All posts by Experian Health

According to Experian Health's State of Patient Access report, patients want two things when it comes to medical billing and collections: clear insurance information and accurate cost estimates. Yet, when they ask, “How much will this cost me?”, many find themselves without a clear answer. Slower payments are an inevitable result. For providers, sub-par billing hurts revenue and limits investment in patient care. Modernizing patient collections with digital tools helps deliver accurate estimates, tailored payment plans and simpler ways to pay, while giving patients the financial clarity they desire. This article looks at the key components of patient collections, and how software-led solutions support a more transparent, patient-friendly and sustainable healthcare revenue cycle. How medical billing and collections impact the revenue cycle Every revenue cycle manager knows that unreliable billing and collections processes can throw the entire revenue cycle into disarray. A single mistake during patient registration, such as an omission in insurance verification or a typo in an address, can lead to inaccurate cost estimates, claim denials and delayed payments. Outdated collections methods force staff to spend valuable time clarifying and chasing payments, instead of focusing on patient care. When these billing inefficiencies pile up, the financial strain spreads beyond the revenue cycle, jeopardizing the organization's ability to make good on its core mission. A reliable medical billing and collection process is essential for both patient satisfaction and organizational resilience. Breaking down the collection process in medical billing To meet the needs of both patients and providers, an ideal medical billing and collection process should include the following components: Pre-visit insurance verification and cost estimates – At registration, staff verify coverage, confirm patient responsibility and provide an upfront cost estimate to prevent any surprise bills. Service and charge capture – Throughout treatment, clinicians document services accurately, and coding staff ensure all medical codes are correct, so bills and claims are error-free. Claim submission – With accurate data from the start, billing teams are set up to submit clean claims the first time and maximize the likelihood of reimbursement. Patient billing and payment – Once insurance processing is checked off, patients receive clear, itemized bills with links to convenient payment options. Follow-up and collections – Rather than pestering patients with phone calls, automated reminders sent via text or email give a less intrusive nudge to encourage timely payments. Healthcare organizations can offer flexible payment plans and, if bills remain unpaid, initiate a structured collections process that balances firm follow-up with compassionate financial counseling. How to optimize the process for maximum revenue If billing and collections teams are used to manual systems, making the switch to automated tools may seem daunting. Focusing on a few core principles, like transparency, accuracy and flexibility, will help ensure they prioritize areas that matter most to patients. Here are a few examples of how digital tools tackle the most common problems that get in the way of better billing and collections: 1. Problem: Patients don't understand their bills Fix: Provider accurate estimates and clear, itemized statements The State of Patient Access report found that 96% of patients want accurate upfront estimates. Yet, 64% did not receive them – and 14% said their estimates were wrong. Tools like Patient Payment Estimates software quickly pull together all the essential data to generate a more precise breakdown of who owes what. Patient Financial Advisor sends patients a pre-service text message with a secure link to their estimated patient responsibility, based on real-time rates, pricing and benefit information. Patients get instant confirmation of what they'll owe and the option to make a secure payment then and there. 2. Problem: Payments are delayed Fix: Offer online and mobile-friendly options With 60% of patients saying they want more online options to pay bills, providers that continue to rely on checks and phone calls are missing a major opportunity. Digital billing and payment methods remove friction and make it easier for patients to keep track of their bills and remember to pay. An integrated payment processing system like PaymentSafe® enables providers to collect payments 24/7 from an increased number of collection points. The tool automatically pre-populates fields in patients' accounts, allowing them to pay multiple bills simultaneously. 3. Problem: High administrative burden is taking a toll on staff Fix: Use technology to prioritize high-value accounts and automate follow-ups and reminders Automation can be a lifesaver for providers struggling with manual follow-up workflows, especially as increasing patient volumes outpace staffing levels. For providers, tools like Collections Optimization Manager help revenue cycle management staff collect more patient balances based on patient segmentation. This solution categorizes patients into different tiers according to their ability and likelihood to pay, using data analysis and predictive modeling. Collections Optimization Manager helps staff prioritize high-value patient accounts, so they don’t pursue uncollectable accounts and collect more with fewer resources. On a recent webinar with Experian Health, Kristen Shoup, Revenue Cycle Director at Wooster Community Hospital, shared how Collections Optimization Manager and automated patient text reminders reduced the administrative burden on staff while offering a more convenient way for patients to pay their balances. Read more about how automated collections strategies helped Wooster achieve a $3.8 million increase in patient payments. 4. Problem: Unpaid balances are piling up Fix: Implement flexible payment plans Patients who are worried about being able to afford their medical bills are more likely to seek out providers that offer flexible payment plans. Personalized plans allow patients to explore tailored payment options and break bills into manageable amounts. For example, Patient Financial Clearance screens patients for Medicaid or other assistance programs, and directs them to the most suitable payment plan. This reduces the risk of unpaid bills and means fewer accounts are written off to bad debt. See how UCHealth used automated financial clearance to identify $26 million in charity care. Strengthening the revenue cycle through better billing and collection practices Providers that listen to what patients say they need to help them stay on track with their financial responsibility will not only improve patient satisfaction, but also gain a competitive edge. Making the medical billing and collection process more compassionate and efficient drives higher collections, reduces bad debt and builds a revenue cycle that is both patient-centered and financially strong. Find out more about how Experian Health helps healthcare organizations improve patient billing and collections. Learn more Contact us

A positive patient experience can quickly sour when difficult financial conversations enter the picture. High out-of-pocket costs and confusing medical bills make payments a sensitive issue for many patients. For providers, the challenge is clear: how to improve patient collections while delivering compassionate care. This article considers proven strategies and best practices to simplify patient collections, maximize revenue, and keep the focus on patient-centered care. The importance of optimizing patient collections for healthcare providers For many patients, an unforeseen medical emergency can quickly become a financial one. According to a 2024 report by the Consumer Financial Protection Bureau, medical debt rose from an average of $2,000 per person to over $3,100 in a year, while 15 million Americans carry medical collections on their credit reports. Such financial strain erodes the patient experience, with one in five patients experiencing distress over healthcare costs they can't afford. Experian Health's State of Patient Access 2024 survey found that both patients and providers agree that understanding coverage helps patients manage their healthcare costs. Still, unpaid bills and aging accounts are a persistent concern for providers. Hospitals' operating margins may have rebounded, but remain extremely tight. Remaining alert to risks and opportunities in patient collections is essential for long-term financial health. As patients shoulder a greater share of their medical costs—and those costs continue to rise—efficient collections are critical for patient trust and financial resilience. Breaking down the patient collections process The patient collections process involves determining how much of the cost of care falls to the patient, and then billing and collecting the correct amounts. During registration, providers verify insurance coverage and eligibility to estimate what the insurer will cover. Accurate cost estimates can then be provided to patients upfront, giving them the option to make payments before or at the time of service. The bulk of billing and collections activities take place post-visit, sometimes involving third-party agencies. However, collections can be thwarted by several challenges. Staff must keep up with frequent changes in insurance policies to prevent errors in billing or cost calculations. Patients may worry about affordability, leading to late payments. Billing teams often lack information about patients' financial circumstances, making it hard to predict how likely they are to pay. On top of this, many patients expect more convenient payment options, such as online or mobile payment methods, and will express frustration if the process feels inconvenient. Proven strategies to collect more revenue, sooner Three ways to create a patient-friendly billing experience and ensure prompt payment include the following: 1. Reduce stress with clear pricing and flexible payment plans Patients want collections processes to be clearer and more transparent. The State of Patient Access survey found that more than four in ten patients say they would be more likely to cancel or postpone care without an accurate estimate. Six in ten say they'd be more confident in their ability to pay for care if they were offered a payment plan that took account of their financial situation. Automated patient estimates arm patients with accurate information about the expected cost of care in advance. They have more time to make their financial arrangements and are less likely to be surprised by a surprise bill. Providers can offer additional clarity and flexibility through tailored payment plans. Experian Health's Patient Financial Clearance software uses advanced analytics and data to analyze individual patient accounts and determine their ability to pay. This allows front desk personnel to quickly choose the most appropriate financial pathway for each patient. It also supports more compassionate financial conversations, as staff can adjust their approach to suit each patient's financial situation. 2. Help patients find and understand coverage Relying on manual processes can slow down registration and miss potential payment sources. Since 2000, unidentified coverage opportunities have landed hospitals with more than $745 billion in uncompensated care. Given that patients are asking for help understanding coverage, it makes sense to build coverage discovery into the collections process. Experian Health's Coverage Discovery® automatically scans patient accounts throughout their care journey to uncover alternative payment methods and reduce financial strain. This has helped healthcare organizations like Luminis Health identify over $240k in active coverage per month, greatly reducing the financial risk for patients and providers. 3. Make payments easier to prevent delays Improving patient collections processes will be fruitless if patients can't easily make payments. Digital and mobile payment options are non-negotiable for today's digital-first consumers. Accepting payments at multiple collection points, including mobile devices, kiosks and patient portals, gives patients the convenience and choice they need to pay promptly. Best practices for patient collections management Aside from automation and digital tools, the strongest strategies for improving patient collections rest on one key ingredient: robust data. Collections software is only as good as the data behind it. With a tool like Collections Optimization Manager, providers can deploy advanced analytics to segment patient accounts so they can be handled appropriately. Using credit, behavior and demographic data, it applies a proprietary propensity-to-pay score to each account, so staff know which accounts to prioritize, write off or refer out. This approach has helped organizations like Novant Health and Cone Health bring in millions of dollars with personalized, patient-centric collections. On-demand webinar: Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager. Tracking patient collections success By monitoring key performance indicators like collection rates, accounts receivable days and patient feedback, providers can continue to fine-tune their processes. Collections Optimization Manager captures this data in user-friendly dashboards and reports, so staff can assess their performance against their own history and industry trends. Users also benefit from expert support from Experian Health consultants, who help teams evaluate reports and recommend the right collections strategies every step of the way. How to build a patient collection strategy that gets results For millions of Americans, medical debt isn't just a financial burden: it's a barrier to care. To overcome this challenge, providers need proactive collections strategies that prioritize patient well-being and financial stability. By incorporating automation, analytics, and digital tools, healthcare organizations can create patient collections processes that are clear, compassionate and effective, delivering better outcomes for both patients and providers. Find out more about how Experian Health's suite of healthcare collections products helps providers boost collections, cash flow and patient satisfaction. Learn more Contact us

“Our call strategies did not yield the desired outcomes, and we recognized the need for additional data to better support our goal. We were also mindful of the potential risk of staff burnout and the impact it could have on overall performance.” —Carey Lawrence, Revenue Cycle Administrator Customer Service and Self-Pay Collections, Weill Cornell Medicine Challenge Weill Cornell Medicine is a leading medical school and research institution with $1.3 billion in annual patient revenue. Facing $42 million in annual bad debt and rising call center demands, Weill Cornell needed to upgrade their collections strategy. Staff lacked real-time insights into patients' propensity to pay and often resorted to calling most patients — a frustrating and inefficient process. They needed a better way to verify insurance coverage, understand patient payment history and determine eligibility for Medicaid eligibility, charity care or other financial assistance. The company had three specific objectives: Increase net revenue by improving self-pay collections through better segmentation and prioritization. Optimize call center operations through automation and better communication with patients. Select the right partner with expertise to provide technical solutions, consultative guidance and process improvements. Solution Weill Cornell turned to Experian Health's Collections Optimization Manager to increase cash collections with smarter segmentation. The partnership provided access to dedicated support from an analytics consulting manager at Experian Health. Together, they used Collections Optimization Manager to create a more targeted collections strategy, and to automatically segment patient accounts based on propensity-to-pay scores. This allowed staff to focus on high-value accounts and stop wasting time on uncollectible accounts. They were able to use Collections Optimization to screen out accounts that weren't deemed collectible, such as accounts for deceased patients, those in bankruptcy, or those eligible for Medicaid or charity care. Access to better data also reduced manual workloads. Validating the database with their existing Epic data also helped catch and correct some missteps. “We were able to eliminate skip tracing, for example, because Experian's extensive data sources ensure our mailing addresses are up to date,” says Lawrence. To improve call center efficiency and deliver a more compassionate payment experience, Weill Cornell also implemented PatientDial, an automated dialer that uses the segmentation data from Collections Optimization Manager, to run targeted outbound patient call campaigns. The initial implementation of automated dialer campaigns increased net collections from 65% to 83%. Outcome Thanks to Collections Optimization Manager and PatientDial, Weill Cornell saw a 7:6:1 return on investment and achieved the following results: $15M collected in pending patient payments $7M reduction in annual bad debt placements 92% of recoveries trending at Champion Benchmarks Automating call campaigns also led to a noticeable improvement in staff morale. Lawrence observes that “staff are more satisfied with the new, automated processes because they can be more productive and don't have to guess at which accounts to call or when. Our operations are flowing more smoothly which decreases all our stress levels.” Lawrence also notes the power of good data: “The detailed, customized reports on our bad debt helped us identify issues early, allowing us to target collections more effectively. We reduced the number of accounts sent to agencies, ultimately saving time and money.” Looking ahead, Weill Cornell plans to explore new ways to use automation to improve management of Medicaid eligibility, presumptive charity and agency reconciliation. Discover how Collections Optimization Manager and PatientDial can streamline your collections process, enable higher collections rates and improve patient communications. Learn more Contact us

Finding missing health insurance is critical to keeping revenue cycles on track. Insurance eligibility verification is an important process providers use to confirm active coverage, including additional coverage a patient may have forgotten. According to Experian Health's State of Claims 2024 survey, almost a fifth of providers say missing coverage is a top reason for claim denials. It helps providers determine what insurance a patient has and what's covered and plays a key role in billing. When a patient has more than one type of active coverage, providers use insurance eligibility verification checks to determine how much should be billed to the correct payer and in what order. However, searching for missing coverage is often time-consuming and error-prone thanks to manual systems, disjointed databases and ever-changing payer regulations. When mistakes are made in the early stages of patient intake, it affects every step of the patient journey and revenue cycle. The struggles to confirm patient coverage are likely to worsen as patient volumes increase, medical needs get more complex and staffing shortages continue. Despite these mounting obstacles, insurance eligibility verification checks remain a critical first step to reducing claims denials, improving patient outcomes and minimizing lost revenue. This article explores why insurance eligibility verification checks matter and how providers can adopt new strategies and digital tools to find missing health insurance and prevent revenue from slipping through the cracks. The hidden costs of missing health insurance Today, more Americans are struggling to afford their medical bills — even with insurance. A KFF study reports that 48% of U.S. adults find affording healthcare difficult, while 25% say they or someone in their household had issues covering medical costs in the past twelve months. About half of those surveyed say paying an unexpected $500 medical bill would put them into debt. Insured patients aren't immune from the burden of high healthcare costs, though. Thanks to rising deductibles, co-pays and premiums, patients are taking on more financial responsibility, and 74% are worried about covering out-of-pocket costs. Nearly half of U.S. adults expressed concerns about affording their monthly insurance premiums. When medical bills go unpaid, provider revenue can take a serious hit. Uncompensated care is a huge financial burden for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. Patients often have additional insurance coverage that could help close the gaps, but they've either forgotten about it or are unaware of their eligibility. Finding missing coverage is a top priority for providers who want to ensure revenue streams stay in check — especially as healthcare costs continue to rise. Benefits of resolving missing health insurance issues Resolving missing health insurance issues has many benefits for both providers and patients, beyond verifying that services are covered and medical bills are paid. These include: Reduces claim denials: Claims denials are on the rise, and missing coverage is a top reason, according to Experian Health data. Incorrect or incomplete information can result in errors on claim forms or providers sending claims to the wrong payer. Finding missing coverage before claims submission reduces errors, denials, delays and rework. Minimizes wasted staff time: An eligibility recheck is needed when providers discover an incomplete claim, due to a change in active benefits after claims submission. With 43% of providers reporting that eligibility rechecks add at least 10 additional minutes per claim, finding missing coverage in advance is critical to freeing up valuable staff time. Improves the patient experience: Patients are often confused about what insurance covers and what they'll be on the hook for out-of-pocket. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care. When providers are able to find missing coverage during insurance discovery, patients are more likely to receive accurate upfront estimates. Complete and transparent pricing allows patients to prepare for the cost and avoid any surprises, while accelerating collections for providers. Tools and strategies to find missing health insurance Insurance eligibility checks help providers verify insurance status, coverage details and benefits in advance. However, performing insurance checks isn't always straightforward, and often requires searching for missing coverage. Patients sometimes forget to let providers know about secondary coverage or insurance changes. Or, coverage can be forgotten because a patient has moved to a new house, changed states, switched employers or signed up for a different policy. In some cases, patients may be misclassified as self-pay or have only one form of insurance. Providers can improve their insurance eligibility verification process and discover missing health insurance at every stage of the revenue cycle with the following strategies: Implement digital insurance discovery solutions Outdated manual systems are often error-prone and make finding missing coverage a labor-intensive task for already overburdened staff. Automated eligibility verification solutions offer a more streamlined approach to finding missing coverage faster with more accurate results. Tools like Experian Health's Coverage Discovery work across the entire revenue cycle and search government and commercial payers to find previously unknown insurance coverage. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Streamline patient intake and updates Matching patient information to payer databases starts at registration. However, patient information, including insurance coverage details, can change anytime. Patients may switch insurers, move states or change their contact information. Catching errors before a claim is submitted is key to keeping the revenue cycle moving and collections. Providers often can't keep up with changes or may struggle with tool overload, with nearly 60% of providers reporting using at least two different tools to gather the necessary patient information for claim submission. Digital tools, like Experian Health's Patient Access Curator, can help solve for bad data quality with real-time correction. This solution uses artificial intelligence (AI) and performs eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, to ensure that all data is correct on the front end. Patient Access Curator also interrogates 271 responses to indicate any secondary or tertiary coverage data. Other tools, like Registration Accelerator, puts the patient in control of inputting and updating information. Using an automated link, patients can enter their personal details and insurance information from their mobile phone or the web-based app, with no login required. Providers can prompt patients to complete registration details during the initial intake process and send reminders to update information that may have changed, like an address or insurance policy, when follow-up appointments are scheduled. Provide accurate upfront estimates The lack of accurate care estimates is an ongoing challenge for both providers and patients. According to Experian Health data, four in 10 patients report spending more on healthcare than they could afford. When providers don't have access to the most up-to-date patient insurance information, or coverage is missing, estimates are often incorrect and patients end up with surprise bills. Inaccurate estimates create a negative patient experience, resulting in unpaid bills and extra work for staff to resubmit claims or chase down collections. However, tools like Eligibility Verification can help providers easily confirm coverage, co-pays and deductibles at the time of service. When armed with real-time coverage data, providers can build more accurate estimates and help patients prepare for the cost of care. How technology makes finding missing health insurance easier 43% of Experian Health's State of Claims survey respondents say that eligibility checks take 10 to more than 20 minutes to complete. Eligibility checks are taking longer, are filled with more errors, and only 54% of providers feel their claims technology can handle current revenue cycle demands. Using technology at every step of the revenue cycle helps providers bridge the gap between front-end eligibility checks and back-end claims management. Digital tools, like Coverage Discovery, fit anywhere into the revenue cycle, allowing providers to easily check for health insurance through the patient journey, not just at registration. Emerging AI and automation tools also help providers find missing health insurance faster. Automated eligibility verification solutions, like Experian Health's Eligibility Verification, seamlessly check insurance benefits across 900 payers using advanced patient matching tools. Patient Access Curator uses AI-based data capture technology to return real-time data in a single click from hundreds of payer responses, allowing providers to quickly verify active coverage, billing information, plan level details, and more. Case studies: See health insurance discovery in practice How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Learn more about how automated health insurance discovery helps providers find missing health insurance, reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

For five years straight, patients responding to the State of Patient Access survey have ranked “seeing a doctor quickly” as a top priority. Unfortunately, 94% of patients are still waiting more than two weeks for an appointment. Too many find themselves stuck in scheduling dead-ends, with unanswered calls, endless hold times and limited options when they finally get through. Providers are working hard to cut wait times, but an aging population, rising rates of chronic conditions and elevated levels of seasonal flu are driving up demand. Failure to manage spikes in patient volumes isn't just a scheduling problem; it has wide-reaching financial and operational consequences. Providers must find more efficient ways to help patients move through the healthcare system more quickly without compromising the quality of care. Could online self-scheduling be the answer? This article looks at how opening the digital front door with patient appointment scheduling software gives patients more control over their health journey, while easing operational strain. Challenges in patient appointment scheduling for healthcare providers Efficient scheduling is the only way to help patients see the right physician at the right time. So, what's getting in the way? Demand outstrips supply — Growing demand for specialists, increasing numbers of older patients, and more people with complex chronic diseases mean there are more patients than available appointments. In some “medical deserts,” there are too few medical providers to support local populations with basic primary care. Staffing pressures — Heavy workloads, seasonal illness spikes and lingering burnout (improving, but still affecting nearly half of physicians) affect staff availability and scheduling operations. Administrative complexity — Specialist care often requires longer visits, specific equipment, or multi-provider coordination, making scheduling more complicated. Poor management leads to bottlenecks and inefficiencies, while reliance on manual scheduling increases errors, double-bookings and delays. Rising patient expectations — When patient volumes are high, keeping patient access running smoothly is challenging. Patients now expect healthcare to function like other service industries, with digital scheduling, same-day appointments and clear communication. Appointment scheduling software is key to delivering on those expectations while maintaining operational efficiency. No-shows and cancellations — Missed appointments create inefficiencies, disrupt workflows and lead to revenue loss, while last-minute cancellations create costly gaps in the schedule. They're a drain on resources that providers can't afford. Without an effective waitlist or rebooking system, providers miss opportunities to help patients and bring in more revenue. Benefits of patient appointment scheduling software in healthcare Self-service patient scheduling tools address many of these challenges by allowing patients to book, cancel and reschedule appointments online and on their schedule. It's convenient for patients, while alleviating the burden on staff. Patient Schedule, Experian Health's online scheduling platform, takes a two-pronged approach. With Patient Schedule – Online Scheduling, new and returning patients can book appointments at any time, from any device. Automated integration with provider calendars and business rules prevents patients from booking the wrong appointment type. It updates immediately when a cancellation occurs, so patients are shown real-time availability and can see their doctor sooner. And for those that need more assistance or prefer to speak to an agent, Patient Schedule – Call Center Scheduling uses sophisticated decision technology to help call center staff schedule faster and more accurately. Automated prompts guide staff through the conversation, so teams can easily find the right providers based on an organization's business rules. Together, these tools allow providers to increase their capacity and improve patient engagement. Discover how IU Health used guided scheduling to transform operations, which resulted in a 114% increase in patient utilization within one year. Patient Schedule by the numbers: Up to 50% reduction in scheduling time, thanks to fast and efficient guided search Staff training is completed in just one hour, so they can start taking calls the same day 89% patient show rate as a result of automated reminders 32% more patients scheduled monthly, as self-scheduling attracts patients and increases market share. The growing importance of patient appointment scheduling software With 89% of patients saying they value the opportunity to book appointments anytime, via online or mobile tools, patient appointment scheduling software is fast becoming a competitive advantage. As more healthcare organizations adopt these automated scheduling tools to streamline booking, reduce no-shows and improve access, those relying on outdated manual systems risk losing patients to other providers and falling behind. Streamlining administrative tasks with digital patient intake solutions The State of Patient Access survey found that 63% of providers offered self-scheduling in 2024, up from 40% in 2022. With a further 16% planning to onboard self-scheduling software, the future looks bright for patients who want to call time on slow and outdated booking systems. However, patient scheduling software is only one piece of the patient access puzzle. When integrated with other automated registration and intake tools, scheduling software reduces paperwork, minimizes errors and accelerates check-in. For example, Registration Accelerator allows patients to complete forms, verify insurance and update their contact information before arrival, while Patient Payment Estimates cut the confusion around medical costs. This means that from the moment an appointment is scheduled, staff can focus on patient care, rather than administrative tasks. With the right digital solutions, patients can take control of these processes themselves – wherever and whenever is most convenient. Find out more about how Experian Health's patient appointment scheduling software can simplify and accelerate patient access. Learn more Contact us

“You know when the Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” —Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences Challenge Exact Sciences is a prominent cancer diagnostics laboratory with an annual net revenue of around $2.6 billion, that's best known for its flagship cancer screening test, Cologuard. After a period of rapid growth demand for its test, Exact Sciences faced the difficult task of collecting accurate patient data and verifying insurance eligibility at scale. Anticipating a 25% growth in annual testing volumes, Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences, says the organization “needed an automated, real-time solution" to capture accurate data from the start. The company had four specific objectives: Improve the accuracy of patient insurance data to reduce errors and denials. Streamline processes to handle rising testing volumes without increasing headcount. Reduce claim denials to bring in more revenue (especially those related to eligibility and timely filing). Ensure accurate identity verification in lab settings, where patient, physician and lab data aren't unified within a single data management system. Watch the webinar: Hear our pre-recorded session from our annual Experian Health High-Performance Summit 2024 (HPS), featuring Exact Sciences and Trinity Health, as they reveal how Patient Access Curator helped their organizations automate eligibility, reduce denials, and more, all with a single click. Solution In need of a single solution to solve multiple challenges, Exact Sciences turned to Experian Health's Patient Access Curator. This new product provided the team with a way to run inquiries for eligibility, Medicare beneficiary identifiers, coordination of benefits, insurance discovery and demographic data with a single click. Instead of juggling multiple products and vendors, registrars would be able to capture and verify patient data in a single transaction. Through automation and machine learning, Patient Access Curator could deliver results in less than 30 seconds and help submit clean claims the first time – reducing the risk of denials even as volumes increased. Experian Health's implementation experts configured the tool to Exact Sciences' needs, integrating over 4,000 payer plans nationwide and customizing parameters for real-time eligibility checks and data validation. Experian Health also delivered staff training to support the transition to the new system. Watch the video: See how Experian Health's Patient Access Curator streamlines patient access and billing, addressing claim denials, data quality and real-time corrections to boost your business's bottom line. Outcome Thanks to Patient Access Curator, Exact Sciences achieved the following results: 15% increase in revenue per test due to accurate eligibility and fewer denials 4x business volume without increasing headcount 50% reduction in denials and major improvement in timely filings $100 million added to the bottom line in 6 months Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors and more. Overall, Kubisty credits Experian Health's Patient Access Curator for helping Exact Sciences overcome critical pain points resulting from data errors and eligibility issues. Solving for bad data quality with real-time data correction freed staff from tedious manual work, ensuring faster, more accurate claims processing – all without growing headcount. After implementing Patient Access Curator, the company is ready to scale and handle growing volumes efficiently, say goodbye to late filing denials and scale smarter. For Kubisty, this highlights how technology drives efficiency and sustainable growth. Learn more about how Patient Access Curator helps patient access teams prevent claim denials by solving for bad data quality with real-time data correction. Learn more Contact us

Ask any healthcare revenue cycle manager how they feel about using artificial intelligence (AI), and the response is likely to be “hopeful, but wary.” The potential is clear — fewer denials, faster reimbursements and more efficient workflows. However, with adoption slowing, it seems many have lingering concerns about implementation. According to Experian Health's State of Claims survey, the number of providers using automation and AI in revenue cycle management has halved from 62% in 2022 to 31% in 2024. Despite these reservations, there are bright spots. From preventing claim denials to automating patient billing, AI and automation are already helping many healthcare organizations improve operations, boost financial performance and deliver a better patient experience. This article examines what providers need to know about bringing AI technology into their revenue cycle. Understanding the role of AI in revenue cycle management AI regularly hits the headlines for its clinical applications, like medical imaging analysis, drug discovery and surgical robotics. But behind the scenes, it's also quietly transforming revenue cycle management (RCM). Non-clinical processes like medical billing, claims management and patient payments are complex. Trying to manage these manually results in slow reimbursement and strained resources. AI offers efficient solutions to reshape how providers manage these pressing issues, giving them a head start in coping with increasing costs, workforce challenges and ever-increasing volumes of data. Benefits of AI in healthcare RCM  For most providers, AI's main draw is its ability to deliver significant financial savings. The most recent CAQH index report suggests that switching from manual to electronic administrative transactions could save the industry at least $18 billion. That's a compelling prospect for revenue cycle leaders looking to do more, and faster, with fewer resources. These financial savings aren't just the result of direct cost-cutting – they stem from the broader operational benefits AI brings to the table. These include: Streamlined billing processes: Automating repetitive tasks and minimizing human error reduces costly mistakes that lead to payment delays Fewer claim denials: Predictive analytics help staff identify claims that may be at risk of denial so that issues can be tackled upfront Real-time eligibility verification: AI tools can check a patient's insurance details in an instant, to catch outdated information and prevent billing mistakes and denials Better data insights: AI has the power to analyze vast datasets and find patterns and bottlenecks to help teams improve decision-making Productivity boost: With reduced admin overhead, staff can focus on higher-priority tasks and improve overall performance, with less stress and burnout. The benefits extend to patients, too. Behind every denied claim or billing error is a patient caught in administrative confusion. By automating processes, eliminating errors and increasing transparency, AI and automation help providers give patients financial clarity throughout their healthcare journey. How AI is revolutionizing healthcare RCM  Here are some examples of what this looks like in practice: Using AI to manage complex billing procedures Medical billing errors cost healthcare organizations millions of dollars each week, and the problem is only getting worse. Experian Health's State of Patient Access survey 2024 found that 49% of providers say patient information errors are a primary cause of claim denials, while in the State of Claims survey, 55% of providers said claim errors were increasing. Manual processes make managing the complexity of insurance plans, billing codes and patient payments near impossible. AI simplifies the task. For example, Patient Access Curator uses AI-powered data capture technology, robotic process automation, and machine learning to verify coverage and eligibility accurately with one click. This ensures accuracy throughout the billing cycle, reducing denials and accelerating collections. On-demand webinar: Watch our recorded session to hear how revenue cycle leaders from Exact Sciences and Trinity Health share their strategies and success stories with the Patient Access Curator. Using AI to prevent claim denials Claims can be denied for many reasons, but poor data consistently tops the list. Even so, around half of providers are still using manual systems to manage claims. AI helps providers buck the trend by improving data quality and using that data to improve claims management. Experian Health's AI AdvantageTM, available to those using the ClaimSource® automated claims management system, analyzes patterns and flags issues before claims are submitted, using providers' historical payment data together with Experian Health's payer datasets. It continuously learns and adapts, so results continue to improve over time. Read the case study: AI Advantage helped Schneck achieve a 4.6% average monthly decrease in denials in the first six months. Using AI to reduce patient payment delays The rise in high-deductible health plans is associated with a greater risk of missed patient payments. According to SOPA, 81% of patients said accurate estimates help them prepare for the cost of care, and 96% are looking for their provider to help them make sense of their insurance coverage. AI is vital for providers looking to help patients understand their financial responsibility early and avoid payment delays. With solutions like Patient Access Curator, staff no longer need to sift through piles of patient data and payer websites to verify eligibility and get a clear picture of a patient's insurance coverage. Instead, they can quickly gather the information they need to give the patient a prompt and accurate breakdown of how the cost of care will be split. "Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly." Ken Kubisty, VP of Revenue Cycle, Exact Sciences Key AI technologies driving RCM transformation Healthcare revenue cycle managers have long trusted automation to handle repetitive tasks. Hesitancy around AI may stem from a lack of familiarity with its more advanced capabilities. Findings from the State of Claims survey reveal a widening comfort gap, with the number of respondents feeling confident in their understanding of AI dropping from 68% in 2022 to 28% in 2024. So, what are some of the key technologies providers should understand to help bridge the gap? While automation relies on straightforward, rule-based processes to handle repetitive tasks, AI tools are capable of learning, adapting and making decisions. A few examples to be aware of include: Machine learning: Analyses historical data to predict trends like claim denials and payment delays, and use this knowledge to prevent future issues Natural language processing: Extracts actionable insights from unstructured data, such as clinical notes and patient communications, giving staff consistently formatted data to use in RCM activities AI-powered robotic process automation: Goes beyond basic automation to handle decision-based workflows with precision, for example, in evaluating claims information to make predictions about the likelihood of reimbursement. Challenges and considerations in implementing AI in RCM Getting to grips with what AI technologies offer is an important first step for healthcare revenue cycle managers. However, successful implementation also calls for consideration of the practical challenges. Can AI solutions be successfully integrated with existing legacy systems? Will the data available be of high enough quality to drive meaningful insights? Are the costs of implementation within budget, especially for smaller providers? Is the workforce ready to buy into AI, or will extensive training be needed? With careful planning and a trusted vendor, these challenges are manageable. Embracing AI for a smarter, more efficient RCM The benefits of AI in revenue cycle management are clear: more innovative, faster processes that free up staff time and reduce errors, resulting in much-needed financial gains. To maximize AI, providers should begin by reviewing their organization's key performance indicators and identifying areas where AI can add the most value. This should focus on points in the revenue cycle where large volumes of data are being processed, such as claims submissions or patient billing, which are common areas for inefficiencies and errors. By taking a strategic, targeted approach, providers can find the right AI solutions to make the biggest impact – whether it's through curating patient insurance information, improving claim accuracy or predicting denials. A trusted vendor like Experian Health can guide teams through the AI setup and make sure it meets their needs. Find out more about how Experian Health helps healthcare providers use AI to solve the most pressing issues in revenue cycle management. Learn more Contact us

Collecting patient payments is an ongoing struggle. Bills are confusing, reminders go missed and patients can't always afford to pay. Rising self-pay costs, new medical debt mitigation regulations, Medicaid changes and staff shortages all put added pressure on billing teams. The result is often poor patient financial experiences, wasted staff time and bad debt. As revenue cycle managers figure out a path forward in today's complex – and costly – healthcare environment, analytics-based collections optimization could be the answer. Solutions like Collection Optimization Manager help providers quickly understand a patient's ability and willingness to pay with screening and segmentation models, identify charity eligibility and implement effective patient billing outreach plans. This article summarizes a recent webinar with two longtime users, Wendi Cardwell of Novant Health and Wanda Taylor of Cone Health, who have successfully partnered with Experian Health to streamline collections, increase self-pay revenue and humanize patient financial experiences through segmentation and automation. How collections optimization boosts revenue Cari Cesaro-Hoffman, Senior Director–Enterprise Consultant for Collections Optimization Manager at Experian Health, set the stage with observations on how collections optimization solutions, like segmentation and automation, help providers maximize collections and engage patients compassionately. “Segmentation is the driver of successful patient billing cycles. It guides the team to focus on collections with those patients or guarantors with a higher likelihood to pay while helping to create patient-centric, positive patient financial experiences. Automation and customized operational processes embedded within collections optimization enhance the process even further.” Having the right collections optimization partner is critical. Both Cardwell and Taylor agree that Experian Health's unique consultative approach and comprehensive technology have been key to their success. The technology integrates seamlessly with account receivable data, helps streamline collections processes and allows for quick pivots to meet ongoing regulation changes — all while adding humanization to the revenue cycle. How to optimize collections with patient-centric insights In collections optimization, segmentation and automation allow healthcare organizations to evolve their payment collection strategies to keep up with rising healthcare costs, meet new industry regulations and drive more self-pay revenue. By using sophisticated, patient-centric insights, providers can make informed decisions on which accounts to prioritize, write off or refer to collection agencies. Collections optimization solutions, like Experian Health's Collection Optimization Manager, use multiple data sources to automatically screen and segment accounts based on propensity-to-pay scores. With a better understanding of each patient's financial situation, staff can prioritize high-value accounts and increase collections revenue. Experian Health's collections consultants provide ongoing support and expert advice, while advanced reporting allows revenue cycle managers to easily benchmark performance, refine patient payment forecasts and manage bad debt. Patient collections processes can be further optimized by integrating complementary financial screening and patient engagement tools, like Patient Financial Clearance, PatientDial and PatientText. Key takeaways from 2 real-world examples of successful collection optimization Cardwell and Taylor share how they are using collections optimization to boost revenue in today's increasingly high-cost healthcare environment. Below are the key takeaways from their conversation about how segmentation and automation are helping streamline collections, improve the patient experience and meet ever-evolving regulations. Segmentation and automation improve collections performance Segmentation and automation drive the patient billing cycle and enhance collection efforts – especially for self-pay collections. With the help of Experian Health's Collections Optimization Manager, Novant Health and Cone Health are able to quickly identify those patients likely to pay their bills and implement patient-first collection strategies. Cardwell shares how segmentation helps personalize the patient collections experience. "If patients have a high propensity to pay their bill and it's a low balance, like $300, they may not need a call quite yet since they may immediately make a payment when they get their bill. But if it's a high propensity to pay their bill and it's $3,000, they may be sitting at home wondering, 'How am I going to do this?' So, they just need that little nudge by someone calling and saying, 'Did you know we have payment plans that are interest-free? Let's help you get set up on that.'" Taylor agrees, "The automation is just remarkable for the ability to give our patients that white glove treatment and to be able to either contact them in some way, talk to people that want to talk to us or offer the automation that others want." Cardwell and Taylor also note that collections optimization helps their billing teams easily integrate charity care and financial assistance processes more closely with collections and revenue cycle workflows. This allows both organizations to quickly adapt to industry changes and new requirements, like medical debt mitigation regulations. Optimizing collections delivers real-world results The successful implementation of Collections Optimization Manager for Novant Health and Cone Health serves as a model for other healthcare organizations looking to improve their collections and revenue cycle performance. To date, Novant Health has seen an impressive ROI of 9.5/1 with a $16 million combined lift across hospital billing and provider billing, while Cone Health cleared $14M in patient payments and a 6:1 ROI. Additionally, Caldwell and Taylor both report saving valuable staff time and resources. Automating some of the screening processes and routing through bankruptcy, deceased and return mail has resulted in more than 3,000 manual hours saved between the two organizations. Caldwell says working with Experian Health reduces IT hours, especially for organizations that outsource IT like Novant Health. For example, “If you decide you no longer need to use a particular vendor partner and need to send data to another vendor partner, Experian Health can quickly make that flip for you.” Successful automated call campaigns driven by segmentation have been another win. Taylor describes using segmentation to efficiently “run unattended call campaigns that push calls out to patients with payment plan reminders.” Caldwell agrees, and shares that Novant Health has seen similar successes with collections call campaigns. Novant Health is using the data to run automated Medicaid enrollment call campaigns and is “looking into doing mother-baby” call campaigns to remind new moms to enroll their newborns for insurance coverage. Choosing the right collections optimization partner matters For providers looking to evolve their collections strategies, both Cardwell and Taylor stress the value of working with a collections optimization partner that offers turnkey solutions for a positive patient financial experience, seamless data integration and up-to-the-minute regulatory knowledge. Cone Health first adopted Coverage Discovery® and ClaimSource® before adding Collections Optimization Manager and Taylor says, “It just came together seamlessly. We've successfully evolved those products into a multi-item suite of information that is seamless in passing information back and forth. Experian Health also has their ear to what's happening at the state level and in federal and regulatory matters. So anytime there are new things coming down that impact our functionalities, they are coming to us with solutions to keep us cutting-edge.” Cardwell elaborates on how collections optimization helps Novant Health foster a human-centric financial experience. She says, “When we look at engaging our communities, Collections Optimization Manager has enabled us to do that effectively and efficiently, allowing us to deliver on our brand promise to care for our patients, each other and our communities.” The future of collections cycle management is here Healthcare organizations are already making strides to adopt collections optimization strategies that improve patient collection rates and boost self–pay collections. In today's fast-changing healthcare environment, it's critical for revenue cycle managers to evolve collections strategies to keep pace with patient needs and regulatory requirements. Working with a partner like Experian Health can help healthcare organizations better fulfill their financial goals, meet the needs of the patient population and deliver positive patient financial experiences. Find out more about how Collections Optimization Manager is changing the future of healthcare collections and watch the webinar to hear the full conversation on 'Boost self-pay collections: Novant Health & Cone Health's 7:1 ROI & $14M patient collections success.' Learn more Contact us

No matter how much the healthcare industry evolves — whether through new legislative priorities or advances in AI and automation — one thing remains constant: the patient experience matters. Patients expect quality care, quickly. For five years running, timely access has been a top priority for patients, according to Experian Health's State of Patient Access surveys. But efficiency is just the start. In an uncertain world, patients also need reassurance, reliability and compassion. For revenue cycle leaders, meeting these expectations isn't just about good service. It's a competitive advantage. A patient experience built on empathy, convenience and personalization fosters loyalty and trust, driving both satisfaction and financial performance. With the right digital tools, providers can take meaningful steps toward improving the patient experience. What is patient experience and why does it matter? The patient experience encompasses every step the patient takes while seeking and receiving medical care. It goes beyond the clinical aspects of care and includes all the systems and strategies that determine a patient's access to care. From the moment they book their appointment through their clinical care and final bill payments, each interaction is an opportunity to make or break a patient's satisfaction with their provider. The patient experience can be a major driver of health outcomes. Inefficient systems lead to missed appointments, while confusing billing practices cause patients to postpone care. Adherence to care plans is more likely when patients are engaged and informed. And when patients feel positive about their healthcare experience, there are trickle-down effects for staff, who have more time to focus on priority tasks. It's also vitally important for an organization's financial outcomes. A positive patient experience increases patient retention, reduces billing disputes and accelerates payments. Research shows this goes both ways: well-implemented revenue cycle management improves the patient experience, too. What does a quality patient experience look like? Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says that a high-quality patient experience should encompass three things: “Choice, flexibility and convenience are themes that have come through strongly in our patient surveys. Patients are more mobile and more digitally active, so they expect services to be available on demand. They have a diverse range of schedules, responsibilities and preferences, and providers need to accommodate these variations so accessing care feels easy and convenient. Providers that leverage digital technology to deliver a patient-centered experience will see higher levels of patient engagement, better health outcomes, and a healthier bottom line.” Key strategies for improving the patient experience For healthcare providers, there's always a new delivery challenge around the corner. But it's also getting easier to improve the patient experience, thanks to digital technology. Here are five practical ways to make an immediate difference: 1. Reduce wait times Long wait times frustrate patients and lead to last-minute cancellations, which hurt revenue. Online self-scheduling, pre-visit digital check-ins and automated appointment reminders help keep schedules on track and reduce no-shows. According to the State of Patient Access 2024, these tools are also a smart way to meet patient expectations: 89% of patients want the ability to schedule appointments anytime, via online or mobile tools. 2. Streamline administrative processes with technology Manual data entry slows everything down. Patients dislike repetitive paperwork, while human error is a frustratingly common cause of denied claims, especially when that paperwork starts to pile up. Digital tools eliminate much of the hassle and allow staff to work more efficiently. Automated patient intake accelerates the admin tasks, so patients get the care they need without delay, and providers can keep revenue flowing without unnecessary roadblocks. 3. Improve communication between patients and providers Confusing communications are a major pain point for patients, and billing is a prime example. With 43% of patients saying they may postpone or cancel care if they don't get an accurate cost estimate, providers have an opportunity to stand out from the competition by offering clear and compassionate financial communications. Upfront estimates, proactive financial counseling, and digital payment options ease patients' anxiety, prevent disputes, build trust and increase collections. 4. Increase healthcare access with automation and AI Insurance hurdles are another source of frustration for patients. Uncertainty over coverage, eligibility and out-of-pocket costs can impede access, lead to billing disputes and increase the risk of claim denials. Manual verification is time-consuming for staff and often leaves patients waiting for answers. Automation and AI can eliminate these bottlenecks. For example, Patient Access Curator uses machine learning to verify and update all patient information with a single click. Watch the webinar: Revenue cycle leaders from Exact Sciences and Trinity Health share how they use Patient Access Curator to redefine patient access 5. Personalize patient care A key point to remember is that patients only care about what's relevant to them: a one-size-fits-all approach is not going to increase patient satisfaction scores. Using data to anticipate patient needs, like flexible payment plans, personalized reminders, or a choice of payment methods, improves the patient's experience and reassures them that they're with the right provider. How technology is revolutionizing the patient journey Here are a few examples of how healthcare organizations are using digital tools to put these strategies into practice: Indiana University Health used Experian Health's Call Center Scheduling solution to increase call center capacity and boost provider, staff and patient satisfaction by improving efficiency and reducing appointment-type scheduling errors. Guided scheduling led to a 114% increase in patient utilization in just one year. UCHealth helped more patients qualify for financial assistance using Patient Financial Clearance, which automates presumptive charity screening. The tool disbursed $26 million in charity care and covered more than 1,700 patients. On-demand webinar: Learn how Community Health System used Experian Data to drive financial assistance automation. Prioritizing patient-centered healthcare The way the patient experience is delivered may change, but its role as a driver of trust, loyalty and financial stability does not. As patients become more mobile and digitally active, they expect care that fits into their busy lives — available on demand and tailored to their needs. By using digital technology to offer choice, flexibility, and convenience, providers can make care easier to access, strengthen relationships and improve both health outcomes and financial performance.  Find out more about how Experian Health's digital solutions help healthcare organizations improve the patient experience. 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