Tag: patient payment estimates

Could patient access software be the 'most valuable player' in healthcare? Experian Health's annual State of Patient Access surveys show an upward trend in the use of digital tools and software to help minimize the hoops patients must jump through to access care. In the most recent, 46% of providers said they expected to increase their digital investment over the next six months. The business advantages around increased capacity, reduced cancellations, improved data accuracy and higher patient satisfaction make a strong case for investing in patient access software. This article looks at how patient access tools can solve for some of the most stubborn problems in patient scheduling, registration and payments. Finding the formula for frictionless patient access Revenue cycle management comes down to minimizing service utilization while maximizing revenue potential. This starts with patient access. Efficient scheduling, intake and financial processes means more patients get better care, sooner – and providers get paid for their services without delay. Patient access software includes a range of digital and self-service tools that allow patients to complete administrative patient intake tasks with ease. Appointment management, patient registration, patient outreach, and patient estimates and billing are common use cases for patient access software. These solutions use in-depth data and automation to pre-fill patient information, check data for accuracy and completeness, tailor patient communications and accelerate workflows. Advances in AI and machine learning are creating new opportunities to remove obstacles in patient access and boost patient satisfaction. 5 problems that can be solved with patient access software 1. Painfully slow scheduling operations  Problem: Too often, patient access processes are complex and time-consuming. Over time, small frustrations from errors, delays, and repetitive manual tasks can cause a significant decline in the patient experience. It's unsurprising that 56% of patients want digital options to manage care and speed things up. Solution: Patient access software makes it easier for patients to see their doctor without delay. For example, rather than being forced to call the provider's office and wait for an agent to check for an available slot, patients can use online scheduling software to book, reschedule and cancel appointments whenever suits them best. This also alleviates call center volumes, easing pressure on staff. 2. Error-prone registration processes Problem: Manual intake and registration systems are vulnerable to quality issues, resulting in denied claims, increased admin costs and delayed access to care. Illegible writing, incomplete insurance information and missing forms mean patients and staff must spend more time going back and forth to find and fix mistakes. And at the extreme end of the spectrum, data errors can lead to medical errors, with life-or-death consequences. Solution: Automated patient registration can pull patient data from reliable sources and fill out basic details ahead of time, reducing the need for manual data entry. Preventing avoidable errors in this way improves communication, workflows and profitability. For example, Registration Accelerator is a text-to-mobile patient intake solution that allows patients to complete appointment registration from the comfort of home. The patient takes a photo of their insurance card and driver's license, and then optical character recognition (OCR) technology automatically enters the correct information for insurance verification. The patient can review and sign authorization and consent forms, and confirm their appointments all at once, with just a few clicks. 3. Excessive (and growing) admin burdens and staffing shortages Problem: Patient access is admin heavy. This wastes valuable staff time and resources and diverts attention from patient care. With healthcare staffing shortages reaching emergency levels and patient volumes on the rise, providers must find ways to manage workloads while maintaining output. Solution: By automating administrative tasks and expanding self-service options, patient access software takes the pressure off busy teams. In Experian Health's survey, 36% of respondents reported that technological improvements offset staff shortages, by making better use of staff time and lowering operational costs. Automated prior authorizations are a good example of how digital tools can help tame the admin burden. This software generates real-time updates for multiple health plans, so staff no longer need to cross-reference individual payer policies and websites. It uses exception-based workflows and guided work queues to help staff prioritize their activities. Patient access tools can also issue performance reports, so staff can continue to find ways to work more efficiently. Cutting-edge technology also offers a less obvious but equally important competitive advantage – helping providers attract and retain high quality staff. 4. A patient experience that falls short of expectations Problem: Unnecessary administrative obstacles, unclear communication, and slow processes result in subpar patient experiences. More than 6 in 10 patients don't think their experiences have improved much in the last few years, despite the wider availability of digital patient access tools. Providers need a solution urgently, given that 56% of patients would switch providers for a better patient experience. Solution: With automation and self-service digital tools, providers can finally put patients in the driver's seat and deliver the patient-centered experience that has been promised for years. Patients say they want access and payment experiences to be convenient and transparent, with specific examples including: Accurate pre-care estimates Payment plans Digital payment options A multi-purpose portal Mobile access for scheduling, registration, communications and care Alex Harwitz, VP, Digital Front Door at Experian Health, says that while this list may seem daunting, providers have reason to be optimistic about delivering a better patient experience: “Patients want a lot from the digital front door, especially younger and digitally savvy consumers. Speed, convenience and compassion are through-lines in our patient surveys. As expectations increase, so does the pressure on providers to deliver. But the good news is that technology is advancing too. There's a wealth of patient access software ready to help optimize the patient experience. And you don't have to implement them all at once: Experian Health's patient access tools are specifically designed to work independently or in combination, for hassle-free implementation.” 5. Missed revenue opportunities Problem: Missed appointments, billing mistakes and operational inefficiencies lead to avoidable revenue leakage. A significant portion of denied claims occur earlier in the revenue cycle, so improving patient access processes should be top of the list when it comes to optimizing revenue. Solution: Revenue loss in patient access comes down to data errors, poor analytics and workflow inefficiencies. By leveraging the right software, front- and back-office teams can collaborate to resolve issues and enhance decision-making. Digital tools can also improve the patient billing and payment experience, so providers get paid promptly. Upfront price estimates, payment plan recommendations and one-click payment options can make it easier for patients to understand and pay their bills. Implementing transparent and empathetic billing procedures not only enhances patient satisfaction but also accelerates the collection process. With Experian Health's Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Maximizing revenue opportunities while meeting the changing needs and expectations of healthcare consumers calls for smart patient access strategies. Find out more about how Experian Health's patient access software helps healthcare organizations lay the foundations for a solid revenue cycle and a positive patient experience.

Advances in medical treatments and technology are ushering in a new era of personalized healthcare. Each patient has their own distinct medical history, genetics, lifestyle and preferences, and it is increasingly clear that tailored care plans are essential to improve patient outcomes and elevate the overall experience. Personalized patient care has become more critical than ever, and is key to creating better patient experiences. Equally rapid transformations in data analytics, automations and machine learning have opened up new possibilities for non-clinical touchpoints in the patient journey. Providers can leverage digital tools to personalize everything from scheduling to payments, ensuring that patients get the right information at the right time. Targeted patient outreach and tailored payment plans are just two examples of how providers can use digital tools to foster better patient engagement without compromising efficiency – one patient at a time. Why does a personalized patient experience matter? Patient expectations have changed. Wearables, apps and a steady stream of health-related content on social media mean today's patients are better informed and increasingly engaged in their own health. They expect to be treated as equal partners, not as passive participants waiting to be told what to do by their doctor. Rather than one-size-fits-all communications, patients value proactive outreach and relevant reminders and prompts that help them move through their healthcare journey with as little friction as possible. They're also accustomed to “high-choice, high-convenience” digital experiences that tailor information to their specific needs and preferences. Digital consumer brands like Amazon and Google are moving into the healthcare space, leveraging their insights and technology to offer patients tailored medical solutions. To remain competitive in this changing landscape, providers must embrace a personalized approach to care. Aside from attracting higher patient satisfaction scores, a personalized patient experience also contributes to better health outcomes. For example, research shows that unclear post-discharge instructions result in preventable, unplanned, and high-cost follow-up care. Specific and relevant advice and reminders – communicated through the patient's preferred channels – can greatly reduce the risk of no-shows, delays and gaps in care. There are financial benefits too. As patients consistently report concerns about the cost of care, support to understand and manage bills can make a major difference in their propensity to pay. What does personalized patient care look like in practice? Clearly, there are practical limits to the level of personalization that can be offered. But with the right digital tools and data analytics, providers can segment groups of patients and deliver an experience that is sufficiently tailored so it feels like they have their own healthcare concierge. And rather than adding to the operational workload, the data analytics and automations that facilitate personalization can also streamline workflows and improve overall efficiency. In this way, tailoring the patient experience can contribute to a reduced manual workload, fewer errors and faster collections. Providers don't need to compromise efficiency for personalized patient experiences. Two specific areas that offer a high ROI are targeted patient outreach and tailored payment plans. Strategy 1: Targeted patient outreach Experian Health's State of Patient Access survey 2.0 showed that patients appreciate proactive outreach by providers, though many said this didn't always happen. With digital patient outreach solutions, communications can be tailored for different patient segments. Consumer data can allow patients to be grouped according to need, behavior and preferences, so they can be supported to move to the next step in their healthcare journey with ease. For example, patients with specific chronic diseases can be sent reminders for annual health checks. Those that may be due for regular cancer screening can be sent pre-appointment information. Providers can also engage patients with automated, timely messages through their preferred channels. At the individual level, self-service patient access tools and automations allow patients to book appointments when and where it suits them. Automated text message and interactive voice response campaigns can be used to issue links to patients so they can book right away. And automated appointment reminders are an easy way to ensure patients don't forget to attend, while minimizing the business impact. Strategy 2: Tailored payment plans and billing Patients worry about the growing burden of healthcare expenses. Generic payment plans that do not take account of individual patient circumstances can leave patients feeling unsupported and detached, so they're less likely to pay in full and on time. A more patient-centric approach can help patients manage bills and reduce the risk of bad debt. Digital technology can analyze patient financial information to anticipate the patient's propensity to pay and generate a customized payment plan. This should start with proactively issuing accurate estimates of the patient's financial responsibility. Patient Payment Estimates gives patients a simple breakdown of their costs, directly to their mobile. It draws on real-time price lists, payer contracts and relevant insurance details to maximize accuracy. Similarly, Patient Financial Advisor offers patients a text-to-mobile experience with a secure link to billing information, personalized payment plans and convenient payment methods. Those that can pay upfront in full can do so, while those that need a little more time or advice on financial assistance can be directed to the right pathway. Patient Financial Clearance helps determine the optimal payment plan by screening patients automatically before their appointment or at the time of service, to see if they qualify for charity support. Finally, offering a choice of payment methods rounds out a tailored financial offering. Personalized patient care: the key to greater patient satisfaction To sum up, integrating targeted outreach strategies and tailored financial support can help providers increase patient satisfaction, improve health outcomes and enhance financial performance. At the heart of a patient-centric approach should be a commitment to anticipating patient needs, by simplifying their healthcare journey and offering the flexibility and choice that have come to be expected. Explore Experian Health's suite of patient engagement solutions for more ideas on how to deliver a compassionate and personalized patient experience.

How do patients rate their “patient access” experience? For most, the rating comes down to how quickly they can see their doctor – and many don't feel like their expectations are met. In December 2022, Experian Health surveyed more than 1000 adults who'd accessed care in the previous 12 months to gauge perceptions of patient access. Most think the experience remains unchanged or has gotten worse in the last two years, despite advancements and providers' heavy investments in technology.  Almost 8 in 10 of those patients say “seeing a doctor/practitioner quickly” is their biggest pain point. Other major factors include the level of friction involved in scheduling and registering for care and obtaining accurate pricing estimates before services are rendered. Patient access tools can help ensure that patients receive the care they need in a timely, efficient manner. Breaking down barriers for friction-free patient access What hinders patients' ability to see their doctor quickly? For some, the obstacles are logistical: patients may live far from facilities or lack reliable transportation to get to appointments. Others may have financial concerns, where a lack of insurance coverage or fear of mounting bills prevents them from seeking care. Language and cultural barriers can make it difficult to engage with healthcare services. But for many, it comes down to friction in the “patient access” process itself. This includes long wait times for appointments, disjointed scheduling systems, manual registration processes, and limited payment options. These processes are not only critical to patient satisfaction but also have real consequences for the patient's health and the provider's bottom line. One effective approach to improve access to care is to continue leveraging patient access tools, which has been proven successful in several use cases. Use case 1: Reduce wait times with online self-scheduling Among patients who think access has worsened over the last two years, 49% say their main challenge is finding appointments that fit their schedule, while 40% blame the scheduling process itself. Online self-scheduling solves both, making it easier to book and reducing wait times. With online self-scheduling, patients can log on to book appointments any time they like. There's no need to wait until the phone lines open and speak to customer support representatives. A self-scheduling tool like Patient Schedule can incorporate each provider's business rules and scheduling protocols, so patients get real-time access to the earliest available appointments. By allowing patients to easily cancel or reschedule appointments, same-day slots can be opened up to other patients, so they can see their doctor sooner. Use case 2: Increase operational efficiency with digital patient registration Staffing shortages are an ongoing stressor for providers, so making the best use of available staff time is crucial. Patient intake software can automate many of the manual activities associated with patient registration, such as helping patients fill out forms or manually entering information into electronic health records. In addition, more than 8 in 10 providers say their patients prefer an online registration experience. This corroborates earlier findings from a study by Experian Health and PYMNTS, which found that a third of patients prefer to fill out registration forms at home. Experian Health's Patient Intake Solutions allow patients to complete registration from their mobile. Data can be automatically pre-filled and checked against existing records to save time and avoid errors. Not only is this more appealing to patients than filling out forms in a stuffy waiting room, but it also helps drive down the risk of costly and time-consuming denials. Use case 3: Boost patient engagement with targeted patient outreach Another way to leverage patient access technology is through targeted, automated outreach. With automated text message (SMS) and interactive voice response (IVR) campaigns, patients can receive a personalized link to schedule their appointment directly. Alerts can be sent when earlier appointments become available, which both reduces wait lists and makes it more likely that patients will book. Patients can be sent bill reminders and payment options in the same way. Automated outreach solutions that incorporate reliable consumer data make sure patients get the details they need in a format and timeframe that helps them take action. Use case 4: Speed up collections with accurate estimates and payment plans As rising staffing and supply costs put a squeeze on healthcare profit margins, expediting collections is crucial. This begins with patient access: if patients can pay for care right at the start of their healthcare journey, this eases pressure on both parties to make sure bills are paid in a timely manner. Upgrading payment technology to include upfront pricing estimates, payment plan recommendations and convenient payment methods can all help patients better manage their financial responsibility. Unfortunately, it's still common for patients to go into procedures without knowing how much they'll owe. In Experian Health's survey, 65% of patients said they did not receive an estimate prior to care, and 40% said they were likely to cancel care without advance notice of costs. Leveraging tools such as Patient Financial Advisor and Patient Payment Estimates can automatically arm patients with the information they need to plan and manage their bills. Utilizing patient access tools to meet patients' expectations It is evident from the results of the State of Patient Access 2023 survey that patient access remains an issue. To ensure patients receive the care they need in a timely and efficient manner, providers must make a concerted effort to leverage digital technology. Although healthcare providers have made great strides in providing more efficient patient access solutions, clearly there is still much progress to be made.  The success of any patient-focused initiative relies heavily on being able to meet patients' expectations with timely, effective tools and resources. As healthcare evolves and continues to put a priority on improving outcomes, it's important to take proactive steps toward ensuring the best possible experience for patients when accessing their care. Find out more about how Experian Health's patient access tools can improve patient access and increase profitability for healthcare providers.

When it comes to healthcare, patient access is the top priority for most individuals. When patients are surveyed on what they value most, timely access to their doctor rises to the top. Experian Health's State of Patient Access 2023 survey found that patient satisfaction hinges on efficient scheduling. Many believe that patient access has improved in recent times due to the ability to book appointments more quickly. On the contrary, those who think otherwise attribute slow booking systems to the decline in accessibility. However, delivering a high-quality patient intake experience isn't always straightforward. Meeting the needs of an aging population – many of whom are managing multiple chronic conditions – is an increasing challenge in the context of ongoing shortages of clinical and administrative staff. With financial performance dependent on attracting and retaining both patients and staff, balancing supply and demand in patient access is a high-stakes equation for providers. Breaking down the key opportunities and challenges can help providers identify appropriate strategies for optimization. Specifically, what role can digital patient access services play in ensuring patients get the care they need when they need it? What is patient access, and why is it critical to the patient experience? Patient access is the cornerstone of the healthcare system. It encompasses the systems and strategies that make or break a patient's access to care. Can they find a suitable provider in their area? How easy is it to book appointments and register for care? Can they understand and pay their bills without too much difficulty? While logistical elements such as geographic location and transportation certainly factor into how easily a patient can get care, patient access tends to focus on the administrative processes involved in scheduling and registration, verifying insurance coverage, appointment management, patient billing and payments, and patient communications. If these services are clunky, slow and disjointed, healthcare providers will fail to deliver high-quality and timely care to those who need it. Top key performance indicators (KPIs) for patient access services Getting patient access right can improve patient outcomes, increase patient satisfaction and reduce healthcare costs over time. But quality is often subjective. What should providers seek when striving for “high-quality” patient access? Common metrics might include: Wait times for appointments, diagnostic tests and procedures Speed and accuracy of the appointment scheduling process Percentage of patient access-related inquiries resolved on first contact No-show rates, which might indicate communication or scheduling issues Efficiency and accuracy of insurance verification, coding and billing Revenue collected before or at the point of service Staff performance and productivity Tracking these metrics can help providers find new ways to optimize patient access services. How to improve patient access services (and why) Monitoring and improving these KPIs is easier with digital and data-driven systems. But the benefits of digital patient access services go far beyond efficient data reporting. Offering patients online, digital and self-service options for scheduling, pre-registration and payments leads to a better patient experience while improving operational efficiency. Improved patient experience Alex Harwitz, Vice President of Product, Digital Front Door, at Experian Health, explains that “For patients, the digital front door results in more convenience, choice and control over their patient access experience. For example, online self-scheduling streamlines the appointment process, so patients can schedule, reschedule, or cancel appointments whenever it is convenient for them, which is often outside provider office hours. We can make sure they're only shown available appointments with the right specialist, and then send them helpful reminders so they're less likely to miss the appointment.” He says, “Digital systems can simplify the booking process for patients with complex medical needs. By incorporating automated scheduling protocols and business rules, navigating specialist appointments becomes more streamlined.” Similarly, digital pre-registration means patients can complete paperwork from home, where they have access to their medical records and insurance information. Tools like Registration Accelerator can pre-fill much of this data, saving time and preventing errors. Patient portals and secure messaging platforms also allow patients to communicate directly with their providers safely and easily. They can seek advice and clarify doubts, fostering a stronger patient-provider relationship. Increased operational efficiency Many providers have hesitated to turn to automation in lieu of human staffing, but implementing automation yields immediate and significant benefits. This includes reduced manual labor, improved workflows and communication, and increased profitability. Self-service tools like Patient Scheduling Software and Registration Accelerator reduce the administrative overhead, so staff can focus on critical tasks that need a human touch. In Experian Heath's survey, 36% of providers said these types of technological improvements have helped to offset staff shortages. By incorporating accurate data from patients' medical records, there's also less risk of data entry errors, which speeds up downstream services and reimbursement. Digital patient access software can also generate performance reports, to drive further operational improvements against the KPIs listed above. What are the main obstacles in implementing patient access solutions?  Implementing patient access software may seem daunting due to resource limitations, outdated technology, and cost concerns. However, with the increasing demand for remote access to digital services, healthcare providers cannot delay any longer. Fortunately, those who have already taken the initiative are experiencing a significant long-term return on investment that outweighs the initial costs. For more complex challenges, a trusted third-party partner can help guide the way. Lack of standardized policies Patient pricing estimates are an essential piece of the patient access experience. However, insurance and reimbursement policies are constantly changing and vary by payer, so delivering accurate estimates is a tough ask. Many hospitals have struggled to comply with new federal price transparency rules. With Patient Payment Estimates, patients can be given an accurate, personalized breakdown of their financial responsibility, sent directly to their phone. Research by Experian Health and PYMNTS suggests that such tools can boost patient satisfaction by 88% and reduce the risk of missed payments. To help providers comply with broader requirements around price transparency, Experian Health has joined forces with Cleverley + Associates to offer a standardized solution. Interoperability and integration with existing systems The lack of compatibility between electronic health records and hospital management software can result in significant errors in patient information. These inaccuracies can lead to miscommunications with patients and payers, as well as delays in providing care and missed opportunities for reimbursement. To avoid this, providers should choose automated patient access tools that integrate with their existing systems. For example, Experian Health clients that already use eCare Next® can integrate additional patient access solutions, such as Eligibility Verification, through the same interface. There's no need for staff to access multiple systems and patient intake is much faster. Comprehensive data analytics give a better overview of operational performance. Safeguarding privacy and data security are also easier with integrated solutions from a single vendor. The future of patient access solutions in healthcare  Rapid technological advancements, evolving policies, and changing patient expectations can make the future of healthcare hard to predict. However, certain patient access trends look set to continue: Patients will increasingly seek out easy-to-use digital platforms for accessing and paying for care, especially as younger generations age and increase their utilization of healthcare services. Patients will increasingly seek personalized care – extending to tailored patient access experiences that reflect individual needs and communication preferences. The use of data analytics and AI will grow exponentially across healthcare services, helping providers identify patterns and automate workflows. Digital patient access services have become an integral part of the healthcare landscape as providers recognize their role in improving patient outcomes and overall business success. In today's healthcare landscape, these services are essential elements to success. Find out more about how Experian Health's patient access solutions can help providers improve patient satisfaction, increase operational efficiency, and future-proof their revenue cycle for years to come.

According to Experian Health's State of Patient Access 2023 survey, providers think recent efforts to improve the patient financial experience are paying off. But do patients agree? The survey, carried out in December 2022, suggests a disconnect between how patients and providers view the patient collections process. Many providers rate their collections services favorably, having invested in pre-service estimates, flexible payment options and tailored payment plans. However, patients see room for improvement and a chance for providers to improve patient collections. Many say they feel anxious about managing medical expenses, with uncertainty prompting some to consider canceling care or switching providers. Could a more compassionate and personalized approach to healthcare billing help patients navigate their financial obligations more easily? Here are 4 ways providers can improve patient collections and create a patient experience that attracts long-term loyalty. 1. Provide proactive price transparency Patients want to know how much their care will cost before they receive it: almost 90% of patients said receiving a price estimate before care is essential. Providers recognize this, and 67% believe their organization is doing a good job of providing clear, understandable estimates prior to care. Unfortunately, only 29% of patients say they actually received one. Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. Giving patients early clarity with precise pricing estimates helps them plan so they're less likely to avoid care or struggle with unexpected and unaffordable bills. Payments can also be collected faster and more efficiently. Despite the implementation of price transparency regulations, the incorporation of cost estimates into healthcare billing is not yet standardized, presenting a significant gap in the industry. Healthcare providers who prioritize accurate and easy-to-understand cost estimates are more likely to boost patient satisfaction ratings and increase improve patient collections. 2. Create personalized payment plans Personalized financial pathways are essential in healthcare. Patients have unique financial situations, and a one-size-fits-all approach won't suffice. Some patients may prefer to pay their bill upfront so they know it's taken care of, while others may need to spread out the cost into more manageable installments. Advanced data analytics can help providers create a more positive payment experience by assessing each individual's ability to pay and assigning them to the appropriate financial pathway. For example, Collections Optimization Manager scores and segments patients according to their propensity to pay, and automates the presumptive charity process so accounts are handled sensitively and efficiently. Using automation helped the University of California San Diego Health (UCSDH) deliver better patient experiences, maximize collections and reduce the cost to collect. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH's Systems Director explains that automation allowed them to maximize staff resources to support patients to understand their bills, as well as provided valuable insights into each patient's situation: “We serve our patients well when we can spend time explaining their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, explains how automation helped their organization optimize patient collections and improve patient satisfaction. 3. Provide support to those in need A topic on many providers' minds is Medicaid redetermination, following the loss of Medicaid coverage for millions of patients. Many may be eligible to re-apply, but in the short term, millions could be left floundering financially. Providers can support patients in this situation to sort through coverage, navigate charity eligibility and offer suitable payment plans to keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, says this is both a challenge and an opportunity for providers: “For providers, this may be a hard situation to navigate. At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offer them help can be powerful.” What can providers do as patients lose Medicaid coverage? The priority should be to identify patients who need charity assistance and connect them to any available support. Using credit data and other demographic data points, Patient Financial Clearance screens patients who may still be eligible for Medicaid and finds self-pay patients who may qualify for charity assistance. It also assigns patients to the appropriate pathways and even auto-enrolls them in financial assistance programs so they feel confident they're on the right path. 4. Offer flexible ways to pay Finally, a compassionate billing experience will involve as little friction as possible when the patient comes to making payments. According to the patients who participated in Experian Health's survey, payment experiences should be convenient, transparent and flexible, with 72% expressing a desire for online and mobile payment options. These features are essential to younger generations, who are less tolerant of inflexible, manual systems. Providers should offer a range of payment options that include in-person, telephone, mobile and online patient portals, so patients can pay in a way that's most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statements. Experian Health offers a suite of patient payment solutions that enable consumers to make secure payments at any point in their healthcare journey, through multiple channels. From customizable patient statements to mobile-enabled payment methods, these tools support a compassionate and convenient approach to patient billing, turning what can be a confusing process into one that is more efficient for both parties. Improve patient collections with automated solutions Consumers are the cornerstone of healthcare and providing a consumer-friendly payment experience can make a huge difference. Money is often a sensitive topic for patients, but with a consumer-centric payment experience, financial matters can be handled compassionately. Patients will be more satisfied and more likely to pay in full and on time, and providers can improve cash flow. With the right tools, healthcare billing and collections can become seamless and clear, and patients can pay their balances with ease. See how Collections Optimization Manager and other patient payment solutions can maximize and improve patient collections.

Upgrading claims technology was the top strategy for reducing denials in 2022, according to Experian Health’s State of Claims 2022 report. The report lists the most common strategies for minimizing the risk and impact of denials, based on a survey of 200 health professionals. With more than half of providers already embracing automation, there’s broad recognition that data-driven software and streamlined workflows are key to getting more claims approved the first time and minimizing avoidable revenue loss. And as new AI-based technologies gain traction as a route to faster and richer data analytics, there are growing opportunities for providers to leverage automated claims management solutions and improve healthcare claims processing. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand the current state of claims management. Watch the video to see the results: Here are 4 ways to improve healthcare claims processing, based on current practice and perceptions of claims management, and the solutions that can help providers reduce denials in 2023. 1. Upgrade claims technology More than half of survey respondents (52%) updated or replaced existing claims process technology in 2022. Healthcare executives were optimistic about using more advanced automation to improve claims processing workflows, with more than 91% saying they would “probably” or “definitely” invest in automation over the next six months. The benefits of automating healthcare claims management are well-documented. Less friction and fewer errors lead to faster and more accurate submissions, so claims are more likely to be reimbursed. Tasks can be assigned to the right specialist to make more efficient use of staff time and alleviate pressure on busy teams. Artificial intelligence (AI) takes this up a notch with additional predictive capabilities and the ability to “learn” from historical claims data. Action: Prioritize automation of data-heavy, repetitive claims management processes and leverage AI to prevent denials Recommended tool: ClaimSource® helps providers manage the entire claims cycle by creating custom work queues so staff can prioritize the most valuable tasks and speed up reimbursement. Experian Health’s new AI Advantage™ solution integrates with ClaimSource to predict and prevent denials. Pre-submission, AI Advantage™ – Predictive Denials identifies claims that are at risk of being denied, so corrections can be made before claims are sent to payers. AI Advantage™ – Denial Triage comes into play post-submission, reviewing patterns in denials to prioritize those with the greatest likelihood of reimbursement. Together, these tools give staff the insights to reduce workload and minimize denials. Experian Health is pleased to announce that we've ranked #1 in Claims Management and Clearinghouse, for our ClaimSource® claims management system, according to the 2023 Best in KLAS: Software and Professional Services report. 2. Automate patient portal claims reviews For 44% of respondents, automating patient portal claims reviews were seen as an effective way to get claims right the first time. Patients can check for errors and inconsistencies in their own accounts, to prevent avoidable mistakes from ending up on claims submissions. Patients can also use portals to track the progress of claims, so they don’t need to speak to an agent. It’s more convenient for patients and reduces the call burden on staff. Action: Review digital patient access strategies to improve patient engagement Recommended tool: Safe and secure patient portals can facilitate better communication between patients and providers, smoothing out many common bumps in the claims management process. If it’s easier for patients to submit accurate and timely insurance, medical and contact information, it’ll be easier for providers to submit prompt, accurate claims. 3. Provide accurate estimates In 2022, 40% of respondents said they’d focused on providing accurate cost estimates to patients as a way of reducing claim denials. Patient estimates may not be the most obvious route to improving the denial rate, but they set the stage for successful claims management. If a provider can pull together all the necessary variables to produce accurate estimates, then they have all the pieces in place to submit clean claims. Other byproducts of reliable, upfront estimates can be seen throughout the revenue cycle: patients are more likely to pay their bills sooner and have better patient experiences. Action: Invest in pre-service patient estimates technology Recommended tool: Patient Payment Estimates allows providers to pull together complex data on each patient’s specific medical, coverage and financial circumstances into an accurate estimate of what the payer will cover and what the patient will have to pay. These accurate, upfront estimates not only improve the patient experience and make it easier for patients to understand and pay their bills, but also ensure the pieces are in place to support smoother claims management. 4. Digitize registration Finally, 39% of providers said they’d embraced digital patient registration in 2022 to tackle the problem of denials. As with patient estimates, this approach works by ensuring patient details are as accurate as possible from the start. Improving accuracy on the front-end prevents errors, delays and rework further on in the claims processing workflow. Digital and self-service registration also reduces the burden on staff. Many of the reasons providers gave for denials related to concerns around managing limited resources for everything from payer policy changes to patient admissions. Digital patient registration allows patients to complete patient access before they come in, so staff are freed up to focus on other tasks. Action: Implement an automated self-service patient registration solution Recommended tool: Registration Accelerator reduces reliance on time-consuming manual data-entry processes, which often result in denied or delayed reimbursements. Not only does it alleviate staff pressures and reduce labor costs, it also improves data quality. This solution integrates with existing health information systems, electronic medical records and eCARE NEXT®, which streamlines data entry. This will be key as providers look to reduce labor costs, increase efficiency and accelerate payments. Effective claims management requires speed, accuracy and flexibility. Find out how Experian Health’s automated claims management solutions can help providers improve healthcare claims processing and reduce denials.

Proactive price transparency could be a competitive advantage for healthcare providers, as a Kaiser Family Foundation survey suggests a majority of Americans believe Congress should prioritize the issue. The survey revealed that 60% of respondents think legislative action to make healthcare prices more transparent should be a “top priority” for the next Congress, while a further 35% said such laws were “important, but not a top priority.” Concerns about the cost of living are top of mind for many households, with 91% of respondents specifically noting their worries about rising healthcare prices. Providers can help meet the demand for more transparent pricing by implementing solutions to make it easier for patients to understand and plan for upcoming bills. Those that proactively meet and exceed patient demand for clearer pricing information will garner more patient trust and loyalty, and in turn, secure an important competitive advantage in a challenging economic context. Why are patients calling for greater price transparency? For many patients, the process of paying for healthcare is like trying to find their way through a maze, with numerous twists and turns and no clear path forward. Unlike most other purchasing decisions, patients lack upfront information about the options in front of them. Many do not fully understand the cost of care, and as a result, may not be aware of or prepared for the forthcoming financial burden. This lack of transparency causes uncertainty and unease, leading to postponed care or missed payments. With transparent pricing, patients can make more informed decisions and choose the most cost-effective options. Those with high out-of-pocket expenses can shop around for services that best fit their budget and estimate the cost of care in advance. Transparent pricing is especially important for patients with chronic conditions or those who require ongoing care. Are providers meeting the demand for price transparency? Many providers have embraced the push for transparent pricing, by introducing upfront patient estimates and tools to help patients understand and manage their bills. Transparency may be a requirement under the Hospital Price Transparency Final Rule, but providers are also incentivized by the promise of faster payments and fewer time-consuming billing queries. However, implementation of price transparency measures has been patchy: as of August 10, 202, only 16% of hospitals were compliant with the rule. In a podcast interview for Becker’s Hospital Review with Riley Matthews, Lead Product Manager at Experian Health, Jamie Cleverley, President of Cleverley + Associates, suggests two main obstacles: confusion around what information needs to be disclosed (more on this below) concerns that sharing pricing information could negatively affect revenue. The second concern is valid, but evidence suggests that disclosing prices to patients can save money, by reducing unnecessary hospitalizations, readmissions and emergency visits. Missed payments are less likely if patients feel in control of their financial situation. In fact, research by Experian Health and PYMNTS suggests that upfront cost estimates improve patient satisfaction by 88%, which encourages prompter payments. Delivering a better patient experience with accessible pricing information To help healthcare organizations meet patient demands for clearer pricing and ensure compliance with the federal rule, Experian Health and Cleverley + Associates have teamed up to provide a standardized solution. Listen in as Jamie Cleverley, President of Cleverley + Associates, and Riley Matthews, Lead Product Manager at Experian Health, discuss how a new partnership is helping providers comply with the Price Transparency Rule: Each organization brings its specific expertise to help healthcare providers provide clear and compliant pricing information: Experian Health’s Self-Service Patient Estimates tool enables compliance with the requirement to display payer-specific rates as a consumer-friendly list of 300 shoppable items. This tool gives patients upfront, accurate estimates that are easy to understand so that they can make informed choices about their care. Cleverley + Associates helps providers make pricing information available as a machine-readable file, quickly and at scale, so providers can fulfill the requirement to display such files on their website. The solution is neatly packaged to save providers from engaging in discussions with multiple vendors or scrambling to find internal solutions for each individual requirement. Cleverley says that working with the two organizations together can save providers time and stress: “We have the information and the technical capacity to offer a format we think is useful, which complies with all the rules. There’s anxiety around this – providers worry about whether CMS will view [their solutions] as compliant. But with us, they’re working with trusted partners that have had those conversations with CMS, that have released these files already and that have been through the audit process.” For Matthews, this adds up to a user-friendly experience that’s not only compliant but gives patients what they need: “We needed to provide a patient-facing estimate-creating solution that shows those top 300 shoppable services for a hospital or a doctor’s office. We were able to do that through our existing product, Self-Service Patient Estimates. We have this portal that we can integrate with our clients’ websites, which guides patients through the entire process. What we did not have – and where Cleverley came in – were those complex machine-readable files… So, we were able to come in from both sides with price transparency and say, ‘ok, now we solve both, and we’re here to provide a holistic solution.’” From compliance to competitive advantage Penalties for non-compliance with the Price Transparency Rule may have been limited to date, but this may change as the rule reaches its second anniversary. Furthermore, some states are starting to bring in their own legislative measures to protect patients from opaque billing practices. And with patient expectations clearly stated, the pressure on providers to deliver transparency is mounting. But as noted, this is about more than compliance. Patients are looking for a clear and compassionate financial experience and will reward providers that deliver this. Providers should consider how to keep patients informed and empowered at every stage of the financial journey. Experian Health offers a suite of payment tools designed to achieve this, which bring together accurate estimates, tailored payment plan recommendations and convenient payment options. Find out more about Experian Health’s Price Transparency Solutions or watch the video to hear more about Experian Health’s price transparency partnership with Cleverley + Associates.

With inflation still high, the economic outlook remains uncertain for healthcare consumers. Many households feel squeezed by rising housing, food and fuel bills, while their incomes remain broadly static. Inflation’s impact on healthcare can be seen in delayed treatments, as a 2022 Gallup poll found that 38% of patients postponed medical care because of concerns about costs – the highest amount since the poll began in 2001. The situation is exacerbated by the fact that Medicaid continuous enrollment came to an end on March 31, 2023. To complicate things further, reimbursement rates and employer health plans tend to be negotiated in advance, which means inflation can take longer to filter through the healthcare economy. Both McKinsey and Deloitte predict that hospital profit margins will reduce in the coming year or so. Resulting price increases will be reflected in employer coverage plans, and ultimately pass to workers in the form of higher deductibles and out-of-pocket costs. In short, inflation’s impact on healthcare may continue to create ripples in the healthcare industry. For healthcare providers, reimbursement may become more challenging as patients find it harder to pay their portion of the cost. What can providers do to mitigate inflation's impact on healthcare? Providers are already working to maximize operational efficiency with automation and digital tools that reduce workforce pressures, streamline back-office processes, and leverage data to drive improvements. Reducing costs is just one side of the coin. The other is to maximize opportunities for reimbursement by supporting patients throughout their financial journey and making it as easy as possible for them to pay. Here are 4 ways that healthcare providers can mitigate inflation’s impact on healthcare while reducing friction for patients and maintaining cash flow: 1. Provide transparent pricing and upfront patient estimates Because inflation has forced patients to prioritize their spending, many are opting to postpone healthcare. But delaying treatment or stretching out medicines to save money could lead to poorer health outcomes, and potentially more expensive treatment being needed later. By proactively offering patients accurate pricing estimates before they come in for care, providers can help patients get a fuller picture of what their final bills are likely to be. Estimates can be sent directly to the patient’s mobile device, along with user-friendly links to payment plans and payment methods. This makes it much easier for patients to plan, so they’re less likely to default on payments or delay care. 2. Help patients find unknown insurance coverage With the end of continuous Medicaid enrollment, millions of patients could have gaps in coverage. While this is largely an issue for states to manage, providers can take steps to help patients find additional coverage, and support those at greatest risk to find financial assistance and plan for upcoming bills. Coverage Discovery can be used at any point in the revenue cycle to search for missing or forgotten billable coverage. It uses advanced search and proprietary data sources to check for both government and commercial insurance coverage. When coverage is found, patients get the reassurance of knowing that their bills will be covered, while providers can avoid writing off these accounts to bad debt. And because Coverage Discovery uses a contingency fee pricing model, providers only pay for the tool when they are reimbursed. 3. Offer simple and convenient methods to plan and manage bills Prescription medications, inpatient visits and other services are expected to increase in price over the coming year. Americans may be more concerned about how they’ll shoulder the costs – especially the 49% who say they’d be unable to pay an unexpected bill of $1000 or more. Providers can make the process easier for patients with data-driven digital tools. Patient Financial Clearance identifies patients that are likely to be able to pay upfront and those who may need a payment plan or financial assistance. This information allows providers to engage in compassionate financial counseling to make sure patients are guided to the most appropriate pathway. Another option is to leverage self-service tools to give patients more control over how and when they pay. Patient Financial Advisor offers pre-service estimates and payment options that patients can access anywhere, anytime. They can take stock of their financial situation, plan for bills, and then make payments at the click of a button. If it’s easier to pay, patients will be less likely to delay. 4. Make it easier for patients to schedule care While many patients may consider delaying care because of cost, many say they’ve postponed treatment for other reasons. Concerns about COVID-19, work commitments, and difficulty booking appointments can also lead to delayed care. For those that are foregoing care for reasons other than cost, providers should look at improving the patient access experience with more self-service options. Online self-scheduling allows patients to book, reschedule and cancel appointments at their own convenience. Digital patient registration similarly reduces friction, by enabling patients to fill out forms from their mobile devices. Patients will be less likely to forego care when access is as easy as ordering groceries online. Proactively reducing inflation's impact on healthcare Inflation’s impact on healthcare continues to be felt – and could get worse as the year goes on. Rising medical bills may cause patients to keep deferring care. Providers can proactively reduce the effects by incorporating digital solutions and patient engagement strategies that make it easier for patients to afford and receive care. Find out more about how Experian Health can help healthcare organizations bolster their revenue cycles and mitigate inflation’s impact on healthcare.

Because so many healthcare claim denials originate in the front end of the revenue cycle, providers should focus on improving insurance eligibility verification at the early stages of the patient journey. Verifying coverage earlier in the billing process with automated eligibility verification software increases the chance of submitting clean claims the first time and protecting future revenue. As coverage and benefits become more challenging for patients to navigate, prioritizing eligibility could also hold the key to better patient-provider relationships. Given the complexity of the healthcare billing system, patients have little tolerance for errors and delays. Many already worry about being able to cover their financial obligations, so denied claims are the last thing they want to see. Insurance verification reduces denials, gives patients greater clarity over their upcoming expenses and allows healthcare organizations to focus on providing the best possible care. This article looks at why improving insurance eligibility verification can help healthcare providers optimize cash flow and achieve higher levels of patient satisfaction and loyalty. What are the steps in the insurance eligibility verification process? Before filling out a claim, providers must be sure that the services they’re seeking reimbursement for are covered by the patient’s health insurance. They must also check that the patient’s details match those on their insurance plan. If a provider offers treatment or services and it later turns out that the patient’s coverage has expired or the patient is ineligible for those items, the claim will be rejected. To verify eligibility, providers must therefore be able to answer the following questions: Are the patient’s contact details current and correct? Does the patient’s insurance plan cover the planned treatment or services? Do any exclusions apply under the patient’s plan? Have all necessary pre-authorizations been obtained? Is the coverage active? What are the thresholds for deductibles, co-pays or coinsurance, and do any annual or lifetime limits apply? Confirming eligibility early on lays the groundwork for better claims management and minimizes the chance of errors. How does an effective eligibility verification system benefit patients and providers? Accurate and timely insurance verification clarifies to all parties how bills will be covered (or not) ahead of time. If a claim ends up being rejected, the patient will find themselves with responsibility for more of the bill, the provider will be left uncompensated for services rendered – or both. Clarifying coverage in advance avoids these scenarios. When providers can generate and communicate pre-service patient estimates with confidence, patients can plan for their bills and even make payments before or at the time of service. The financial benefits are clear, but patient satisfaction is also likely to increase: a study by Experian Health and PYMNTS found that patients who received pre-treatment estimates were more satisfied with their care than those who did not. Automated pre-service eligibility checks also improve communication between patients, providers and payers by reducing the manual workload on staff. Instead of spending time checking and fixing errors, staff can focus on helping patients with more complex cases. According to the CAQH, as much as $10 billion could be saved each year by switching to electronic eligibility and benefits verification. How does it help the claims process? In Experian Health’s report on the State of Claims 2022, the most common reasons given for claims being denied included: issues with prior authorizations, provider eligibility, patient information, changing payer policies and services not being covered. Automated eligibility verification helps solve each of these. With fewer errors in the pipeline, organizations can file claims faster and receive payments in a timelier manner. Eligibility Verification accesses up-to-date eligibility and benefits data from multiple sources, generating an instant read-out of a patient’s insurance status. More accurate information increases clean claims rates, accelerates reimbursement and allows providers to forecast future revenue levels more reliably. Staff can view responses in a clear and concise format and receive alerts when follow-ups or edits are required. This sets the tone for a more efficient claims process all around. Proactive and error-free claims management saves staff time that might otherwise be spent on reworking claims and engaging in lengthy disputes with payers. From the patient's perspective, earlier verification can fast-track registration because much of their information is checked before they even arrive for care. Waiting time is reduced because staff benefit from more streamlined workflows. As noted, finding missing coverage gives patients clarity over what they owe, so they’re more apt to pay bills on time. Automation can also be used to connect patients to the appropriate financial support. For example, with Patient Financial Clearance, providers can offer compassionate financial counseling and get patients on the right financial pathway. It improves the patient experience while reducing the risk of bad debt. What does a good insurance eligibility verification system look like? When it comes to choosing an insurance eligibility verification solution, the checklist should include the following features: Compatibility with existing systems and electronic health records - Eligibility Verification accelerates verification and registration by drawing together accurate patient data. And through eCare NEXT®, clients can manage multiple patient access functions through a single interface. Simple methods for updating or changing patient information - User-friendly interfaces allow staff to make changes from any device, as and when new information arises. Integration with patient portals means patients can spot errors themselves, too. And tools such as Registration QA can drive data accuracy by highlighting errors as soon as they occur, both pre-and at the point of service. Rapid results, with patient benefits information readily available when needed - Eligibility Verification confirms patient eligibility and calculates reimbursement estimates with precision. This incorporates CAQH COB Smart® data for enhanced coordination of benefits in relevant transactions. Ability to calculate patient estimates - A verification tool that integrates with automated patient payment estimates ensures patients understand their coverage, co-pays and deductibles before treatment proceeds so that they can plan for their final bills. Integration with pre-authorization tools - For some services, a payer may require the provider to seek authorization before going ahead. An insurance verification solution can flag up where prior authorization is needed to prompt action and prevent delays. Ability to source data from major health insurance carriers, including Medicare - Eligibility Verification connects with nearly 900 payers with advanced search functionality to match patients to current eligibility and benefits data. This can be used alongside an optional lookup service for Medicare beneficiaries to find and validate MBI numbers. Ongoing changes to the health insurance landscape mean that providers must pay close attention to the process of verifying coverage and benefits. Although insurance verification is a small step in patient access, the impact can be felt throughout the patient’s journey and the provider’s revenue cycle. By optimizing for earlier and more accurate insurance verification with workflow automation and advanced data analytics, providers can reduce the risk of denied claims, improve financial performance and protect patient-provider relationships. Find out more about how Experian Health can help healthcare providers streamline their claims process with front-end improvements to verify insurance eligibility, file error-free claims and get paid faster.