycle processes that lead to delayed reimbursements. New solutions that use artificial intelligence (AI) software can help in other areas (like claims denials) to save staff time and reduce workloads. Result 2: A lack of staff directly impacts successful patient engagement. Surveyed staff say 55% of patients experience engagement issues at scheduling and intake. 40% say patient estimates suffer, leading to potential miscommunications in credit and collections. Experian Health's The State of Patient Access, 2023: The Digital Front Door reported patients and providers believe healthcare access is worsening. 87% of providers in the survey blamed the effects of healthcare staffing shortages. Earlier data from ECRI shows patients wait longer for care, and nearly 50% of providers say access is worse. Over 100 academic studies in the past two decades confirm the correlation between poor patient health outcomes and industry staff shortages. Existing staff members may take on heavier workloads to cover gaps in patient care. The resulting fatigue can impact the quality of care delivery. When healthcare organizations are short-staffed, each team member may spend less time with patients, resulting in rushed assessments and potentially missed diagnoses. Staff shortages can impact every phase of the patient journey, beginning with patient scheduling and potentially delayed essential medical services. On the backend, patients suffer when the pressure staff members feel to work faster causes preventable errors leading to healthcare claim denials. Collections suffer, as frustrations mount, and healthcare staff waste time on patients who are simply unable to pay. The adverse effects of staffing shortages in healthcare weaken with technology to improve the patient experience at every stage of their encounter. Better technology lessens the burden of care for staff by automating mundane administrative tasks so every provider can focus on serving patients—not filling out forms. Improving patient engagement starts at the beginning of the healthcare encounter. For example, patient scheduling software can create a seamless online experience that halves appointment booking time. More than 70% of patients say they prefer the control these self-scheduling portals offer, putting access to care back in their hands. Patient payment estimation software creates much-needed healthcare price transparency, improving satisfaction by eliminating financial surprises after treatment. These solutions, combined with automated revenue cycle management software, can streamline healthcare processes and improve patient experiences. Result 3: Overwork is the norm as staff work environments decline and turnover increases. 37% of survey respondents report issues with staff burnout. 29% list the departure of experienced staff as one of their top challenges. Whether in frontend care delivery or backend revenue cycle, overworked and stressed healthcare professionals are more susceptible to making mistakes, diminishing the overall quality of the patient experience. The attention to detail, a critical component in a complex, high-stakes business, may be compromised due to the strain on the existing staff. When a healthcare organization is short-staffed, it increases the stress on the existing employees. In turn, this contributes to higher turnover rates. Job dissatisfaction and increased stress levels create a challenging work environment, perpetuating the cycle of staffing shortages. Recruiting and training new staff to fill these gaps further exacerbate the strain on existing teams. One area that is critically impacted by staffing shortages is seen in claims management, as claim denials continue to increase, which cost American healthcare providers an estimated 2.5% of their gross revenues annually. Billions of reimbursement dollars logjam in the endless cycle of claims submissions, rejections, and manual mitigations. In 2022, the cost of denials management increased by 67%. Revenue cycle staff, stretched to their limits by staffing shortages, will likely continue to make preventable mistakes during patient intake and claims submission. However, automating claims management with a solution like ClaimSource® can help lower denial rates and ease this burden.  This solution delivers increased operational efficiencies and effectiveness by prioritizing claims, payments and denials so that users can work the highest impact accounts first. Other solutions, like Claim Scrubber, can improve claim accuracy before submission, by submitting clean and accurate claims every time. These technologies enable healthcare providers to reduce claims denials while relieving some of the terrible pressure felt by their financial teams to work harder and faster. By automating clean claims submissions, healthcare organizations free up their teams to focus on taking better care of patients—and themselves. Healthcare staffing shortages + manual revenue cycle = Unsustainability What happens to a process that heavily relies on human labor—when there aren’t enough people to go around? In the case of the healthcare revenue cycle, it means staffing shortages heavily impact a hospital's ability to collect revenue. Medical Economics reports that 78% of providers still conduct patient collections with traditional paper statements or other manual processes. In an era of talent shortages, these manual processes bog down the entire organization with no relief in sight. Overwork leads to burnout, a significant problem in the industry that also contributes to staff turnover. But this is exactly how digital technology can solve the healthcare staffing shortage. While AI and automation can’t help providers find the staff they need, it can eliminate manual tasks and reduce errors that lead to more work, staff burnout, and patient care disruption. McKinsey says automation can eliminate approximately half of the activities employees now perform. It could considerably improve the work environments for revenue cycle staff, allowing them to focus on high-value tasks, and engage patients in more caring and personalized experiences. Experian Health offers providers proven technologies to increase revenue, improve patient care, and lessen the strain on existing staff, to combat the effects of healthcare staffing shortages. Contact Experian Health today to get started.

100% isn't always a good thing. That's especially the case when 100% of healthcare providers agree that staffing shortages have impacted their revenue cycle management and patient engagement efforts. The pressure is on, especially as providers start to see the financial consequences impact their bottom lines. Experian Health's latest report, Short-staffed for the long term, takes a deeper-dive into the many ways staffing shortages have impacted healthcare providers and their organizations. This report, released in November 2023, surveyed 200 healthcare employees responsible for staffing the revenue cycle function. It takes a look at the causes of staffing shortages, the impact on different revenue cycle areas, and the ways technology can help. Take a look at some of the healthcare staffing shortage stats: Download the report, Short-staffed for the long term, or contact us to see how Experian Health can help your organization find some relief from staffing shortages.

The media has extensively covered the healthcare workforce shortage and its impact on patient care. It's a chronic, dangerous problem that seems to worsen, despite the industry's efforts to staff up. A recent Experian Health survey found severe and long-term implications for revenue cycle management and its impact on provider and patient care. 100% of revenue cycle leaders surveyed agree the pervasive healthcare workforce shortage impacts their facility's ability to get paid. The problem isn't going away; most survey participants (69%) expect recruiting challenges to continue. Furthermore, nine of 10 survey participants admit to a double-digit turnover rate. However, the shortage of qualified labor is impacting healthcare in other areas beyond patient outcomes. The report shows the bottom line is clear: The healthcare workforce shortage impedes the industry's ability to get paid. How can providers solve this? Experian Health's survey, “Short Staffed for the Long-Term,” polled 200 revenue cycle executives to understand the impact of the hiring deficit's impact on provider cash flow. Survey Finding #1: Staffing shortages impede payer reimbursements and patient collections. 32% of survey participants said patient collections is the revenue cycle channel most impacted by healthcare workforce shortage. 22% said payer reimbursements are most affected by staff shortages. 43% said both channels were equally impactful to the healthcare revenue cycle. There was little disagreement in the survey around whether provider revenue cycle suffers from a lack of qualified staff. The debate centered on which reimbursement channel took the biggest hit. Experian Health's staffing survey revealed revenue cycle executives agree that collecting late patient payments is much more complicated now. The worker shortage impedes the ability to manage this process. In an era when many patients put off care due to high out-of-pocket costs, maximizing collections is more important than ever. Short-staffed, overworked healthcare collections teams require the time and tools to optimize the collections process by identifying the accounts more likely to pay. Patient collections teams could also benefit from software that finds financial assistance that could ease self-pay burdens. Collections Optimization Manager saves staff time by automatically determining the most suitable patient collections approach. The University of San Diego California Health (UCSDH) uses this software to segment patients by propensity to pay. It allows collections agents a more efficient, personalized approach to improve the revenue cycle and the patient relationship. From 2019 to 2021, UCSDH increased collections from $6 million to more than $21 million with this solution. Patient Financial Clearance automates screening prior to service or at the point of-service to determine if patients qualify for financial assistance, Medicaid, or other assistance programs. Kootenai Health leverages the software, which increased the accuracy of determining patient financial assistance by 88%, and saved 60 hours of staff time through automation. Together, these tools can ease the healthcare workforce shortage by optimizing and streamlining collections. Survey Finding #2: The healthcare workforce shortage contributes to increasing denial rates. 70% say escalating staff shortages increase claims denials. 92% report new staff member errors are a significant factor in delayed or declined reimbursement. Today, healthcare providers are seeing claim denials increase by 10 to 15% year over year. A lack of qualified revenue cycle staff costs billions annually in preventable revenue cycle errors. 35% of healthcare leaders admit losing more than $50 million yearly on denied claims. The complexities of the revenue cycle particularly challenge new staff; 92% of survey respondents say errors are common. Denied claims ripple across the revenue cycle, tying up staff time and provider cash flow. Ultimately, it is patients and staff who suffer. When hospitals experience restricted cash flow, it can hamper their ability to effectively deliver the highest quality care. When staff stretch to their limit due to the healthcare workforce shortage, they may make more errors, burnout, or quit. Automating the claims process is a necessity in this challenging environment. Tools like ClaimSource® and Claim Scrubber can catch errors before submission, reducing undercharges and denials. Franklin Healthcare Associates, a 100-provider, four-location practice, used Claim Scrubber to reduce accounts receivable (A/R) by 13%. As claims volume grew, the practice decreases its full-time employee (FTE) requirements by leveraging this automated tool. It's one clear example of how technology can stretch staff farther to improve the bottom line. Survey Finding #3 Staffing deficits aren't going away. Close to 70% of respondents believe revenue cycle staffing levels will continue as a problem into the future. Staff turnover is a contributing factor; 80% said their organization's turnover revenue of cycle management staff is between 11-40%. Experian Health's survey confirms that healthcare teams struggle to find qualified staff. Staff turnover is a significant contributor to a revolving hiring door. One survey showed the average hospital turnover rate is 100% every five years. Traditional solutions to the problem include throwing more money into salaries, bonuses, or other perks. Overtime is a go-to remedy for the chronic healthcare worker shortage. But these approaches strain the provider bottom line. A recent Kauffman Hall survey shows: 98% of healthcare providers have raised minimum wage or starting salaries. 84% offer signing bonuses, and 73% offer retention bonuses. 67% experienced wage increases of more than 10% for clinical staff. The American Hospital Association (AHA) states, “Hospitals also have incurred significant costs in recruiting and retaining staff, which have included overtime pay, bonus pay and other incentives.” But what if recruiting isn't the answer to the healthcare workforce shortage at all? Artificial intelligence (AI) and automation software can help cut costs and lessen the workload of existing staff. The latest data suggest providers could save close to $25 billion annually (one-half of what they spend on administrative tasks) if they leveraged these tools. Experian Health's  AI Advantage™ uses powerful algorithms to automate manual claims processes to reduce denial and lessen the volume of tasks for revenue cycle staff. The software works in two critical areas: Predictive Denials proactively cleans claims before they are submitted. The software flags claims at risk of denial, allowing manual intervention for a clean submission—with no denials. Denial Triage manages denied claims by identifying the highest value reimbursements to maximize cash flow. Instead of chasing low-value claims or those least likely to pay, the software prioritizes where revenue cycle staff should spend their time for the greatest return. Schneck Medical Center saw significant ROI from this software in just six months. AI Advantage helped the facility reduce denials by an average of 4.6% per month. Claims corrections that took up to 15 minutes in the past now take under five minutes. Better software can do more than help hospitals get paid faster. Automating revenue cycle management processes frees up staff time. More time and less pressure mean fewer mistakes. Automation can ease the impact of the healthcare workforce shortage Two of the most pressing problems hospitals face today are the healthcare workforce shortage and revenue cycle impediments that keep them from getting paid. These challenges interconnect, and providers can solve them both with better technology to automate time-wasting manual functions. AI and automation in healthcare can cut costs and reduce staff burnout. Deploying revenue cycle software to automate billing, claims management, and collections could save $200 billion to $360 billion in spending in this country. These numbers are real. But so are the numbers showing increasing claims denials, staff burnout, turnover, and difficulties recruiting in the healthcare field. Today, the answer for hospitals to get paid faster is to leverage modern technology to improve the revenue cycle. Learn more about how Experian Health's revenue cycle management solutions can help automate common processes, and download the new survey to see the latest healthcare staffing shortage stats.

As retail and technology companies make moves in healthcare, existing providers must find new ways to attract and retain patients. Offering personalized patient payment plans is one way to meet evolving consumer demands and hold on to the competitive edge. The best part of this strategy? Providers can use data they already hold to deliver convenient and compassionate collections. Digital disruptors are driving a consumer-centric approach to healthcare payments Having transformed consumer expectations over the last decade, digital technology giants – along with a new generation of start-ups – are now actively pursuing a share of the multi-billion-dollar US healthcare market. Concierge medicine, on-demand virtual health and other personalized services are solidifying consumer expectations of flexibility, convenience and control. While consumers have more choice, they're also paying more for healthcare. Inflation-weary consumers are apprehensive about rising costs, and many report frustrations with healthcare billing and payment processes. According to a 2022 Gallup poll, nearly four in ten patients postponed medical care because of cost concerns. This tension between demand for choice and concerns about affordability leaves the sector vulnerable to disruption by players that offer alternative payment models that make healthcare more affordable for consumers, while making it easier to pay for care. Creating a more consumer-friendly approach to patient collections is essential for profitability. 1 in 10 patients use payment plans to manage the cost of care Research by Experian Health and PYMNTs shows that patients welcome payment plans to spread out the cost of care. One in ten patients had used a payment plan to pay for their most recent doctor's visit. Nearly three in ten older patients used a payment plan after receiving an unexpected bill. Unsurprisingly, those on lower incomes were most likely to need payment plans. Experian Health's State of Patient Access survey 2023 emphasized patients' desire for more flexible and transparent payment options, including pre-service estimates, payment plans and digital payment methods. Providers see the benefits too: around two-thirds of providers said their organization understands patients' unique financial situations and offers payment plans and financial assistance where appropriate. Using data to tailor patient payment plans For payment plans to work effectively, personalization is non-negotiable. Too often, payment plans apply a generic “one size fits all” formula to patient accounts, regardless of payment history, financial situation or other key indicators of the patient's ability to pay. This runs the risk of delivering a poor consumer experience while doing little to reduce patient bad debt. With a data-driven approach, healthcare organizations can identify the optimal plan for each patient. For example, PatientSimple® uses Experian Health's proprietary data and analytics to assess each patient's propensity to pay and guide them to the most appropriate financial pathway. A self-service portal gives patients a convenient way to generate estimates and consider different pricing plans, so they can make a more informed and confident decision about how to pay their bills. It also supports staff to have more compassionate financial conversations with patients. Similarly, Patient Financial Advisor and Patient Estimates give patients upfront, accurate estimates of what they're likely to owe, drawing on current chargemaster lists, payer contracts and the patient's insurance data. Together with payment plans, these estimates help patients avoid unexpected bills, so they have a more positive payment experience and are less likely to miss payments. A third tactic is to make it as easy as possible for patients to pay. Self-service and contactless payment options remove friction from the payment process, so patients are more inclined to pay promptly where they can. The patient's account data can be securely auto-populated into payment tools so they can pay and go with minimal fuss. Stay ahead of competitors by creating patient-friendly experiences As healthcare evolves, healthcare organizations need to develop strategies to remain competitive while still delivering compassionate care. Personalized patient payment plans are one way to strike that balance. Not only do they give patients the flexibility and convenience they’re looking for, but providers can also use existing data to tailor plans that benefit both company and customers alike. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says these tools can help providers stay competitive as patients are exposed to a growing range of consumer-friendly healthcare services: “The move towards more patient friendly online experiences is a catalyst for improved price transparency. The challenge for providers is to adapt to shifting consumer needs while managing their resources wisely. But there's a major opportunity for providers to use data they already hold to help patients figure out the best financial pathway. Putting patients first is a sure-fire strategy to see patient satisfaction and patient collections rise in parallel.” Find out how healthcare organizations can remain profitable in an increasingly competitive market with personalized patient payment plans and patient payment solutions.

With artificial intelligence (AI) continuing to dominate conversations among healthcare's strategic thinkers, it's clear that recent innovations in this field could herald a step-change in healthcare delivery. AI's ability to mimic human intelligence and machine learning (ML)'s capacity to learn from vast amounts of data means these technologies are fast becoming indispensable tools for healthcare leaders who want to optimize operations. Understanding how they work – and where to apply them for maximum impact – will be crucial to stay ahead of the competition as the revenue cycle landscape evolves. This article breaks down the what, why and how of AI technology in healthcare, and includes a look at Experian Health's new AI-based claims denial solution, AI Advantage™. Understanding machine learning and AI in healthcare The terms “machine learning” and “artificial intelligence” are often used indiscriminately, but what do they mean in a healthcare context? Generally speaking, AI is a machine's ability to perform cognitive functions that would normally be associated with humans, such as interacting with an environment, perceiving information, and solving problems. It can spot patterns, learn from experience and choose the right course of action to achieve a desired outcome. This includes natural language processing, robotics and machine learning. In healthcare, AI might be used to transform diagnosis through the analysis of medical images, expedite drug discovery by monitoring side effects, improve the safety and efficiency of surgery through robotics, and support patients to take ownership of their own health through health monitoring and wearables. Machine learning is a broad term that covers the processes used to extract meaning from (usually large) datasets to create and train a predictive model. It will look for historical patterns in input and output that a human eye might miss, and generate recommendations based on outcome parameters defined by the user. For example, it can look at patients' electronic health records to identify those who may be at risk of specific medical conditions so they can be offered appropriate advice. Another useful application is in predicting service demand, for more efficient appointment scheduling and resource allocation. Further subsets of machine learning include supervised learning, where training data is labelled with the desired outcomes that the algorithm should aim to detect, and unsupervised learning, which has no predefined targets and is useful for discovering patterns, insights and anomalies. Unlocking the AI Advantage™: how AI can reduce claim denials and improve financial performance The transformative potential of ML and AI technology in healthcare isn't limited to clinical decision-making and patient engagement: optimizing revenue cycle operations is a particularly attractive place to leverage the technology. It can be used to identify and reduce billing errors, enhance coding accuracy, and predict revenue leakage. This results in faster payments, better use of staff time and fewer claim denials. However, Experian Health's State of Claims 2022 survey revealed that while 51% of providers were using automation, only 11% of providers had integrated AI technology into their claims processes. Experian Health's new AI-based claims solution is specifically designed for those looking to take the next step to leverage AI to predict and prevent denials. AI Advantage takes a two-pronged approach to reduce the risk of denials and expedite any rework that may be needed. AI Advantage – Predictive Denials examines claims before they are submitted and calculates the probability of denial, based on thresholds set by the provider. It incorporates historical payment data and undocumented payer claim processing behavior to evaluate individual claims in real-time, with a level of speed and accuracy that would be unachievable using manual processes alone. High-risk claims can be edited before submission to reduce the risk of denial. AI Advantage – Denial Triage evaluates and segments denials based the likelihood of reimbursement following resubmission and prioritizes the work queue based on financial impact. It learns from payers' past decisions to formulate recommendations with increasing accuracy. This means staff can eliminate guesswork and focus their attention on the denials that will be most likely to yield results. See how Experian Health's AI-powered solution works to reduce and prevent denials. Challenges to watch out for when implementing AI While the benefits are clear, the rise of AI in healthcare applications also brings some challenges. Here are some key questions to consider for smooth implementation: How reliable is the data underpinning AI technology? AI tools are only as good as the data they're analyzing. Without high-quality, structured data, they will be unable to make accurate predictions. Providers need to ensure that data is available in a usable format and free from errors. Partnering with a reliable third-party vendor can help ensure all the relevant boxes are ticked. Does the technology integrate easily with existing workflows and software systems? Integrating new tools with the existing RCM infrastructure can be complex. Organizations often have legacy systems that may trigger interoperability issues, limiting effective data exchange and requiring staff to log in to multiple interfaces. A single vendor solution can mitigate for this. For example, AI Advantage fits together seamlessly with the industry-leading claims processing tool, ClaimSource®. Experian Health's consultancy team are also on hand to ensure smooth implementation. Does the software protect data privacy and security? Healthcare data is subject to multiple privacy and security regulations, such as HIPAA. Any new technology that processes data must comply with regulations and industry best practice. Being able to reassure patients that their data is safe is also an important driver of patient loyalty. What does the future hold for AI technology in healthcare? Looking ahead, the role of ML and AI in both patient-facing healthcare processes and revenue cycle operations is only going to grow. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursement, while minimizing the burden on the workforce. Emerging technologies such as robotic process automation and natural language processing will offer more sophisticated and comprehensive workflow solutions, while AI's ability to continually learn and improve means providers that leverage AI will be better placed to make full use of their data and adapt to evolving trends and challenges. Discover how AI Advantage™ is helping Experian Health's clients transform their healthcare operations.

Staffing shortages are the new normal in healthcare. Most news headlines focus on gaps between the supply of providers and the growing demand for care. However, a recent survey by Experian Health, released in November 2023. shows the massive impact staffing shortages have on back office revenue cycle where these functions intersect with front-of-house patient engagement. Strikingly, the healthcare staffing shortage statistics in the survey show revenue cycle executives are 100% in agreement—staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees. Experian Health's report, Short-staffed for the long term, surveyed 200 healthcare executives responsible for revenue cycle functions. The goal was to gauge the impact of worker shortages on revenue cycle management and patient engagement. While the pandemic brought these shortages into the public purview, this new data shows most providers believe healthcare staffing gaps are chronic and here to stay. These results reinforce The State of Patient Access 2023 survey, where 87% of providers blamed staffing shortages for declining access to care. As the healthcare industry continues to struggle with an ever-increasing staffing shortage, it has become increasingly evident that if left unresolved, this situation can wreak havoc on revenue cycle management (RCM). The latest survey illustrates the need for new strategies to alleviate healthcare worker shortfalls. This article explores the most recent healthcare staffing shortage statistics and some key findings from the study to help determine how healthcare providers can turn these challenges into opportunities. Experian Health surveyed 200 revenue cycle executives to determine the impact of staffing shortages on reimbursement and patient engagement. Download the report to get the full results. Finding 1: Most revenue cycle leaders believe staffing shortfalls negatively affect payer reimbursements and collections. 96% of survey respondents indicated a lack of qualified workers has a detrimental impact on organizational revenue channels. 80% say turnover in their department ranges from 11 to 40%, much higher than the national average of 3.8%. When healthcare organizations lack revenue cycle talent, they risk missing performance goals. High turnover and the departure of experienced staff create information deserts within healthcare organizations. It forces new team members to train faster, handle bigger caseloads before they're ready, and potentially burnout from stress. The pressure to do more faster creates a higher volume of preventable claims errors that lead to denials. The survey showed all these factors at play, and their negative impact on reimbursement, collections, and the patient experience. While the traditional way to alleviate staffing shortages is to increase recruiting and retention efforts, these approaches no longer work when there simply isn't enough available staff to hire and train. Healthcare organizations must consider new partnerships with technology providers who offer automation tools to streamline human workflows. Revenue cycle management software eliminates repetitive tasks and lessens errors that lead to rejected claims. Digital technology can help solve labor shortages by reducing staff workloads and improving operational performance. Automation can streamline collections by prioritizing the accounts most likely to pay. These tools help existing revenue cycle teams work more efficiently while enhancing patient encounters. Finding 2: Healthcare staffing shortages roadblock a positive patient experience. 8 of 10 survey respondents say patient experience suffers due to gaps in staffing coverage. 55% report the patient experience is most heavily affected at intake, and 50% say at appointment scheduling. Staffing shortages and turnover cause an undue burden on the healthcare workers left behind. The survey asked respondents to indicate the top pain points experienced by revenue cycle professionals, and one of the major challenges was staff burnout. Stress has a detrimental effect on patient interactions throughout the revenue cycle. The survey shows staffing shortages impede patient satisfaction in critical areas within revenue cycle functions, including: Scheduling appointments Patient registration Prior authorization Insurance coverage confirmation Patient estimates Revenue cycle interactions can be delicate, requiring extreme patience and clear communication. Healthcare organizations must provide the support their revenue cycle teams need to handle these crucial conversations appropriately. To improve the patient experience, organizations must first improve the workflows and workloads of these critical back-office teams. When healthcare organizations have the right tools to eliminate manual tasks that bog down revenue cycle staff, these professionals can spend more time on the compassionate handling of patients and their accounts. Providers have the opportunity to solve these challenges with digital patient engagement solutions that improve workflow efficiencies at every level of the revenue cycle. Patient scheduling software creates a self-service environment that 73% of healthcare customers prefer. Patient intake improves with online software that automates the tedious paperwork that tie up staff. Better technology can create price transparency without manual effort, ensuring patients understand their responsibilities up front instead of facing surprises during or after care delivery. Finally, a frictionless online payment platform allows patients to handle their obligations seamlessly without staff intervention. Finding 3: Errors arise when healthcare providers are short staffed, leading to claims denials. 70% of survey respondents say staff shortages exacerbate denial rates. 92% of survey respondents said new staff members make errors that negatively impact claims processing. Some of the most common reasons for healthcare claim denials include: Incomplete collection of claims data Coding errors Billing errors Eligibility verification errors Missed insurance verification Healthcare operations and revenue cycles are full of manual processes. RevCycleIntelligence reports one-third of prior authorizations are completed manually, and two-thirds of hospitals haven't automated any part of their denials management processes. Yet technology has made significant strides toward reducing these error-prone manual tasks. Leveraging artificial intelligence (AI), with solutions like AI Advantage™, within the complexities of claims processing could cut provider spending by up to 10% annually. Eliminating repetitive tasks with automated claims management solutions improves the lives of staff, cuts manual errors that tie up cash flow in reimbursement wrangling, and creates a better, less stressful environment for customers. Reducing the impact of healthcare staffing shortages with revenue cycle automation and technology Sometimes, 100% agreement isn't the desired outcome. In this case, the healthcare staffing shortage statistics found in the survey shows healthcare providers agree unanimously that chronic staffing shortages create a problematic environment for employees that costs revenue and patient engagement. While technology exists that can maximize revenue staff workflows to extend the reach of overburdened employees; survey participants suggest that healthcare organizations continue to approach solving these issues by adding staff.  But healthcare's staffing challenges are not new. While organizations have historically invested revenue in higher salaries and sign-on bonuses to attract staff, technology offers a new opportunity for history to avoid repeating itself. It's time for healthcare organizations to support their teams with automation. These tools alleviate mundane, error-prone tasks that tie up staff. Experian Health offers these organizations a way to improve the lives of everyone within the revenue cycle by allowing back and front-office teams to focus on patient care, rather than filling in forms. It's a more humane way to handle a very human staffing crisis. Download the survey or connect with an Experian Health expert today to learn how we can help your healthcare organization combat staffing shortages.

Hospital admissions for COVID-19 increased by almost 92% between the last week in July 2023 and the last week in August 2023, according to figures published by the Centers for Disease Control and Prevention (CDC). It is worth noting that this time last year, the numbers were double what they are now. However, it is important to acknowledge that the virus is still evolving. Demand for services may be unpredictable over the coming months, so providers will need to position their teams to adapt to changing patient volumes and staff absences. Additionally, seasonal flu vaccination programs are underway, putting extra pressure on patient access. Now is the perfect opportunity for healthcare providers to reassess and streamline patient intake processses. This article looks specifically at how online scheduling for patients can help providers prepare for the unexpected this fall. Rethinking patient intake Online scheduling helps providers create a more efficient patient access experience by allowing patients to schedule appointments from home, instead of by phone or in person. It's more convenient for patients, limits exposure to infection and reduces the administrative burden on front office staff. Understandably, some providers without online scheduling software in place may worry about implementing new tools during the busiest time of year. They may see it as a “nice to have” to deploy when demand is more stable. But this is a false economy: any time saved by postponing the switch to online scheduling will be lost to costly inefficiencies over the hectic winter period. It's crucial to start the process now, before the stress hits. In a 2022 evaluation of self-scheduling processes at the Mayo Clinic, the authors describe themselves as “fortunate to have the self-triage and self-schedule process in place during the unanticipated surge of COVID variant omicron in the winter of 2021-2022.” The organization saw utilization of self-scheduling for COVID-19 tests increase from 4% of appointments booked in December 2020 to 44% in January 2022, saving thousands of hours of staff time, reducing no-shows and streamlining the patient experience. Get more benefits from online scheduling with a tailored approach Switching to online scheduling doesn't have to be complicated. To simplify implementation, providers should focus on how online scheduling can support their organization's specific operational challenges and goals. Choosing a solution that integrates with existing practice management and hospital information systems will also ensure implementation is as frictionless as possible. Here are a few examples of ways to maximize the benefits of online scheduling for their organization: 1. Create screening questionnaires to manage demand Screening questionnaires can be given to patients as soon as the log in to book appointments for specific services. Their answers can then be used to determine the appropriate appointment type and guide patients to their next step quickly and efficiently. Clinical needs, billing requirements, and patient preferences (such as the need for an accessible location or interpreter), can all be managed automatically.It's an effective strategy to manage demand for high throughput and routine services that are less likely to need staff assessment, such as COVID-19 testing or flu vaccinations. In the Mayo Clinic example, self-scheduling took just 3.1 minutes for asymptomatic patients, increasing to just 5.8 minutes for symptomatic patients who self-triaged with a screening questionnaire. 2. Use guided search to direct patients to virtual services Online scheduling can also guide patients to appropriate and convenient services they may not otherwise have considered, such as virtual care. Virtual care proved its value at the height of the pandemic, and while utilization has levelled off, providers should not see this as a lack of appetite for digitally-enabled care among patients. In Experian Health's State of Patient Access survey 2023, 56% of patients said they wanted more digital options for managing healthcare. Respondents (particularly younger patients) listed mobile scheduling for telehealth appointments among their expectations of the digital front door.The recent explosion in digital health companies offering at-home care solutions also speaks to patient demand for virtual services. Established providers should look to expand and promote their digital offerings, or risk losing their competitive edge. Leveraging the incumbent advantage is a move to make now, while new players are still finding their feet. One effective method to achieve this is by directing patients to existing virtual services through an online scheduling platform. 3. Eliminate walk-in traffic at urgent care centers Urgent care centers are the 'doctor of choice' for many patients, with patient volumes increasing by 60% since 2019, according to the Urgent Care Association. If COVID-19 and seasonal flu cases collide over the winter, urgent care centers may become overwhelmed by patients with both infections. Urgent care center managers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This helps reduce the number of in-person visits and walk-in traffic, which will not only help prevent spread of infection, but also contribute to a better patient experience.Online self-scheduling also eases pressure on urgent care centers in another important way. Allowing patients to book their own appointments reduces the risk of cancellations and no-shows. This proactive approach prevents delays in care, effectively bridging gaps that can potentially escalate into costlier and riskier emergency situations. 4. Extend staffing capacity with real-time resource allocation Experian Health's data shows that between June 2022 and June 2023, providers that used Patient Schedule saw an average of 40% of patients book appointments after hours, saving hours of administrative time. Efficiencies on this scale will be invaluable, should COVID-19 or seasonal flu cases trigger a rise in patient volumes and staff absences.Patient Schedule automatically optimizes patient and provider capacity in real-time. Scheduling rules based on providers' calendars, appointment types and business needs are built into the platform, so that patients only see the available appointments based on those rules. The tool gathers calendar inventory from across multiple providers for a comprehensive view of network capacity, to make even better use of available staff time. The calendar inventory can cover an entire care team, such as a physician, physician assistant and nurse practitioners. This frees up staff to focus on other administrative tasks and assist patients with additional needs. Get ahead of winter pressure points with online self-scheduling These are just a few examples of how providers can use online patient scheduling to zero in on their own operational priorities, make life easier for schedulers and patients, and ease pressure on services over the coming months. Contact Experian Health today to explore self-scheduling options and immediately boost your service capacity.

Humans increasingly benefit from the convenience of a self-service world. Thanks to the internet and companies like Amazon, online digital interactions yield an almost immediate result. It's a standard consumers have adapted to and unconsciously expect from every service provider, whether it's same-day grocery delivery or scheduling the next doctor's appointment. Today's gold standard for most services is a few clicks with a favorite handheld digital device. But when it comes to healthcare, sometimes expectations don't meet reality. Healthcare providers must accommodate patient expectations by opening a digital front door. Despite the complexities inherent in American healthcare, patients increasingly demand a frictionless online experience where they manage their care at their leisure. Clarissa Riggins, Chief Product Officer at Experian Health, says, “Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services. They seek convenient self-scheduling options, accurate cost estimates, and the ability to pre-register through their smartphones.” Understanding the need for a digital front door in healthcare Healthcare's digital front door is a set of online tools that enable patients to manage their care. These tools began growing in popularity during COVID, when the necessity of limiting physical interactions drove many patients to online healthcare alternatives. These digital encounters further increased patient expectations of a seamless healthcare experience from scheduling to service delivery to payment. Meeting patient demand for digital services Increasingly, the level of control that stems from online scheduling is what healthcare customers demand. Digital tools used to book appointments, register for care, and make payments are becoming a norm across the healthcare continuum. Survey results from the State of Patient Access 2023 found that some of the most important digital services for patients that drive a positive experience include being able to schedule appointments online or via a mobile device (76%), having an online/mobile option for payments (72%), and more digital options for managing healthcare (56%). Clarissa Riggins points out the gap between these expectations and the reality of most patient experiences, stating, “In general, findings seem to show progress has stalled when it comes to making patient access functions like scheduling, registration, coverage verification, and cost estimates more efficient.” Yet providers seem aware of their patient's interest in seeing more, not fewer, digital front door tools in healthcare delivery. The State of Patient Access 2023 report shows 86% of healthcare providers want their organizations to improve by adopting digital front door software. Riggins says, “But provider's motivation is not necessarily generating action.” Patients are growing frustrated; nearly half say they can't find appointments to fit their schedule, and 40% complain that even trying to schedule with a doctor is challenging. Today, 87% of patients perceive the across-the-board accessibility of their healthcare practitioners as a problem. Digital front door software is healthcare's solution to provider shortages, decreasing access, and our patient's on-demand scheduling requirements. Patients and doctors want digital front door software to increase access to care Patients are turning to providers who use automated solutions. Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, and 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. A prior study showed 44% of patients say they prefer to receive test results via a secure online hub. While staffing shortages certainly impact the ability to schedule care, Riggins points out, “Since patients associate 'access' with their ability to see a provider quickly, it makes sense that, without technology in place, staffing shortages will negatively impact the consumer experience.” It's a good point; nearly 40% of healthcare providers say technology solutions like digital front door software offset staffing shortages. Healthcare patients demand digital front door access and their doctors agree. But healthcare organizations are lagging in implementing these tools. Where is the disconnect? Eliminating the tedious human tasks that accompany manual patient registration, automating accurate price estimates, or offering patients one-click, convenient payment options, will free up staff to focus on key initiatives. Not to mention that these digital innovations will give patients and providers what they want. Perhaps the lag in implementing healthcare digital front doors occurs because these organizations find digital transformation daunting. But healthcare providers can work with a third-party trusted advisor with the right expertise to make the transition to digital front door software. Utilize mobile and self-service scheduling Experian Health specializes in opening healthcare's digital front door, beginning at the front door of any practice. Automated patient scheduling gives patients 24/7 control over when they visit doctors. Easy one-click functionality in a comfortable user interface allows patients to reach the right doctor at the best time for everyone. For providers, this kind of digital front door software alleviates the pressure on overburdened scheduling staff by moving these processes to a self-service online environment. Provide a better registration experience Experian Health's registration software also takes the next step, inviting patients through the digital front door by simplifying and streamlining intake. Healthcare organizations can create a better registration experience and increase patient booking with text-to-mobile registration. Two-way automated communications with patients decrease no-shows and engage patients at every step of their journey. For new and existing patients, automated cost estimates with easy payment options let them know their obligations to a healthcare practice, increasing co-pay collections while lessening burdens on providers and staff. Communicate costs upfront Communicating the costs associated with healthcare delivery is a critically important step toward improving patient experience. Experian Health's State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. That's why Experian Health expanded their digital front door software to include tools like Patient Estimates and Patient Financial Advisor. These tools creates true price transparency between healthcare providers and their patients. Providing a patient with an on-demand, clear, accurate cost estimate for healthcare should be a standard part of the care delivery paradigm. These solutions automate this process so that every customer understands the costs associated with receiving care. The bottom line There is evidence now that patients want a digital front door to improve access to care. They want to retake control of their health and do it from their preferred digital device. Experian Health has a set of digital front door tools that brings healthcare consumers exactly what they want while lowering provider staffing costs. Adopting innovative digital solutions is no longer an “if” proposition; healthcare customers have shown they will seek out new providers if their scheduling, registration, and payment processes are not seamless. This shift in the consumerism of our healthcare services means that healthcare organizations face a strategic imperative to open the digital front door—or lose patients to the competition.  Contact Experian Health to learn we help organizations open their digital front door with automated patient access solutions.