All posts by Kelly Nguyen

“I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.”—Andrew Pederson, Director of Patient Experience, UCHealth Challenge UCHealth, in Aurora, Colorado, is an integrated system of 12 hospitals and more than 30,000 employees. When the state of Colorado released data on non-profit hospital charity care and community benefits, UCHealth's spending was lower than anticipated despite having policies on equitable charity care in place. Additionally, the state was about to implement new legislation on charity care, setting a cap on charges for low-income patients. UCHealth proactively sought to revamp how they handled charity care in preparation for higher patient volumes in the future. The organization decided to review its charity policy and processes. After examining other providers, UCHealth determined that it lacked presumptive charity functionality early in the patient encounter. New technology would help patients avoid the accrual of unpaid medical bills and keep UCHealth from accruing bad debt. Solution UCHealth added Patient Financial Clearance in 2023 after their favorable experiences with Experian Health's Coverage Discovery® and Insurance Eligibility Verification. Patient Financial Clearance allowed the provider a more nuanced understanding of each patient's ability to pay by going beyond their reported income to look at the Federal Poverty Level ratio and their propensity-to-pay. The technology used powerful analytics to create a Healthcare Financial Risk Score, encompassing historical credit activities, including payment of past medical bills. Importantly, Patient Financial Clearance helped UCHealth staff determine options for financial assistance automatically, without relying on the patients themselves. Automation in the platform reduces time spent per encounter, improving the patient and staff experience and, ultimately, the bottom line. Discover how UCHealth secured $62M+ in insurance payments with Experian Health's Coverage Discovery solution. Outcome Thanks to Patient Financial Clearance, UCHealth achieved the following results: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). Overall, Patient Financial Clearance helped UCHealth create a more streamlined approach to providing charity care to patients who need it. The technology integrates easily with the provider's electronic health record (EHR) system, eliminating the back-and-forth between multiple systems during patient registration. Identifying patients who need financial assistance saves the UCHealth team from misclassifying them as bad debt, minimizing financial losses on the organization while improving their overall experience. Andrew Pederson, Director of Patient Financial Experience at UCHealth, highly recommends this software and the team that provides it, stating, “I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.” For providers seeking to streamline the revenue cycle, Pederson says, “Get out of your own way and just do it.” Learn more about how Patient Financial Clearance streamlines patient charity screening while maintaining an outstanding experience at every step of the encounter.

The ecosystem of healthcare revenue management involves the entire lifecycle of medical billing. It starts with patient scheduling to encounters, then moves to coding and medical billing. However, understanding the basics of medical billing isn't just for the back-office team: it's vital for front-office staff too, especially those dealing directly with patients. Many patients arrive with coverage from multiple payers and high deductibles, which makes claims and collections processes increasingly complex. Providers that get the billing basics right can deliver a better patient experience while setting themselves up for financial success. Discover the key steps in the medical billing cycle and learn how healthcare providers can improve efficiency, streamline collections, and increase profits from appointment scheduling to payment completion. What are medical billing basics? Medical billing is about ensuring providers get paid for the services they provide, whether that be submitting claims to payers or invoices to patients. The workflow may be broken down into three phases: Front-end medical billing: The process starts with patient intake and registration. During this process, staff collect relevant information about the patient, their coverage, and their diagnosis and treatment. They must know what payers require in terms of claims documentation so they can collect the right data upfront. At this time, staff will also inform patients of their financial responsibility, so patients are prepared for their upcoming bills, or can make payments before service.yr45 Back-end medical billing: This part of the cycle occurs after the encounter. Once it's documented, medical coders and billers use information obtained during registration to figure out who pays what toward the final bill. Coding rules and documentation requirements vary considerably, depending on payer type (commercial, government or self-pay) and individual payer policies, so many organizations use automation and artificial intelligence to increase medical billing accuracy and minimize denials. These tools also support the claims adjudication process. Patient collections: If there are any remaining balances after insurance reimbursement, healthcare organizations generate bills for patients. These detail the services provided, the amount already covered by insurance, and any outstanding balances owed by the patients. Increasing numbers of self-pay patients with high deductibles put new pressure on patient collections, and managing the workflow is challenging without technology, data and analytics. Healthcare organizations struggle to collect more than one-third of patient balances greater than $200, which makes understanding how to improve medical billing is essential. What’s the relationship between the medical billing revenue cycle, successful billing and patient collections? Within the medical billing revenue cycle, there are opportunities to maximize efficiency and accuracy, with tangible benefits for staff, patients, and those with an eye on profits. These opportunities rely on bridging the gaps between the three phases above with reliable data and integrated workflows. Some strategies and tools include: Find missing coverage: Proactively identifying billable government and commercial coverage is a huge relief for patients, who won't be billed for amounts that could be paid via alternative sources. Additionally, providers are more likely to be reimbursed. Coverage Discovery uses multiple proprietary databases to scan for missing or forgotten coverage throughout the patient journey. In 2023, this solution tracked down billable coverage in 32.1% of patient accounts, resulting in more than $25 million in previously unknown coverage. Tailored payment options for patients: Providing upfront pre-service cost estimates for patients gives them clarity about what they'll owe so they're less likely to be shocked when they receive their bill, and are more likely to pay on time. Patient Payment Estimates generates quick, accurate pricing estimates along with a clear breakdown of how the costs have been calculated and secure links to instant payment methods. Helping patients find financial assistance: From the first encounter, patient financial data can be interrogated to determine whether they may be eligible for financial assistance. Getting them on the right pathway from the start means they're less likely to delay and default on bill payments. Flexible payment plans: Research from Experian Health and PYMNTS shows patients are eager for flexible ways to pay. Rigid and protracted processes are inconvenient for patients and often end up multiplying medical debt, which is bad news all round. Simple self-service tools can meet patients where they are and help them manage their bills, whether they prefer to pay in full and up front, or they need to break it into more manageable instalments. This reduces payment delays and lessens the medical debt burden on all parties. Streamlined, secure payments: PaymentSafe® accepts secure payments anywhere, anytime, using eChecking, debit or credit card, cash, check and recurring billing – all through a single, easy-to-use web tool. Every patient encounter becomes an opportunity to collect payments with minimal fuss. Automated patient outreach: An easy win with automation is to issue appropriate reminders to patients about upcoming and overdue payments. Automated dialing and texting campaigns mean patients get relevant information through convenient channels, and staff can focus on more complex collections cases. Strategic collections management: Segmenting and prioritizing collections accounts based on propensity to pay allows staff to spend their time where it matters most. Automation and data analytics can be used to route accounts to the correct pathway, resulting in a more compassionate patient experience, better use of resources, and increased collections overall. Identifying inefficiencies in medical billing To select and implement the above strategies and RCM medical billing solutions, it's important to identify where inefficiencies and gaps are in the process. Some questions to consider are: Are we relying too heavily on manual entry in our billing activities? What are the root causes behind our medical billing errors? Are our tracking and reporting efforts throughout the billing lifecycle? How accurate are our payment estimates and eligibility verification processes? Are our current payment acceptance practices and plans effective? How successful and compassionate are our patient outreach efforts? By assessing each area, providers can pinpoint opportunities to simplify the medical billing workflow and use revenue cycle management technology to accelerate collections. Optimize patient collections with the Collections Optimization Manager One specific example of how healthcare organizations can improve patient collections is with Collections Optimization Manager, which uses data analytics to manage the medical billing basics and customize collections strategies. The platform streamlines patient collections by screening out bankruptcies, deceased accounts, Medicaid and other charity eligibility, so staff don’t waste time chasing payments. Remaining accounts are grouped and routed to the most appropriate pathway, so they can be dealt with quickly and effectively. Case study: See how St. Luke's University Health used Collections Optimization Manager to collect an additional $1.2 million in average monthly collections,, in the midst of staffing shortages. Explore more ways to use Collections Optimization Manager to streamline the medical billing basics and accelerate patient collections.

Claims denials are a thorn in the side of any healthcare organization. Even with claims denial mitigation tools and processes in place, denials are growing. In Experian Health's State of Claims 2022 report, 30 percent of respondents said denials increased between 10% –15% annually. To combat rising denials, ensure faster reimbursements, and improve the revenue cycle, healthcare providers need new claims technology that focuses on efficiency. In this post, learn about the common challenges in traditional claims processing and how to implement automated or AI-based claims management technology to drive healthcare revenue cycle efficiency. Challenges in traditional claims processing When it comes to reimbursement, the odds of being paid do not always favor the healthcare provider. The complexity of claims makes for labor-intensive workflows in traditional reimbursement processing. Data is often culled from multiple systems, including electronic health records (EHRs), paper files, diagnoses, test results, insurance verification, and more. Providers lacking a streamlined set of workflows supported by claims technology, experience errors that can lead to denied claims. Three of the most common challenges in traditional claims processing include missing or incomplete claims information, payer-related problems, and a need for more staff, which slows down processing productivity. 1. Missing or incomplete claim information Missing data is also a huge issue in traditional claims processing. In fact, missing or incomplete data is one of the top reasons for claims denials, particularly in the area of prior authorization. These mistakes often begin upstream at the first point of patient contact and, if not corrected, snowball toward the inevitable denial. Compounding the problem is that disparate healthcare systems and workflows make it increasingly challenging to collect all the data effectively. The larger the healthcare provider, the more touchpoints for claims processing, creating back-and-forth workflows that can lead to miscommunication or the loss of information. 2. Payer-related challenges Just keeping up with changes in payer requirements is a full-time job. Payers often change reimbursement requirements, and providers aren't aware of these new adjudication rules. It requires strict monitoring of all payers, which is impossible for organizations to manage. Prior authorizations are also increasingly burdensome for providers to handle. An AMA survey found that 88 percent of physicians said these burdens were high or extremely high. Providers estimated they process 45 prior authorizations weekly, equivalent to 14 hours of staff time. 3. Reduced or new staff can't keep pace Another challenge is not having the workforce necessary to review claims to identify errors. Workforce shortages continue to impact every healthcare area. The chronic challenge of high workloads and short staffing means most teams work as quickly as possible, leading to preventable mistakes. Without advanced claim technology, staff manually handle heavy workloads, which is driving denials through the roof. The lack of staff also affects traditional claims processing by slowing denials resubmissions. A less efficient denials management process directly affects provider cash flow, creating more delays in getting paid. Resolving these challenges requires modern, advanced claims technology powered by automation and artificial intelligence (AI). By leveraging this technology for claims management, healthcare providers can solve these problems for greater reimbursement efficiency and a better bottom line. Best practices for implementing AI-based claims management technology Experian Health data shows 51% of healthcare providers currently leverage some software automation. However, only 11% had integrated AI technology into their organization. Mounting evidence suggests preventing healthcare claims denials starts with innovative AI-driven claims management technology. AI and automation applied to a claim technology solution can prevent claims denials on the front-end of the patient encounter and improve denial management on the back-end of the process. When evaluating how to implement advanced claim technology, consider these best practices: Start by identifying the pain points in existing claims processing workflows. Review claims denials and mitigation data and talk with existing staff to develop this list. If the organization leverages legacy reimbursement tools, consider how efficiency gaps affect the organization. Consider organizational goals and objectives for replacing manual workflows or upgrading legacy claims management technology. As the organization explores the benefits of advanced claim technology featuring AI, develop use cases for employing these tools for more effective claims management. Compare new product features to these real-life scenarios. Seek stakeholder feedback. All technology rollouts require significant buy-in at every level in the organization. Don't miss engaging with the boots-on-the-ground workforce using the claims technology Ensure the organization has the infrastructure to support the new platform long after it goes live. When evaluating new digital tools, keep these things in mind: Select AI-based claims technology that utilizes workflow customization to manage the entire reimbursement cycle. Seek out a solution that automatically reviews each line in a claim to check for errors so that first submissions are accurate. Leverage a system with automation features that eliminate error-prone manual processes. Choose a platform that enables denial prediction and mitigation. Find a product with denials workflows and enhanced claims monitoring functionality. AI technology is the game-changer for healthcare's skyrocketing claim denial challenges. These new tools deliver immediate value to an increasingly disjointed and complex reimbursement process. With the right technology, healthcare providers improve the claims processing efficiency to get paid faster. Transformative impact of Experian Health's advanced claims technology Experian Health is a leader in digitally transforming traditional claims processing. AI-powered technology can increase staff efficiency at every stage of the claims management process. Experian Health's AI Advantage™, part of the Best in KLAS ClaimSource® platform, is transforming provider claims processing. This software reduces the need for additional staff by automating manual tasks. It lessens the burden on existing teams by lightening their claims processing and denials management workloads. AI Advantage has two primary solutions affecting every stage of the claims management process: Predictive Denials identify undocumented payer rules resulting in new denials. This AI-driven solution finds the claims most likely to fail, flagging them back to payment processing for correction before they're even submitted to the payer. Denial Triage manages prioritization of denied claims. Advanced algorithms in this solution identify and flag denials based on their potential value. Organizations maximize their returns on denied claims by focusing on the resubmissions with the highest financial impact. It removes the guesswork from reworking claims, lessening staff workloads by eliminating time wasted on low-value cases. Another solution, Patient Access Curator, uses AI and robotic process automation to enable healthcare staff to capture all patient data at registration, with a single click solution that returns multiple results - all in 30 seconds.  Experian Health's automated and AI-fueled advanced claim technology improves provider reimbursement efficiency at every stage of the process. The efficiency-related benefits of AI for claims management include avoiding denials, accelerating denial mitigation, and getting paid faster. To explore these tools—and their extraordinary ROI, contact the Experian Health team today.

“As the IU Health Revenue Cycle team rallied to respond to the claims processing disruption, we were uniquely positioned with our long-time Experian partnership to quickly re-institute critical claims routines and restore a significant volume of claims transmissions.  This would not have been possible without Experian's nimble and comprehensive approach, immediately applying talented and committed resources that leveraged existing Experian platform infrastructure.” – Bryan Daniels, Vice President Revenue Cycle Solutions, IU Health Challenge Indiana University Health (IU Health) is the largest network of physicians in Indiana comprised of over 38,000 team members and 2,717 available beds. Based in Indianapolis, Indiana, the organization has dozens of facilities statewide and is on a mission to make the state one of the healthiest in the nation. In February 2024, IU Health found itself impacted by the cybersecurity incident so many providers across the country abruptly faced. They were unable to send claims to insurance companies and their revenue cycle operations came to screeching halt. Knowing they needed a trusted solution fast, the revenue cycle leadership team asked Experian Health if they could help. Solution Conversations advanced quickly and the Experian Health team was able to implement its Best in KLAS ClaimSource® platform within a week. ClaimSource is an innovative claims management solution designed for scalability and improves revenue streams by minimizing denials. By using automation, it boosts operational efficiency by prioritizing claims, payments, and denials, allowing users to tackle high-impact accounts promptly. Outcome Thanks to ClaimSource, IU Health achieved the following results: Accelerated $632 million in claims transmissions in the first five days of business. Processed $1.1B of claims backlog by March 27.  “We value our longstanding partnership with IU Health and it's very rewarding that we were able to help in a very critical situation,” said Jason Considine, Experian Health's Chief Commercial Officer. “We know IU Health places the utmost importance on patient care, and being an important part of our client's solution to deliver on their service commitment is reflective of our service commitment to simplify healthcare.” Learn more about how ClaimSource can help your healthcare organization accelerate cash flow, reduce denials and optimize efficiency.

Healthcare leaders often zero in on how uninsured rates affect their bottom line. But another patient group presents a quieter financial dilemma for providers: those with multiple active health plans. In these cases, it's important to ensure each plan pays the right amount – in the right order. Should any confusion arise, providers may end up with their claims being denied, resulting in underpayments. This is where the coordination of benefits (COB) process comes in. What is coordination of benefits (COB) and why is it important? When a patient is covered by more than one plan, the “coordination of benefits” process kicks in to help health plans figure out their respective payment responsibilities. With patients often having multiple insurance policies, ensuring that each policy pays its share is vital. The purpose of coordination of benefits is to prevent overpayment or duplication of benefits, ensuring that the total benefits paid do not exceed the actual cost of the service received. Integrating a digital COB solution within registration and scheduling workflows can help providers ensure they bill primary and secondary payers correctly, preventing unnecessary claim denials. Challenges of coordination of benefits  Coordination of Benefits is a pivotal aspect of RCM, but it's not without its hurdles. Here's a look at the complexities that often arise:  Overlapping Policies: Determining which policy pays first can be confusing. Patients with dual coverage might not always be aware of the hierarchy, leading to billing complications. And many legacy systems only select the primary, without consideration for secondary or tertiary. And regional plans add another layer of complexity.  Claim Denials: Incorrect coordination of benefits can lead to claim denials or overpayments. This not only affects revenue but also strains the patient-provider relationship when patients are billed incorrectly.  Administrative Burden: Manual COB verification is time-consuming and prone to errors. Staff often spend hours cross-referencing policies, which could be better spent on patient care.  Coordination of benefits: the dream vs. reality In an ideal world, patients would register for care weeks ahead of their scheduled treatment. During the registration process, they would inform the provider of all their active insurance coverage, with correct and complete details close to hand. No plan would go unmentioned, and no policy number misplaced. Registration staff would quickly enter the information into their EMR without error, so coverage could be verified in real-time. The reality is far different. Recent findings show that 65% of consumers struggle to understand what their health insurance covers. They do not carry copies of their insurance cards. They may not be aware that they are covered under a relative's health plan. Patient access teams are under-staffed and over-stretched, with little time to ask guiding questions that would uncover additional insurance. Coordination of benefits efforts should start as soon as it becomes apparent that a patient has active coverage under multiple plans. Unfortunately, the messy reality of coverage discovery and patient registration means patients and providers are left in the dark until a claim is denied. The payer rejects the claim for a COB-related reason, leaving billers with no clue how to resolve it. The problem gets worse from there. Automating coordination of benefits for faster, cleaner claims As with all aspects of healthcare billing, there are many complex rules and regulations governing COB transactions. Under HIPAA, health plans and payers (including Medicare and Medicaid) must coordinate benefits for each patient and determine the primary and secondary payers. Tracking this manually is extremely challenging for providers: using the information provided by the patient (which may or may not be accurate), staff would contact each payer by phone or email to verify coverage. They would then review the COB rules and guidelines for each health plan to determine the primary payer and follow specific rules for billing secondary payers. It's no wonder that COB transactions are now among the most automated administrative tasks. Automating coordination of benefits not only saves staff time, but also increases the chances of finding all active coverage, collating complete insurance profiles for the patient, and making an accurate primacy determination. Digital systems also make it easier for providers and payers to communicate with one another, facilitating smoother dispute resolution and regulatory compliance. Patient Access Curator brings real-time COB to EH clients In late 2023, Experian Health acquired Wave HDC, bringing clients a new and unrivalled package of real-time coverage and benefits solutions based on AI-powered data curation. This new solution, Patient Access Curator, helps healthcare billing teams prevent claim denials in seconds through real-time data analysis. This includes COB curation, which automatically analyzes payer responses to identify hidden cues that staff cannot see. If other insurance is identified, the tool alerts the user and triggers additional queries to verify active coverage and build a complete insurance profile for the patient. Each policy is then analyzed further to determine the patient's primary, secondary and tertiary coverage, reliably sifting out any non-billable coverage. Since 2020, the technology powering Patient Access Curator has prevented denials amounting to more than $1 billion. Integrating coordination of benefits automation yields savings throughout the revenue cycle Integrating COB automation with other RCM tools, such as coverage discovery and eligibility verification, means providers can prevent and manage denials in a single workflow. Doing this during patient registration allows teams to resolve issues in the early stages of the revenue cycle, rather than wait to deal with them once claims are denied. While catching errors on the front-end results in faster patient registration and clean claims first time, the tool adds value later in the revenue cycle, too. Streamlining the correction process prevents revenue loss and reduces the need for manual intervention. Here's how these use cases look in practice: In one multistate practice, the technology automated COB curation with insurance verification during patient registration. This enabled primary coverage corrections for 12% of patient registrations and identified undocumented Medicare and Medicaid coverages for 6% of registrations. Left unchecked, these omissions would have resulted in denials, delays, and missed revenue opportunities. The technology was deployed in the denials workflow at a large health system, where it identified COB corrections for 92% of all COB denials. Of these, 60% were immediately refiled to the correct primary payer, minimizing delays in revenue recovery. In the remaining claims, the tool found evidence of inaccurate or outdated third-party liability records within payer claim adjudication systems. Providers urgently need revenue cycle processes to be as efficient and reliable as possible – especially when dealing with patients with multiple, complex health plans. A powerful denial prevention solution that slots neatly into the registration workflow means they can maximize revenue with minimal human intervention. And with accurate results delivered in seconds, Patient Access Curator could be just what the doctor ordered. Get in touch today to find out more about coordination of benefits automation and discuss other ways to increase efficiency on the front-end of the revenue cycle, using Patient Access Curator.

Discovering that a patient's insurance doesn't cover planned care is frustrating for patients and providers. With revenue and patient satisfaction on the line, verifying active coverage should be simple and efficient. However, the process often involves digging through an ever-expanding mountain of data, which consumes valuable time and resources. Increasing patient volumes, frequent payer updates, and new demands for pre-authorization all play a role. Additionally, the impact of nearly 12 million Americans losing Medicaid coverage since April 2023 adds to the challenge.  It's unsurprising that many healthcare organizations no longer rely on manual processes to verify a patient's insurance details. To address these issues, many providers are turning to medical insurance verification software. The CAQH 2022 Index reports that automation of eligibility and benefits verification has increased by 25% over the last 10 years, as providers turn to medical insurance eligibility verification software for more reliable results. This article looks at how these tools are helping healthcare organizations increase their profitability and the questions to consider when selecting the right eligibility verification solution. What is medical insurance verification software? Medical insurance verification software automates the process of checking that a patient's insurance information is current and correct. With just a few clicks (or just a single click when using Patient Access Curator), the software collects data from multiple sources to confirm that prescribed services or treatment are covered by the patient's health plan. Unlike manual processes that involve checking individual payer websites and cross-referencing patient data by hand, an automated solution returns accurate information in an instant. Adoption of this software has grown significantly in recent years because of its ability to drive operational efficiency and reduce revenue loss. More than 90% of medical providers now opt for electronic eligibility verification, according to the CAQH 2022 Index. The report highlights this as a top savings opportunity for the industry, having helped providers avoid almost $81m in costs arising from manual transactions. It's particularly cost-effective for smaller organizations with tighter budgets. How it works: the eligibility workflow Here's what the insurance eligibility verification process looks like in practice: As soon as the user registers the patient, they can make an eligibility request and the software immediately determines whether the patient has coverage on file and whether that coverage has been verified. An optional MBI lookup service can be used to check transactions against MBI databases to see if the patient may be eligible for Medicare. If a patient is eligible for Medicare, the response will confirm the type of Medicare and flag up any missing patient information. If they are not eligible, the transaction will be routed through the regular verification process. For non-Medicare transactions, the software will confirm any other coverage found and provide subscriber details. Benefits of medical insurance eligibility verification software for providers and patients As with all data-driven revenue cycle processes, even the smallest eligibility verification errors can result in denied claims, wasted staff time and lost dollars. Automating the process minimizes the risk of incomplete patient data, outdated insurance information and simple human mistakes. But while accuracy is paramount, the benefits of insurance eligibility software go much further: Boost cash flow and cost savings: Identifying the correct insurance coverage improves the billing process to increase and accelerate reimbursement. With fewer denied claims, more revenue comes in the door and staff time need not be spent on costly rework. Increase operational efficiency: Software automates and streamlines the verification process, saving time and reducing the burden on staff. As labor shortages persist, fewer staff may be available, so any action that makes better use of resources will result in efficiency gains and let staff focus on higher-value tasks. Simplify workflows: Busy providers don't have time for lengthy onboarding exercises or training programs. An eligibility verification product with an intuitive interface that integrates with other information management systems can shortcut the learning curve, while alerts and smart work queues help staff prioritize the right tasks. Leave room to grow: Providers need solutions that can scale in step with increasing patient numbers and administrative complexity. Medical insurance eligibility verification software can adapt to changing needs with minimal disruption. Improve the patient experience: A more reliable verification process means providers can generate accurate and timely cost estimates for patients, which makes it easier for them to understand their financial responsibility and plan for bills. And by eliminating time-consuming manual tasks, software speeds up registration and gives staff more time to focus on patient care. Again, this means more dollars coming in the door. Key features to look for in medical insurance verification software When selecting a platform, healthcare organizations should consider the following questions: Does it pull from reliable data sources? Does the software integrate with existing payer and information management systems? Is the system easy for staff to use? Does it incorporate monitoring and reporting functions? Does the supplier offer ongoing support? Experian Health's Insurance Eligibility Verification solution was developed with these questions in mind. It gathers data from more than 900 payer websites, along with other sources, to generate detailed responses. Advanced search optimization increases the chance of a positive match, so no active coverage slips through the net, while the CAQH Coordination of Benefits Solution data feature gives access to real-time primary and secondary coverage data with 99.5 percent accuracy. Providers that already use Experian Health products, such as eCare NEXT®, can access Eligibility through the same interface, so staff can use it right away and generate combined performance reports. One of the major advantages of Eligibility is the optional Medicare beneficiary identifier (MBI) look-up service, as described below. And now, healthcare providers have an additional tool to add to their eligibility arsenal: Patient Access Curator. With Experian Health's recent acquisition of Wave HDC, users can leverage AI-guided data capture technology to quickly check and correct patient insurance information. Patient Access Curator not only verifies insurance eligibility, it also facilitates accelerated coordination of benefits processing, runs automated MBI checks, searches for missing coverage, and analyzes a patient's propensity to pay – all in a single click. Close the coverage gap with medical insurance verification software While insurance verification software improves eligibility review processes, one question remains: how can providers help patients who are found to have invalid coverage? One option is to help patients find alternative coverage, using a solution like Coverage Discovery. Similarly, Patient Financial Clearance can identify patients who may be eligible for Medicaid or charity assistance, and can point them toward manageable payment plans if they have a self-pay balance. In this way, automated solutions can go even further to help providers create a positive patient experience and ultimately reduce the burden of bad debt. As providers embrace the benefits of automation, selecting the right solution is crucial. Tools that integrate workflows throughout patient access and the wider revenue cycle will make it easier to manage change, maximize resources and boost profitability. Find out more about how Insurance Eligibility Verification helps healthcare organizations increase reimbursements with automated eligibility checks. Learn more Contact us

Labor shortages and the uptick in claim denials are undoubtedly putting heavy financial strain on healthcare providers. Could automated claim denial prevention help ease the pressure? In a recent webinar, Jason Considine, Chief Commercial Officer at Experian Health, and Jordan Levitt, Co-founder at Wave HDC (recently acquired by Experian Health), discussed strategies to tackle denials head-on in the coming year. This article summarizes the key insights, including a new automated one-click denial prevention tool that shifts denials management to the front end of the revenue cycle. 5 revenue cycle challenges causing claim denials and strained margins To start, Considine opened the webinar with a discussion of the root causes of denials. These often originate during registration, and for many providers, “registration and data integrity continue to be a problem.” A fifth of denials are attributed to just five key issues: Coordination of benefits (COB) denials, which account for a major portion of denials as more patients have secondary and tertiary coverage; Contingency fees, which eat up margins in exchange for information that providers should be able to obtain themselves during registration; Labor costs, which can increase with labor-saving automations that push manual input downstream; Epic plan mapping, which becomes increasingly complex and error-prone as payer requirements evolve; Transactional pricing, where “pay-per-click” pricing models disincentivize providers from using registration tools to find patient information during registration. These interrelated issues should be solved with one up-front revenue cycle management (RCM) solution, rather than piecemeal fixes that are implemented later. According to Considine: “Vendors tend to offer ways to solve these problems after the patient leaves, but really we should have gotten the right information right up front. Pushing problem-solving downstream means you need more people to manage these solutions, you've got more vendors to manage, and you end up staffing denial management departments and throwing more people at the problem.” Shifting from denial management to denial prevention Part of the challenge is the sheer volume of patient information that must be collected from the start. Staff interact with multiple systems to collate, check and coordinate data on eligibility, COB, Medicare Beneficiary Identifiers, demographics and coverage. Many of these data points can be points of failure if the wrong information is captured and penetrates the rest of the system. This makes patient access the perfect place to solve the denials problem. Levitt says this is exactly what Wave HDC set out to do when they developed the technology that underpins Patient Access Curator. “The answer isn't multiple clicks, running one transaction at a time. With Patient Access Curator, you can know everything about the patient to run a clean revenue cycle process and propagate only clean data downstream, all within two to thirty seconds.” Patient Access Curator prevents denials by capturing all patient data at registration through a single click solution that returns multiple results in less than a minute. It's fast because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer. This means data can be transferred easily between interfaces. Levitt explained how the tool builds a “perimeter defense against bad data,” by ensuring data accuracy from the start. Bad data is less likely to propagate through the system, which reduces the risk of denials. As a result, clients using the tool have been able to reduce contingency volume by over 60%. Introducing the next generation of smart RCM technology Many organizations are investing in staffing to address claim denials, but this approach is not effective in the long run. Levitt described how preventing denials calls for technology that's built for today's challenges. “Most tools out there are built to manage the problems of the last twenty years. But twenty years ago, we didn't really have COB issues. Patients were either insured or uninsured. Now, some are over-insured and some are under-insured. You see more patients come in with one insurance card in their hand, but with two, three, or four other coverages. It's much more complex. Patient Access Curator makes it simple by bundling all the transactions into one.” The technology uses artificial intelligence, in-memory analytics, and robotic process automation to verify eligibility and COB, find and fix patient identifiers, check contact information, and generate information about the patient's propensity to pay. And the result? Providers can simplify denials management even as the insurance and operational landscape becomes more complex. Watch the webinar to hear the full discussion and find out more about how Patient Access Curator helps healthcare organizations capture accurate patient information at registration with a single click.

Patient expectations of their healthcare providers have changed. Today, patients expect providers to offer the same convenience as their favorite e-commerce site, with intuitive self-service options that put them in the driver's seat. It's a brave new world for healthcare providers, who know the patient experience is about more than providing quality care—it's also about opening a digital front door with patient access technology. What do patients want from their healthcare providers? Experian Health's State of Patient Access 2023 survey shed light on what healthcare customers want: 76% want online scheduling from their favorite mobile device. 72% want an online payment option that is mobile-friendly. 56% want more (not fewer) digital options for managing their health. Outdated manual workflows do more than bog down backend healthcare teams; there's evidence this also frustrates patients. One study showed that 85% of patients believe technology can improve communication with their providers. Beyond the convenience of self-scheduling and improved communication, there is also evidence that patient access technology improves patient safety. Most people hate paperwork, and patients are no exception. Providers can digitize many of these manual tasks. Streamlining the patient access experience online could include: Online self-service appointment scheduling. Pre-registration via a patient portal. Real-time insurance eligibility verification. Automated, accurate out-of-pocket estimates. Text and email reminders to reduce no-shows. Online bill payments with personalized payment plans. Today's patients have grown accustomed to the immediacy of online shopping thanks to vendors like Amazon. That expectation transfers to healthcare, where administrative and financial tasks can be repetitious and frustrating. Technology can improve engagement with healthcare consumers, from patient intake to bill payment, while lowering the administrative burden on medical staff. How can patient access technology make healthcare convenient? Digital technology can transform the healthcare experience into a more accessible and patient-centric model. For example, 24/7 online scheduling lets patients book appointments at their convenience from their favorite online device without lengthy phone calls or complex scheduling processes. These solutions reduce wait times and patient frustration. Providers benefit from improved call center efficiency, lower no-show rates, and higher patient satisfaction. Digital patient portals are an easy conduit to better communication and faster access to healthcare information. Patients can fill out forms, get price estimates, check test results, and update insurance details. Providers benefit from more accurate patient data, not to mention more satisfied patients. Mobile-friendly tools enable on-the-go access to patient health information. From viewing test results to communicating with healthcare providers, mobile apps empower patients to actively engage in their healthcare journey. Secure messaging platforms enable patients to interact with healthcare providers by email and text, when they want, on their chosen device. Patient access technology also streamlines labor-intensive administrative processes with digital registration systems. Patients experience reduced wait times, as these technologies expedite check-in, contributing to a more efficient and hassle-free healthcare experience. Ultimately, these tools make life for patients and providers easier. Manual healthcare workflows cause bottlenecks and mistakes that lead to increasing claims denials. Patient access technology automates many labor-intensive tasks for patients and providers, including prior authorizations, which, if declined, can delay care and negatively affect patient outcomes. Tools like Experian Health's Patient Access Curator can check patient coverage within just a few seconds, speeding up reimbursement workflows from registration through payment. The software is particularly helpful for self-pay patients, helping providers identify a clear path towards financial accountability at the beginning of the encounter. Can automation improve patient engagement? Automation technology does more than improve human workflows in the complex service delivery world. These tools engage patients across their healthcare journey, a crucial component of effective, patient-centered care. Patient engagement refers to the active involvement of individuals in their healthcare journey, and automation can play a pivotal role in facilitating this process. Patient data allows technology to personalize each encounter. Automated systems can deliver timely and tailored messages to patients, reminding them of appointments, medication schedules, and preventive care. Automated patient access technology lets patients know that their chosen healthcare provider is looking out for their well-being. These solutions help patients stay informed and create accountability for adhering to treatment plans. Behind the scenes, sophisticated analytics provide valuable insights into the health of various patient populations. Healthcare providers make data-driven decisions that can guide any intervention before issues escalate. Automation can streamline administrative tasks, allowing healthcare providers to focus more on direct patient care. Digital platforms handle appointment scheduling, prescription refills, and routine inquiries, reducing the burden on healthcare staff and patients. Automating routine processes allows healthcare professionals to spend more time on meaningful patient interactions that build stronger long-term relationships. Improve patient access technology and improve patient experiences A recent Accenture study shows healthcare consumers are willing to switch providers if their needs and preferences are not met. Millennial and Gen Z populations are six times more likely to switch providers. The study also showed patient access was the top factor when choosing to stay or leave their healthcare provider. The increasing level of consumerism in healthcare should be incentive to change for any provider with legacy technology and outdated administrative processes. Experian Health’s automated patient access solutions improve the patient's experience at each point in their encounter with their provider. To find out more, speak to the Experian Health team.

A recent study by Experian Health found that 62% of healthcare workers consider patient scheduling to be one of the areas hit hardest by staffing shortages. Labor gaps result in delayed patient care, staff burnout, additional hiring and training demands – not to mention snowballing overtime costs. Faced with wide-reaching financial and operational ramifications, healthcare organizations must make a strategic shift in how they manage patient scheduling. For Indiana University (IU) Health, the answer lay in using automation to handle increasing patient volumes with less staff. Justin Baur, Alex Nussman and Josh Brown of IU Health's Patient Access management team partnered with Experian Health to share how guided scheduling has allowed them to scale their operations, optimize staff efficiency and reduce scheduling errors, keeping both providers and patients happy. This article breaks down IU Health's key successes with Patient Schedule (including some that were unexpected), as discussed on the webinar. Discover how IU's strategic shift to automated scheduling not only scaled their operations and optimized staff efficiency, but also significantly reduced scheduling errors, keeping both providers and patients happy. “Guided scheduling helps us deliver better care, more efficiently” Like many healthcare organizations, changing market dynamics forced IU Health to find a fresh approach to patient scheduling. Competitor closures led to an influx of new patients, while the precarious labor market demanded a solution be found within the existing headcount. That solution was Patient Schedule, a digital scheduling platform that uses automation to support convenient patient self-scheduling, more efficient call center scheduling, and targeted patient outreach. IU Health piloted the platform across 52 service lines in 2023. Josh Brown, Program Manager for Provider Match at IU Health, outlined the key results: “We were able to accomplish some significant achievements to set our system up for success in 2024. We've booked over 230,000 patients through Patient Schedule and 35,000 through the Self Scheduling platform. It's as efficient as two schedulers doing similar work. We've had a 3% increase in one call resolutions and 16% growth in new patients since implementation. “Overall, guided scheduling has given us an opportunity to transform our operations by improving our patient access and reducing some administrative burdens. We've seen a reduction in no shows and an increase in patient engagement. By leveraging technology and data analysis, the guided scheduling platform has helped deliver better care more efficiently and effectively.” “Call Center Scheduling helps us minimize training and maximize referral capture rates.” IU Health's Patient Access Centre supports 31 specialties, 24 primary care clinics and radiology scheduling across Indianapolis, handling a total of 2.4 million calls in 2023. Finding innovative ways to meet growing demand was imperative. Justin Baur, Manager of Patient Access and Referral Management, described how Patient Schedule's Call Center Scheduling tool improves the workflow for call center coordinators: “Patient Schedule simplified processes in all our call centers so we can work with more patients and more service lines than before. Coordinators are onboarded quickly and can schedule for more service lines. Patient Schedule builds specialty considerations into the algorithm, reducing the need for subject matter experts. This increases scheduling accuracy, and reduces cancellation and reschedule rates, resulting in more effective visits between patient and provider.” The referral team also piloted Patient Schedule in urgent care and primary care facilities, successfully scheduling specialty referral appointments for patients before they leave their primary care provider's office. In the emergency department, providers can send messages to registration staff to schedule follow-up appointments. Baur says, “checkout staff can schedule patients' referrals within 3-5 minutes, instead of spending 30 minutes making follow up calls to reach those patients.” This reduces wait times, improves continuity of care, and streamlines the entire experience for patients and providers. “Self Scheduling does the work of two full time schedulers.” IU Health's pilot also involved using the platform to allow patients to book their own appointments. With Patient Schedule's Self Scheduling component, patients can make appointments online when and where it's most convenient. The sophisticated decision support technology means they only see relevant calendars and appointment types. During the pilot, almost 40% of patients opted to use self-scheduling, with 28% of those patients succeeding in booking an appointment online, significantly reducing the pressure on call centers. Josh Brown observed that “around 64% of our patients self-scheduled during non-business hours, so we're getting a lot of value-add when we're not at work. This gives us an opportunity to meet the patient when they're available. It enhances patient satisfaction and increases access to care. More than 35,000 appointments were booked using Self Scheduling, without any staff intervention, which Brown said equates to two full-time schedulers. He also observed that the platform is helping to grow IU Health's patient base and reduce no-shows: “We're seeing that the platform is very new patient-focused, with new patients accounting for over 59% of Self Scheduling bookings. With those bookings, we're seeing an 87% show rate.” Guided scheduling: the foundation of efficiency To close, the team explained how Patient Schedule had cut the time taken to secure appointments, by ensuring patients get the assistance they need and eliminating unnecessary paper-pushing. The next steps for IU Health are to roll out Patient Schedule across more specialties. They want to increase uptake of self-scheduling and ensure more patients can successfully book appointments using their preferred method. They also hope to implement location- and diagnosis-specific starting points for online bookings. By 2025, the team hopes to introduce a single phone number to cover scheduling needs across the whole state. Patient Schedule will form a key part of the solution by supporting efficient, centralized scheduling across four additional regions. Watch the webinar to hear examples on how guided scheduling was implemented in specific specialties, and find out more about using automated patient scheduling to create a resilient and efficient scheduling infrastructure that works better for patients, providers and staff.