All posts by Kelly Nguyen

Key takeaways: Changes to Medicaid, Medicare and the Affordable Care Act provisions in H.R. 1 are expected to increase financial pressure across the healthcare system. Hospitals could face higher uncompensated care costs and a growing administrative burden as millions lose coverage and payer rules grow more complex. Revenue cycle leaders should focus on strengthening eligibility checks, improving claims accuracy, and automating operations to remain financially resilient. On July 4, the budget reconciliation bill known as the “One Big Beautiful Bill Act” was signed into law, introducing sweeping changes to Medicaid, Medicare and Affordable Care Act (ACA) marketplace plans. At almost 900 pages, H.R. 1 sets out new eligibility, coverage and funding rules that will reshape how hospitals are reimbursed. This article explains what revenue cycle leaders need to know about the reforms and offers practical strategies for maintaining financial stability. Understanding the healthcare implications of H.R. 1 The healthcare provisions in H.R. 1 reflect a broader push by lawmakers to contain federal spending and return more control to states. While the reforms are framed as efforts to improve fiscal sustainability, they also introduce new financial risks for hospitals, particularly those serving low-income and high-utilization populations. How does the Act affect Medicaid? Enrollment H.R. 1 makes major changes to Medicaid enrollment, with direct implications for hospital revenue and patient coverage. Starting in 2027, states will be required to run automated eligibility checks every six months for Medicaid expansion adults, and cross-check against federal databases to remove ineligible or deceased enrollees. The Act pauses implementation of a federal rule related to streamlining enrollment in Medicaid and the Children’s Health Insurance Program. Eligibility Eligibility rules are also changing. A new community engagement requirement will require some enrollees to demonstrate that they work, volunteer, or are in education for at least 80 hours a month, unless exempted. While aimed at reducing fraud, waste and misuse, changes to eligibility and enrollment could result in more patients losing coverage and increase churn and care gaps – particularly among vulnerable populations. Uncertainty around citizenship status could deter patients from seeking care, and even affect staffing in hospitals that serve immigrant communities. Cost-sharing and funding To ensure beneficiaries have a financial stake in their care, the law introduces cost-sharing requirements for some enrollees. Providers will need to be ready to help patients understand their costs and adjust collections workflows accordingly. There are also new financial penalties for states that fail to recover overpayments, and limits on how provider taxes and supplemental payments can be used to boost federal matching funds. Over time, these provisions could constrain how hospitals are reimbursed for Medicaid services, especially in non-expansion states. How does the Act affect Medicare? For Medicare, the Act offers some short-term financial relief along with longer-term reductions. Outpatient providers will see a 2.5% increase to the Medicare Physician Fee Schedule in 2026, partially offsetting inflation and COVID-related losses. However, spending cuts of 4% per year are projected to reduce Medicare funding by more than $500 billion over eight years, beginning in 2026. In addition, the law brings Medicare eligibility in closer alignment to Medicaid, by restricting access for individuals without verified lawful status or sufficient residency history. It also delays until 2035 a rule that would have made it easier for low-income beneficiaries to enroll in Medicare Savings Programs. The Congressional Budget Office (CBO) estimates that this means 1.38 million fewer beneficiaries  will be covered by MSPs. How does the Act affect the ACA? One of the most immediate concerns for hospitals involves the end of enhanced premium subsidies for low-income ACA marketplace plan enrollees. Unless Congress steps in, these will expire at the end of 2025, making coverage less affordable for many. This comes as insurers prepare to increase premiums by an average of 15% in 2026, the most significant rise since 2018. H.R. 1 also modifies eligibility and repayment rules around subsidies. Subsidies will no longer be available to individuals disenrolled from Medicaid due to immigration status. Starting in 2027, most enrollees in marketplace plans will need to verify their eligibility for premium tax credits each year, effectively ending automatic re-enrollment. Without these subsidies, over 4 million people are likely to be uninsured in 2034. For hospitals, this means more self-pay patients, delayed collections and higher uncompensated care, especially in areas with large working-age populations. Financial risks: Medicaid cuts and rising uncompensated care The CBO projects that 10 million people could lose health coverage by 2034 due to combined Medicaid and ACA reforms. Of these, nearly 6 million will lose Medicaid coverage due to the new work requirements, eligibility checks and narrower enrollment windows. This is a major financial risk for hospitals, particularly safety-net and rural providers. The Center for American Progress suggests that uncompensated care costs could increase by at least $31 billion each year – a figure that will be especially painful in the context of reduced federal funding. Some newly uninsured patients may not seek alternative coverage, potentially leading to higher emergency department use. Those with ongoing health needs are more likely to find new coverage, but hospitals could still see a smaller insured population overall, and it could well be one that is older, sicker and more expensive to treat. Revenue cycle teams should prepare for an increase in self-pay volumes and greater demand for charity care and financial assistance. Organizations in high-Medicaid regions may need to reassess cost estimation tools, financial assistance screening and collections workflows to manage the effects. Strengthening front-end access and eligibility workflows Jason Considine, President at Experian Health, says that providers can be proactive in ensuring their revenue cycle operations are ready to adapt and scale, if and when the time comes: “It’s an uncertain time. However, as we wait to see how the changes to coverage and reimbursement play out in practice, providers aren’t just looking for predictions. They need actionable strategies. Strengthening front-end eligibility and financial clearance processes is one of the most immediate ways to reduce risk and support patients through coverage transitions. Experian Health helps organizations do that by offering automated tools that uncover hidden coverage, verify eligibility in real time, and provide clear, accurate patient estimates.” Here are a few examples: Getting eligibility right. Patient Access Curator uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics and coverage discovery. Minimizing the risk of uncompensated care. Patient Financial Clearance uses real-time data to identify patients who may qualify for charity care and recommends suitable payment plan options, while minimizing manual work for staff. Helping patients figure out their financial obligations. Patient Payment Estimates draws on real-time data, including insurance coverage, payer contract terms and provider pricing, to give patients an accurate breakdown of their treatment costs. This improves transparency and reduces the risk of missed payments. Case study: Experian Health and Exact Sciences See how Exact Sciences added $100 million to their bottom line in just two quarters with Patient Access Curator. Optimizing claims and collections in a tighter reimbursement environment In addition to strengthening front-end processes, providers need to ensure their back-end operations are ready to handle the ups and downs. Denied claims are already a major challenge for providers: in Experian Health’s 2024 State of Claims survey, 73% said denials are increasing and 77% report more frequent payer policy changes. More than half have seen a rise in claims errors, highlighting an opportunity for improvement. As automation and AI continue to advance, healthcare providers have a chance to improve claims management and reduce denials. Embracing these solutions can reduce the costly burden of reworking claim denials and improve cash flow. If claims workflows are already struggling, providers can’t afford any extra friction. However, the H.R. 1 reforms will likely increase the administrative burden and make timely reimbursement even harder to secure. This makes digital transformation increasingly urgent. Some priorities to tackle with automation and analytics include: Improving first-pass claim accuracy.  AI Advantage™– Predictive Denials  uses artificial intelligence, machine learning and predictive analytics to scan claims before they are submitted to root out errors and flag high-risk submissions so they can be corrected. It analyzes historical payment data and real-time payer behavior to determine whether a claim is likely to be rejected, so staff can work faster and more efficiently to increase clean claim rates. Streamlining claims management. ClaimSource® helps providers manage the entire claim cycle from a single application. Voted Best in KLAS for Claims Management and Clearinghouse for the last two years, the platform automates claim submission to reduce manual work and support cleaner submissions. It performs customizable edits, formats and submits claims, and allows staff to create custom work queues for greater efficiency. Using data to optimize collections. Collections Optimization Manager uses data-driven insights to help revenue cycle management (RCM) teams focus on the right accounts and collect more, faster. By segmenting patients based on their propensity to pay and screening out accounts unlikely to yield returns (such as deceased, bankrupt or charity accounts) the tool helps reduce the cost to collect and saves valuable staff time. Case study: Experian Health and Weill Cornell See how Weill Cornell increased collections by $15 million with Collections Optimization Manager. Preparing for volatility with scalable technology Revenue cycle teams can’t control policy changes or budget decisions, but they can control the systems that keep their operations running. Experian Health’s end-to-end revenue cycle solutions are designed to support this kind of operational resilience. From coverage discovery to claims analytics, scalable platforms give providers the flexibility to respond quickly to financial disruptions using consistent and familiar technology. “When so much is out of your hands, the smartest move is to focus on what you can control. Scalable tech gives RCM leaders that control, so when payer rules shift or self-pay volumes spike, they’re ready to respond without slowing down,” says Considine. “It also helps them stay ready for compliance shifts and respond faster to regulatory changes without overhauling their workflows.” Blog: Revenue cycle management checklist - improve experience and profits Get a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Readiness today protects financial resilience tomorrow The H.R. 1 bill has introduced significant changes across Medicaid, Medicare and the Affordable Care Act. New eligibility requirements, adjustments to reimbursement formulas, reduced subsidies and greater administrative complexity are all expected to influence how patients access coverage and how care is financed moving forward. While the long-term impact will vary by market and patient population, disruption is coming. Hospitals and health systems that rely on outdated workflows or fragmented technology will face growing challenges in managing changing coverage patterns and rising uncompensated care. As the specific effects of the “One Big Beautiful Bill” become clearer, revenue cycle leaders will be tasked with making fast choices under pressure. How will coverage changes affect patient behavior? What happens to reimbursement if eligibility gaps widen? The focus won’t just be on protecting revenue, but also on supporting patients who may be confused or anxious about what the new rules mean for them. The ability to track changes and adapt accordingly will be a competitive advantage for providers looking to stay ahead. Find out how Experian Health can help hospitals prepare for reforms by modernizing revenue cycle operations and reducing exposure to revenue loss. Learn more Contact us

Manual prior authorization workflows represent one of the most tedious and expensive aspects of the healthcare revenue cycle. However, despite access to automated prior authorization software, only 31% of providers use electronic prior authorizations, according to the Council for Affordable Quality Healthcare (CAQH). The CAQH predicts that providers who switch to automated prior authorization software could not only gain back valuable staff time, but also see significant cost savings. What is prior authorization and why is it important? In healthcare, prior authorizations are when providers and payers decide in advance if a patient's insurance plan will pay for a specific treatment. Prior authorizations are crucial to reimbursements and keeping revenue cycles on track. Providers that offer services without prior authorization are unlikely to receive reimbursement from the patient's insurer. This can result in unpaid medical bills, leaving billing teams chasing patient collections or writing off bad debt. During the prior authorization process, providers submit a rationale for a proposed treatment to the payer. The request is approved or denied based on certain criteria, including payer policies and medical necessity. The payer may reject a prior authorization request if the treatment or service isn't covered under the patient's insurance plan, if it's not considered medically necessary or if a more affordable alternative is available. Simple paperwork errors, like missed deadlines or incomplete documentation when submitting a prior authorization, may also result in a denial. Challenges of manual prior authorization processes Despite the importance of prior authorizations in the revenue cycle, tedious manual prior authorization processes present challenges for many healthcare providers. Some of the key obstacles providers face using manual prior authorization include: Heavy administrative burden Healthcare providers spend a significant amount of time starting, completing and revising prior authorization paperwork. An AMA survey found that 86% of physicians say prior authorization has increased healthcare resource usage. At the same time, additional AMA data reports that providers spend around 13 hours working on 39 prior authorizations each week, and nearly one-third of providers report that these prior authorization requests usually end up being denied. Changing payer policies Keeping up with multiple payers and ever-evolving payer policies adds strain on staff and ultimately results in prior authorization denials. Changes are often unannounced, making it hard for providers to stay on top of updates. As a result, prior authorization submissions aren’t always accurate and may be based on outdated rules. This can lead to instant rejection and wasted time correcting and resubmitting requests. Inefficient workflows Prior authorization requirements can be complicated, especially when providers are juggling different payers, standards and service lines. Coping with these complexities often puts strain on manual systems, especially when multiple staff and notetaking methods are involved. Staff members may each get different pieces of information from payer websites (or over the phone) and not have the ability to benefit from their shared knowledge efficiently. Navigating communication hurdles and rapid payer information changes can result in workflow inefficiencies that snowball quickly. How prior authorization software can improve efficiency Replacing manual prior authorizations processes with automated prior authorization software can help providers improve efficiency. Here are some key ways providers benefit from automated prior authorization solutions, like Experian Health's Authorizations. Reduces manual interventions: This solution limits guesswork, human errors, and misinterpretations by automating data originating from the EMRs. Automation saves staff time and energy and prevents frustration. Stays current with latest payer policies: The prior authorization system stays up-to-date with the latest regulations and payer requirements. Automatic updates provide staff with the most current information, eliminating the need for staff to visit multiple payer websites or cross-check data by hand. Provides real-time updates: Providers can promptly clear authorizations for service by proactively identifying authorization status as pending, denied or authorized. This allows physicians to make timely treatment plans and for patients to avoid disruptions in care. Reduces risk of denials: Through automation, electronic prior authorization software ensures the accuracy and completeness of submissions by automatically checking with payers and vendors to validate that the authorization is on file. Payers and providers also get a shared view of account information, reducing the need for prolonged discussions about the status of authorization and rework requests. Key features to look for in prior authorization software When implementing prior authorization software, look for a solution that offers a wide range of features to automate and streamline the prior authorization process. Experian Health's prior authorization solution, Authorizations, for instance, offers healthcare providers the following key features: Real-time knowledgebase: Access to up-to-date prior authorization requirements and criteria in the National Payer Rulesets Submissions support: Removes guesswork and directs users to the correct payer portal based on procedure Automated inquiries: Automates the prior authorization payer inquiry process Enhanced workflow: Dynamic work queues display status and guides users through next steps Postback: Allows users to easily send authorization status, number and validity dates to health information systems (HIS) and practice management systems (PMS) Image storage: Receives and securely stores payer responses in an integrated document imaging system Reconciliation: Provides insights into authorization variations and helps resolve them, so staff can take proactive steps to prevent denials and appeals Integration with electronic health records and billing systems: Why it matters Providers often choose a prior authorizations platform that seamlessly integrates with existing Electronic Health Records (EHR) and billing systems for maximum efficiency. Solutions like Experian Health's automated prior authorization management tool, Authorizations, easily adapt to existing processes. This eliminates the need for a complete workflow overhaul and minimizes the learning curve for staff. Embracing prior authorization software for a more efficient revenue cycle Revenue cycle leaders who implement prior authorization automation strategies could see significant savings – $494 million annually as an industry, according to CAQH data.  Claims and revenue management processes are often complex and outdated, costing healthcare organizations time and money. High denial rates and slow reimbursements can hurt cash flow and get in the way of financial stability. Automating prior authorization can reduce claim denials, speed up reimbursements and improve the bottom line. Learn more about how Experian Health's electronic prior authorization software, Authorizations, uses automation to achieve greater consistency and efficiency for healthcare organizations. Learn more Contact us

Key takeaways: Many eligible patients don't apply for charity care simply because they don't know it's available, leading to financial strain for patients and providers. Improving charity care communication helps patients understand their options early, builds trust and reduces uncompensated care for providers. Automating financial assistance screening with tools like Patient Financial Clearance supports compassionate financial conversations and ensures more patients are connected to support at scale. Patients face difficult choices when the cost of care feels out of reach. Some hesitate to proceed with planned services due to affordability concerns, even though financial assistance may be available. For providers, Medicaid rollbacks under the budget reconciliation bill could leave more patients without coverage, increasing the volume of uncompensated care and making revenue less predictable. Charity care programs provide a financial safety net – but only if patients know about them. This article looks at how improving charity care communication connects more patients to the financial support they need. Why clear communication about charity care matters Charity care programs are designed to remove financial barriers to care for those most in need. They provide full or partial discounts to uninsured or underinsured patients for medically necessary services, as set out in hospital policies and state-level regulations. However, according to a 2025 Lown Institute study, millions of eligible patients do not apply because they do not realize the support is available. This lack of charity care awareness could affect care decisions. Experian Health's 2025 State of Patient Access survey found that 43% of patients would consider cancelling or postponing care without an accurate cost estimate. Meanwhile, 34% report they often struggle to pay for healthcare, and 95% say they experience affordability challenges at least occasionally. Making patients aware of available support means they'll feel more confident about what they owe, build trust in their provider and reduce the risk of uncompensated care. The barriers patients face when learning about financial assistance Limited information isn't the only reason for low charity care uptake. Confusing eligibility rules and complicated application processes also make support harder to access. Socioeconomic factors, language barriers and poor digital literacy compound these obstacles. Without action, the challenge looks set to intensify. A Kaiser Family Foundation investigation found that hospitals in states with limited access to Medicaid generally had higher charity care costs. With the Congressional Budget Office projecting that changes under the “One Big Beautiful Bill” Act will result in a further 16.9 million Americans without insurance over the next decade, improving charity care and patient education is likely to become more urgent. Jason Considine, President at Experian Health, explains: “When coverage gaps widen, healthcare providers must be financial advocates for their patients. Hospitals can't afford to wait for patients to ask for help or default on bills. It will become even more important for providers to guide the financial journey. This includes helping patients qualify for financial aid or identify personal payment plans." He says, "Proactive financial screening must be embedded throughout the patient journey and providers need to take every opportunity to help patients understand their options. It's not just about protecting revenue, it's about ensuring that every patient has access to the care they need, regardless of their financial circumstances. That means offering clear education, transparent communication and robust charity care options at every touchpoint.” “When coverage gaps widen, healthcare providers must be financial advocates for their patients. Hospitals can't afford to wait for patients to ask for help or default on bills. It will become even more important for providers to guide the financial journey.”- Jason Considine, President at Experian Health How to build trust when discussing financial support to patients For many patients, discussing financial hardship can be uncomfortable. Providers must approach these conversations with empathy, clarity and consistency. When thinking about how to explain charity care to patients, staff should focus on using plain language, avoiding jargon and being as clear and compassionate as possible. Timing matters as much as tone: patients who understand their options early are more likely to meet their financial obligations. Alex Liao, Senior Product Manager for Patient Financial Clearance at Experian Health, says talking about financial support should be normalized as part of the standard intake process: "While we know a lot of patients worry about cost, there are also those who are unsure if it's okay to bring up,” Liao says. “When providers take the first step and lead the conversation, it takes the pressure off patients and gives them extra reassurance. They feel more comfortable having honest and judgment-free discussions about how to manage their bills." Strategies for improving charity care awareness and understanding Liao says that providers need practical strategies for holding compassionate financial conversations: “Compassion isn't just about how we speak to patients. It's about making sure they trust and process the information they're given, and can act on it,” he says. “That means meeting patients where they are – financially, culturally and technologically. Staff should be trained to explain assistance options confidently and consistently, using standardized messaging, multilingual materials and awareness of culturally appropriate messaging.” Technology can further close the gap. Patient portals, SMS tools and mobile apps can deliver personalized financial messages and guide patients through eligibility pathways in a way that's particularly convenient for younger or mobile-first populations. Integrating charity care communication with eligibility screening Of course, these conversations depend on knowing who needs support in the first place. Automated screening processes make it easier to identify patients who qualify for assistance. This should be done as early as possible, so patients get early clarity about any support that may be available. Embedding charity care screening directly into scheduling, pre-registration and intake workflows means staff can proactively flag patients who need help before balances become unmanageable. By identifying eligible patients upfront, providers can reduce downstream bad debt and avoid the costs of collections and write-offs. On-demand webinar: Hear how Eskenazi Health boosted Medicaid charity approvals by 111% with financial aid automation Discover how Eskenazi Health partnered with Experian Health to automate the entire financial assistance process. How Experian Health supports better charity care communication at scale As states mandate charity care screening, Liao says these processes should be scalable: “We're seeing more states pass legislation that requires screening for financial assistance in hospitals. With other bills like Oregon's HB3320 being enacted, more patients will need to be screened for charity care eligibility. Because more individuals may now qualify, healthcare providers will need an efficient way to screen at scale and make sure patients are informed about their options. A tool like Patient Financial Clearance does well with volume.” Patient Financial Clearance helps reduce the manual burden of screening patients for financial assistance by automatically estimating the patient's income, household size and Federal Poverty Line percentage, and then scoring their propensity to pay. It can pre-populate charity care applications and help suggest custom-tailored payment plans to make patient bills more manageable. Automating key steps and communicating options early in the process helps staff and patients have better financial conversations. Patient Financial Advisor builds on that by allowing providers to contact patients directly with clear, upfront cost information before their visit. It sends a pre-service text message with a secure link to real-time estimates based on current rates and benefits data. Patients can easily see what they owe, explore available assistance and make secure payments, all through an intuitive, mobile-friendly platform. On-demand webinar: The X Factor - Using Experian data to drive financial assistance automation Discover how your peers are automating processes to meet new state charity screening regulations and finding new efficiencies. Empowering patients through transparent financial communication Too often, patients miss out on financial assistance simply because no one told them it was available. That communication gap creates a risk for patients facing unexpected bills, and for providers managing uncompensated care. Transparent financial conversations help remove barriers to care and build trust between patients and providers. With more patients likely to fall into eligible categories in the coming months and years, healthcare organizations need to rethink how and when they talk about financial assistance. Experian Health helps providers take a more proactive and compassionate approach to charity care communication, with scalable strategies that leave no patient overlooked. Learn more about how Experian Health's financial assistance solutions simplify charity care communication, so more patients get the help they need. Learn more Contact us

Healthy revenue cycles rely on efficient patient collections. Collections processes that drag on can frustrate both providers and patients, leading to delayed payments, a high administrative burden on staff and unpaid balances piling up. For many providers, adopting collections optimization technology is a proven strategy to make the collection process more efficient, compassionate and patient-centered.   What is collections optimization in healthcare?  The title says it all: optimizing patient collections. More specifically, collections optimization in healthcare refers to technology-based solutions that streamline the patient collections process to collect a greater percentage of the money owed. Using data-driven, patient-centric insights, collections optimization solutions allow billing staff to efficiently identify patient payment capabilities, focus collection efforts and improve patient communications. Collection performance metrics are often built into collections optimization platforms and help providers continuously improve collections strategies over time. So, it's not simply a process to collect, it's a holistic approach to improving a health system billing team's cashflow, in addition to capturing revenue that's owed to the organization.   Key components of the collections optimization process  The collections optimization process typically includes specific key components to help providers accelerate patient collections strategies. For instance, Experian Health's Collections Optimization Manager solution has six foundational areas that save time and accelerate payments:  Screening: Cleans up accounts receivable data by screening patient accounts for bankruptcy, deceased, Medicaid and charity so that staff can spend their collection efforts on accounts that have a higher likelihood of payment. Collections staff often spend time on accounts that are deceased, bankrupt, or eligible for Medicaid or charity—accounts unlikely to yield payment. This diverts attention from accounts with higher recovery potential, ultimately impacting overall cash flow. With Collections Optimization Manager, this AR becomes more manageable, and staff can work high-yield accounts in-house, while saving time and money.  Segmentation: Uses credit, behavior and demographic data to help providers identify which accounts are most likely to pay. Experian Health has robust patient data and powerful predictive analytics that reveal which accounts are most likely to pay. By leveraging propensity-to-pay scores, providers can prioritize efforts where they'll have the most impact. This targeted approach helps increase collections while reducing time and cost to collect.  Routing and reconciliation: A data-driven rules engine builds routing and recall rules that distribute accounts to the internal and external servicing channels that are most likely to collect the amount owed and reconciles provider and agency inventory  Agency management: Offers real-time insights into third-party collections agencies' performance with reports and dashboards. This puts a focus on key metrics, so teams can measure performance against industry standards to improve patient payment forecasting and successfully manage bad debt reserves   Monitoring: Monitors unpaid patient accounts for changes in a patient's contact information or ability to pay, and notifies in-house staff so that they can re-engage patients to collect their pending balances   Consulting and analytics: Collections consultants evaluate reports, suggest best-practice collections strategies and provide users with industry know-how. They can also provide quarterly performance reports to show performance and progress.  The link between collections and financial success in revenue cycle management  Healthy revenue cycles rely on timely patient payments. With so many other financial pressures on patients today – paying for groceries, filling up the family car or basic home repairs - it can become overwhelming to manage it all. When bills are confusing, reminders are missed or affordability is a concern, it can result in late payments. Busy billing teams are then tasked with chasing down collections, leaving little time to focus on other revenue-generating activities. As collection timelines drag on, providers may experience cash flow issues, revenue losses and even bad debt. This can lead to disruptions in the revenue cycle, affect the bottom line and ultimately impact the quality of patient care.  Why collections optimization matters  Healthcare costs are rising, and Americans are carrying about $3,100 in medical debt on average, up from $2,000 the previous year. One in five patients report experiencing distress over healthcare costs they can't afford, and 15 million Americans have medical collections on their credit reports, according to 2024 data from the Consumer Financial Protection Bureau.   By adopting collection optimization solutions, providers not only strengthen the revenue cycle but also have the opportunity to improve the overall patient financial experience. Tools like Collection Optimization Manager help billing teams quickly understand their patients' ability and willingness to pay, identify charity eligibility and implement effective and compassionate patient billing outreach. Plus, performance analytics help staff assess performance over time and adjust collection strategies accordingly. Healthcare institutions aim to understand a patient's financial situation and take steps to assist them in their medical journey. This approach is central to their mission.  On-demand webinar: Boost self-pay collections - Novant Health & Cone Health's 7:1 ROI & $14M patient collections success Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager.  Key challenges    Maximizing patient collections is always a priority for providers. However, getting patients to pay their medical bills often comes with challenges, due to:    Poor financial insights: Billing staff may not have enough information about patients' financial circumstances to make predictions about how likely they are to pay. This can make prioritizing accounts and creating patient engagement strategies tricky. Collections staff may often spend time on accounts that are deceased, bankrupt, or eligible for Medicaid or charity – accounts unlikely to yield payment.   Ineffective outreach: Collections staff may spend hours calling patients with low collection yields.  Affordability concerns: Patients may be worried about how they'll pay for their bills, especially if they have a high-deductible healthcare plan. This can lead to late payments.  Insurance policy updates: Busy billing staff might not always be able to stay on top of frequent insurance changes and regulatory updates. This can lead to errors in patient billing or incorrect cost calculations, resulting in late or unpaid payments.   Lack of easy payment options: Patients want convenient, secure ways to pay on their time. When easy options like online and mobile payment methods aren’t available, it can lead to frustration and late payments.   Outdated manual processes: Valuable staff hours are often lost to cumbersome steps in the collections process, like phone calls and follow-up paperwork.   How technology is transforming collections ​​optimization  When implementing billing and collections optimization, today's providers are turning to technology that includes a growing range of automated solutions for more transparent billing, personalized payment options and increased efficiencies. Combining collections and automation enables a more transparent, user-friendly process that gives patients more financial control. Additionally, new technologies, like predictive analytics, machine learning and artificial intelligence, also help providers better understand their patients' financial needs so that they can deliver a more compassionate and supportive collections experience.   Case study: How Wooster Community Hospital collected $3.8M in patient balances with Collections Optimization Manager Read more about how automated collections strategies helped Wooster Community Hospital achieve a $3.8 million increase in patient payments.  Three best practices that accelerate collections A strong collections optimization solution should be able to accomplish the following:  Segment accounts based on propensity to pay  Billing teams can improve collections optimization by using automation and segmentation to obtain the data needed to prioritize high-value accounts. Collections Optimization Manager, for instance, uses multiple data sources to automatically screen and segment accounts based on propensity-to-pay scores.   Improve patient communication   Providers can use collections optimization tools and complementary automated patient outreach tools to foster better patient communication without putting additional strain on busy staff. Solutions like PatientDial and PatientText send patients timely bill reminders and self-pay options via voice or text message, while other financial assistance tools, like Patient Financial Clearance, assign patients to the correct financial pathway.  Benchmark performance  Billing teams can use their collections optimization tools to review comprehensive reports and scorecards on their agencies' performance. This allows healthcare organizations to compare performances across multiple vendors. Advanced reporting helps identify performance improvement opportunities, refine patient payment forecasts and manage bad debt. In some cases, such as with Experian Health's Collections Optimization Manager, users can also access expert consultative support to refine collections strategies further.   How can healthcare companies measure success?  Revenue cycle leaders know that “what gets measured, gets managed.” Using a collections optimization solution to monitor key performance indicators (KPIs) enables providers to fine-tune their collections process and assess performance over time. For instance, Experian Health's Collections Optimization Manager captures critical KPIs, such as accounts receivable days and collection rates. User-friendly dashboards and reports allow staff to measure performance against past metrics and industry trends. Plus, users benefit from consultants who can help choose the ​​right KPIs to track, evaluate reports and develop new collection strategies.  Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle management staff collect more patient balances.  Learn more Contact us

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. These 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. Payment 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 payment 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 Estimates 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.  Join us for an exclusive session on August 21, 2025 to explore how Experian Health is reshaping the way healthcare organizations manage Coordination of Benefits (COB). Learn how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue. Register 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