All posts by Kelly Nguyen

Highlights: Patient payment estimator tools give patients a clear, accurate view of the cost of care upfront. Patients who understand their financial responsibility have better financial experiences and are more likely to make a plan to pay their medical bills. Experian Health data has found that 43% of patients say they're likely to postpone or cancel care without an estimate. However, when patients know the cost of care up front, 81% say it helps them better prepare to pay, and nearly 40% say they have a better payment experience. As price transparency laws become stricter and enforcement tightens, providers can use patient estimator tools to ensure compliance with evolving regulations. When healthcare estimates are inaccurate, patients are more likely to cancel medical appointments or struggle to pay their bills. Despite upticks in the number of estimates sent to patients, accuracy has declined, leaving patients unsure about the cost of care and providers vulnerable to chasing collections and potential compliance issues. With healthcare costs continuing to climb and pricing transparency regulations getting tighter, nearly 90% of providers feel an urgent need to improve or implement accurate estimates. Patient payment estimator tools offer a solution that providers can leverage to improve accuracy and stay compliant. Webinar: Price Transparency – Mandates met? Audit ready? Register for our upcoming webinar to explore the latest evolutions in the Price Transparency regulatory environment. What is a patient payment estimator? In healthcare, a patient payment estimator is a technology solution providers can use to create and send patient estimates. Payment estimators use specific data inputs like insurance benefits, contracted payer rates, and provider service pricing to generate estimates. Providers are then able to print them in-office or send them to patients through a self-service web portal or mobile device with a secure text link. Patient payment estimators play an important role in keeping revenue cycles on track. When patients have accurate upfront estimates, they can make more informed decisions about their healthcare and make a plan to pay. Patient estimating tools are also commonly leveraged by providers to meet regulatory requirements, like the new executive order aimed at strengthening hospital price transparency signed by the U.S. president on February 25, 2025. Benefits of implementing a patient payment estimator Patients want to understand the cost of care before receiving services and how much insurance will cover, while providers want to keep schedules full and spend less time chasing point-of-service payments. Patient payment estimator solutions benefit both patients and providers. According to recent Experian Health data, 43% of patients say they're likely to postpone or cancel care without an estimate. However, when patients know the cost of care up front, 81% say it helps them better prepare to pay, and nearly 40% say they have a better payment experience. Patient payment estimator solutions allow providers to easily create and send clear and accurate upfront estimates. This helps providers avoid revenue leaks, improve revenue cycles, streamline estimate delivery, reduce errors and replace outdated manual processes. Additionally, today's healthcare providers are tasked with meeting new regulatory requirements for price transparency, like the Hospital Price Transparency Rule and No Surprises Act. Failure to do so can result in non-compliance penalties or other enforcement actions by the Centers for Medicare & Medicaid Services (CMS). Adopting patient payment estimator technology can help providers stay audit-ready, avoid hefty fines and remain vigilant as compliance requirements rapidly evolve. Report: State of Patient Access 2025 Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. Key features of an effective patient payment estimator When adopting a patient payment estimator solution to strengthen price transparency and deliver more accurate upfront estimates, providers should look for the following key features: Real-time data integration Patient estimator tools are only as accurate as the information available to create the estimates, so it's critical that the data is up-to-date. Solutions offering seamless real-time data integration with the latest payer contract terms, patient insurance benefits, claims history and other data sets influencing patient costs can provide the most accurate estimates. User-friendly interface A patient payment estimator solution must be easy to use for both providers and patients. Web-based platforms make it simple for busy staff to create and send accurate estimates to patients with just a few clicks. Then, patients can access their estimates through a secure self-service web portal or a link sent to their mobile device. Audit protection With the passing of the new executive order, providers must have audit-ready patient payment estimator tools. Solutions like Patient Estimates from Experian Health and Cleverley + Associates log every estimate into a robust reporting system and automatically format estimates as compliant machine-readable files. How to implement a patient payment estimator Implementing a price estimate solution often helps providers improve the accuracy of patient estimates, eliminate tedious manual tasks and boost self-pay collections. Here's a closer look at the steps to take. Assess the needs of the healthcare organization. Before adopting a new patient estimator technology, evaluating current billing and estimating processes is critical. Providers need to think about what's working and where there are opportunities for improvement. What are the overall goals for implementing a patient payment estimator? Is the organization looking to improve accuracy or reduce administrative burden? Are there any apparent compliance or regulatory gaps that need filling? Select the right solution. Providers must choose a patient estimator solution that meets the needs and goals of the healthcare organization and its patients. Does the tool integrate with existing systems? Is it easy for staff to send estimates and for patients to access their them? Is it compliant with price transparency regulations? Does it offer audit protection? Train staff. Once a patient estimator tool is in place, staff must be trained to use the new system effectively. Training may include teaching staff to use the platform to create and send estimates, utilize reporting tools for compliance audits or educate patients on how to access estimates. Ongoing education on changing regulatory requirements Monitor performance. With payer requirements, insurance benefits and regulatory requirements constantly changing, healthcare providers must continuously monitor the performance of their patient payment estimator solution. Are the estimates accurate? Is it scalable to keep up with a growing practice? Does it offer flexibility to adapt to evolving compliance needs? Have point-of-service collections metrics improved? Improving transparency with patient payment estimators As the demand for more accurate patient estimates grows and jumping through compliance hoops becomes more challenging, providers can adopt patient payment estimator solutions to strengthen price transparency. Tools like Experian Health's Patient Estimates solution and partnership with Cleverley + Associates offer more accurate, compliant estimates, streamlined workflows and improved patient access. Audit-ready reporting and regulatory support, like educational webinars, help providers stay equipped and competitive when transparency requirements shift. Learn how Experian Health's patient payment estimator and price transparency solutions can help healthcare providers stay compliant with current regulations and help patients better understand the cost of care. Learn more Contact us

Key takeaways: As healthcare costs increase, the demand for patient financial assistance also rises as more patients find themselves without insurance coverage or facing economic hardship. Early identification of charity care eligibility reduces patient financial stress, makes the financial experience more compassionate, and protects providers from bad debt. Automated screening tools like Patient Financial Clearance, built on accurate, real-time data, are essential for flagging eligible patients before accounts go to collections and ensuring that no one misses out on vital support. Too often, patients who qualify for financial assistance aren't identified until after their accounts have been sent to collections. As healthcare costs increase and coverage becomes less certain, more patients will likely face financial challenges, making timely support even more critical. With estimated income data and financial behavior indicators, healthcare organizations can identify patient eligibility for charity care earlier, before the bills pile up. This article looks at how automated charity screening tools like Patient Financial Clearance can help providers support patients, protect revenue and remove the financial barriers that get in the way of care. The rising demand for patient financial assistance Demand for financial support is climbing quickly as economic pressures and policy changes make it harder for patients to keep up with medical costs. Nearly one in four adults are uninsured, often delaying or forgoing care because of high deductibles and out-of-pocket costs. Medicaid redeterminations have already resulted in more than 19 million disenrollments. At the same time, the Congressional Budget Office estimates that new federal spending provisions could push an additional 10.9 million people out of health coverage by 2034. As a result, revenue cycle teams will increasingly find themselves trying to collect payments from patients who are more likely to need financial help. "We're also seeing more states pass legislation that effectively mandates early screening for financial assistance before billing, such as Oregon's HB 3320," says Alex Liao, Senior Product Manager for Patient Financial Clearance at Experian Health. "These policies are becoming major drivers of financial clearance efforts. Identifying financial need early in the process helps patients avoid unexpected medical debt, and gives providers the insight they need to manage accounts appropriately and protect revenue." For providers, growing administrative costs, claim denials and underpayments mean less flexibility to absorb uncompensated care. Early screening protects against the burden of medical debt and facilitates the transparency and clarity patients need to manage their bills. Why does early identification of patient charity care eligibility matter? When charity care eligibility is missed or delayed, patients can quickly accumulate medical debt they can't afford. In an interview about the latest State of Patient Access survey, Clarissa Riggins, Chief Product Officer at Experian Health, explains why this is so important: "Cost is a major pain point," she says. "The report shows that 34% of patients struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care." Identifying charity care eligibility early on ensures these patients don't fall through the cracks. This reduces financial stress for patients and protects providers from avoidable write-offs and bad debt. When staff know which patients are likely to need support, they can have more compassionate and helpful financial conversations and connect patients with appropriate resources. Unlock patient charity care eligibility with automated screening  Manual charity care screening processes are often time-consuming and prone to delays, especially when staff have huge volumes of information to handle. Automated financial assistance screening tools use real-time data to identify patients who may qualify for charity care with greater speed and accuracy. For example, Patient Financial Clearance (PFC) helps providers screen patients earlier in the financial journey by automatically checking for eligibility at or before the point of service. It uses a range of estimated data points, including household income, household size and Federal Poverty Level (FPL) percentage, to assess whether a patient qualifies for charity care, Medicaid or other financial assistance. After calculating a risk score to evaluate the patient's propensity to pay, PFC can pre-fill application forms, reducing the need for staff input and accelerating enrollment. For those who may not qualify for charity care, PFC can recommend payment plan options that align with the provider's financial policies. This proactive, behind-the-scenes screening enables providers to flag eligible patients at multiple points in the care journey, ensuring more patients get the support they qualify for while minimizing manual work for staff. Case study: How UCHealth wrote off $26 million in charity care with Patient Financial Clearance See how UCHealth partnered with Experian Health to create a more streamlined approach to providing charity care to patients who needed it. Take a smarter approach to patient financial assistance with Experian Health Automated charity screening tools like Patient Financial Clearance are faster, more consistent and easier for staff to act on. But they'll fall short without reliable data. "Strong data practices are key," says Riggins. "That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records… By automating tasks traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can prevent billing and claim errors in the long run. Clean data makes everything easier, from billing to insurance verification to patient trust." She gives the specific example of Patient Access Curator, which uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics, and coverage discovery. When thinking about how to use data to find charity care eligible patients, tools like this lay the foundation for more proactive financial engagement. By cleaning up data and automating repetitive tasks, Experian Health's revenue cycle solutions enable providers to streamline their financial operations and give financial counsellors the details they need to engage patients at the right time and help them understand their options. The bottom line Automation and accurate data aren't just backend upgrades. They're essential to building a smarter, more compassionate financial experience, with fewer accounts going to collections. By embracing the best practices for identifying patients needing financial assistance, early action, better data quality, and automation, providers will be better placed to make sure no one misses out on the help they need. Find out more about how Patient Financial Clearance can help healthcare organizations automate financial assistance and identify patients eligible for charity care. Learn more Contact us

Managing claims efficiently—and reducing denials—remains one of the biggest challenges for healthcare providers. Statistics reveal that 46% of denials are caused by missing or inaccurate data, as highlighted by Experian Health's 2024 State of Claims Survey. For providers, these denials translate into endless follow-ups with patients, staff burnout, rising bad debt (which has increased by 7% year-over-year), and slim revenue margins. Reworking a denied claim costs providers an average of $25 and hospitals $181—an expense that is difficult to justify. Introducing Patient Access Curator: Automated claims accuracy from day 1 Fortunately, there is now a way to ensure claims are processed accurately from the start, without excessive effort: Patient Access Curator (PAC), Experian Health's groundbreaking new tool that uses artificial intelligence (AI) to revolutionize the claims process. As a central component of Experian Health's Patient Access portfolio, this innovative solution automates front-end processes, identifies incorrect data upfront, and resolves inaccuracies in real time, preventing costly claim denials before they occur. Introduced in early 2024, the curation tool is getting the attention of revenue cycle leaders at health systems and laboratories, with good reason.  This article gives a run-down of Patient Access Curator and how it helps providers prevent claim denials in seconds.  Discover how leading organizations like Exact Sciences and Trinity Health have leveraged Patient Access Curator to automate eligibility, reduce denials, and transform their revenue cycles. Watch our pre-recorded session from the 2024 Experian Health High-Performance Summit to see Patient Access Curator in action. Watch now Built-in AI for more accurate data and seamless claims denial prevention Most issues that lead to denials crop up early in the revenue cycle, when information is missed or captured incorrectly during patient registration. For this reason, it makes sense to focus on denial prevention strategies  on the front end. With so much data to capture, manual strategies are bound to stumble. Unfortunately, many digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility and check for any billable coverage that might have been missed. Patient Access Curator takes on these tasks seamlessly, and right within Epic workflows. From patient demographics and eligibility checks to coordination of benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), and insurance discovery, the system automates these essential processes, providing precise data within moments. This solution ensures data integrity from the moment of registration by replacing manual guesswork with advanced AI-driven technology. This reduces the frequency of denials, minimizes A/R write-offs, and curtails vendor fees. Beyond enhancing efficiency, the tool safeguards the financial health of healthcare providers.  Jason Considine, President of Experian Health, says, "Our mission is to simplify healthcare. Patient Access Curator's advanced AI technology equips providers to address claim denials more effectively and efficiently than ever before."  Say goodbye to manual work with instant eligibility and insurance verification Patient Access Curator simplifies operations for billing teams, healthcare staff and patients. By removing administrative hurdles, staff can focus on patient engagement, rather than spending time on paperwork, phone calls and browsing websites for data. The outcome is improved satisfaction for both healthcare providers and their patients.  "We know this technology is revolutionizing the healthcare industry," shares Jordan Levitt, Senior Vice President at Experian Health. Levitt, who developed the AI-powered data capture technology, explains, "By delivering faster, more accurate results, providers can improve financial solvency while giving staff and patients a better experience."  Gone are the days of asking patients for insurance cards or verifying numbers and dates that might be inaccurate. With this solution, registrars and billing teams can be confident in the data they collect, right from the start.  PAC was created to replace the manual guesswork that often bogs down eligibility and insurance verification processes. From patient demographics and eligibility checks to COB primacy, MBI, and insurance discovery, this solution automates these critical touchpoints, delivering accurate data in seconds.  Fewer denials, faster reimbursements  The impact on denial prevention is unparalleled. Patient Access Curator ensures fewer claim rejections and faster payer reimbursements by identifying and correcting bad data across eligibility, COB, and discovery at the start of the revenue cycle. Providers are left with more retained revenue, which can be reinvested into what truly matters: patient care.  Patient Access Curator: Key features that set it apart Patient Access Curator differentiates itself as a comprehensive, all-in-one product that simplifies the most complex aspects of claims management. Key features include:  Real-time data correction: Fixes inaccurate data instantly without staff intervention.  Comprehensive coverage: Finds and corrects bad data across eligibility, COB primacy, MBI, demographics, and insurance discovery.  Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing  Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches Demographics: The platform can quickly check and correct patient contact information.  Seamless integration: Automatically updates host systems (Epic) with verified and corrected coverage data in seconds.  The results? Fewer clicks, faster workflows, and more accurate billing processes. PAC doesn't just prevent claim denials; it transforms how healthcare teams approach patient access and revenue cycle management.  Proven ROI: How Patient Access Curator delivers $100 million boost to Exact Sciences Explore how Patient Access Curator powered a $100M improvement at Exact Sciences by automating insurance discovery and reducing claim denials. Improve financial health by focusing on patient health By eliminating redundant administrative questions, Patient Access Curator allows patients to focus on their health rather than the complexities of billing and coverage. Meanwhile, healthcare staff enjoy a boost in morale, thanks to fewer manual tasks and more efficient workflows—a benefit that can lead to higher staff retention over time.  Patient Access Curator is more than a tool; it's a game-changer for healthcare organizations looking to protect their revenue while delivering a better, more seamless experience for both staff and patients. Say goodbye to manual guesswork and hello to a smarter, faster, and more reliable way to manage claims. With PAC, healthcare organizations can finally get claims right from the start, without the hassle.  Patient Access Curator is available now - learn how your healthcare organization can get started and prevent claim denials in seconds. Learn more Contact us

Highlights: Payer contract management software helps reduce revenue lost through denied claims and underpayments – two of the biggest pain points for providers – by validating reimbursements, supporting compliance and flagging policy changes in real time. Named "Best in KLAS" three years in a row, Experian Health's contract management tools optimize payer contracts and improve financial performance without adding staff. Experian Health's Contract Manager enabled OrthoTennessee to achieve an 86% success rate on appeals, saving time and recovering thousands of dollars. Claim denials and underpayments continue to cut into provider revenue, making them top pain points for healthcare chief financial officers. In Experian Health's 2024 State of Claims survey, 73% of providers reported an uptick in denials over the previous year, while 77% were seeing more frequent payer policy changes. When contract terms aren't up to date or properly understood, these changes can lead to costly surprises. Many healthcare organizations are turning to claims management automation to improve front-end operations and prevent downstream denials. But could they be overlooking another digital tool? Implementing payer contract management software is a practical way to strengthen early revenue cycle performance and ward off discrepancies that lead to denials. This software helps hospitals and health systems recover hundreds of thousands of dollars annually by auditing payer contracts and identifying underpayments. The role of payer software in enhancing contract efficiency Payer contracts set the terms for how providers get paid. These agreements cover details like claim submission timelines, reimbursement schedules, covered services, reimbursement rates, dispute procedures, contract duration and renegotiation terms. When managed well, they ensure providers are reimbursed accurately and promptly. However, monitoring complex payer contracts is becoming increasingly challenging for providers. According to the State of Claims survey, 43% of providers are very or extremely concerned about receiving full reimbursement. Frequent changes to pre-authorization rules and other payer policies are the main reason for this. Many contracts renew automatically or are amended with little notice, making oversight difficult. "Depending on how the contract is written, providers may receive very little notice of these changes," says Tricia Ibrahim, Director of Product Management, Contract Manager Suite. "Without a way to systematically and efficiently monitor these agreements throughout the contract term, there is simply no way for a provider to ensure they're paid properly." Payer contract management software addresses this by streamlining contract workflows and standardizing how agreements are handled. Built-in modelling tools allow providers to simulate different claim scenarios so they can negotiate terms from a stronger, well-informed position. Dashboards offer real-time insights that help staff ensure compliance, prevent denials and secure proper reimbursement. Key benefits of healthcare payer software for managing contracts A big part of the challenge for providers is that they are often juggling multiple contracts with multiple payers, including private insurers, Medicare, Medicaid and third-party administrators. Each has its own rules, rates and timelines. Without an automated way to track everything, it's easy for revenue to slip away. Payer contract management software helps by: Centralizing all contracts in one place Tracking critical dates like renewals and amendments Flagging changes in reimbursement terms Linking payer terms directly to claims workflows Identifying underpayments by comparing actual and expected reimbursements. This amounts to more than just good record-keeping: these tools offer instant feedback to reduce errors that could trigger denials. Teams save significant time because they no longer need to review contracts or chase down missing payments manually. Frances Thomas, Manager of Payer Strategy at OrthoTennessee, uses Experian Health's payer contract management software to negotiate more favorable settlements and terms with payers. "The system gives us the information we need to be successful," she says. "They can't really argue with you on that." Watch the webinar: See how OrthoTennessee achieved an 86% successful appeals rate with Contract Manager. Optimizing payer contracts with advanced contract management tools A first step in reducing denials and boosting revenue should be ensuring the revenue cycle team thoroughly understands their payer contracts. Contract management systems support this by rooting out ambiguous language, complex reimbursement terms or overly strict coding requirements. By analyzing contracts in detail, these tools identify hidden pitfalls that might go unnoticed until revenue is at risk. Experian Health's Contract Manager and Contract Analysis solution optimizes this process by checking claims before submission, then validating expected reimbursement against allowed amounts. Rates and authorization rules are populated automatically to reduce manual input, while contract mapping and real-time alerts help teams stay compliant. Providers also benefit from extra support through Experian Health's team of contract analysts, who are on hand to review contract terms, fee schedules and payment policies to ensure nothing is overlooked. This end-to-end visibility and guidance is why Experian Health's payer software has been named "Best in KLAS" for three consecutive years. One major benefit for OrthoTennessee was being able to handle claims in bulk. Thomas says, "We had over 600 claims for one day in the wrong network. I was able to take that bulk of claims and handle those. Otherwise, I was going to have to sit there and go claim by claim. It's a huge time saver to work smarter, not harder." Listen in to hear how another Experian Health client, Boston Children's Hospital, used Contract Manager to resolve underpayments and work with payers to resolve issues and errors, resulting in increased revenue. Learn more about how payer contract management software optimizes revenue, ensures compliance and streamlines payer contracts. Learn more Contact us

Key takeaways: The healthcare industry isn't necessarily recession-proof, but revenue cycle leaders can take steps to build financial resilience. Financial resiliency strategies in healthcare should include: diversified revenue streams, operational efficiencies and strategic financial planning. Leveraging technology to optimize patient collections helps providers enhance the collections process and improve financial resiliency now, and in the case of a recession. The relationship between economic downturns and the resilience of the healthcare industry is complex. Healthcare is an essential service, so whether the economy is considered good or bad, people still need to see their provider. However, with many economists anticipating a potential recession, it begs the question: is healthcare truly recession-proof? In this article, we'll explore healthcare's economic resilience and why financial resiliency and collections optimization may be the key to surviving the next recession. The healthcare sector's economic resilience: fact or myth? While not necessarily recession-proof, the healthcare sector has historically been more insulated against economic uncertainty than other industries. However, since healthcare delivery organizations, like hospitals, typically operate with narrow health margins to begin with, a recession could further compound the issue. Factors that already affect a hospital's everyday bottom line could significantly worsen during a recession. Today's hospitals are burdened by high fixed costs, staffing shortages, regulatory and compliance costs, value-based care pressures and the financial challenges of low reimbursement rates and insured patients. During a recession, even the slightest shift could potentially knock a healthcare delivery organization's revenue cycle off balance. The importance of financial resilience in healthcare Financial resilience is crucial for healthcare organizations that want to cultivate long-term stability, regardless of what's happening in the economy. To weather economic uncertainty, healthcare organizations must have a solid financial foundation. The cornerstones of creating financial resilience for healthcare organizations include: Diversified revenue streams: Providers that offer multiple service points have more opportunities to better serve patients. To attract and retain patients, healthcare organizations must stay nimble and invest in new revenue-generating services, such as virtual or outpatient care. Efficient operations: Streamlining every aspect of the revenue cycle — especially through technology like automation and artificial intelligence (AI) — not only eliminates costly, error-prone processes, but also bolsters the bottom line, prevents revenue leaks and allows for new investments. Strategic financial planning: The healthcare industry is constantly evolving, from automated patient collections technology to artificial intelligence (AI) in claims management. Revenue cycle leaders can use data-driven insights from these technologies to inform short- and long-term financial planning. Patient collections during a recession: a critical area of focus Accelerating patient collections is always a top priority for revenue cycle leaders, especially as patients shoulder an increasing financial burden for the cost of care. However, during a recession, the focus on patient payments becomes even more critical. Recessions often bring job loss, leaving patients without insurance or the income to pay their medical bills. This can leave providers scrambling to update insurance information, chasing patients for payment, sending unpaid bills to collections, or worse — getting stuck with bad debt. Healthcare organizations can improve patient collections and maintain steady cash flow during tough economic times by adopting technology to optimize the patient collections process. Tools like Experian Health's Collections Optimization Manager streamline the entire patient collections process without adding additional workload for existing staffing. Leveraging technology for recession-proofing healthcare operations Recessions often come with many unknowns, but healthcare organizations can take steps to help recession-proof their financial operations. Adopting healthcare technology, like collections optimization tools, can help providers in these key ways: Streamline collections Solutions like Collections Optimization Manager uses intelligent segmentation to help billing teams quickly prioritize high-priority accounts based on propensity-to-pay scores. This frees up busy staff from the burden of chasing accounts — and is especially beneficial with large accounts receivable volumes. Instead, billing teams can focus on a small amount of patient accounts that have a high propensity to pay and bring in high revenue. Additionally, costs are further reduced since these accounts don't need to be sent to an external collections agency. To further streamline collections, complementary automated patient outreach tools, like PatientDial and PatientText can send patients bill reminders and self-pay options via voice or text message. Patient Financial Clearance takes this a step further by helping providers run their presumptive charity process, which estimates a patients' Federal Poverty Level percentage (FPL%), to identify those who qualify for greater financial assistance. Enhance financial forecasting Collections Optimization Manager offers healthcare providers real-time insights into collection performance with reports and dashboards that focus on key metrics. Billing teams can see how their team measures against industry standards to improve patient payment forecasting and successfully manage bad debt reserves. Plus, users get access to an experienced collections consultant to evaluate reports and further refine collections strategies. Improve financial resilience Implementing billing and collections optimization gives providers more visibility into the collections cycle, allowing for improved short- and long-term strategic planning. This can be useful for healthcare organizations that need to make financial decisions to prepare for upcoming recessions or shift priorities as needs change mid-recession. Emerging technologies, like predictive analytics, machine learning and artificial intelligence also offer providers a deeper understanding of patients' financial needs, allowing for a more compassionate collections experience. In times of economic uncertainty, when patients may struggle to afford their medical bills, a supportive collections process can help improve collection rates and reduce the chance of bad debt. Building a recession-resilient healthcare organization While it may not be possible to fully recession-proof a healthcare organization, revenue cycle leaders can take proactive steps to make their organization recession-resilient. Turning to technology that leverages a growing range of automated solutions for clearer billing, personalized payment options and increased efficiencies is one way healthcare organizations can start to build financial resiliency for today – and for any future economic downturns. Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle leaders enhance the collections process and improve financial resiliency during challenging times. Learn more Contact us

Prompt patient payment after service is a key factor in keeping revenue cycles on track. However, patients don't always pay right away or in full. Despite around 90% of Americans having health insurance coverage, many patients still face medical debt. Unpaid patient bills often leave providers on the hook chasing patient collections and footing the cost for uncompensated care.   This article covers some of the key patient collections metrics to help revenue cycle leaders get insights on how to measure and improve revenue cycle collections.  Why measuring patient collections is critical in revenue cycle management  When protecting profits in today's increasingly challenging healthcare landscape, revenue cycle management (RCM) leaders know that “what gets measured, gets managed.” The first step to improve patient collections rates is reviewing current data for issues. To do this, healthcare organizations must identify key performance indicators (KPIs) for measuring patient collections in the revenue cycle. Patient collections metrics are quantifiable measures that illustrate if a healthcare organization is effectively optimizing its collections process. They provide RCMs visibility and insights that help indicate if the organization is achieving its goals and effectively managing inflows and outflows.   Key revenue cycle patient collection metrics  Streamlining revenue cycle collections often hinges on collecting patient payments — and quickly. Here are a few common ways healthcare organizations can measure patient collections in revenue cycles.    Days In Accounts Receivable (A/R) Rate - The days in Accounts Receivable rate is a metric that measures the average number of days it takes healthcare providers to collect payment for services — from both payers and patients. Lower days in A/R typically indicate an efficient billing and collections process. Days in A/R over 30 could lead to an increase in collections efforts, unloading to collections agencies, and even write offs to bad debt – all potentially resulting in cash flow issues and revenue loss.  Gross Collection Rate - The Gross Collection Rate, or GCR, shows the percentage of total patient balances collected and indicates the health of the overall effectiveness of an organization's billing and collections process. Healthcare providers generally strive to keep GCRs as high as possible to prevent cash flow issues. The industry benchmark is typically around 95%, but this can vary by provider.  Adjusted Collection Rate - Also known as the Net Adjustment Rate (NCR), this metric is shown as a percentage of the reimbursement healthcare providers collect in comparison to what they could have collected. It represents the amount of revenue healthcare organizations are losing, and a high NCR is typically an indicator of issues in the revenue cycle like uncollectible bad debt.  Patient Balance After Insurance Ratio - The Patient Balance After Insurance Ratio, or PBAI Ratio, is the percentage of financial responsibility that falls on the patient after insurance pays. Tracking PBAI Ratios closely helps providers identify trends early on to stay ahead of issues that could potentially impact cash flow. As today's patients shoulder more self-pay costs, keeping tabs on this metric can help providers prioritize billing and collections that are compassionate and simple to access.   Patient Contact Rate - The Patient Contact Rate measures how often a provider contacts patients with outstanding balances. Higher Patient Contacts Rates typically indicate high levels of engagement with patients about their unpaid bills that often leads to an easier collections process and improved cash flow. When Patient Contact Rates are low, providers may have an opportunity to increase patient communication efforts. Bad Debt Rate - The Bad Debt Rate shows providers how much patient debt goes uncollected and is written off as “bad debt” over a period of time. A high Bad Debt Rate often indicates a need to tighten up process improvements, like collecting more patient patients upfront. A good rule of thumb is to aim for a Bad Debt Rate of less than 5%. The lower the rate, the more efficiently the billing team collects patient balances. Cost to Collect - The cost to collect is a percentage-based metric that refers to the expenses healthcare organizations spend to recover payments from patients and payers. Many times, hospitals spend more to collect than what the patient owes, whether it's from time and resources calling unresponsive patients, paper statements sent to wrong addresses, etc., which makes this an important metric to track. Contingency Fees - When healthcare organizations turn to third-party agencies for their collections, a contingency fee is often paid for their services. This fee is usually a percentage of what the third-party agency is able to recover, and is often around 20-50% of the total amount. Some healthcare organizations work with multiple collections agencies, which can strain hospital cash flow even further. Hospitals must weigh the cost of outsourcing collections against maintaining in-house billing departments.  Strengthening the revenue cycle with effective patient collection metrics  Optimizing patient collections metrics helps strengthen the revenue cycle. Here are some strategies revenue cycle leaders can consider to help boost patient collections rates overall, improve patient engagement and lower bad debt rates:  Improve patient communication: Sometimes patients need additional reminders to pay their bills. Providers looking to raise their Patient Contact Rate might benefit from engaging more with patients. Strategies can include making additional phone calls or  sending monthly billing statements. Healthcare organizations that want to scale patient contact without adding to headcount may also benefit from tools like Patient Outreach Solutions, which increases collections through automated solutions like touchless text messaging, queue callback and bill reminders.   Make it easier for patients to pay: Providers can shorten the amount of time it takes to collect payment from patients by implementing billing and collections processes that make it simple for patients to know costs up front and pay their bills. With a solution like PatientSimple, patients get access to self-service account management tools, like secure self-pay and patient estimates. Tools that automate the payment process, like Experian Health's PaymentSafe®, further enhance the payment experience by helping providers collect more revenue earlier and creating a seamless payment experience.   Utilize data and analytics solutions to optimize patient collections: Experian Health's Patient Access Curator solution uses artificial intelligence (AI) to quickly verify patient insurance eligibility and coverage data in real-time. This can help ensure patient estimates and bills are accurate before the patient collections process even begins.  Segment and screen patients by propensity to pay: During the patient collections process, Collections Optimization Manager helps identify high-value patient accounts and screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility in advance. This solution segments patients by propensity of pay scores, and reduces the cost to collect. The Screening component of Collections Optimization Manager alerts staff to accounts that are not worth collecting from – whether it's a deceased or bankrupt, or charity care account. This saves valuable staff time and resources. Discover how Weill Cornell increased collections by $15M with Collections Optimization Manager. Gaining clear visibility in patient collections metrics  Patient collections metrics data must be current and easily accessible in order to provide healthcare organizations with the most valuable insights into billing and collections challenges and opportunities. However, RCM analysts are often tasked with compiling data from numerous legacy processes and disjointed systems. Bringing together critical patient collections information into a revenue cycle dashboard can help revenue cycle leaders track the KPIs that matter most and show changes over time. This visibility into trends can help RCM understand how what areas of patient billing and collections need the most attention to improve patient communication, create workflow efficiencies and reduce revenue leaks.  Learn more about how Experian Health's collections optimizations solutions can help healthcare organizations improve collections and increase their bottom lines.  Learn more Contact us

“Data is cleaner throughout all the downstream systems. Our refreshed power reporting now provides encounter-level data, which offers more actionable insights for our client's operational teams.”-Cindy Biggio, Director of Patient Accounting at Virtua Health Challenge Virtua Health is a large New Jersey health system with over 2,000 staffed hospital beds across multiple locations. An inefficient Notice of Admissions (NOA) process was becoming unsustainable for inpatient admissions, putting revenue at risk. “Manually faxing NOAs to payers was an administrative nightmare,” says Ginny Norton, Lead IT Applications Analyst at Virtua Health. “Tracking the sheer volume of NOAs and ensuring they reached the payers on time was time-consuming. The process was inefficient and risky.” Missing a payer's NOA deadline for an inpatient stay can result in reimbursement denials for the entire duration of the patient's stay, which jeopardizes cash flow. At Virtua, connectivity issues, faulty fax machines and human error left the revenue cycle team without a reliable way to track NOA submissions or challenge payer denials. This increased the likelihood of missed deadlines and delayed payments. Adhering to different rules and deadlines for multiple payers made the process even harder to control. The pressure was on to find a scalable solution that would prevent further revenue loss by: Minimizing manual work for admissions staff and insurance verifiers Ensuring NOAs were submitted on time and within each payer's deadline Improving efficiency by freeing staff to focus on more urgent tasks Streamlining the process of requesting additional payer connections. Solution Switching from manual to automated NOAs was the obvious way forward. Cindy Biggio, Director of Patient Accounting at Virtua, says Experian Health's Notice of Care solution, featuring Notice of Admissions (NOA) functionality, was a natural fit, due to its easy integration with their existing Epic® set-up: “Based on recommendations from other Epic health systems and Experian's integration with Epic, choosing Notice of Care was a logical decision for us. We were already using other Experian Health solutions, so it made sense to build up the portfolio of products we were already using.” Because Experian Health's NOA operates within the eCare NEXT® eligibility platform, Virtua staff can manage it within their existing workflows. NOAs are triggered as soon as a patient's insurance eligibility is verified. Submissions are sent directly to payers within their required timeframes, with patient and procedure information automatically pre-filled to save time and reduce data-entry errors. Each request is formatted according to the payer's rules, while incoming payer responses are standardized so staff can view them all in a consistent way. While faxes remain a feature of payers' NOA processes, this tool makes handling them much easier. It captures key information from each fax, links it to the appropriate order, and then sorts and converts data from multiple document types so staff can look it up quickly. This is a major improvement on the previous approach, which required staff to monitor and update submission status by hand and liaise with a clearinghouse over delays and errors. Norton says that working closely with the Experian Health team was key to easy implementation: “Clear onboarding processes for existing and new team members helped maintain smooth operations, along with opportunities to seek feedback from staff so we could keep making improvements… Overall, the implementation process and transition to 'go-live' were smooth. Our staff adapted to the changes well. There was far less chaos without having to manage a mountain of paper. It reduced the volume of manual work and freed up time for other tasks. Onboarding was relatively easy.” Read more about how automation reduces administrative costs in healthcare. Outcome Since implementing NOA, Virtua Health has seen immediate improvements across its revenue cycle operations, including: Less manual work, as automation allows staff to operate more efficiently Quicker and more accurate submissions, resulting in fewer denials and more revenue Smoother dispute resolution, thanks to electronic paper trails Better compliance with payer requirements. “Data is cleaner throughout all the downstream systems,” says Biggio. “Our refreshed power reporting now provides encounter-level data, which offers more actionable insights for our client's operational teams.” The solution also fulfills Virtua's need for a scalable approach to NOAs. Instead of classifying new payers by operational platform, staff can now add all payers through one system. Should payer requirements change, Virtua will be ready to adapt. In addition to preventing revenue loss, NOA has had a meaningful impact on staff satisfaction. The solution has lightened workloads, improved day-to-day efficiency and enabled remote work by eliminating repetitive administrative tasks. Freed from the need to visit payer websites or call up payers for admission notification and status updates, staff can focus on more complex tasks and pay more attention to the patient experience. This benefits staff and patients, and positions Virtua as an attractive employer in a tight labor market. Looking ahead, Norton says Virtua will focus on adding more payers and continue using Experian NOA data to improve processes: “We'll keep listening to our staff, who are heads-down in the work, to see if we need to make changes to improve workflow. Moving forward, leadership will decide on adding more solutions based on the needs of our patients, staff, market and operations. We're excited to see what's next.” Learn more about how Experian Health's Notice of Care solution, with Notice of Admissions functionality, automates and integrates NOAs, resulting in fewer errors and faster payments. Learn more Contact us

Key takeaways: Error-prone manual processes are a top reason for delayed reimbursements. Automation across the revenue cycle can help providers see quicker reimbursements. Many processes can be automated: patient estimates, eligibility verification checks, collections, claims management, and more. Prompt reimbursements are crucial for today's healthcare organizations. Delayed reimbursements can lead to a domino effect that impacts the entire revenue cycle. Provider productivity goes down along with quality of care, patients have poor experiences and the bottom line takes a hit. Reimbursement delays often stem from error-prone, outdated manual processes, overburdened staff and excessive administrative work. However, incorporating revenue cycle management automation can help providers overcome numerous reimbursement challenges and improve processes overall. With revenue cycle automation, providers can eliminate many persistent pain points in traditional revenue cycle management (RCM). Staff no longer lose time to tedious manual tasks, patients get their queries answered faster, and managers get the meaningful data they need to drive improvements. And the biggest win? It's easier for providers to get reimbursed for their services, faster and in full. What is revenue cycle automation and how does it work? Healthcare revenue cycle management knits together the financial and clinical components of care to ensure providers are properly reimbursed. As staff and patients know all too well, this can be a complex and time-consuming process, involving repetitive tasks and lengthy forms to ensure the right parties get the right information at the right time. This requires data pulled from multiple databases and systems for accurate claims and billing, and is a perfect use case for automation. In practice, revenue cycle automation involves using technology to complete tasks and processes that may have previously been manually completed. These tasks might include: Automatically generating and issuing invoices, bills and financial statements Streamlining patient data management and exchanging information quickly and reliably Processing digital payments Collating and analyzing performance data to draw out valuable insights. Understanding the challenges in traditional revenue cycle management When it comes to delayed reimbursements, providers lacking revenue cycle management automation typically face the following challenges: Inefficiencies in patient access According to The State of Patient Access 2025, front-end operations are still a source of friction for patients and providers. Four out of the five top patient access challenges reported by providers relate to front-end data collection. Top concerns include insurance searches, reducing errors, and speeding up authorization. Nearly 48% say data collected at registration is “somewhere” or “not” accurate, while 85% report an urgent need for faster, more comprehensive insurance verification. Rising claim denials due to manual errors The State of Patient Access also showed that manual, error-prone processes often lead to delays, claim denials and patient frustration. In fact, more than half (56%) of providers say patient information errors are a primary cause of denied claims. When claims are denied, reworks are often time-consuming, costly and place additional burdens on already overworked staff. Difficulty in managing patient collections Due to rising costs, confusion over estimates and a lack of patient payment options, providers are often left to deal with unpaid medical bills. According to Experian Health data, 29% of patients say paying for healthcare is getting worse. Affordability is a key factor, but patients are also struggling to understand how much their insurance covers and looking for convenient payment options, like payment plans. Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. Six ways revenue cycle automation accelerates reimbursements Revenue cycle improvement through automation can help speed up reimbursements for healthcare providers by: 1. Capturing accurate information quickly during patient access Gathering patient data manually is time-consuming. Errors in the process can lead to denied claims and roadblocks in patient care. Tools like Experian Health's Patient Access Curator use artificial intelligence (AI) to streamline patient access and billing, improve data quality and address claim denials from the outset. This solution also ensures that all data is correct on the front end by checking eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery. 2. Simplifying collections and focusing on the right accounts Healthcare collections are a drag on resources. Automating the repetitive elements in the collections process helps reduce the burden on staff. Collections Optimization Manager leverages automation to analyze patients' payment histories and other financial information to route their accounts to the right collections pathway. Scoring and segmenting accounts means no time is wasted chasing the wrong accounts. Patients who can pay promptly can do so without unnecessary friction. As a result, providers get paid faster. 3. Reducing manual work and staff burnout Chronic staffing shortages continue to plague healthcare providers. In Experian Health's recent staffing survey, 96% of respondents said this affected payer reimbursements and patient collections. While automation cannot replace much-needed expert staff, it can ease pressure on busy teams by relieving them of repetitive tasks, reducing error rates and speeding up workflows. 4. Maintaining regulatory compliance with minimal effort While regulatory compliance may not directly influence how quickly providers get paid, it does play a crucial role in preventing the delays, denials and financial penalties that impede the overall revenue cycle. Constant changes in regulations and payer reimbursement policies can be difficult to track. Automation helps teams continuously monitor and adapt to these changes for a smoother revenue cycle, often with parallel benefits such as improving the patient experience. One example is Experian Health's price transparency solutions, which help providers demonstrate compliance with new legislation and provide extra clarity for patients. 5. Improving the end-to-end claims process Perhaps the most apparent way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claims management solutions, like Experian Health's award-winning ClaimSource®, reduce the need for error-prone manual processes, while improving accuracy and efficiencies in the claims editing and submission process. Additional claims management tools, like Claim Scrubber, also help providers submit more complete and accurate claims. Other tools, like Denial Workflow Manager, can be used if claims are denied. With automation and its extensive data analysis capabilities, work lists are generated based on the client's specifications, like denial category and dollar amount, to identify the root cause of denials and improve upstream processes to prevent them. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI Advantage™ uses AI and machine learning to find patterns in payer behavior and identify undocumented rules that could lead to a claim being denied, alerting staff so they can act quickly and avert issues. Then, it uses algorithmic logic to help staff segment and rework denials most efficiently. Providers get paid sooner while minimizing downstream revenue loss. 6. Providing better visibility into improvement opportunities Finally, automation helps providers analyze and act on revenue cycle data by identifying bottlenecks, trends and improvement opportunities. Automated analyses bring together relevant data from multiple sources in an instant to validate decisions. Machine learning draws on historical information to predict future outcomes, so providers can understand the root cause of delays and take steps to resolve issues. A healthcare revenue cycle dashboard is not just a presentation tool; it facilitates real-time monitoring of the organization's financial health, so staff can optimize workflows and speed up reimbursement. Embracing automation for a more efficient revenue cycle Like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth and speed up reimbursements. Learn more about Experian Health's revenue cycle management technology and see where automation could have the biggest impact on your organization's financial health. 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Revenue cycle management (RCM) plays a central role in healthcare, influencing both patient access and the financial well-being of providers. As healthcare organizations navigate growing costs, shifting patient expectations, and increasingly complex administrative tasks, they're finding themselves at a crossroads. Experian Health's State of Patient Access 2025 report offers a look at these challenges from the views of patients and providers, while showcasing how technology is changing the way we approach patient access and revenue cycle operations. In this interview, Clarissa Riggins, Chief Product Officer at Experian Health, shares key takeaways from the report, offers actionable solutions for providers, and outlines trends that are set to shape the future of RCM.  Q1: "Let's start with the big picture. What's going on with patients' access to healthcare right now?" Riggins says, "It's stabilizing, which is a good sign. According to The State of Patient Access 2025, 68% of patients and 43% of providers say access has stayed the same. That's the highest it's been since 2022. Only 15% of patients said it's gotten worse, and that's the lowest number we've seen in a few years."  Q2: "That's reassuring. But there are still challenges, right? What are patients struggling with most?"  "The number one issue continues to be wait times," explains Riggins. "About 25% of patients said getting in to see a provider quickly is still a major hurdle. On top of that, 22% reported delays because of insurance verification, and 20% said they ran into problems with errors in their medical records or billing information. So, while some things have improved, there are still gaps to close.”  Q3: "You mentioned insurance verification. How much of a barrier is that?" "It's a big one," she says. "When insurance verification isn't seamless, it creates a domino effect. That 22% figure I mentioned, those are people who had to wait for care because their insurance details weren't sorted out. Automating that part of the process can make a huge difference in getting people the care they need faster.” Q4: "Are digital tools making a difference in these areas?"  "They have the potential to, but adoption is a challenge. 37% of providers said one of their biggest obstacles is getting patients to actually use the tools available. And 55% said patients don't know how to navigate self-scheduling. We're seeing some resistance, but it's not because the tech isn't there. It's more about awareness and ease of use. She continues, "For example, going back to insurance eligibility, Experian Health's Patient Access Curator uses artificial intelligence (AI) to automatically check coverage in real time. This helps providers confirm benefits instantly and spot issues early. That kind of automation takes the guesswork and delays out of the equation, so patients can get the care they need without unnecessary holdups. It's not just more efficient for staff; it literally speeds up access to treatment."  Q5: "Let's talk about cost. How is that affecting access for patients today?"  “Cost is a major pain point," she explains. "The report shows that 34% of patients say they often struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care."  Q6: "What can providers do to improve the payment experience for patients?"  “It starts with transparency. Patients want to know what they'll owe before they get care. When 81% of patients say they feel more prepared after receiving an accurate estimate, it shows just how critical that upfront information is," Riggins notes. "Experian Health's Patient Estimates solution was built around this need. It allows providers to give patients clear, personalized cost estimates before they receive care, helping them feel informed and in control." "And 43% said they would consider canceling or postponing care if they didn't get that information," she continues. "That's huge. It proves this isn't just about convenience; it's about access. These tools help patients avoid financial surprises, which can be the deciding factor in whether they follow through with treatment." “This solution isn't just making billing easier. It's directly supporting better health outcomes by making care more accessible and less intimidating financially."  Q7: "So, it's not just about having the tools. It's about how they're used?"  "Exactly. Providers need to make sure the tools are easy to use and that patients understand how to use them. That means clear instructions, mobile-friendly interfaces, and support when people get stuck. If the experience feels complicated, people just won't engage." Q8: "What are patients looking for when it comes to better access?"  "Patients are very clear. They want convenience," Riggins says. "According to The State of Patient Access 2025 report:  82% don't want to complete forms multiple times if their information hasn't changed  80% want to be able to schedule appointments from their phone (via a browser or an app)  77% want a heads-up on insurance coverage before treatment  52% want more digital options, period  So, if providers listen to these preferences and meet patients where they are, access improves naturally."  Q9: "What about billing and patient record issues? How can providers avoid those mistakes?"  "Strong data practices are key. That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records. Adding tools like Patient Access Curator can really make a difference. It uses artificial intelligence to handle a bunch of tasks all at once – eligibility checks, COB, MBI, demographics, and insurance discovery. By automating tasks that are traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can help prevent billing and claim errors in the long run.  Clean data makes everything easier, from billing to insurance verification to patient trust," Riggins concludes.   Patient access is evolving, but not without its challenges. As the State of Patient Access 2025 report highlights, stability is improving, but issues like price transparency, low adoption of digital access tools and insurance verification continue to create friction. The path forward lies in listening to what patients are asking for: easy-to-use digital tools, clear pricing, and fewer administrative headaches. By utilizing automation and AI, providers can streamline access and build stronger, more trusted relationships with their patients.  Learn more about how Experian Health can help healthcare organizations improve patient access, and download the report for the full survey results.   Download now Contact us