All posts by Kelly Nguyen

As revenue cycle leaders continue to navigate an increasingly complex financial landscape, preventing healthcare claim denials remains the number one priority. Experian Health's State of Claims 2022 report found that 30% of respondents see claims denied 10-15% of the time, while 42% were seeing the rate of denials increase year over year. Denials in healthcare, which can be easily avoided, contribute significantly to the waste of healthcare funds. These denials cause providers to lose hundreds of billions of dollars in profits annually. This blog looks at the key questions providers should ask to get to the bottom of why healthcare claims get denied, how to prevent healthcare claim denials and ways technology can support better denial management. Why do healthcare claims get denied? The State of Claims 2022 survey revealed that the most common causes of denied claims boil down to three issues: 1. Missing or incomplete prior authorizations Health insurers use prior authorizations to determine whether a patient's treatment is medically necessary and how much they can cover. Despite being introduced to encourage delivering high-quality, cost-effective care, the authorization process has become an intimidating administrative burden for healthcare providers. Even now, many healthcare providers rely on manual paperwork to execute an already complex and tedious authorization process. This outdated approach to authorization not only consumes time and money but also creates opportunities for missing or incomplete prior authorizations, increasing claims denial rates. Unsurprisingly, 48% identified missing or incomplete prior authorizations as one of the top three reasons for denials. 2. Failure to verify provider eligibility To be eligible for reimbursement, a provider must be a participant in the proposed Medicare or Medicaid program or other private health insurance plan. Eligibility verification involves confirming a patient's insurance information and that the planned services and provider are under their plan, which is critical for successful claims approval. Failure to verify provider eligibility may lead to claims denial if an out-of-network provider provides the services. Likewise, 42% of respondents said failure to verify provider eligibility was a common reason for denials. 3. Inaccurate medical coding Accuracy is the backbone of medical coding, another administrative task indispensable to claims approval. The slightest mistake when translating patients' diagnostic and treatment information into clinical codes can result in rejected claims. Unfortunately, providers are susceptible to coding errors due to the ever-changing coding rules, especially when they do it manually or work with unreliable automation solutions. They may work with outdated or incorrect codes, leading to claims denials. The State of Claims 2022 survey revealed similar shortcomings, with 42% of respondents stating that inaccurate medical coding led to denial. Other reasons for denied claims include: Incorrect modifiers Failure to meet submission deadlines Patient information inaccuracy Missing or inaccurate claim data Not enough staff to keep up Formulary changes Changing policies Procedure changes Improperly bundled services Service not covered 6 in 10 respondents said insufficient data and analytics made identifying and resolving issues with claims submissions difficult. A similar number said a lack of automation was hindering operational improvements. The good news is that these obstacles can all be effectively addressed with the right denial management strategy and digital tools. How do claim denials affect revenue cycles? Denials can be justified as necessary to prioritize spending on high-value care, but they have heavy consequences for hospitals' financial health. As highlighted in the Journal of Managed Care & Specialty Pharmacy, the weight of denied claims adds up to about $260 billion each year. This financial burden is pushed on hospitals, who may need to classify denied claims as debt, which, among other consequences of claims denial, ultimately disrupts their revenue cycles. The ripple effect of denied and underpaid claims on hospital revenue cycles also manifests in how delayed and non-payments restrict cash flow, hampering the provider's ability to operate efficiently and deliver care effectively. Significant staff time is lost to avoidable administrative activities and rework, as claims need to be corrected and resubmitted. This creates a bottleneck in the revenue cycle, which can lead to decreased revenue and additional costs. Extra work is particularly challenging for staff already under pressure due to ongoing labor shortages. For patients, denials can cause stress and confusion around how the cost of care will be met. How can providers reduce or prevent healthcare claim denials? Since most denials result from inaccuracies that originate early in the patient journey, the solution calls for better data management in patient access and robust checks just before claims are submitted. Reducing claims errors will contribute to better claim submission and higher reimbursement rates. Here's a step-by-step guide to improving healthcare claims processing: Utilize prior authorization software to automate the prior authorization process. This software-driven solution automates inquiries and submissions using updated and stored payer data, making the prior authorization process seamless and time-efficient and resulting in higher claim approval rates. Upgrade claims technology with tools such as ClaimSource®, which helps providers manage the entire claims cycle from one platform. By automating claims processing, ClaimSource helps ensure claims are clean before being submitted. The tool creates custom work queues so staff can prioritize high-value tasks and get paid faster. Improve the claims management process and prevent healthcare claim denials with AI Advantage™ — Predictive Denials and AI Advantage™ — Denial Triage. Predictive Denials flags claims that are more likely to be denied before they are submitted to the payer and tracks payer rule changes, reducing denial rates. Denial Triage prioritizes and segments denials most likely to be reimbursed, leading to increased revenue. Automate line-by-line claim reviews with Claim Scrubber to eliminate errors or omissions in claims before they are submitted. Claim Scrubber makes claims management operations more efficient, resulting in less rework, administrative costs, and delays. It can also be paired with Contract Manager, so providers can audit claims before and after remittance. Use an early-and-often approach to monitoring claim status and expedite reimbursement. Enhanced Claim Status eliminates manual follow-up and helps providers react quickly to any pending, returned-to-provider, denied, or zero-pay transactions, further improving cash flow. Experian Health's ClaimSource and Contract Manager solutions were both ranked number one in their respective categories in the 2024 Best in KLAS awards What is the best way to track and manage claim denials?  Most providers rely on manual and automated processes to manage claims and denials. Shifting from manual to digital can save time, reduce errors, and increase overall efficiency. However, providers may be wary of implementing new systems due to concerns about costs, data interoperability, and the staff learning curve. For this reason, it's essential to select a denials management solution that fits the provider's unique specifications. Denials Workflow Manager eliminates manual processes and allows providers to optimize the claims process according to the metrics that matter to them. It generates work lists based on the client's specifications, such as denial category and dollar amount, and incorporates extensive data analysis capabilities to identify the root causes of denials and improve upstream processes to prevent them. It can be easily implemented as a standalone product or integrated with ClaimSource to give users access to the entire claims and denial management cycle on a single screen. Staff training on claims management The State of Claims 2022 report revealed that 46% of respondents admitted that lack of staff training was an operational challenge contributing to claims denial. Training healthcare staff in managing and preventing claim denials is one of the most worthy investments to reduce the rate of claim denials. Hospitals can provide healthcare staff with adequate ongoing training on the granular details of claims processes before and after submission and access to automated claims management solutions. Healthcare staff should also be kept up-to-date on the latest tools and strategies on denial prevention and payer rules for claims submissions to ensure payment receipt after claim submission. Engaging patients in the claims process Though patients are usually not responsible for submitting claims to payers, they are an equal third party in the claims process and can be empowered to actively participate in every stage, from submission to approval and paying copays or deductibles. Effective patient engagement can be achieved by providing patients with an accessible, all-inclusive platform to register, review, and update information related to their care and benefit plan and communicate with healthcare staff as needed. Collaborating with payers to reduce denials The quality of collaboration between payers and providers affects the seamlessness and efficiency of the claims process. Therefore, it is crucial for providers to collaborate effectively with payers, especially given the constant changes in payer policies, to ensure that they stay up-to-date with and comply with the payer claims submission requirements. In cases of claim denials, they can also manage them effectively. By working together, payers and providers can also quickly resolve denial issues, ultimately improving system efficiency. Adopting automation and AI to prevent healthcare claim denials As one of the most complex institutions today, the healthcare industry has always grappled with a critical shortage of healthcare workers, staff burnout, and wasteful medical care spending, which costs $600 billion annually in the US. Despite the potential benefits of automation and artificial intelligence (AI) to ease these burdens and save about $200 billion to $360 billion annually in healthcare spending, their adoption has been lagging and met with resistance. However, more and more healthcare stakeholders are realizing that these technologies are a principal partner in making the healthcare system more efficient, simplifying and streamlining deeply complex processes, such as claims processing. For example, Experian Health's Patient Access Curator, an AI—and robotic process automation (RPA)-driven solution that enables eligibility and coverage verification and more accurate and submission-ready claims. By performing these tasks in seconds, all in one click, Patient Access Curator has helped clients save over $1 billion in denied claims since 2020, significantly boosting their bottom lines. Another example of efficient claims technology is ClaimSource. This all-in-one claim cycle management platform, powered by automation, transmitted $632 million in claims within five days and processed $1.1 billion of claims backlog for IU Health. AI Advantage™, Experian Health's revolutionary claims management solution that offers a two-pronged approach to preventing and managing denials: AI Advantage – Predictive Denials identifies claims that are at risk of being denied, so corrections can be made before claims are sent to payers. AI Advantage – Denial Triage comes into play post-submission, reviewing patterns in denials to prioritize those with the greatest likelihood of reimbursement. Given the volume, complexity and financial impact of the current claims workload, automation and AI are critical elements in the denials management toolkit. In the State of Claims survey, more than half of respondents said they were using automated claims processing, with many using automation to keep track of payer policy changes, automate patient portal claims reviews and digitize patient registration. Despite much media furor, AI is still the domain of early adopters: only 11% of respondents said they were using AI. But while automation can effectively eliminate unnecessary manual tasks, AI is a force multiplier for denials management, offering additional predictive capabilities and “learning” from historical data to prevent denials. Client feedback to date suggests that incorporating AI-powered denial management solutions could be a game-changer for providers looking to streamline operations, prevent lost revenue and free up capacity to focus on their primary mission of delivering quality patient care. Technology solutions for managing and preventing claim denials Efficiently managing the claims process and preventing or resolving claims denial requires robust and reliable technology solutions at every stage, especially in the complex and constantly changing world of claims management, where everything hinges on accuracy. These technology solutions can be responsible for heavy lifting many administrative tasks involved in the claims processes, from accurate data capturing during patient registration and prior authorization to submission to monitoring claim status and addressing claims submission outcomes. Hospitals can adopt claims technology, such as Experian Health's Patient Access Curator, for verifying insurance eligibility and coverage with real-time patient data correction or ClaimSource®, a single platform for monitoring and managing the claims cycle in one place. Find out more about how Experian Health helps healthcare providers prevent healthcare claim denials with automation and AI.

“We are really happy with Experian. It takes away duplication of efforts and allows us to see the bigger picture. The eligibility solution works well for our team and patients.” —Emily Brown, Director of Operation Excellence at Providence Health  Challenge Providence Health is a leading health system comprising of 56 hospitals and over 1,000 physician clinics. With an annual patient volume of over 28 million, Providence strives to prioritize the well-being of their patients by providing convenient, accessible, and affordable medical services.   Because of high patient volumes, they faced issues with slow payer eligibility processes and increased eligibility denials, which meant their staff spent a lot of valuable time verifying eligibility manually.   Additionally, as Epic's payer plan table expanded, Providence Health needed an efficient way to consolidate and align the data pertaining to insurance plans, contracts, and reimbursement details. In order to streamline the process and keep their staff within the system, Providence Health sought to automate eligibility tracking.  Solution Providence Health implemented Eligibility Verification and leveraged the Bad Plan Code Detection tool, which identifies coding errors before they're submitted to payers. With this solution, the system immediately alerts users when an incorrect plan code is flagged, allowing users to fix any issues quickly and avoid costly claim rework. Additionally, integration with Epic facilitated seamless 1:1 plan mapping, and automated the creation of new coverage records in Epic based on responses received. This streamlined the process, eliminating guesswork for staff and ensuring accurate plan selection. Emily Brown, Director of Operation Excellence says, “Our search for a solution that seamlessly integrates with Epic led us to choose Experian Health as our preferred vendor, given their proven track record of working with Epic.” By working with Experian Health, Providence has uninterrupted service and connections to over 900 payers, with backup connectivity to 300 additional payers. Providence staff can utilize automated work queues fueled by response data and custom alerts, which allows them to work more efficiently.   Outcome Thanks to Eligibility Verification, Providence Health achieved the following results:  Found an average of $30 million in coverage annually   Saved $18 million due to decreased denial rates within five months  By automating eligibility checks for high patient volumes, Providence Health boosted patient satisfaction while significantly reducing staff workload. Partnering with Experian Health allowed them to identify an increased amount of active eligibility, ensuring accurate reimbursement and avoiding claim denials. Automation also eliminated time-consuming tasks, allowing staff to focus on providing better patient care.   “Checking if my insurance was accepted was a fast and friendly process. The staff even helped clarify which insurance was the right one for me since I had multiple cards.”   - Providence Health Patient  Learn more about how Eligibility Verification helps healthcare organizations access real-time insurance coverage data, improve reimbursement rates and avoid claim denials.  

Slow communications, confusing billing and a scarcity of digital options are the last things patients want to deal with when seeking medical care. Yet, this is exactly what happens for too many – and it's a significant financial risk for providers. This article examines why the patient experience matters and suggests four areas for improvement. Specifically, it looks at the digital tools that put patients in the driving seat and boost patient satisfaction and profitability. What is the patient experience? Improving the patient experience starts with answering the following question: what does receiving care feel like to patients at each stage of their healthcare journey? The patient experience includes all the touchpoints between patients and their providers, such as scheduling appointments, attending consultations, collecting prescriptions, and settling bills. There are also intangible components like empathy, respect, trust, and transparency, which shape a patient's lasting impressions of the healthcare organization. The experience goes beyond clinical care and face-to-face moments: back-end processes matter, too. Administrative workflows like insurance verification and claims management may be hidden behind the scenes, but they can soon influence what care “feels like” to patients if they're not running smoothly. Why is the patient experience so important to healthcare organizations? When patients have a positive experience, they're more likely to attend appointments, adhere to treatment plans and make healthier lifestyle choices. Health outcomes improve and the provider can build their reputation as a top choice for quality care. Satisfied patients are less likely to switch providers and are more likely to recommend services to family and friends. Everyone wants their loved ones to get the best possible care. The strong through-line from the patient experience to profitability tops the list for revenue cycle managers. Well-designed patient flows lead to better resource utilization, while improvements in attraction and retention rates directly benefit the bottom line. Positive patient feedback improves staff morale, so performance remains high. Prioritizing the patient experience is not only beneficial for patients, but is an essential strategy for financial sustainability. How to improve the patient experience in healthcare So, what do patients want? Experian Health's State of Patient Access 2024 report shows they want convenience, simplicity and choice, with 60% of patients saying they want more digital options to manage their care. They don't want to be passengers in their healthcare journey: they want to be the drivers, but with the support of a trusted guide. That's where digital tools come in. Here are four ways to use digital tools to improve the patient experience in healthcare: 1. Give patients speedy access to care with online self-scheduling Almost 8 in 10 dissatisfied patients say seeing their doctor quickly is their biggest challenge when accessing care. Online self-scheduling puts patients in charge and accelerates the process by making it easier for patients to find, book and cancel appointments, using an intuitive digital platform. Automated integration with the organization's business rules and calendars means patients only see appropriate appointments. This software maximizes patient show rates with appointments accurately matched to patients' needs. Case study: See how IU Health transformed patient scheduling with automation. 2. Simplify the financial experience with transparent pricing and payment plans Paying for healthcare is notoriously complex. Providers can simplify the patient experience with digital tools that deliver accurate pre-care estimates and flexible payment plans. Experian Health's Patient Payments Estimates solution uses data and automation to help providers give patients an early heads-up about what their bills are likely to be, and directs them to the most suitable financial pathway. In addition, offering hassle-free, secure payment options makes it easier for patients to pay their bills promptly, reducing the risk of bad debt for providers. Case study: See how Blessing Health System used integrated revenue cycle solutions to improve the patient financial experience and increase point of service collections by over 80%. 3. Personalize the patient experience with tailored outreach One of the major advantages of using digital tools is the ability to offer a personalized experience. These tools segment patients for tailored and targeted outreach based on their needs and preferences. This helps providers communicate with patients via their preferred channels and encourages prompt action. For example, text message and interactive voice response campaigns enable target outreach at scale to help accelerate scheduling and referrals and close gaps in care. Case study: See how Dayton Children's Hospital used PatientDial to increase outbound call efficiency. 4. Streamline back-office workflows for a frictionless front-end experience Finally, providers should consider how administrative processes affect what's happening in the front office and waiting room. Neglecting back-end processes can lead to bottlenecks, errors and inefficiencies that compromise the overall quality of the patient experience. Automated, data-driven revenue cycle management solutions not only eliminate time-wasting manual processes and help providers reduce errors and rework, but they also elevate the patient experience by reducing data errors and delays. Implementing tools like Patient Access Curator can also help take the pain out of registration and scheduling for patients, by capturing all patient data at registration with an all-in-one, single-click solution. By making every patient-provider interaction as simple and supportive as possible, healthcare organizations can build a patient experience that inspires loyalty, trust and engagement. With a bit of help from the right data and digital tools, providers can deliver a better patient experience and, in turn, secure financial sustainability. Find out more about how Experian Health's digital patient engagement solutions can boost patient satisfaction and provider profitability.

What do patients and providers really think about patient access services in 2024? Drawing insights from more than 1000 patients and 200 healthcare executives, Experian Health's fourth State of Patient Access survey pulls back the curtain. Previous surveys revealed a persistent gap between patient and provider perspectives on patient access, but could the gap finally be closing? The State of Patient Access 2024 report suggests that while discrepancies remain, the two groups appear closer than ever. This article provides a summary of the State of Patient Access 2024 report, and gives a run-down of patient and provider perspectives on patient access, what they see as top challenges, where opinions diverge and the steps providers can take to continue building a positive patient access experience in the year ahead. How do patients feel about patient access? 1. More patients think access has improved compared to last year 28% of patients believe patient access has improved over the last year, which is up from just 17% in 2023. As in previous years, patients' perception of whether access has improved hinges on how quickly they can see their doctor. Anything providers can do to accelerate scheduling and registration will be a winner. 2. Patients welcome the efficiency and accuracy of digital tools Patients have noticed improvements in scheduling and registration processes. They welcome the ability to book appointments anytime and avoid unnecessary paperwork using digital technology. That said, financial considerations trump convenience: the ability to look up insurance coverage and obtain accurate price estimates before care have risen to the top of the list of what patients consider the most important aspects to improve. 3. Cost of care remains a concern Unfortunately, patient sentiment around healthcare payments has remained relatively flat since 2022. Slightly more patients are receiving upfront cost estimates compared to previous years, but accuracy appears to have dropped, with 74% of patients reporting accurate estimates compared to 78% in 2023. Patients must have faith in their estimates if they are to plan for upcoming bills with confidence, and providers should be able to provide transparent and accurate payment estimates. What do providers think about patient access? 1. Providers are again more optimistic about improvements than patients Like patients, providers are generally positive about the state of patient access, though they may be a little too optimistic about the effect of improvement efforts. Around twice as many providers think access is better than the previous year compared to patients (55% compared to 28%). For providers, perceptions of improvements in patient access are closely tied to the impact of staffing levels. 2. Self-scheduling is back in favor Providers are aligned with patients on the need for digital scheduling and registration options. Interestingly, after the urgency to implement contactless scheduling during the pandemic began to wane in 2022, the latest survey suggests that self-scheduling is back in fashion, with 63% offering self-scheduling compared to 40% in 2022. 3. “Dirty data” remains a stubborn challenge Data collection at patient intake is a persistent headache for providers. Almost half (49%) say that inaccurate patient information contributes to claim denials. Improving the speed and accuracy of resolving patient information prior to claims submission were frequently listed in providers' top three challenges. See how healthcare organizations are using AI AdvantageTM to improve data accuracy and reduce claim denials. Digital technology bridges the gap between patient and provider perspectives on patient access When asked for their top three priorities for improvement, both groups ranked accurate price estimates and efficient insurance verification among their top two. While they diverge on the third – access to online health management tools for patients, and automated pre-authorizations for providers – it's interesting to note that these both reflect a desire to use digital solutions for greater efficiency and convenience. The survey highlights several opportunities to use digital technology to address upcoming challenges and continue to close the gap. Key challenges in patient access in the year ahead 1. Improving accuracy of upfront price estimates The survey showed 79% of providers plan to invest in patient access improvements soon. Given shared concerns about patients' ability to cover the cost of care, and worrying hints that some may postpone care due to cost concerns, prioritizing and providing accurate patient estimates would be a smart choice. While patients and providers are in closer agreement that estimates are accurate most or all of the time (74% and 85% respectively), there's clearly room for improvement. 2. Accelerating insurance verification and claims submission processes Several of the providers' top challenges speak to how difficult it can be to collate accurate information prior to claims submission. The need for better insurance reviews, more efficient management of prior authorizations, and more accurate patient information all contribute to the overarching goal of getting properly reimbursed. Almost a fifth say that managing multiple tools to determine eligibility, coordination of benefits (COB), and other pre-service checks is a top challenge. Could a single solution be the answer? Experian Health's new Patient Access Curator solution checks eligibility, COB, Medicare and commercial coverage, demographics and financial status in less than 30 seconds. Staff can check off several of these tedious tasks with just a single click. 3. Bolstering workforce capacity with technology A final challenge in the year ahead is the ongoing impact of staffing shortages. For the of providers who feel that staffing levels are disrupting delivery of scheduling and registration services, technology may offer a way through. Automation and artificial intelligence not only reduce the burden on staff by eliminating time-consuming manual tasks, but also allow staff to work smarter and faster on remaining tasks by improving data accuracy and insights. Most importantly, digital technology can improve scheduling, registration and payment processes for patients – and bring the patient experience in line with what both groups aspire to see. Download the full report: State of Patient Access 2024, or contact Experian Health to learn how technology can help streamline patient access.

Improving the patient pre-registration process continues to present a challenge on both sides of the front desk. For patients, dealing with paperwork, struggling to provide the right information, and worrying about payment and insurance coverage make in-person registration feel fraught. Meanwhile, providers are searching for digital solutions to make the patient registration process simpler, more accurate, and more efficient. How are providers tackling these patient registration challenges? Barb Terry, Product Manager at Experian Health, who oversees Registration Accelerator, a digital pre-registration solution, shares her perspective on the state of the industry and insights from Experian Health's State of Patient Access 2024, a survey of 200 healthcare executives and more than 1,000 consumers conducted in February, 2024. Q1: Why is patient registration still so challenging for providers? “It continues to present challenges for both providers and patients,” says Terry. Despite the growing availability of patient registration software, many providers and their patients still contend with outmoded manual processes and confusion over insurance and the cost of care. For providers still coping with staffing shortages, manual registration can be time-consuming and error prone. According to the State of Patient Access 2024 survey, 82% of providers who say access is a challenge cite staffing as a reason. Meanwhile, Terry estimates a typical registration process consumes 15 minutes of staff time and 10 minutes for patients: “It's time that neither the provider nor the patient has,” she points out. “The manual registration process for most offices requires printing, scanning, faxing, calling the patient a few times, and then manual data entry into the office systems,” Terry explains. “The provider is also under pressure to obtain financial clearance before the appointment. In many cases the provider team is working with reduced or new staff, managing repetitive and manual tasks for registration, all while striving to maintain a positive patient experience.” Q2: Why is creating a positive registration experience important for patients? “Patients are evolving into consumers of healthcare, meaning they're more active in their healthcare decisions,” says Terry. “They have growing expectations of their healthcare experience and expect the same convenience and modernization they find with other industries like retail and financial services.” To keep up, healthcare providers need to meet patients where they're used to completing tasks and communicating---namely, on their smartphones. “Patients use their smartphones to complete many everyday tasks at their convenience. Many prefer to be contacted via text rather than with a phone call, since text allows them to answer when they have time.” Terry says. Helping patients complete registration on their time increasingly means providing mobile solutions. As an example, Registration Accelerator sends patients a pre-registration link they can use to scan in their identity and insurance cards. Patients can locate their cards and scan them in wherever and whenever they prefer. Data is captured accurately and sent automatically to the eCare NEXT platform, where it can be verified and used for billing. “Compare this process to time-consuming phone calls that must be made and re-made until contact happens,” Terry says, “or trying to collect information at the time of the appointment. Simply put, patients do not want to spend time in a waiting room completing paper forms that could have been completed digitally.” Q3: How is patient pre-registration important to the revenue cycle? “The traditional registration process isn't very efficient,” says Terry. “Manual processes can easily lead to inaccurate patient information. If the registration process does not include real-time insurance verification, there will likely be more denials and a slower revenue cycle process." “Waiting until the patient's appointment to collect insurance information doesn't give providers much time to verify insurance, or to determine the patient's financial responsibility for copays, deductibles, and out-of-pocket expenses,” Terry continues. “At the same time, patients don't have time to prepare for their out-of-pocket costs. In the 2024 survey, 94% of providers said they felt a sense of urgency to implement a faster, more comprehensive review of insurance coverage." “We know from past surveys that 40% of providers say registration errors are a primary cause of denied claims,” Terry concludes. “When the provider has patient information early, they can start facilitating an estimate and confirm insurance coverage before the appointment. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.” Q4: Greater efficiency is better for providers, but how does it help patients? “The State of Patient Access 2024 survey found that patients expect efficiency as well as convenience,” Terry says. “Here's an example: 85% of the patients surveyed think they shouldn't have to fill out paperwork if their information hasn't changed.” Digital pre-registration solutions that allow providers to re-use valid patient information on file simplify registration all around. “For the patient, spending less time filling out paperwork in the waiting room contributes to a positive experience and improves their overall satisfaction with their provider, in turn leading to increased consumer loyalty,” says Terry. “Instead of managing forms at the appointment, the staff can focus on addressing any questions or discrepancies, and getting the patient settled in for their appointment. For many reasons, going to the doctor can be stressful for patients. Minimizing the forms they need to complete in the waiting room can alleviate some of that pressure.” Q5: How are providers improving the patient pre-registration process? “Providers are presenting additional registration options to their patients, including a modernized and digital process,” says Terry. “In the 2024 survey, 65% of providers agreed that patients prefer digital and self-service pre-registration,” so patient-facing mobile solutions like Registration Accelerator are a clear option for providers to explore. “Patients expect an easy digital experience,” Terry continues, “and, in response, providers should make registration as simple and straightforward as possible.” Yet, the same tools that make pre-registration better for patients can improve the process for providers as well. “Optical character recognition (OCR) is a great example of a feature that creates mutual benefits,” says Terry. “OCR can be leveraged to read insurance cards and pull out relevant and correct information. Staff members are under less pressure to avoid manual errors, and so are patients, who are relieved of the pressure of having to decipher their own insurance cards. “A registration solution should streamline the workflow, reuse patient information, keep data private and secure, and reduce manual entry,” Terry concludes. “By putting the registration process in the patient's hands, the provider is gathering information directly from the source while reducing their operational costs. Once registration data is obtained, it should flow into the front-end revenue cycle processes, so that eligibility is validated and errors are highlighted. This helps the provider ensure they have up-to-date insurance information for billing, leading to faster claims processing and reimbursement.” Q6: What does the future of pre-registration look like? “As patient expectations and provider demands grow, providers will increasingly turn to digital solutions,” says Terry. “Our survey found that 42% of providers have already expanded digital/mobile patient communications to reduce intake friction, and that trend is likely to continue.” “Digital solutions like Registration Accelerator give patients the ability to complete the registration process at their convenience and give providers more consistency in gathering information, less manual data entry errors, and opportunities to integrate with other patient access processes. All these benefits provide much-appreciated efficiencies for providers, and can lead to a better healthcare experience for the patient, so they can focus on their appointment and time with their provider.” Learn more about Registration Accelerator, a patient-facing mobile solution that lets patients scan in their own insurance and identity cards, captures data accurately, and uploads it automatically into Experian Health's eCare NEXT® platform, simplifying registration for patients and providers.

A recent Peterson-KFF brief found that around 20 million adults have unpaid medical bills, with 14 million owing at least $1,000. Data from the Survey of Income and Program Participation puts the total figure at more than $220 billion. Healthcare providers must find ways to streamline patient financial assistance screening, to help patients and prevent unpaid bills piling up from uncompensated care. Many patients who would be eligible for financial assistance miss out on much-needed discounts due to outdated screening processes, leaving their unpaid bills to linger in accounts receivable. Automated presumptive charity screening offers a cost-effective solution for healthcare providers to modernize the process and reduce avoidable write-offs. Patient financial assistance software can also aid providers in fostering compassionate patient experiences, by identifying individuals in need of help and efficiently guiding them towards appropriate financial assistance pathways. The hidden consequences of medical debt Rising costs, unexpected medical emergencies and lack of insurance are the main culprits in the growing problem of medical debt. Though uninsured rates have dropped, millions of insured Americans remain without adequate coverage: high deductibles and co-payments leave many individuals “underinsured” with out-of-pocket costs they cannot afford. Providers end up shouldering the costs, leading to revenue loss, operational strain, and impaired capacity to deliver high-quality care. In some cases, the burden of an individual's medical debt may be initially concealed from the health system, papered over with credit card bills and loans. But it does not remain hidden for long: medical debt becomes simply “debt,” as families cut back on food and clothing, fall behind on other household bills, or even declare bankruptcy. The repercussions can escalate for patients and providers as patients opt out of further care, which eventually causes their medical needs – and costs – to spiral. Creating a more compassionate financial experience for patients will help avoid these ripple effects, with benefits for providers, too. Who is eligible for patient financial assistance programs? Patients who cannot afford to pay may be eligible for support via a patient financial assistance program. These programs, offered by providers, charities and government agencies, alleviate the financial pressures on patients by covering some or all of the cost of care in the form of partial or full discounts. Providers can offer patients information and support early in their healthcare journey to help them access such programs. The challenge is figuring out who is eligible. Eligibility criteria for financial assistance is often complex, covering the individual's income, household income and size, savings and medical need. Gathering and analyzing this data using manual processes can be time-consuming and often lead to gaps and inaccuracies. These inadequate screening processes result in missed opportunities to connect patients with the financial assistance they need, and risk falling foul of charity care regulations and policies. On-demand webinar: Hear how Eskenazi Health boosted Medicaid charity approvals by 111% with financial aid automation. How to use data to identify patients eligible for financial assistance Instead of asking the patient to fill out a stack of forms and manually checking data against the Federal Poverty Level to determine eligibility for charity care, providers can get the answers they need using data analytics and automation. Patient Financial Clearance automates eligibility checks prior to service to see if patients qualify for financial assistance programs. It uses Experian data and analytics to predict the patient's ability to pay and calculate the best-fit payment plan based on individual needs and circumstances. It also generates scripts for staff to use when running the tool and helping patients find assistance, which makes for a more compassionate experience. Alex Liao, Product Manager for Patient Financial Clearance at Experian Health, says, “Many patients are unaware that they're even eligible for financial assistance and need help to navigate the process. Discussing personal finances can also be uncomfortable, so it's not uncommon for patients to avoid sharing information that could actually lead to them getting support. Automating presumptive charity screening is more efficient and reliable. It's also a lot more compassionate than the old way of collecting forms and documents. Patient Financial Clearance pulls together credit information and demographic data to determine whether the patient qualifies without long, drawn-out discussions. Patients get the help they need and providers can reduce bad debt without delay.” Case study: Discover How UCHealth wrote off $26 million in charity care with Patient Financial Clearance. Using patient financial assistance technology to create compassionate patient experiences As Liao notes, many patients feel awkward or hesitant when discussing their financial situation with a stranger. Additionally, patients are increasingly looking for digital channels to handle their administrative tasks. Experian Health's Self-Service Patient Financial Clearance option offers patients a simple and more private way to complete eligibility checks, whenever and wherever it suits them. Using a mobile and web-based platform, patients can fill out screening forms and upload supporting documents, then get real-time status updates without having to call up their providers. Information is stored securely so staff can check application status as needed. How Self-Service Patient Financial Clearance works Self-Service Patient Financial Clearance puts patients in control, so more individuals complete their applications and find out if they’re eligible for financial assistance. This frees up staff to focus on other revenue-generating tasks that require their attention. With a cost-effective, compassionate and convenient option on the table, is it time to say goodbye to paper-based presumptive charity checks? Find out more about how Patient Financial Clearance helps providers reduce bad debt and improve the patient experience by quickly and correctly checking eligibility for charity care.

Patient registration is a critical step in healthcare delivery, where providers capture the necessary information to deliver high-quality, personalized care while facilitating administrative and financial processes. It is typically one of the first steps when a patient interacts with a healthcare organization. From the provider’s perspective, patient registration is also the beginning of the revenue cycle.

“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. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery Discover how Experian Health's Coverage Discovery helped UCHealth create a more streamlined approach to verification and billing. 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. Learn more Contact us

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.