Healthcare providers have heard it before – high employee turnover and the constant need to train on new solutions can severely impact the efficiency of revenue cycle management (RCM) teams. As denials increase, the resources required to address them grow, putting additional strain on healthcare providers and their teams.
For decades, manual claim management has been the cornerstone of revenue cycle operations. However, with shifting payer algorithms, higher patient volumes, and evolving insurance coverages, this approach is no longer sustainable. Getting the highest percentage of claims paid with the exact amount of human capital is unachievable. Many health systems can’t keep up, and RCM teams are experiencing burnout. There is a glaring need for the rapid adaptation of automation to improve front-end data collection, where reducing errors can have the highest impact on claims, and the teams responsible for them. According to Experian Health’s latest State of Patient Access survey, 56% of providers say patient information errors are a primary cause of denied claims, 48% report inaccuracies in data collected at registration, and 83% emphasize the urgent need for faster, more comprehensive insurance verification.
Front-end operations are a major source of friction. Four out of the five top patient access challenges reported by providers relate to front-end data collection, including improving insurance eligibility searches, reducing errors and speeding up authorizations. Is it any wonder that these actions are typically performed by hard-working and taxed humans?
These inefficiencies don’t just slow down internal workflows. Manual, error-prone processes lead to delays, claim denials and patient frustration, not to mention low morale with revenue cycle teams trying to find the errant data. Providers note that staffing shortages are compounding the problem, which suggests that tackling front-end workflows would be a strategic operational win.
How Patient Access Curator enhances revenue cycle efficiency
What if providers could take that manually laden process, integrate automation, and allow their staff to apply their revenue cycle experience, equity and strategic thinking in the right place?
Patient Access Curator (PAC) uses automation and artificial intelligence (AI) to streamline patient access and billing, address claim denials and improve data quality without the need for human intervention. This integrated solution performs rapid eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery checks to ensure that all data is correct on the front end, freeing teams up to focus on more strategic tasks.
It doesn’t require the long training requirement of standalone products; it fits seamlessly into existing EHR systems, and works directly within the system, with no need for drawn-out onboarding programs.
According to one of the early adopters of the Patient Access Curator, their revenue cycle team is already seeing – and feeling – the results of automation.
A Senior Director of Revenue Cycle at a large Midwestern health system says, “One of the primary reasons we chose the Patient Access Curator was because it makes the normally manual work of revenue cycle much easier, which in turn improves productivity, empowerment and morale. Registrars are now able to make determinations right within the system. It’s easy to use.”
With so much data to capture, manual strategies are bound to stumble and apply downward pressure on those tasked with high-volume work. Patient Access Curator removes the need for manual checks on multiple payer websites and data repositories to verify insurance eligibility, and checks for any billable coverage that might have been missed. Experian Health’s industry-leading claims management products are designed to simplify these processes. The newest denial prevention technology strengthens this suite with capabilities previously unavailable.
Efficient claims management with artificial intelligence and automation
Patient Access Curator captures and processes patient insurance data at registration using an “if-then” logic that returns multiple data points from a single inquiry, in seconds. Registration staff can leverage this technology to collect and verify much of the information they need to compile an accurate claim, with just a single click. In a matter of seconds, they’ll have a comprehensive readout of:
- Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps
- Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing
- Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support
- Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches
- Demographics: The platform can quickly check and verify patient contact information
Patient Access Curator achieves such speedy results “because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer,” says Jordan Levitt, Senior Vice President of Experian Health. “This means data can be transferred easily between interfaces.”
Hear how Columbus Regional Hospital has used the Patient Access Curator to simplify and streamline its revenue cycle operations.
With Patient Access Curator, better data adds up to increased revenue cycle efficiency, along with the following:
- Reduced errors: Automation minimizes human intervention in repetitive tasks.
- Faster processing: Automated systems can handle large volumes of claims and payments much faster than manual processes, accelerating the reimbursement cycle, improving cash flow and reducing delays in revenue collection.
- Enhanced compliance: Automation tools like Patient Access Curator are continually learning from inputs, and adapt to stay up-to-date with evolving regulatory requirements and payer policies. This ensures that claims are compliant, reducing the risk of denials and costly rework.
- Improved denial prevention: Patient Access Curator identifies patterns in historical claim data, flagging or fixing potential errors before submission. This proactive approach helps in preventing denials and optimizing revenue recovery.
- Streamlined workflows: Automation frees up staff from mundane tasks, allowing them to focus on strategic initiatives such as patient engagement and financial planning. This leads to more efficient use of resources and improved overall productivity.
At a time when revenue cycles are under increasing pressure from changing payer rules, labor dynamics and operational constraints, this new solution offers a long-awaited boost to both reimbursement rates and productivity.
Patient Access Curator is available now – learn how it can help healthcare organizations boost revenue cycle efficiency and prevent claim denials in seconds.
