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Many hospitals and health systems are rethinking their responses to the growing challenge of healthcare claims management. After all, claims are becoming increasingly more complex. Payer policy edits are changing at a scale not seen before. And the legacy of the pandemic continues to take a toll on administrative workflows. In Experian Health's State of Claims survey 2022, providers reiterated the urgent need to optimize claims management – and the mountains of wasted dollars that are the by-product of preventable denials. Could artificial intelligence (AI) and machine learning (ML) be the key? What does the future of healthcare claims and AI look like? The internet is buzzing with excitement about the AI revolution, but the adoption of AI technology in healthcare has been slow, compared to other industries. Providers may be unclear about implementing AI effectively or struggle to see a route around barriers to adoption. This includes concerns around legacy systems and data interoperability. That said, the uptake of AI in healthcare shot up by 167% between 2019 and 2021, as organizations spotted opportunities to leverage new technology to reduce denials, optimize processes and identify patterns. Now, the AI genie is out of the bottle. As the trend continues to grow, providers that fail to embrace these technological advances risk falling behind as their competitors race forward. This article looks at AI's role in the future of healthcare claims management, and specifically, how it can help providers streamline claims processing, recoup more revenue and gain a competitive edge. The growing challenge of healthcare claims management In Experian Health's State of Claims Survey 2022, providers said reducing denials was their number one priority. It's clear to see why. There have been more than 100,000 payer policy changes between March 2020 and March 2022. Staffing shortages continue to put pressure on both front-and back-office teams. Increasing patient volumes and changes to insurance coverage means more claims to process – with more complexity to boot. Looking ahead, providers need to find more efficient ways to manage and utilize increasing volumes of claims data to alleviate staffing pressure, improve productivity and future-proof against unexpected events. Failure to do so could be an expensive mistake, especially when margins are already tight and the economic landscape remains shaky. Digital claims management: from process-automation to pattern-spotting The survey suggests providers are increasingly turning to automation to improve claims management, with 78% saying they were likely to replace their current solution to achieve lower denial rates in the coming year. Upgrading claims technology, automating the tracking of payer policy edits, and automating patient portal claims reviews were the top three strategies for reducing denials. Automation can generate years of ROI by executing repetitive and error-prone administrative tasks at speed and at scale. A few examples of automation in action are tools like: ClaimSource®, which manages the entire claims cycle, creating custom work queues and automating the claims process for greater efficiency and accuracy. Claim Scrubber, which automatically reviews every line of every claim to check for errors, so claims are clean the first time, prior to submission.  Denials Workflow Manager uses automation to help providers eliminate manual processes, prevent errors and increase reimbursement. AI takes this a step further, by analyzing vast amounts of information to find patterns and make predictions that support better, faster decision-making. Clarissa Riggins, Chief Product Officer at Experian Health explains why providers should embrace AI in claims and denials management: "Claims submissions and managing claims after denial are highly manual processes – and they are both extremely error-prone. AI/ML can learn from the data patterns in your claims to provide insights on where your claims are being denied most frequently. These solutions can also provide decision support to staff to help them to prioritize the work within their current claims processes, to avoid unnecessary denials in the first place and then to optimize their work to ensure a cleaner claim rate." While many providers see the potential of AI to streamline claims operations, prevent denials and accelerate reimbursement, others are hesitant to invest or are stumped by logistical barriers. Legacy technology, data compatibility issues and staff skills gaps can all put the brakes on AI implementation. But the AI train is showing no signs of slowing, and providers that fail to jump aboard could get left behind. With the right tools and an experienced vendor, implementation can be simplified. AI Advantage™ – the engine for predictive denials and denials triage Experian Health's new AI-powered denials management solution uses a two-pronged approach to predict, prevent and prioritize denials. First, AI Advantage – Predictive Denials identifies claims that may be at risk of being denied, based on analysis of historical payment data and payer decisions. This gives staff time to intervene and make any necessary amendments before the claim is submitted. The second element, AI Advantage – Denial Triage, applies an algorithm to segment denials based on the likelihood of reimbursement. This means staff can focus on high-impact resubmissions, rather than simply prioritizing high-value claims that may or may not be paid. Rob Strucker, Product SVP at Experian Health, explains that AI Advantage™ is continuously learning in real-time, so that predictions are increasingly accurate: “We look at the provider's own information for this type of service for this payer, and how those claims have been adjudicated. From that, we can score each claim in terms of its probability of being denied or claimed, and then based on that probability score, trigger an appropriate alert.” How Schneck Medical Center optimized healthcare claims management with AI Advantage™ AI Advantage™ proved to be the solution Schneck Medical Center was looking for when they set out to reduce denials. Within six months, Experian Health's AI-powered solution enabled Schneck to reduce denials by an average of 4.6% each month. Staff reported that the probability thresholds calculated by AI Advantage™ were highly accurate, facilitating a more efficient approach to reworking claims. Processing time was cut from 12 to 15 minutes to less than 5 minutes per claim. Clarissa Riggins says that AI Advantage gives staff confidence that they're spending their time on the right tasks: "When you have an algorithm that can evaluate the probability that a denial will be overturned, you can make sure that staff are working on the claims with the most potential for yield. Taken together, these solutions can help ensure that hospitals and health systems are getting paid for the good work they do in delivering care." Thanks to the tool's predictive capabilities, staff now have the insights (uncovered from within their own data) to prevent denials before claims are submitted, and to speed up rework should any be denied. As claim denials continue to increase in number and complexity and healthcare costs continue to grow, providers are feeling the impact on their revenue and margins. AI can ease the pressure by optimizing the healthcare claims management process. Find out more about how AI Advantage™ can help providers improve healthcare claims management and prevent costly claim denials.

Prior authorizations allow health insurers to determine if a patient's planned care is medically necessary and how much of the cost they'll cover. But what began as a well-intentioned process to promote high-quality, cost-effective care has become one of the most time-consuming and expensive manual transactions for providers. Transitioning from manual systems to automated prior authorization software is one way to expedite the decision-making process so patients get the care they need – and providers get paid – without undue delay. Prior authorization software eliminates friction in the pre-approval process Disjointed manual prior authorizations processes place a major administrative burden on staff, who must spend hours filling out forms, gathering information about the patient's medical history, and communicating with insurance companies to submit and track requests. Walking this bureaucratic tightrope delays tests and treatments for patients and often fails to fulfill the promise of cost containment. To streamline the process, providers are increasingly turning to automated prior authorization solutions. Prior authorization software helps providers check whether pre-approval is needed, compile and submit the request, and track payer decisions. It can check requirements in real time and quickly connect staff to the correct payer portal so they can progress without delay or guesswork. Data can be pre-formatted according to the payer's rules, to avoid the roadblocks that pop up without interoperability. Software can monitor performance over time, to drive ongoing improvements and prevent denials and appeals. This helps providers increase operational efficiency, reduce the administrative load, and obtain the payer's decision as soon as possible. Soon, fully electronic prior authorizations may also be a requirement: in December 2022, the Centers for Medicaid and Medicare Services proposed a new rule to improve and expedite the electronic health information exchange. The Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule would require affected payers to process urgent requests within 72 hours and standard requests within 7 days, beginning January 1, 2026. With more than 35 million prior authorizations submitted to Medicare Advantage plans in a single year (and more than 2 million of those being denied), providers will find these timeframes extremely challenging without electronic systems in place. Manual prior authorizations: creaking under pressure? Prior authorization software may be gathering momentum, but manual processes still dominate: 33% of prior authorizations were fully manual in 2022, barely moving from 34% in 2020. Many providers continue to grapple with the fall-out of inefficient systems, such as: The administrative burden - The American Medical Association estimates that physicians spend an average of nearly two days per week handling prior authorizations while 35% have staff who work exclusively on prior authorizations. As the volume of prior authorizations increases, these time-consuming processes cannot keep up. The communications challenge - Manual communication channels create too many opportunities for information to be misunderstood or misplaced when being passed between providers and payers. Providers' staff find themselves juggling faxes, telephone calls and payer portal log-ins. Without data interoperability, payers and providers end up in data silos where they're not working from the same account information. Delays mean real-time monitoring and decision-making are impossible. The denials problem - With manual processes, providers lack real-time visibility into changing payer rules. This lack of clarity means requirements may be missed or misinterpreted, leading to longer waits for approval and requests being denied. Not only does this have major consequences for patient care, but it also runs the risk of increasing out-of-pocket costs. It's unsurprising that the MGMA members repeatedly say that prior authorizations are the most burdensome regulatory issue they face. The business case for prior authorization software Transitioning from manual to electronic prior authorization processes can help overcome many of these challenges. Providers should focus on three main benefits when making the case for implementing prior authorization software: 1. Faster workflows Revenue cycle management teams are tired of being asked to “do more with less,” but automated prior authorizations actually check this box. This software can increase efficiency by initiating more requests in less time, so staff can spend less time chasing down documentation and reworking denials. It takes charge of monitoring and managing requests, reducing the need for manual follow-up. 2. Easier authorizations management Keeping pace with payer policy changes was a top concern for providers, according to Experian Health's State of Claims Survey 2022. To address this, Experian Health's online authorizations tool gives users access to a central payer database that instantly and automatically syncs with payer updates. Staff no longer need to log into multiple payer portals and cross-reference rules and requests by hand. It integrates customizable client-specific and plan-specific rules for more streamlined and accurate submissions. A guided, exceptions-based workflow gives staff immediate information on whether submissions are pending, denied or authorized. 3. Enhanced features (that go above and beyond manual processes) Prior authorization software not only makes the whole process more efficient and user-friendly, but it also offers additional features that simply aren't possible using manual processes alone. For example, with Experian Health's Prior Authorizations software, an additional post-back service can be integrated with hospital information and patient management systems to share authorization status, number and validity dates and flag any inconsistencies. It can store digital images of payers' responses for future reference. The software supports reconciliation by comparing authorized requests with pre-submission requests, to identify potential discrepancies and prevent denials. Finally, it also provides integrated faxing capabilities, so submissions can be sent to electronic and non-electronic payers using the same system. An increased need for prior authorizations software as the number of authorizations increase As patient volumes and payer policy changes continue to increase, providers will need to find ways to speed up prior authorization processes. Experian Health's State of Claims Survey 2022 found that more than half of providers find it hard to track changes to prior authorization requirements – unsurprising given that Experian identified more than 100,000 payer policy changes between March 2020 and March 2022. Neeraj Joshi, Director of Product Management at Experian Health, says that transitioning to automated prior authorizations will be essential to process requests efficiently at scale: “With prior authorization software, we can help our clients cut decision times to the absolute minimum. Automation reduces processing time and enables real-time tracking of authorizations, which translates to faster, more efficient communication between providers and payers. As authorizations increase, providers should speak to software vendors to explore the opportunities to speed up approvals and expedite the delivery of medical care to patients.” A nationwide survey confirmed that the use of electronic prior authorizations resulted in a shorter decision time. It also found that this advantage could be amplified with better integration into existing workflows. Experian Health clients who already use the eCare NEXT® platform to automate patient management and revenue cycle workflows will find that Prior Authorizations can be integrated seamlessly. This single-vendor solution allows providers to improve efficiency even further for faster processing times – and faster payments. Contact Experian Health today to streamline, simplify and speed up the pre-approval process with prior authorization software.

The healthcare staffing crisis was one of the biggest challenges facing healthcare providers pre-pandemic, only to be exacerbated by the pressures of dealing with the COVID-19 crisis. Almost a fifth of healthcare workers resigned between February 2020 and September 2021. Unfortunately, the problem isn't in the rearview mirror yet – a new study from McKinsey reveals that worker shortages persist, with 31% of nurses declaring their intent to leave their jobs in the next year. These shortages put pressure on remaining staff, compromise hiring efforts and make high-quality services difficult to maintain. Without a thriving, vibrant workforce, how can healthcare providers meet the needs of their patients? Can automation help address the healthcare staffing crisis? Stubborn staff turnover levels aren't unique to healthcare, but addressing them is even more critical, given the detrimental effect on patients. As the staffing crisis shows no signs of letting up, providers should consider how technologies that leverage automation and AI can help. Tom Cox, President at Experian Health, says, “Automation has transformed many aspects of healthcare, from driving down appeals and denials to improving the digital front door. We're now seeing AI starting to make waves, too. These technologies are the future and are changing healthcare for the better.” Opening healthcare's digital front door is a good place to start. By eliminating repetitive and time-consuming tasks like data entry, manual patient registration and prior authorizations, staff will be freed up to focus on what matters most: delivering high-quality patient care. Here, we look at three areas where automation can simultaneously alleviate the burden of staff shortages and create a better patient experience. Use case 1: automate patient access to manage the growing demand for services Manual and repetitive processes eat up valuable time and create greater workloads that contribute to staff burnout. This is especially true in patient access, which is a typically admin-heavy process. Allowing patients to complete more of their registration and scheduling tasks themselves can reduce the workload in understaffed teams. Many patients prefer not to book appointments through call centers, and high call volumes are a major pressure point for staff. Similarly, manual patient registration is labor-intensive and error-prone, eating up staff time and creating bottlenecks for patients. Automated registration and self-scheduling solutions help patients access care without waiting in phone queues. Patients can book, cancel and reschedule appointments through their mobile devices. On the back end, data can be leveraged to predict and manage demand, while digitized scheduling means agents can spend less time checking referrals against scheduling rules. Automated prior authorizations mean staff no longer need to spend hours poring over payer policies and checking individual payer websites to check for changes – the software updates automatically in real-time. Simplifying these processes with automation not only minimizes operational strain but also reduces friction for patients who want to see the right specialist in the least amount of time. Use case 2: automate personalized patient outreach to reduce call volumes Another way to reduce the administrative burden is with automated patient outreach. Reducing no-shows is an important strategy to promote better health outcomes and boost financial performance. Instead of burying staff with a list of patients to follow up with, providers should utilize automated patient reminders. Automated patient outreach solutions allow providers to segment patients according to their individual needs and preferences, so patients get relevant information through the most appropriate channel. This allows patients to proactively and conveniently manage their own healthcare journey. Automated messages can also be sent to remind patients of outstanding bills and link them to payment options. This means patient collections teams can spend less time on calls and focus instead on meaningful conversations with patients who need extra guidance or support. Use case 3: automate patient collections for faster payments and a better patient experience With fewer staff, patient collections teams must figure out which accounts to prioritize, while navigating increasingly complex payer policies. Advanced data analytics and automation can be used to make these processes more efficient. Similarly, automated patient collections software can screen and segment patient accounts to allow staff to quickly prioritize those with the highest probability of being paid. Collections Optimization Manager offers convenience and clarity to staff with an easy-to-use interface, while targeted collections strategies facilitate conversations with patients based on accurate information and fewer calls and emails. Speed and accessibility create a better experience all around for both patients and staff. Using automated solutions to reduce the pressure of the healthcare staffing crisis Cox says, “Over the last few years, Experian Health has focused on helping providers and payers solve the immediate challenges associated with a remote workforce and staffing constraints while scaling services in response to surging demand. Integrating automation with self-service tools is just the beginning. Our vision is to continue driving innovative and automated solutions that will improve care outcomes and transform our clients' healthcare operations.” These are just a few examples of how automation can create new opportunities for healthcare providers. Digital processes that were once considered merely “nice to have” are now critical components to alleviate the healthcare staffing crisis and deliver positive patient experiences. Contact us to find out more about how Experian Health can help your organization use automation to alleviate the healthcare staffing crisis.

In today's digital world, it's easy to access information with just a click. But despite being constantly connected, many patients find themselves lacking the vital information they need to navigate their medical journey successfully. Waiting weeks or months for appointments and dealing with confusing medical jargon on forms can create additional stress. Additionally, limited office hours make it difficult for busy patients to receive important information. Closing the patient engagement gap is just as crucial for providers: delays and misunderstandings lead to scheduling gaps, poor productivity, missed reimbursement opportunities and costly no-shows. Automated patient outreach has the potential to eliminate these challenges. By implementing the right strategy, providers can establish better communication with patients, anticipate their needs, optimize care plans, and provide improved patient experiences. This approach allows staff resources to be utilized more efficiently and effectively, resulting in better health outcomes and financial performance. It's a win-win situation for both patients and providers. What is patient outreach? Patient outreach refers to proactive efforts by a healthcare organization to educate, inform and engage patients in their healthcare journey. Effective patient outreach strategies may include sending patients prompts for health checks, appointment reminders, test results, and information about billing and payment. Ideally, communication will be initiated through whichever channel the patient finds most convenient, whether it's a phone call, text message, email or patient portal. If patients are supported to stay engaged in their care, they will be more likely to adhere to care plans and take the necessary next steps. Leveraging the benefits of automated patient outreach While online self-scheduling, digital patient registration and contactless payment methods deliver the convenience and choice patients desire, automated patient outreach goes a step further to improve patient access and close more gaps in care. Interactive voice response (IVR) and text messaging (SMS) campaigns are helping providers reach out proactively and efficiently to scale scheduling efforts without pulling in additional staff resources. Here are just a few benefits that providers see as a result: 1. Extended outreach capabilities Automated patient outreach surpasses traditional call centers in its ability to effectively reach multiple patients with timely and accurate information. This advanced technology allows for thousands of automated calls per day, eliminating the need for manual facilitation by agents. For instance, SMS and IVR campaigns empower patients to self-schedule appointments without requiring a phone call. Call center agents can easily identify patients who have not booked appointments and follow up accordingly. For those who prefer booking by phone, automated outreach provides a queue callback feature, ensuring that patients are promptly connected to an available agent instead of waiting on hold. This allows agents to efficiently work through the queue. 2. Increased appointment bookings Reaching more patients means more booked appointments, and in turn, fewer gaps in care. Experian Health's patient outreach technology automates the entire scheduling process, from guiding patients to best-fit appointments to issuing reminders to reduce no-shows. Real-time scheduling information ensures that canceled slots are offered to other patients, so those patients can see their doctor sooner, and the doctor's time doesn't go to waste. Convenient self-scheduling options can also increase patient satisfaction and loyalty, which can benefit both patients and providers - by ensuring timely access to care and better use of healthcare resources. 3. Better adherence to treatment plans and fewer unplanned admissions Strategic communication can also help patients stick to medication schedules, book follow-up appointments and make lifestyle changes that will reduce the risk of complications and improve their health overall. This is particularly helpful for chronic disease management and post-operative care, where post-discharge engagement allows providers to monitor and catch any issues before symptoms get worse. A 2022 evaluation of automated text message outreach found that this technology can reduce the risk of 30-day hospital readmission by 41%. 4. Improved patient engagement and satisfaction In today's world, phone calls dominate healthcare communications. But is that always convenient for patients? What if they are at work when their provider calls? In such cases, would they prefer a text message or an email? With reliable consumer data, providers can select the channel that patients will be most likely to engage with. Experian Health's State of Patient Access survey 2.0 found that patients appreciate proactive outreach, though many say this doesn't always happen. Providers that can leverage consumer data, combined with automated outreach, will be better placed to keep pace with evolving consumer expectations. 5. Improved collection rates A final important benefit of patient outreach software is evident on provider balance sheets. Inbound and outbound calling with secure, cloud-based dialing software can generate and issue bill reminders and self-pay options to patients. Experian Health's PatientDial solution provides IVR, bill reminders and self-pay options, which reduce the need for agent interaction. If it's quick and easy to pay, then patients will be more likely to clear their bills in a timely manner. For providers, that means higher in-house collection rates and fewer accounts receivable days eating into the bottom line. In 2021, Experian Health's PatientDial solution helped clients collect over $50 million in patient collections, through more than 250,000 IVR transactions. The automated dialer featured helped our clients save 900,000 labor hours, which would have been otherwise spent in manual dialing. Key considerations when implementing automated patient outreach Building a successful patient outreach strategy can be challenging. It's crucial for providers to deliver timely and pertinent information without overwhelming patients already susceptible to information overload. It is crucial that communications are secure and compliant with privacy regulations such as HIPAA, and consistent with the provider's brand to avoid being mistaken for spam. Additionally, any new systems or technology implemented should be easy for both staff and patients to navigate. By choosing a patient outreach solution that offers a user-friendly interface and ongoing support, providers can ensure that staff hit the ground running. Find out more about how Experian Health's automated patient outreach solutions can help providers improve patient engagement and close more gaps in care.

In today's healthcare landscape, providers face the challenge of making costs transparent and understandable for consumers. The Hospital Price Transparency Rule has driven progress in this area, but there is still work to be done. In 2022, 70% of hospitals complied with the Hospital Price Transparency Rule, up from 21% in 2021, according to the Centers for Medicare & Medicaid Services. The Rule mandates hospitals to provide consumer-friendly pricing displays for more than 300 shoppable services, plus a machine-readable file with rate information. To address this challenge, healthcare organizations need to leverage price transparency solutions that empower patients throughout their financial journey. By equipping patients with advanced knowledge of treatment costs and coverage details, providers can facilitate informed healthcare decisions, expedite payments, foster patient loyalty, and gain a competitive advantage. Prevent confusion about costs with transparent healthcare pricing A recent KFF survey found that almost six in ten insured healthcare consumers have encountered problems paying for care in the last year. More than half said they found it difficult to understand their health insurance, while three in ten said their insurance paid less than expected. Confusion about coverage can lead to delays, denials and difficulties in accessing care. Two scenarios are common when patients are faced with unexpected and increasing healthcare costs: 1) they delay care until their year-end deductibles are met, or 2) they forego care completely. Neither is good for their health, and both can disrupt providers' revenue cycles. By arming patients with advanced knowledge of treatment costs and how these will be split between patients and payers, providers can help patients make informed healthcare decisions without worrying about sticker shock. And price transparency is not just a question of compliance - making healthcare billing more transparent can be a driver for growth, through expedited payments, patient loyalty and market advantage. Compassionate financial counseling, flexible financing programs, clear billing statements and simple payment options all play a role. What can providers do to improve price transparency? Step 1 in delivering price transparency is to ensure compliance with the Hospital Price Transparency Rule. Experian Health and Cleverley + Associates have partnered to help providers satisfy the requirements. Experian Health's Patient Estimates supports providers in compiling the required list of shoppable service items, while Cleverley + Associates delivers the machine-readable files quickly and at scale. Jamie Cleverley, President of Cleverley + Associates, says: “Trying to pull together all of the required information in one place led to a lot of complexity for hospitals, at a time when a lot were short-staffed. We became a natural resource for hospitals. Since we have the information and the technical capacity, we could relieve the anxiety around compliance.” Riley Matthews, Lead Product Manager at Experian Health, says the joint approach has succeeded in helping hospitals comply with both aspects of the rule: “We had a portal that we can integrate with our clients' websites, where patients are able to walk through a user experience that guides them to their price estimates. Cleverley came in with the complex machine-readable files and has been a fantastic partner from the start… We're able to solve both sides of the price transparency rule and provide a holistic solution that delivers value for our clients.” Hear Riley Matthews and Jamie Cleverley discuss how this strategic partnership will help healthcare organizations address the challenges with compliance: Utilizing healthcare price transparency solutions throughout the patient journey To round out the patient financial experience, healthcare organizations should consider proactive solutions that promote clarity and convenience at every financial touchpoint. For example: Patient Financial Advisor is the first solution in the market to provide consumers with a pre-service, mobile-estimated patient responsibility and payment experience. This allows patients to make easy, secure payments as soon as they're ready. Patients get a clear breakdown of everything they need to know about their financial obligations, delivered straight to their mobile devices. To solve for confusion around coverage, Experian Health's Coverage Discovery® solution helps patients find missing or forgotten coverage. Patients welcome their providers' help in identifying additional coverage options, so they aren't billed for costs unnecessarily. Providers can seek reimbursement through those plans, rather than sending accounts to collections. Providers can also promote clarity when it comes to payments. PatientSimple offers patients a secure, 24/7 portal to view and manage their healthcare costs in a straightforward and convenient way. Not only can they see accurate price estimates at the touch of a button, but they can also apply for charity care, set up payment plans, update payer information and make payments to multiple providers. Implementing healthcare price transparency solutions to meet regulatory requirements Creating a more transparent approach to healthcare pricing and billing can be a daunting task in the context of ongoing regulatory change and operational challenges. It's time to incorporate Experian Health's innovative solutions to navigate ongoing regulatory changes, overcome operational challenges, and enhance the financial experience for both providers and patients. Find out more about how Experian Health is helping providers comply with price transparency rules and exceed patient expectations for clear and comprehensive billing experiences.

Is the digitalization of patient access services losing momentum? Experian Health’s State of Patient Access 2023 survey suggests that both patients and providers feel there’s still work to do to open healthcare’s digital front door. Where are the gaps? And how can providers fulfill patients’ digital expectations? This article looks at the advantages of offering a digital patient access experience and three technologies that can help providers stay competitive and give patients what they need and want. What is healthcare’s digital front door? The term “digital front door” refers to the virtual gateway through which patients access healthcare services and information. It has become a synonym for patient access, encompassing the digital touchpoints patients interact with when they’re booking appointments, registering for care, verifying insurance eligibility, paying for services and checking their medical records. This can include a hospital’s website, mobile apps for registration and payment, patient portals, telemedicine platforms and online appointment scheduling systems. Digital services have become an integral part of daily life, and healthcare should be no different. Patients and providers alike are seeking streamlined ways to connect and engage. What are the benefits of opening healthcare’s digital front door?  According to the State of Patient Access survey, patients want one thing above all else: to see their doctor as soon as possible. More than three-quarters said online scheduling was a top priority. Being able to book appointments online sidesteps geographical and practical barriers to care, reduces wait times, and prevents more serious and costly health situations from arising. For providers, this is an effective route to patient loyalty as well as better health outcomes. Opening healthcare’s digital front door unlocks financial advantages, too. Registration forms can be pre-filled with verified patient data, eliminating the errors that can occur through manual processes. This saves time, effort and expense for patients and providers later. CAQH estimates that the efficiencies gained through automated processes across the entire revenue cycle, including patient access, could allow the medical industry to release savings of as much as $22.3 billion each year. As healthcare labor challenges continue, a third of providers also noted that digital technology can help offset staff shortages, easing pressure on staff by automating repetitive tasks. Clarissa Riggins, Chief Product Officer at Experian Health, says, "For those in the healthcare industry who have been hesitant about implementing technology due to fears about replacing workers, the current staffing shortage may be the catalyst they need to change." And with a wealth of insights about service utilization and staff workflows now at their fingertips, data-driven digital services can facilitate continuous operational improvements. Why has the digital momentum slowed? Despite these benefits, patients report a slowdown in the digitalization of patient access. While the acceleration of the adoption of digital services seen during the pandemic could be expected to level off, survey responses from patients and providers hint at a more significant dip. Only 17% of patients think patient access has improved over the last two years, and 47% of providers say it’s gotten worse. Riggins says, "Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services...The bottom line is providers must prioritize updating their technology to avoid being left behind. Patients, especially younger generations, are demanding a better 'digital front door' experience or they could look elsewhere for care. In fact, Experian Health's survey found that 56% of patients who believed the access experience was worse said they would switch providers because of it." How can healthcare providers improve their digital front door? Fulfilling patients’ digital expectations comes down to three things: 1. Quick and convenient self-scheduling Survey results show that 76% of patients want to schedule appointments online or via a mobile device. With Experian Health’s patient scheduling software, providers can offer patients the option to book, cancel and reschedule appointments from any device, at any time. This omnichannel platform acts as the central scheduling hub across an entire health system. Self-service scheduling and integrated text and IVR outreach campaigns reduce the number of calls to agents. And for those calls that are needed, guided search makes scheduling quicker and easier. 2. Mobile-enabled patient registration Data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% said they’d consider switching providers to one that could let them manage care through a patient portal. Aside from boosting patient engagement, automated registration also reduces the risk of denied claims, by preventing data entry errors that occur during patient registration. With Experian Health’s patient intake software, providers can simplify registration for a better patient experience, reduced administrative costs and fewer denied claims. 3. Anytime, anywhere payments More than seven in ten patients say they want to be able to pay for healthcare using online or mobile methods. But before that, they also want to know in advance how much their bill is likely to be. The survey suggests that providers still struggle to deliver accurate, upfront cost estimates to patients. With tools like Patient Financial Advisor, Patient Estimates and self-service payment options, providers can help patients navigate the financial side of their healthcare journey, resulting in prompter payments and more positive reviews. Implementing new systems and tools can be daunting, but with the support of an expert vendor, providers can deliver the convenience and choice that patients demand in the most efficient and cost-effective way. As labor costs continue to rise, now is the time to invest in digital technology to ease pressure on staff, increase patient engagement and safeguard revenue going forward. Discover how Experian Health is helping to open healthcare’s digital front door with comprehensive patient access solutions.

How do patients rate their “patient access” experience? For most, the rating comes down to how quickly they can see their doctor – and many don't feel like their expectations are met. In December 2022, Experian Health surveyed more than 1000 adults who'd accessed care in the previous 12 months to gauge perceptions of patient access. Most think the experience remains unchanged or has gotten worse in the last two years, despite advancements and providers' heavy investments in technology.  Almost 8 in 10 of those patients say “seeing a doctor/practitioner quickly” is their biggest pain point. Other major factors include the level of friction involved in scheduling and registering for care and obtaining accurate pricing estimates before services are rendered. Patient access tools can help ensure that patients receive the care they need in a timely, efficient manner. Breaking down barriers for friction-free patient access What hinders patients' ability to see their doctor quickly? For some, the obstacles are logistical: patients may live far from facilities or lack reliable transportation to get to appointments. Others may have financial concerns, where a lack of insurance coverage or fear of mounting bills prevents them from seeking care. Language and cultural barriers can make it difficult to engage with healthcare services. But for many, it comes down to friction in the “patient access” process itself. This includes long wait times for appointments, disjointed scheduling systems, manual registration processes, and limited payment options. These processes are not only critical to patient satisfaction but also have real consequences for the patient's health and the provider's bottom line. One effective approach to improve access to care is to continue leveraging patient access tools, which has been proven successful in several use cases. Use case 1: Reduce wait times with online self-scheduling Among patients who think access has worsened over the last two years, 49% say their main challenge is finding appointments that fit their schedule, while 40% blame the scheduling process itself. Online self-scheduling solves both, making it easier to book and reducing wait times. With online self-scheduling, patients can log on to book appointments any time they like. There's no need to wait until the phone lines open and speak to customer support representatives. A self-scheduling tool like Patient Schedule can incorporate each provider's business rules and scheduling protocols, so patients get real-time access to the earliest available appointments. By allowing patients to easily cancel or reschedule appointments, same-day slots can be opened up to other patients, so they can see their doctor sooner. Use case 2: Increase operational efficiency with digital patient registration Staffing shortages are an ongoing stressor for providers, so making the best use of available staff time is crucial. Patient intake software can automate many of the manual activities associated with patient registration, such as helping patients fill out forms or manually entering information into electronic health records. In addition, more than 8 in 10 providers say their patients prefer an online registration experience. This corroborates earlier findings from a study by Experian Health and PYMNTS, which found that a third of patients prefer to fill out registration forms at home. Experian Health's Patient Intake Solutions allow patients to complete registration from their mobile. Data can be automatically pre-filled and checked against existing records to save time and avoid errors. Not only is this more appealing to patients than filling out forms in a stuffy waiting room, but it also helps drive down the risk of costly and time-consuming denials. Use case 3: Boost patient engagement with targeted patient outreach Another way to leverage patient access technology is through targeted, automated outreach. With automated text message (SMS) and interactive voice response (IVR) campaigns, patients can receive a personalized link to schedule their appointment directly. Alerts can be sent when earlier appointments become available, which both reduces wait lists and makes it more likely that patients will book. Patients can be sent bill reminders and payment options in the same way. Automated outreach solutions that incorporate reliable consumer data make sure patients get the details they need in a format and timeframe that helps them take action. Use case 4: Speed up collections with accurate estimates and payment plans As rising staffing and supply costs put a squeeze on healthcare profit margins, expediting collections is crucial. This begins with patient access: if patients can pay for care right at the start of their healthcare journey, this eases pressure on both parties to make sure bills are paid in a timely manner. Upgrading payment technology to include upfront pricing estimates, payment plan recommendations and convenient payment methods can all help patients better manage their financial responsibility. Unfortunately, it's still common for patients to go into procedures without knowing how much they'll owe. In Experian Health's survey, 65% of patients said they did not receive an estimate prior to care, and 40% said they were likely to cancel care without advance notice of costs. Leveraging tools such as Patient Financial Advisor and Patient Payment Estimates can automatically arm patients with the information they need to plan and manage their bills. Utilizing patient access tools to meet patients' expectations It is evident from the results of the State of Patient Access 2023 survey that patient access remains an issue. To ensure patients receive the care they need in a timely and efficient manner, providers must make a concerted effort to leverage digital technology. Although healthcare providers have made great strides in providing more efficient patient access solutions, clearly there is still much progress to be made.  The success of any patient-focused initiative relies heavily on being able to meet patients' expectations with timely, effective tools and resources. As healthcare evolves and continues to put a priority on improving outcomes, it's important to take proactive steps toward ensuring the best possible experience for patients when accessing their care. Find out more about how Experian Health's patient access tools can improve patient access and increase profitability for healthcare providers.

Could the era of manual claims processing be coming to an end? Experian Health's State of Claims 2022 survey revealed that more than half of healthcare providers have embraced advanced automation, freeing up staff from time-consuming and inefficient manual tasks. Automation has dominated as the key strategy used by providers to reduce denials in the previous 12 months. This evident optimism about technology's ability to address challenges in the claims process suggests that automation is here to stay. However, while automation has cracked open the doors to more efficient claims processing, the predictive power of artificial intelligence (AI) in claims processing can unlock exponentially higher rates of reimbursement. Providers may be increasingly aware of the benefits of automation, but many have yet to step into the world of AI. This article considers the advantages to be found in layering AI technology on top of automated claims processing and looks at how two new AI solutions are helping providers reduce denials and expedite payments.  How automation helps with claims processing Healthcare organizations with automated claims processing report improvements in speed, accuracy, financial performance and patient experience. For example: Automated claims management solution ClaimSource® helped Hattiesburg Clinic in Mississippi accelerate cash flow, reduce denials to 6.1%, and expedite claims from secondary and tertiary payers. Summit Medical Group Oregon used Enhanced Claim Status and Claim Scrubber to reduce accounts receivable days by 15% and achieve a first-time pass-through rate of 92%. These tools improve efficiency across the entire claims cycle by automating repetitive tasks, executing effective workflows and generating data-driven insights into root causes of denials so staff can prioritize high-impact tasks and errors are far less likely. Industry reports corroborate these positive results: CAQH reports that the medical industry could save as much as $22.3 billion per year through further automation. Unlocking the untapped potential of AI in claims processing Despite automation's impressive results, claim denials remain a thorn in the side of many revenue cycle leaders. This is where AI can help, thanks to its ability to predict and respond to payer behavior and claims data. But while 51% of survey respondents were using automation, only 11% had introduced AI-based technology to their claims process. For the AI-curious, combining automation and AI could be a good starting point to supercharge claims processing. AI technology can predict potential issues before they even occur by analyzing claims and denials and making suggested corrections or interventions in real-time. It can also assist in identifying fraudulent claims and denials, leading to improved claims processing accuracy and revenue cycle management. By using automation and AI together, healthcare providers can gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. What does that look like in practice? More efficient and accurate claims predictions Automation can relieve staff of manual data handling activities, increasing the speed and accuracy of claim processing, from patient intake through scrubbing, submission and adjudication. AI enables staff to perform remaining tasks with greater confidence and accuracy. They no longer need to wonder, “which claim should I rework first?” – AI has the answer. Without AI, the logical approach would be to rework what appear to be the highest-value denials first. But in many cases, these aren't the ones most likely to result in reimbursement. AI can help staff prioritize by analyzing historical payment data and undocumented payer adjudication rules to flag denials that are most likely to be paid. This is exactly how AI Advantage™ – Predictive Denials works. Experian Health's new AI-based solution checks for any changes to the way payers handle denials and assesses these against previous payment behavior. Providers can set their own threshold for the probability of denial, and if the solution determines that a claim will exceed this threshold, it alerts staff so they can act quickly and decisively before the claim is submitted. Schneck Medical Center was an early adopter of this tool and used it to complement their existing claims workflow (built around ClaimSource®). Within six months, they saw average monthly denials drop by 4.6%. Predictive alerts allowed staff to focus efforts on submitting clean claims the first time, so both the number of denials and hours spent reworking them were drastically reduced. “Learning” from denials data to drive financial performance By definition, automated claims processing systems will repeat the same tasks over and over. This is great for operational efficiency but has limited capacity to handle variation. A major advantage of an AI-based solution is its capacity to “learn” and predict, so each claim can be individually assessed and directed to the most appropriate workflow. AI Advantage™ – Denial Triage uses advanced algorithms to identify and intelligently segment denials so that providers can prioritize accordingly. Just as Predictive Denials uses historical payment data to predict the claims that may be at risk of rejection, Denial Triage learns from payers' past decisions to predict the denials that are most likely to be reimbursed if reworked. Read more about Schneck Medical Center's experience with AI Advantage. How does using AI benefit healthcare staff? The use of AI in claims management can be met with different reactions: some staff are enthusiastic about the prospect of having manual tasks taken off their plate and being able to use their time more effectively. Others may be concerned about the impact of AI on jobs and recruitment. The reality is that many providers face ongoing staffing shortages, and therefore have little option but to augment their existing teams with new technology. Maintaining pre-pandemic headcounts in light of post-pandemic work patterns and budgets may not be possible. Automation and AI can resolve these short-term challenges while generating a positive ROI in the long term, as the volume and complexity of claim denials continue to grow. As noted in the State of Claims 2022 report, technology should no longer be viewed as a threat to jobs, but as a way of making life easier for staff. Automation and AI work hand in hand to execute tasks that many staff find time-consuming and laborious, leaving the more stimulating and high-value tasks for the human workforce. Improving operational performance can therefore have a positive effect on job satisfaction and retention. The integration of AI in claims processing is not about replacing human expertise, but about harnessing the power of AI-powered algorithms to enhance efficiency and minimize denials. The optimal approach lies in combining the strengths of automation, AI and staff. Automation handles repetitive processes, AI expedites decision-making, and human expertise brings contextual understanding and empathy to the process. Learn more about how Experian Health can help organizations utilize AI in healthcare claims processing with AI Advantage.

American consumers may be more optimistic about the state of the economy, but concerns about healthcare costs are always top-of-mind. A survey by Experian Health found that 40% of patients would cancel or postpone care if they were not informed of costs in advance. Planning for medical expenses can be a struggle for families facing rising costs and increasing deductibles. With profit margins under increasing pressure, providers must make constant improvements to patient collections processes to help patients navigate their financial obligations more easily. Finding new ways to maximize patient collections and increase efficiency while reducing friction in the patient experience is more important than ever. Technology and patient collections software offer a way to bridge the gap. This article looks at two case studies that involve leveraging automation and digital technology to create better patient collections processes. Case Study 1: how UCSDH improved patient collections with Collections Optimization Manager Patients are footing more of the bill for healthcare, leaving providers more exposed to each individuals' ability to pay. If patients are unable to pay in full and on time, providers will be left with growing ­– but avoidable – collections costs and an escalating risk of uncompensated care. Given that patients can have different financial circumstances, mailing out uniform statements and hoping they will be paid is a futile effort. Instead, providers should look for opportunities to proactively engage patients with personalized information, delivered earlier in the process. This can help maximize patient collections. One way to determine the most suitable collections strategy for each patient is to use data-driven software like Collections Optimization Manager. This tool helped the University of San Diego California Health (UCSDH) score and segment patients according to their propensity to pay so that each account was dealt with in the most appropriate way. For example, patients with a high likelihood of payment could be sent billing information automatically via inbound call campaigns, and offered self-service options to manage payments. Collections Optimization Manager also enabled UCSDH to automate the presumptive charity process, quickly identify patient accounts eligible for Medicaid or charity support, and direct them to the correct work queue to maximize workforce productivity. As a result, UCSDH increased collections by 250% in a single year, from $6 million to $21 million between 2019-20 and 2020-21. UCSDH also used Coverage Discovery® to track down active commercial and government coverage that patients were unaware of. More than $5 million was found in 2021 that would otherwise have been written off. For UCSDH, being able to provide a compassionate patient collections experience has been central to this success: “We serve our patients well when we can explain their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, System Director of Patient Revenue Cycle, UCSDH Case Study 2: how Kootenai Health streamlined eligibility checks with Patient Financial Clearance Another way to provide early clarity is to make sure patients aren't missing out on Medicaid assistance. However, this can be a time-consuming and labor-intensive exercise when attempted through manual processes. Because Kootenai Health needed a more streamlined workflow to screen patients for financial assistance, they implemented Patient Financial Clearance to assess and assign patients to the right pathways and programs, based on their specific circumstances. Patient Financial Clearance uses credit and non-credit data to identify patients missing out on Medicaid or charity assistance in real-time. It automates screening and document-gathering, reducing the manual burden on staff while improving the patient experience. Verifying Medicaid eligibility early prevents patient accounts from being sent down long and expensive collections pathways that would never result in payment. Kootenai's Financial Counseling manager reported that thanks to Patient Financial Clearance, “One of our patients with a $200,000 bill answered a few questions and was found eligible for Veterans benefits. With our previous vendor, we would have written the account off to charity.” In just 8 weeks, Patient Financial Clearance saved Kootenai 60 hours of staff time by automating the presumptive charity process and eliminating unnecessary applications. It also maintained an 88% accuracy in determining the right financial assistance program for the right patient. As Medicaid continuous enrollment under the COVID-19 public health emergency declaration comes to an end, uncertainty around eligibility is likely to increase. Taking steps to verify patients' status quickly and efficiently will be even more important. Bottom line: Maximize patient collections by making it easy to pay These are just two examples of how providers are using automation and digital technology to improve patient collection processes. In addition to screening and segmentation, providers can further tailor the financial experience by offering patients realistic payment plan options to make bills more manageable. Patients are provided with a range of convenient, self-service payment options to settle their bills according to their preferred method. Tools like Patient Financial Advisor allow patients to receive a text message with a link to a clear breakdown of their bill and the option to make a payment right from their mobile device. Find out more about how Experian Health's patient collections software and payment tools can help providers stop chasing the wrong accounts and deliver a proactive and personalized financial experience for patients.