Patient Access

Time is not on the side of patient intake personnel. Getting bogged down with complex manual data collection isn't ideal when a worried family member or a sick patient is in the registration seat. Yet this is a familiar problem, punctuated by the tapping of keyboard keys and the scratch of a pen on a clipboard. The pressure to process patients quickly via these manual processes often leads to errors that carry through to claims administration. Given the prevalence of claims errors and the high rate of denials, patient registration is a step in the healthcare journey that could benefit from automation and self-service. Patient registration software can improve the experience and reduce manual errors. These tools can set the stage for a better patient journey, greater staff efficiency, and faster provider payments. What is patient registration? Patient registration is collecting and recording essential information about individuals seeking healthcare services from a medical facility or provider. It is typically one of the first steps when a patient interacts with a healthcare organization. From the provider's perspective, patient registration is also the beginning of the revenue cycle. Patient registration gathers pertinent demographic, medical, and payment information to create a comprehensive and accurate record for each customer. Healthcare personnel must capture: Personal information, such as the patient's name, date of birth, gender, address, contact details, and emergency contacts. Medical history details, such as previous illnesses or surgeries, allergies, current medications, and family health predispositions. Insurance or payment details, including primary and secondary providers and policy numbers. Consent and authorizations, which are critical for regulatory compliance. Patient registration may also include the sometimes-difficult workflows where provider staff ask for co-pays or other self-pay requirements. It can be a challenging collection point; some patients may need education on the upfront, out-of-pocket payments their policies require. For providers, the registration process can serve as the baseline for patient payment accountability. It's an opportunity to provide the patient with cost estimates for their procedure. Despite federal requirements to provide these estimates, only 29% of patients report receiving this information before their procedure. Why is patient registration important? Patient registration serves several important functions: Establish the patient's medical record, which healthcare providers reference during diagnosis, treatment, and ongoing care. Ensure administrative and billing details so the provider gets paid for the services they render. The registrar can also facilitate communication between the healthcare provider and patient regarding appointment scheduling, reminders, and follow-ups. Manage compliance with various legal and regulatory requirements for patient privacy and healthcare documentation. Patient registration is a critical step in healthcare delivery, ensuring that providers capture the necessary information to deliver high-quality, personalized care while facilitating administrative and financial processes. The problem is the rate of manual errors during this process; one study showed providers frequently miss even the most basic details of patient identification. These errors cost healthcare providers $17.4 million or more annually in denied claims, but more importantly negatively impact patient care. Providers can improve the intake process by adopting better patient registration software. How can patient registration software improve the registration process? Patient registration software can significantly improve the healthcare intake process by streamlining workflows, enhancing accuracy and efficiency, and improving the overall patient experience. Streamlined workflows Experian Health's Registration Accelerator solution eliminates the scanning, faxing, and filing of patient forms. Automated patient intake also eliminates the need to call patients (and call again) to verify their data. With automated workflows, data captured with Registration Accelerator via the eCare Next® platform seamlessly flows into other Experian Health products, such as Eligibility for real-time insurance verification. It's a single source of truth for staff bogged down by multiple system logins. Training workflows improve with easy-to-use interfaces and automation to lessen the tedium and repetition of manual intake. Registration Accelerator integrates well with other Experian Health tools connected to the eCare Next Platform to streamline to streamline intake workflows. These applications can automate up to 80% of the pre-registration process. Enhanced accuracy and efficiency The “waiting room experience” often frustrates patients and their families. Experian Health's patient registration software captures financial and health information electronically, eliminating the need for paper forms Patients access the link from their favorite personal device to answer questions, sign forms, upload documents and scan their insurance cards. The data goes straight to Experian's eCare NEXT platform to be validated against information already held in the system, reducing the risk of paperwork errors that lead to claim denials. Anthony Myers, Director of Patient Access at West Tennessee Healthcare, described their patient registration as “cumbersome” before leveraging Experian Health's Registration Accelerator. He says, “We wanted to not be a bottleneck. People were waiting on us. We set the stage for the entire admission. We partnered with Experian, and the metrics went up every month,” for online registration. Capturing accurate patient data electronically from a card scan at the front end of the healthcare visit decreases the risk of a claim denial later on. Registration Accelerator eliminates the repetitive tasks often associated with intake paperwork that frustrate patients. Patient registration starts with one link sent via text. Authorization and consent forms are e-signed, turning the registration experience into an intuitive, efficient online process without clipboards or paper. Improved patient experience Providers say their patients want more digital tools. More than 80% of patients prefer an online experience. The State of Patient Access 2023 survey showed the most important digital services that improve the patient experience include: mobile device scheduling, online payments, and more digital options for managing healthcare. Experian Health's entire line of patient access software products is devoted to providing these experiences to patients while improving providers' efficiency and revenue cycle. Registration Accelerator is a patient-facing, mobile-friendly digital registration tool that improves customers' experience from the beginning of their healthcare journey. Intake teams can spend more time building patient relationships, answering questions, and setting the stage for a better experience throughout their encounter. Healthcare organizations seeking streamlined workflows, greater accuracy, and an improved patient experience at the point of registration—or throughout their journey—should contact Experian Health to discuss their options.

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

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

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

There is growing concern that the healthcare industry needs more clinical and administrative staff to handle care demands. The crisis affects patients beyond treatment delays or lower care quality. Staff shortages in the revenue cycle create problems with patient engagement, billing, and collections. A recent Experian Health survey reveals unanimous concerns among providers about the challenges posed by workforce shortages. But what are the root causes of staffing shortages in healthcare? Is there a remedy for healthcare organizations struggling to find the talent they need? This article dives into the survey findings and the ways healthcare providers can address staffing shortages effectively. Finding 1: Staff turnover is a significant cause of healthcare staffing shortages. 80% of providers report turnover between 11-40%. Nearly one in 10 say turnover is between 41-60%. The causes of staff shortages were evident before COVID. A rapidly aging Baby Boomer population and limited availability of training in areas such as nursing led to predictions that looming staff shortages were on the horizon. The pandemic exacerbated the situation, leading to a mass exodus of workers and The Great Resignation. Some reports show healthcare lost 20% of its workforce, including 30% of nurses. Today, the average hospital turns over one-quarter of its staff annually, an increase of more than 6% from the prior year. As a result, the State of Patient Access 2023 reported nearly 50% of providers say access to care is worsening. Simultaneously, healthcare is bogged down with administrative tasks. Increasing evidence shows providers must turn to automation software to decrease human workloads and stretch small teams further. These automated tools can: Create a seamless registration process for patients to improve care access, reduce no-shows, and reduce provider administrative burdens. Provide 24/7 patient scheduling and put patients in charge with self-scheduling options Automate patient outreach to increase collections and improve communication. Improve claims management, reduce denials, and free up existing staff from manual tasks. Automation can improve the work-life balance of healthcare staff, potentially closing the revolving turnover door, one of the most significant causes of staff shortages. For example, IU Health implemented automated guided scheduling, which helped scale their operations, reduce scheduling errors and improve staff efficiency. Finding 2: Finding and hiring staff is an undue burden for healthcare providers. 73% of respondents said finding qualified staff is difficult. 61% reported that meeting entry-level staff's salary expectations is a challenge. Healthcare organizations feel the staffing crisis at every level. A recent Medical Group Management Association (MGMA) poll cited the difficulties in hiring revenue cycle staff: 34% of respondents stated hiring medical coders is their biggest challenge. 26% stated billers were difficult to find. One-third said finding schedulers and prior authorization staff is hard. Other hiring challenges included revenue cycle management (RCM) managers. When and if healthcare providers find staff, bringing them into the fold is costly. Experian Health's staffing survey showed most organizations struggle to meet the salary expectations of even the least experienced members of their teams. The causes of staff shortages can be remedied by leveraging new artificial intelligence (AI)-powered tools. Tools like AI Advantage™ can automate and transform claim denials management, a problem costing healthcare providers around $250 billion annually. Experian Health's State of Claims 2022 survey showed the most common causes of denied claims include: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Inaccurate medical coding. AI Advantage reduces denial rates by scrubbing claims and flagging errors before submission. After claim submission, the software prioritizes the most high-value denials for correction to maximize revenue generation. Organizations like Schneck Medical Center use these tools to reduce denials by 4.6% each month. The facility also increased the speed of claims submissions. Tasks that used to take 12 to 15 minutes to rework now process in less than five minutes, lessening the need for hiring more staff and improving the workloads of their existing team. Finding 3: Burnout is a top contributor to staffing shortages. 53% of poll respondents said staff burnout is a key cause of the current staff shortage. 48% said the new expectation for schedule flexibility and hybrid work models also contributes to the healthcare workforce shortage. Burnout is one of the most significant causes of staff shortages impeding high quality care and wreaking havoc on the revenue cycle. The latest data shows the percentages of clinical and administrative burnout in healthcare is approaching or exceeding 50% in most job categories: 56% of nurses report burnout symptoms. 54% of clinical staff. 47% of doctors. 46% of non-clinical staff. Cost-cutting and increasing care demands have led to increasing fatigue in healthcare staff. But technology exists to automate back office functions that could free up staff time. For example, organizations like Kootenai Health saved close to 60 hours of staff time in over 8 weeks by automating the presumptive charity process Patient Financial Clearance. Stanford Health used Collections Optimization Manager to cut 672 hours each month from overburdened back office staff. The COVID pandemic also changed expectations about how and where Americans should work. Remote work became normal; three years post-COVID, 58% of the American workforce report working remotely at least one day a week. The same data also shows that when workers have the chance to work virtually, 87% take it. Healthcare is not immune to the desire for more schedule flexibility. Becker's Hospital Review states, “Many workers desire the ability to work remotely, even if they only get the option a few days a week. Flexibility allows people to maintain work-life balance—and in a high-burnout field like healthcare, balance can be crucial.” Surveys show 31% of healthcare roles are remote full-time while 14% offer this flexibility part-time. The problem is that many healthcare positions cannot allow this flexibility—and the industry competes with others that do. To remain competitive, healthcare organizations must embrace technology to offer work flexibility. Cloud-based digital technology is beneficial in areas like the revenue cycle. For example, automated technology from Experian Health can: Use advanced analytics to streamline workflows. Facilitate patient self-service. Minimize staff time spent on manual tasks. AI-powered automation tools can lessen staff burnout by allowing them to work smarter. These tools provide the workforce with the scheduling flexibility they desire. Eliminate the causes of healthcare staffing shortages with better technology AI and automation technology in healthcare can lessen worker fatigue, lighten workloads, and give administrative workers the schedule flexibility they demand. Experian Health offers healthcare providers better technology to improve the lives of their staff, increase patient satisfaction, and generate more revenue. Download the survey or connect with an Experian Health expert today to learn how we can help your organization tackle the causes of healthcare staffing shortages effectively.

The relationship between hospitals and payers has often carried an undercurrent of tension. Stacks of paperwork, complex claims rules and manual adjustments are a recipe for disrupted cash flow and time-consuming rework. With profit margins hanging in the balance, providers need the reimbursement process to move forward without a hitch. To the relief of revenue cycle managers, recent developments in digital technology are paving the way for more effective claims management. Case in point: Experian Health's recent acquisition of Wave HDC, which brings together a suite of advanced patient registration solutions for faster and more accurate claims management at the front end of the process. Shifting sands in the hospital-payer relationship could increase denials For healthcare organizations, getting paid in full- and on-time hinges on seamless communications with payers. Any missteps can lead to revenue losses, with denied claims and delayed payments being the outcomes providers most want to avoid. Payers will automatically deny claims that have errors or missing information, while disputes and slow processing times can seriously hamper a hospital's cash flow. The sources of potential conflict have been pretty steady over time, stemming from complex billing processes, frequent changes to payers' requirements, and a lack of standardization between payers.  Tension created by the cost of services and the need to control healthcare costs is a constant in the revenue cycle. Recently, a major shift in dynamics has occurred with the widespread adoption of artificial intelligence by payers. This enables them to process – and deny – claims with unprecedented speed and scale, leaving providers struggling to catch up. On a recent webinar, Makenzie Smith, Experian Health Product Manager for AI AdvantageTM, explained how this change was reshaping the relationship between payers and providers: “So many payer decisions are now being driven by artificial intelligence. Insurers are reviewing and denying at scale using intelligent logic, leaving providers fighting harder for every dollar… Many revenue cycle managers will stick in their comfort zone because operating margins are tight and changing course seems risky. But given this change in payer behavior, the cost of staying the course could put organizations at risk.” How AI-powered revenue cycle management solutions help close the gap between payers and providers Providers are increasingly leveraging digital technology to level the playing field with payers. Integrated software and automation give revenue cycle management teams the right data in the right format and at the right time to respond to queries promptly and accurately. These solutions enable teams to work more efficiently, so they can process more claims in less time. Experian Health's flagship AI-based claims management solution, AI AdvantageTM, is a prime example. This tool predicts and prevents denials by identifying patterns in payer behavior and flagging claims with a high probability of denial so specialists can intervene before the claim is sent to the payer. This works alongside ClaimSource®, which automates clean claim submissions at scale. Using a single application, all claims are prepared and submitted with all necessary documentation, reducing the risk of denial due to missing or inaccurate information. Integrating Wave HDC's data capture technology for comprehensive claims management In November 2023, Experian Health acquired Wave HDC, which specializes in using AI-guided solutions to capture and process patient insurance data at registration with unrivalled speed and accuracy. This gives Experian Health clients access to a single denial management solution, known as Patient Access Curator. This new technology is a single click solution that spans eligibility verification, coordination of benefits, coverage and financial status checks with near-100% accuracy in less than 30 seconds. Crucial registration data can be captured in real time as soon as the patient checks in for an appointment, with no need to chase and update data post-registration. A single inquiry can search for all the essential insurance and patient demographics instantly, enabling better use of staff resources and smoother communications with payers. Tom Cox, President of Experian Health, says the move “allows us to quickly scale our portfolio with advanced logic and AI-powered technology to help solve one of the biggest administrative problems providers face today, which is claim denials.” Accurate patient data from the outset is key to preventing downstream denials, many of which originate in patient access. By reducing errors and enabling faster processing times, this comprehensive approach to denial management will help strengthen the relationship between providers and payers, ensuring timely payments and clean claims. Contact Experian Health today to find out how AI and automation can help build a successful relationship between providers and payers – and drive down denials.

By all forecasts, the healthcare worker shortage isn't going away. More than 80% of healthcare executives admit talent acquisition is so challenging it puts their organizations at risk. The latest survey from Experian Health shows complete agreement across the industry—the inability to recruit and retain staff hampers timely reimbursements. The side effects of the healthcare worker shortage are increased errors, staff turnover, and lower patient satisfaction. With the healthcare worker shortage becoming a chronic red flag on the list of industry challenges, is throwing more revenue at hiring the best answer? Experian Health's new report, Short-staffed for the long term, polled 200 healthcare revenue cycle executives to find out the effects of the continuing healthcare worker shortage on the bottom line. Respondents unanimous agreed that healthcare's recruitment problem is limiting their ability to get paid. Could investing in better revenue cycle technology to automate manual human functions be the answer to the healthcare recruiting dilemma? Effect of the healthcare worker shortage on healthcare revenue cycle Result 1: Providers losing money and patient engagement simultaneously. 96% of respondents said the healthcare worker shortage negatively impacts revenue. 82% of survey participants said patient engagement suffers when providers are short-staffed. Experian Health's latest survey showed almost unanimous agreement that the revenue cycle suffers significantly when providers are short-staffed. The only area of disagreement among revenue cycle leaders is whether patient collections or payer reimbursements are affected the most by the industry's lack of human talent. As revenue cycle teams struggle to cover their workload, the need for speed increases manual error rates. The Experian Health survey showed that 70% of revenue cycle teams say healthcare worker shortages increase denial rates. This finding reinforces an earlier survey showing nearly three of four healthcare executives place reducing claims denials as their top priority. As errors snowball, patient engagement and satisfaction begin to decline. Data entry errors impact claims submissions, resulting in billing mistakes that confuse and frustrate patients. Data errors often start at patient registration and persist through claims submission, creating denial reimbursement snarls and tying up cash flow. With the average denial rate above 11%, that's one in every 10 patients facing uncertainty around whether their bill will be paid. What's worse is that Experian Health's State of Claims Report shows denial rates increasing. While providers are leaning into increasing recruiting efforts to find the employees they need, is staffing up even possible in an era of chronic labor shortages? Technology offers healthcare providers new ways to handle revenue cycles without hiring more staff. For example, patient access software reduces registration friction, where up to 60% of denied claims start. Patient scheduling software automates access to care and gives customers greater control over their healthcare journey. It's a digital front door that engages patients with online options for managing care. On the backend of the revenue cycle, automation also offers a way to decrease reliance on manual labor to handle claims submissions. Automating clean claims submissions alleviates the denials burden, freeing up staff time and provider revenue streams.  Result 2: Staffing shortages heavily impact payer reimbursement and patient collections. 70% of those saying payer reimbursement has been affected the most by staff shortages also agree that escalating denial rates are a result. 83% of those saying patient collections have been affected most by staff shortages also agree that it’s now harder to follow up on late payments or help patients struggling to pay. Addressing healthcare staffing shortages is crucial for providing quality patient care, maintaining financial stability, and maximizing reimbursement in the complex healthcare reimbursement landscape. Staff shortages lead to reduced productivity within healthcare facilities, and existing teams may need to take on extra work to fill the gap. Overworked staff may be more prone to errors, leading to claims denials. Medical Economics says manual collections processes suffer due to the healthcare worker shortage. They state, “Mailed paper statements and staff-dependent processes are significantly more costly than electronic and paperless options, yet the majority of physicians still primarily collect from patients with paper and manual processes.” Technology exists for self-pay receivables that allow patients easy online payment options. Experian Health's Collections Optimization Manager offers powerful analytics to segment and prioritize accounts by their propensity to pay and create the best engagementstrategy for each patient segment. Advocate Aurora Healthcare took control of collections by using this tool and automated their collections processes, so that existing staff could focus on working with the patients who had the resources to handle their self-pay commitments. The software's automation and analytics features allowed the provider to experience a double-digit increase in collected revenues annually. Patients also benefit from collections optimization software. For example, Kootenai Health qualifies more patients for charity or other financial assistance with Experian Health's Patient Financial Clearance solution. In addition to automating up to 80% of pre-registration workflows, the software uses data-driven insights to carve out the best financial pathway for each patient. It's a valuable tool for overburdened revenue cycle teams that struggle to collect from patients. Kootenai Health saved 60 hours of staff time by automating these manual payment verification processes. Result 3: Recruiting alone isn't solving the healthcare worker shortage. Healthcare hiring is a revolving door, with 80% reporting turnover as high as 40%. 73% said finding qualified staff is a significant issue. A significant contributor to the healthcare worker shortage is the grim reality that these organizations are losing human resources to burnout and stress. Being short-staffed drags down the entire organization, from the employed teams to the patients they serve. But it's impossible for recruiting alone to fix the problem when more than 200,000 providers and staff leave healthcare each year. A recent study suggests that if experienced workers continue to leave the industry, by 2026, more than 6.5 million healthcare professionals will exit their positions. Only 1.9 million new employees will step in to replace them. The news worsens with the realization that nearly 45% of doctors are older than 55 and nearing retirement age. Artificial intelligence (AI) and automation technology in healthcare can cut costs and alleviate some of the severe staff burnout leading to all this turnover. However, one-third of healthcare providers have never used automation in the revenue cycle. A recent report states that providers could save one-half of what they spend on administrative tasks—or close to $25 billion annually—if they leveraged these tools. For example, Experian Health's Patient Access solutions can automate registration, scheduling and other front-end processes. AI can also help increase staff capacity and output without adding work volume. Experian Health's AI Advantage™ solution works in two critical ways to help stretch staff and improve their efficiency: The Predictive Denials module reviews the provider's historical rejection data to pinpoint the claims most likely to bounce back before they are submitted. The tool allows the organization to fix costly mistakes before submission, eliminating the time spent fighting the payer over a denial. The claims go in clean, so the denial never happens. The revenue cycle improves, saving staff time and stress. Denial Triage focuses on sorting denied claims by their likelihood to pay out. The software segments denied claims by their value so internal teams focus on remits with the most positive impact on the bottom line. Instead of chasing denials needlessly, this AI software allows revenue cycle teams to do more by working smarter. Revenue cycle technology to fill healthcare worker shortage gaps There is no question that the healthcare worker shortage is causing a significant burden on patients and providers. Experian Health's Short-staffed for the Long Term report illustrated the effect of this crisis on the healthcare revenue cycle, patient engagement, and worker satisfaction. Technology can solve staffing challenges by allowing the healthcare workers we do have to spread further and work more efficiently. AI and automation technology in healthcare can cut costs, alleviate staff burnout and can even help healthcare providers retain their existing workforce. By implementing these new solutions, healthcare providers can help stop the bleeding of existing staff that contributes to the healthcare worker shortage, while improving the efficiency of the revenue cycle. These tools save time and money and improve the lives of everyone touched by the healthcare industry. Contact Experian Health to see how your healthcare organization can use technology to help eliminate the pressures of the healthcare worker shortage.

What's weighing on providers' minds as we head into 2024? According to a 2023 Medical Group Management Association (MGMA) survey, an overwhelming percentage of providers are wondering how to speed up prior authorizations. The answer: automation and electronic prior authorizations. The 2023 MGMA Annual Regulatory Burden Report surveyed executives representing more than 350 group practices about the impact of federal policies and regulations. The MGMA is the nation's largest association focused on the business of medical practice management. Respondents cited a growing volume of pre-authorizations as a key challenge, along with complex coding requirements, lengthy response times, and delays in treatment. Survey results showed that prior authorizations are a pervasive issue: 89% of respondents called pre-authorizations either “very” or “extremely” burdensome. 90% said the regulatory burden has grown in the past 12 months. 92% had hired additional staff to deal with prior authorizations. 97% said patients had experienced delays or denials due to pre-authorization requirements. 97% said a reduced regulatory burden would allow resources to be reallocated toward patient care. Neeraj Joshi, Director of Product Management at Experian Health, sees the issue as complex but solvable: “Providers have to get ahead of the constant changes in regulations and payer rules, while also overcoming the operational limitations inherent in manual processes and the industry's ongoing staffing shortages,” he says. Joshi shared his perspective on the state of pre-authorizations going into 2024—and what may be ahead as providers consider automation and new technologies surrounding electronic prior authorizations. Here's where he sees the industry heading in the year to come. Q1: What feedback have you received from providers about the challenges they face, and how is this feedback shaping the development of Experian Health's solutions? “The feedback from providers is clear: They highlight the challenges of managing an increasing volume of pre-authorizations, the complexity of payer rules, and the burdens of manual data entry,” says Joshi. “This feedback has been crucial in shaping Experian Health's solutions, leading to the development of tools that automate the pre-authorization process and keep providers up-to-date with payer rules.” Technology plays a key role in helping providers take on these challenges. Case in point: Experian Health's online authorizations solution includes access to a complete payer database that stores and dynamically updates payer prior authorization requirements. Experian Health's pre-authorization Knowledgebase works together with Authorizations software to reduce the manual workload. Automated inquiries work behind the scenes without intervention to maintain a high level of accuracy that improves efficiency, drives revenue, and protects profits. “Features like the Knowledgebase and tools such as Medical Necessity, which automatically checks patient orders against payer rules, and Claims Scrubber, an automated solution that reviews and edits claims pre-submission, reduce the time and effort required to manage pre-authorizations and minimize the risk of errors,” says Joshi. “These tools address providers' specific challenges around maintaining operational efficiency and optimizing the revenue cycle as they navigate a complicated pre-authorization landscape.” Q2: Why are providers increasingly concerned about pre-authorizations now? “A number of factors are contributing,” says Joshi. “Providers' concerns about pre-authorizations have intensified due to the pandemic's impact on healthcare operations, leading to rescheduled care and uncertainties around existing authorizations. Additionally, evolving and diverse payer rules, coupled with manual, labor-intensive processes, have exacerbated these challenges.” Each of these concerns is significant by itself. Together, they create an even greater challenge to operational efficiency. “Providers are grappling with the need to adapt to these changes, often with reduced staff,” says Joshi. “This has increased the administrative burden and complexity of managing pre-authorizations. State-specific regulations, such as New York's temporary suspension of prior authorizations, have added another layer of complexity, creating a landscape where providers must continuously adapt to both national and regional policy changes.” Q3: How do regulatory changes impact the pre-authorization landscape, and how is Experian Health adapting to these changes? “Regulatory changes, including state-specific mandates and evolving payer policies, significantly impact pre-authorizations by introducing new requirements and exceptions,” Joshi explains. As of late 2023, 40 states have enacted prior authorization regulations, with the possibility of additional and amended regulations constantly looming. Additionally, the 2024 Medicare Advantage and Part D Final Rule will change pre-authorization requirements nationwide for patients with Medicare Advantage plans. Payer rules shift constantly—both in response to regulation and independent of it—creating a massive operational challenge for providers. “These constant changes necessitate a dynamic response from healthcare providers,” says Joshi. Outdated manual processes simply aren't up to the task, least of all when staffing is limited. “Experian Health helps providers adapt by continuously updating its platforms and solutions to align with the latest regulations and payer policies. This includes integrating real-time updates and automating the process of keeping track of changing requirements, thus ensuring that providers using Experian Health's solutions are always working with the most current information.” Q4: What other ways can electronic prior authorization tools help providers address current pre-authorizations challenges? “Leveraging technology to streamline and automate the pre-authorization process is the core advantage,” Joshi says. Electronic prior authorization tools, powered by AI, represent a giant leap forward.  “Adopting solutions that reduce manual workloads, such as Experian Health's Knowledgebase, and dynamic work queues that help operational teams work the exceptions and discrepancies, rather than spending their time handling every authorization transaction, can make complex processes manageable. Emphasizing back-end automation and keeping abreast of the latest payer policies are key strategies to manage increasing patient volumes effectively. “Providers can also focus on implementing patient-facing digital tools to facilitate self-service,” Joshi continues. “A greater emphasis on self-service can reduce administrative burdens without sacrificing the patient experience.” Q5: How do you see the future of patient care being impacted by electronic prior authorizations and other advancements? “The future of patient care is poised to be significantly impacted by these advancements,” Joshi says. “Streamlined and automated pre-authorizations can lead to reduced wait times for patients and more timely access to necessary treatments.” Automating the pre-authorization process and introducing new technologies to deal with an ever-evolving, ever-expanding workflow may also help providers break a difficult cycle of overwork and understaffing. “As the administrative burden on healthcare providers decreases, more resources can be allocated to direct patient care,” Joshi maintains. “This shift will not only improve the efficiency of healthcare delivery but also enhance the overall patient experience, leading to better health outcomes and higher patient satisfaction.” Learn more about how Experian Health can help your organization improve operational efficiency and drive revenue with electronic prior authorizations.

As 2023 draws to a close, revenue cycle leaders are in planning mode, reviewing financial performance, and gearing up for resource allocation negotiations in the new year. What should they be prioritizing? Three of Experian Health's senior executives share their healthcare predictions for 2024 based on the latest healthcare trends, and the steps providers can take to maximize reimbursements in the year ahead. Healthcare prediction #1: “Staffing shortages will persist, driving demand for technology-based solutions over traditional HR tactics” According to Jason Considine, Chief Commercial Officer, the healthcare staffing shortage is unlikely to let up any time soon: “In our recent survey, we found that 100% of respondents are seeing ongoing shortages affect revenue cycle management and patient engagement. There's an urgent need to address the problem, but too many providers are relying on traditional recruitment approaches that won't give them the longer-term resilience they need. Heading into 2024, providers should leverage technology and data to alleviate the burdens on front and back-end operations, and drastically improve efficiencies. This will better protect providers from the talent pipeline fluctuations that cause major disruptions.” This healthcare prediction for 2024 is based on Experian Health's staffing survey that was relased in 2023. Participants in the survey agreed that the staffing crisis would continue, expressing concerns about its impact on revenue and patient engagement. For many, the culprit is high turnover rates. More than four in ten said turnover in their administrative teams exceeds 25%. Given the difficulties in finding skilled candidates and addressing staff burnout, it seems clear that traditional HR-based strategies will fall short. Despite this, salary increases, cross-training and incentives remain go-to responses. Responding to the survey findings, Considine says, “It's time to look at the many areas where automation – and even artificial intelligence – can stabilize, improve and optimize understaffed functions.” One use case for artificial intelligence is in claims management. Experian Health's AI Advantage™ solution uses historical and real-time claims data to identify claims that may be at risk of being denied. This allows staff to zero in on those claims and ensure all information is correct and complete before submission. It integrates seamlessly with ClaimSource® to augment the claims workflow, so staff can focus on claims and denials with the highest likelihood of payment. As well as alleviating pressure on staff, it reduces costs and maximizes reimbursements, helping providers to protect margins during uncertain times. See how AI Advantage helps healthcare organizations reduce and prevent claims denials. Prediction 2: “Patients' changing digital expectations will prompt more providers to adapt (and those that don't will risk losing market share)” Clarissa Riggins, Chief Product Officer, says that patients are increasingly likely to expect a better “digital front door” experience, and will start to look elsewhere care if they encounter too much friction: “Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services. They seek convenient self-scheduling options, accurate cost estimates, and the ability to pre-register through their smartphones. We're seeing a continuing trend in the number of patients who say they'd switch providers if the digital front door isn't open.” That healthcare trend was evident in Experian Health's State of Patient Access 2023 survey, which showed that 56% of patients who had seen a deterioration in the patient access experience would switch providers because of it. Demand for more digital options can be tracked back to the “Amazon effect” and the rise of online retail environments that give consumers convenience and choice at the tap of a button. Indeed, healthcare providers stepped up during the pandemic to deliver flexible, contactless care, so patients have seen that it's possible. With digital transactions now well-established, patients will find it surprising to be asked to fill out paper forms at the registration desk or have limited online payment options in 2024. Riggins says providers must update their technology or risk being left behind. “Clients who are making the switch to digital patient access offerings tell us they don't want to look stuck in the 90s. They want a more contemporary patient experience that's smoother and more efficient for both patients and staff.” To open the digital front door and kepe up with healthcare predictions in 2024, Riggins recommends prioritizing self-service and digital options for patient registration, scheduling and billing inquiries. Prediction #3: “More patients are struggling financially, so providers will need to do more – and sooner – to help them manage bills” Victoria Dames, Vice President of Product Management, says that with household finances under pressure, patients will remain anxious about the cost of care: “The earlier providers can give patients clarity, the better for all involved. Creating a convenient and transparent patient collections experience should begin during patient onboarding, so patients can start to plan. With integrated patient access software, providers can deliver a more compassionate and efficient collections process, which supports patients while accelerating the revenue cycle. They don't have to choose between prioritizing revenue and patient experience – patient access technology delivers on both.” Recent Experian data suggests that many Americans are not confident in their financial literacy. This does not bode well for their ability to navigate the increasingly complex processes involved in healthcare billing. The troubling health consequences are already evident: a 2023 Gallup poll revealed that record numbers of patients were putting off medical care because they were worried about the cost. Anything providers can do to simplify the payment process is going to improve access to care and minimize bad debt, as noted in Dames' healthcare predictions for 2024. Dames says the collections effort should be viewed as an ongoing interaction with patients, beginning in patient access: “Patient access is where providers begin collecting data, confirming insurance eligibility, and providing accurate patient estimates. Completing these actions successfully at the beginning of the patient journey, with compassionate and frictionless patient interactions, can facilitate payment and collections downstream.” A better financial experience in 2024 should include self-service and digital tools that guide patients through each step of their financial journey. For example, PatientSimple® gives patients a user-friendly, comprehensive way to generate price estimates, apply for charity care, set up payments plans and even make payments, all through a single web-based portal. Patient Payment Estimates deliver accurate pre-service cost estimates through the patient's preferred channels and point them toward any appropriate financial assistance. And of course, offering a wide range of convenient and flexible payment options will promote timely payments and maximize collections. Learn more about our revenue cycle management solutions or contact Experian Health today to discuss how we can support your strategies, based on our healthcare predictions for 2024.