Patient Access

Staffing shortages are the new normal in healthcare. Most news headlines focus on gaps between the supply of providers and the growing demand for care. However, a recent survey by Experian Health, released in November 2023. shows the massive impact staffing shortages have on back office revenue cycle where these functions intersect with front-of-house patient engagement. Strikingly, the healthcare staffing shortage statistics in the survey show revenue cycle executives are 100% in agreement—staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees. Experian Health's report, Short-staffed for the long term, surveyed 200 healthcare executives responsible for revenue cycle functions. The goal was to gauge the impact of worker shortages on revenue cycle management and patient engagement. While the pandemic brought these shortages into the public purview, this new data shows most providers believe healthcare staffing gaps are chronic and here to stay. These results reinforce The State of Patient Access 2023 survey, where 87% of providers blamed staffing shortages for declining access to care. As the healthcare industry continues to struggle with an ever-increasing staffing shortage, it has become increasingly evident that if left unresolved, this situation can wreak havoc on revenue cycle management (RCM). The latest survey illustrates the need for new strategies to alleviate healthcare worker shortfalls. This article explores the most recent healthcare staffing shortage statistics and some key findings from the study to help determine how healthcare providers can turn these challenges into opportunities. Experian Health surveyed 200 revenue cycle executives to determine the impact of staffing shortages on reimbursement and patient engagement. Download the report to get the full results. Finding 1: Most revenue cycle leaders believe staffing shortfalls negatively affect payer reimbursements and collections. 96% of survey respondents indicated a lack of qualified workers has a detrimental impact on organizational revenue channels. 80% say turnover in their department ranges from 11 to 40%, much higher than the national average of 3.8%. When healthcare organizations lack revenue cycle talent, they risk missing performance goals. High turnover and the departure of experienced staff create information deserts within healthcare organizations. It forces new team members to train faster, handle bigger caseloads before they're ready, and potentially burnout from stress. The pressure to do more faster creates a higher volume of preventable claims errors that lead to denials. The survey showed all these factors at play, and their negative impact on reimbursement, collections, and the patient experience. While the traditional way to alleviate staffing shortages is to increase recruiting and retention efforts, these approaches no longer work when there simply isn't enough available staff to hire and train. Healthcare organizations must consider new partnerships with technology providers who offer automation tools to streamline human workflows. Revenue cycle management software eliminates repetitive tasks and lessens errors that lead to rejected claims. Digital technology can help solve labor shortages by reducing staff workloads and improving operational performance. Automation can streamline collections by prioritizing the accounts most likely to pay. These tools help existing revenue cycle teams work more efficiently while enhancing patient encounters. Finding 2: Healthcare staffing shortages roadblock a positive patient experience. 8 of 10 survey respondents say patient experience suffers due to gaps in staffing coverage. 55% report the patient experience is most heavily affected at intake, and 50% say at appointment scheduling. Staffing shortages and turnover cause an undue burden on the healthcare workers left behind. The survey asked respondents to indicate the top pain points experienced by revenue cycle professionals, and one of the major challenges was staff burnout. Stress has a detrimental effect on patient interactions throughout the revenue cycle. The survey shows staffing shortages impede patient satisfaction in critical areas within revenue cycle functions, including: Scheduling appointments Patient registration Prior authorization Insurance coverage confirmation Patient estimates Revenue cycle interactions can be delicate, requiring extreme patience and clear communication. Healthcare organizations must provide the support their revenue cycle teams need to handle these crucial conversations appropriately. To improve the patient experience, organizations must first improve the workflows and workloads of these critical back-office teams. When healthcare organizations have the right tools to eliminate manual tasks that bog down revenue cycle staff, these professionals can spend more time on the compassionate handling of patients and their accounts. Providers have the opportunity to solve these challenges with digital patient engagement solutions that improve workflow efficiencies at every level of the revenue cycle. Patient scheduling software creates a self-service environment that 73% of healthcare customers prefer. Patient intake improves with online software that automates the tedious paperwork that tie up staff. Better technology can create price transparency without manual effort, ensuring patients understand their responsibilities up front instead of facing surprises during or after care delivery. Finally, a frictionless online payment platform allows patients to handle their obligations seamlessly without staff intervention. Finding 3: Errors arise when healthcare providers are short staffed, leading to claims denials. 70% of survey respondents say staff shortages exacerbate denial rates. 92% of survey respondents said new staff members make errors that negatively impact claims processing. Some of the most common reasons for healthcare claim denials include: Incomplete collection of claims data Coding errors Billing errors Eligibility verification errors Missed insurance verification Healthcare operations and revenue cycles are full of manual processes. RevCycleIntelligence reports one-third of prior authorizations are completed manually, and two-thirds of hospitals haven't automated any part of their denials management processes. Yet technology has made significant strides toward reducing these error-prone manual tasks. Leveraging artificial intelligence (AI), with solutions like AI Advantage™, within the complexities of claims processing could cut provider spending by up to 10% annually. Eliminating repetitive tasks with automated claims management solutions improves the lives of staff, cuts manual errors that tie up cash flow in reimbursement wrangling, and creates a better, less stressful environment for customers. Reducing the impact of healthcare staffing shortages with revenue cycle automation and technology Sometimes, 100% agreement isn't the desired outcome. In this case, the healthcare staffing shortage statistics found in the survey shows healthcare providers agree unanimously that chronic staffing shortages create a problematic environment for employees that costs revenue and patient engagement. While technology exists that can maximize revenue staff workflows to extend the reach of overburdened employees; survey participants suggest that healthcare organizations continue to approach solving these issues by adding staff.  But healthcare's staffing challenges are not new. While organizations have historically invested revenue in higher salaries and sign-on bonuses to attract staff, technology offers a new opportunity for history to avoid repeating itself. It's time for healthcare organizations to support their teams with automation. These tools alleviate mundane, error-prone tasks that tie up staff. Experian Health offers these organizations a way to improve the lives of everyone within the revenue cycle by allowing back and front-office teams to focus on patient care, rather than filling in forms. It's a more humane way to handle a very human staffing crisis. Download the survey or connect with an Experian Health expert today to learn how we can help your healthcare organization combat staffing shortages.

Hospital admissions for COVID-19 increased by almost 92% between the last week in July 2023 and the last week in August 2023, according to figures published by the Centers for Disease Control and Prevention (CDC). It is worth noting that this time last year, the numbers were double what they are now. However, it is important to acknowledge that the virus is still evolving. Demand for services may be unpredictable over the coming months, so providers will need to position their teams to adapt to changing patient volumes and staff absences. Additionally, seasonal flu vaccination programs are underway, putting extra pressure on patient access. Now is the perfect opportunity for healthcare providers to reassess and streamline patient intake processses. This article looks specifically at how online scheduling for patients can help providers prepare for the unexpected this fall. Rethinking patient intake Online scheduling helps providers create a more efficient patient access experience by allowing patients to schedule appointments from home, instead of by phone or in person. It's more convenient for patients, limits exposure to infection and reduces the administrative burden on front office staff. Understandably, some providers without online scheduling software in place may worry about implementing new tools during the busiest time of year. They may see it as a “nice to have” to deploy when demand is more stable. But this is a false economy: any time saved by postponing the switch to online scheduling will be lost to costly inefficiencies over the hectic winter period. It's crucial to start the process now, before the stress hits. In a 2022 evaluation of self-scheduling processes at the Mayo Clinic, the authors describe themselves as “fortunate to have the self-triage and self-schedule process in place during the unanticipated surge of COVID variant omicron in the winter of 2021-2022.” The organization saw utilization of self-scheduling for COVID-19 tests increase from 4% of appointments booked in December 2020 to 44% in January 2022, saving thousands of hours of staff time, reducing no-shows and streamlining the patient experience. Get more benefits from online scheduling with a tailored approach Switching to online scheduling doesn't have to be complicated. To simplify implementation, providers should focus on how online scheduling can support their organization's specific operational challenges and goals. Choosing a solution that integrates with existing practice management and hospital information systems will also ensure implementation is as frictionless as possible. Here are a few examples of ways to maximize the benefits of online scheduling for their organization: 1. Create screening questionnaires to manage demand Screening questionnaires can be given to patients as soon as the log in to book appointments for specific services. Their answers can then be used to determine the appropriate appointment type and guide patients to their next step quickly and efficiently. Clinical needs, billing requirements, and patient preferences (such as the need for an accessible location or interpreter), can all be managed automatically.It's an effective strategy to manage demand for high throughput and routine services that are less likely to need staff assessment, such as COVID-19 testing or flu vaccinations. In the Mayo Clinic example, self-scheduling took just 3.1 minutes for asymptomatic patients, increasing to just 5.8 minutes for symptomatic patients who self-triaged with a screening questionnaire. 2. Use guided search to direct patients to virtual services Online scheduling can also guide patients to appropriate and convenient services they may not otherwise have considered, such as virtual care. Virtual care proved its value at the height of the pandemic, and while utilization has levelled off, providers should not see this as a lack of appetite for digitally-enabled care among patients. In Experian Health's State of Patient Access survey 2023, 56% of patients said they wanted more digital options for managing healthcare. Respondents (particularly younger patients) listed mobile scheduling for telehealth appointments among their expectations of the digital front door.The recent explosion in digital health companies offering at-home care solutions also speaks to patient demand for virtual services. Established providers should look to expand and promote their digital offerings, or risk losing their competitive edge. Leveraging the incumbent advantage is a move to make now, while new players are still finding their feet. One effective method to achieve this is by directing patients to existing virtual services through an online scheduling platform. 3. Eliminate walk-in traffic at urgent care centers Urgent care centers are the 'doctor of choice' for many patients, with patient volumes increasing by 60% since 2019, according to the Urgent Care Association. If COVID-19 and seasonal flu cases collide over the winter, urgent care centers may become overwhelmed by patients with both infections. Urgent care center managers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This helps reduce the number of in-person visits and walk-in traffic, which will not only help prevent spread of infection, but also contribute to a better patient experience.Online self-scheduling also eases pressure on urgent care centers in another important way. Allowing patients to book their own appointments reduces the risk of cancellations and no-shows. This proactive approach prevents delays in care, effectively bridging gaps that can potentially escalate into costlier and riskier emergency situations. 4. Extend staffing capacity with real-time resource allocation Experian Health's data shows that between June 2022 and June 2023, providers that used Patient Schedule saw an average of 40% of patients book appointments after hours, saving hours of administrative time. Efficiencies on this scale will be invaluable, should COVID-19 or seasonal flu cases trigger a rise in patient volumes and staff absences.Patient Schedule automatically optimizes patient and provider capacity in real-time. Scheduling rules based on providers' calendars, appointment types and business needs are built into the platform, so that patients only see the available appointments based on those rules. The tool gathers calendar inventory from across multiple providers for a comprehensive view of network capacity, to make even better use of available staff time. The calendar inventory can cover an entire care team, such as a physician, physician assistant and nurse practitioners. This frees up staff to focus on other administrative tasks and assist patients with additional needs. Get ahead of winter pressure points with online self-scheduling These are just a few examples of how providers can use online patient scheduling to zero in on their own operational priorities, make life easier for schedulers and patients, and ease pressure on services over the coming months. Contact Experian Health today to explore self-scheduling options and immediately boost your service capacity.

The phrase “it's complicated” resonates well in the realm of prior authorizations in healthcare. Initially devised as a cost control strategy by insurance payers, the concept of prior authorization holds merit. However, the reality unfolds as a different tale, with 94% of doctors attributing care delays and diminished clinical outcomes to prior authorization hurdles. Furthermore, one in three doctors  connect these authorizations to escalated healthcare resource utilization, manifested through patient hospitalizations and life-threatening clinical events. There is a shimmer of hope as some insurers are retracting prior authorization prerequisites for certain conditions and procedures. However, this move might produce more complexities, given the distinct protocols of each payer. The traditional manual handling of prior authorizations by most providers leaves ample room for errors amidst these changes. A viable solution lies in leveraging technology. Experian Health's electronic prior authorization software can expedite and streamline pre-certification workflows, keeping providers updated with the ever-evolving payer requirements. What are prior authorizations?  Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. This process can be time-consuming, burdensome, and can lead to delays in patient care. Kaiser Family Foundation (KFF) says, “Prior authorization, or pre-certification, emerged decades ago to deter physicians from prescribing costly tests or procedures unjustifiably, aiming at delivering cost-effective care.” Initially, the focus was on high-cost care like chronic condition treatments. However, the spectrum has broadened, encompassing mundane clinical encounters like basic imaging or medication refills. Since 2020, a whopping 80% of providers have witnessed a surge in prior authorization volumes, stirring discussions on their necessity. The American Medical Association (AMA) critiques the overuse of prior authorization, emphasizing the administrative and clinical issues it spawns. The lack of uniform documentation requirements across payers often culminates in unwarranted care denials and treatment delays. The administrative overhead is hefty; an average doctor processes 45 pre-authorizations weekly, a task primarily manual, time-consuming, and error prone. Some insurers lifting prior authorization requirements  The scrutiny over the years has prompted some payers to relax prior authorization mandates:  UnitedHealth is reducing nearly 20% of their prior authorization requisites for a variety of treatments from spine surgery and breast reconstruction to outpatient therapies and durable medical equipment Humana has eliminated prior authorizations for cataract surgery for Georgia Medicare Advantage beneficiaries.  Following suit, Aetna has waived pre-certification for certain cataract surgeries, albeit excluding Medicare Advantage beneficiaries in Georgia and Florida. They have also ceased prior authorization for physical therapy in five states. Currently, 30 state bills aiming to rectify the prior authorization problem are in the pipeline. Washington is on the verge of introducing new mandates for both private and public payers. However, the diverse new rules from payers and legislative attempts to address the issue might create new challenges.  How to keep track of prior authorization changes  The traditional reliance on manual paperwork for prior authorizations remains predominant. Over half of the providers find the process daunting to organize and maintain. Experian Health's electronic prior authorization solution stands to help automate this process, enhancing operational efficiency and curbing costly denials. The solution auto-updates with the latest payer rules, offering real-time tracking of authorization status and allowing manual look-up by CPT code or service description. This significantly reduces the time spent hunting for updated information. Furthermore, the software can add actionable alerts, creating flags when payers change their requirements. For example, the Prior Authorization Knowledgebase, a proprietary repository for more than 160 national payers and their pre-certification rules, allows quick check functionality to see if a procedure requires appropriate use criteria adherence. Users can create service work queues when CMS requires adherence to Appropriate Use Criteria (AUC). Two supporting tools to aid these processes include the Medical Necessity tool, which validates clinical orders against CMS and private payer rules for fewer denials, and Claims Scrubber, which helps healthcare organizations prevent denials by improving claims accuracy.  Neeraj Joshi, Director of Product Management, at Experian Health, says, “Technology has the potential to significantly reduce the need for pre-authorization in healthcare by improving efficiency, streamlining processes, and enhancing decision-making. Automating prior authorizations eliminates the burden of tracking these constantly changing requirements. Following these changes by hand, scrolling back and forth between websites, then manually adding them to a rules list leaves room for error that no one can afford.”   Using technology to streamline prior authorizations Today, a mere 21% of providers have adopted electronic prior authorization software. The Council for Affordable Quality Healthcare (CAQH) projects that automation of service preapproval could slash healthcare's administrative encumbrances by $437 million annually. More crucially, it would expedite patient decision timelines and care delivery. The impact on patient outcomes could be significantly positive over time. The utilization of electronic prior authorization software promises to alleviate the anxiety doctors and patients endure while awaiting treatment approval. The AMA reports that 8 in 10 doctors acknowledge patient experience unwarranted care delays, sometimes leading to treatment abandonment due to prolonged prior authorization procedures. The technology to expedite prior authorizations is at our disposal, and progressively, healthcare organizations are transitioning towards it, mending the broken pieces of care delivery and reimbursement. Joshi says, “While technology can reduce the need for pre-authorization in healthcare, it's essential to strike a balance between ensuring the appropriate use of medical services and avoiding unnecessary delays in patient care. Healthcare providers can use technology to design more efficient workflows that minimize administrative burdens. For example, automating data entry and documentation can free up healthcare staff to focus on patient care. We have the tools available that can speed up these processes.”   Today, better health requires reducing the complexities of the healthcare paradigm. Experian Health offers provider organizations improved options for delivering care with robust technological solutions that improve the lives of clinicians, staff, and patients. We specialize in offering digital tools to improve every stage of the patient journey. Contact Experian Health today to improve your pre-approval processes with electronic prior authorization software. 

Humans increasingly benefit from the convenience of a self-service world. Thanks to the internet and companies like Amazon, online digital interactions yield an almost immediate result. It's a standard consumers have adapted to and unconsciously expect from every service provider, whether it's same-day grocery delivery or scheduling the next doctor's appointment. Today's gold standard for most services is a few clicks with a favorite handheld digital device. But when it comes to healthcare, sometimes expectations don't meet reality. Healthcare providers must accommodate patient expectations by opening a digital front door. Despite the complexities inherent in American healthcare, patients increasingly demand a frictionless online experience where they manage their care at their leisure. Clarissa Riggins, Chief Product Officer at Experian Health, says, “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.” Understanding the need for a digital front door in healthcare Healthcare's digital front door is a set of online tools that enable patients to manage their care. These tools began growing in popularity during COVID, when the necessity of limiting physical interactions drove many patients to online healthcare alternatives. These digital encounters further increased patient expectations of a seamless healthcare experience from scheduling to service delivery to payment. Meeting patient demand for digital services Increasingly, the level of control that stems from online scheduling is what healthcare customers demand. Digital tools used to book appointments, register for care, and make payments are becoming a norm across the healthcare continuum. Survey results from the State of Patient Access 2023 found that some of the most important digital services for patients that drive a positive experience include being able to schedule appointments online or via a mobile device (76%), having an online/mobile option for payments (72%), and more digital options for managing healthcare (56%). Clarissa Riggins points out the gap between these expectations and the reality of most patient experiences, stating, “In general, findings seem to show progress has stalled when it comes to making patient access functions like scheduling, registration, coverage verification, and cost estimates more efficient.” Yet providers seem aware of their patient's interest in seeing more, not fewer, digital front door tools in healthcare delivery. The State of Patient Access 2023 report shows 86% of healthcare providers want their organizations to improve by adopting digital front door software. Riggins says, “But provider's motivation is not necessarily generating action.” Patients are growing frustrated; nearly half say they can't find appointments to fit their schedule, and 40% complain that even trying to schedule with a doctor is challenging. Today, 87% of patients perceive the across-the-board accessibility of their healthcare practitioners as a problem. Digital front door software is healthcare's solution to provider shortages, decreasing access, and our patient's on-demand scheduling requirements. Patients and doctors want digital front door software to increase access to care Patients are turning to providers who use automated solutions. Recent 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, and 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. A prior study showed 44% of patients say they prefer to receive test results via a secure online hub. While staffing shortages certainly impact the ability to schedule care, Riggins points out, “Since patients associate 'access' with their ability to see a provider quickly, it makes sense that, without technology in place, staffing shortages will negatively impact the consumer experience.” It's a good point; nearly 40% of healthcare providers say technology solutions like digital front door software offset staffing shortages. Healthcare patients demand digital front door access and their doctors agree. But healthcare organizations are lagging in implementing these tools. Where is the disconnect? Eliminating the tedious human tasks that accompany manual patient registration, automating accurate price estimates, or offering patients one-click, convenient payment options, will free up staff to focus on key initiatives. Not to mention that these digital innovations will give patients and providers what they want. Perhaps the lag in implementing healthcare digital front doors occurs because these organizations find digital transformation daunting. But healthcare providers can work with a third-party trusted advisor with the right expertise to make the transition to digital front door software. Utilize mobile and self-service scheduling Experian Health specializes in opening healthcare's digital front door, beginning at the front door of any practice. Automated patient scheduling gives patients 24/7 control over when they visit doctors. Easy one-click functionality in a comfortable user interface allows patients to reach the right doctor at the best time for everyone. For providers, this kind of digital front door software alleviates the pressure on overburdened scheduling staff by moving these processes to a self-service online environment. Provide a better registration experience Experian Health's registration software also takes the next step, inviting patients through the digital front door by simplifying and streamlining intake. Healthcare organizations can create a better registration experience and increase patient booking with text-to-mobile registration. Two-way automated communications with patients decrease no-shows and engage patients at every step of their journey. For new and existing patients, automated cost estimates with easy payment options let them know their obligations to a healthcare practice, increasing co-pay collections while lessening burdens on providers and staff. Communicate costs upfront Communicating the costs associated with healthcare delivery is a critically important step toward improving patient experience. Experian Health's State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. That's why Experian Health expanded their digital front door software to include tools like Patient Estimates and Patient Financial Advisor. These tools creates true price transparency between healthcare providers and their patients. Providing a patient with an on-demand, clear, accurate cost estimate for healthcare should be a standard part of the care delivery paradigm. These solutions automate this process so that every customer understands the costs associated with receiving care. The bottom line There is evidence now that patients want a digital front door to improve access to care. They want to retake control of their health and do it from their preferred digital device. Experian Health has a set of digital front door tools that brings healthcare consumers exactly what they want while lowering provider staffing costs. Adopting innovative digital solutions is no longer an “if” proposition; healthcare customers have shown they will seek out new providers if their scheduling, registration, and payment processes are not seamless. This shift in the consumerism of our healthcare services means that healthcare organizations face a strategic imperative to open the digital front door—or lose patients to the competition.  Contact Experian Health to learn we help organizations open their digital front door with automated patient access solutions.

Is streamlining patient access with technology the key to improving revenue cycle management? Technology is already making intake, insurance verification, patient estimates, and other elements of patient access simpler. The same technology can also speed up and smooth out the healthcare revenue cycle: a goal many providers can get behind. Victoria Dames, Vice President of Product Management at Experian Health, says, "Patient access is the first step in simplifying healthcare and revenue cycle processes. Trading in manual processes and disjointed systems for integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle. For providers trying to choose between prioritizing revenue and patient experience, patient access technology can deliver on both.” The digital transformation journey starts with patient access technology Starting at the beginning with patient access makes perfect sense for providers who want to embark on their digital transformation journey. The early touchpoints in the patient experience, like patient intake and scheduling, not only set the tone but also lay the foundation for successful claims and collections in the future. Patient access technology can help streamline patient access processes, making it easier for patients to receive accurate cost estimates, understand insurance eligibility and coverage, and work out payment strategies. Integrated patient access solutions—including automated registration and financial clearance with eCareNext®, and accurate patient estimates and mobile payment options with Patient Financial Advisor —deliver convenience to the patient while requiring less manual work and reducing data errors that can cause problems with billing and collections. Dames says, "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 can facilitate payment and collections downstream. As providers continue their digital transformation journeys, improvements made in patient access enable further improvements in later stages of the revenue cycle: collections, claims management, and payer contracts.” Streamlining patient access affects revenue cycle management Efficiency in patient access has a direct impact on revenue cycle management. Here are three key areas where streamlining patient access can bring real improvements: Efficient revenue management begins with good data Up to 50% of denied claims originate in patient access. Manual intake processes are time-consuming for staff and carry the risk of human error. Staffing shortages put increased demands on workers, leading to an even larger potential for problems. To add to the mix, patients may be increasingly likely to have incorrect information. Medicaid redetermination following the end of the COVID-19 pandemic is ending coverage—and creating confusion—for millions of patients. Job and coverage changes can translate to confusion over coverage and eligibility. “Automation virtually eliminates human error, so providers get accurate patient information and standardized data they can use throughout an integrated revenue cycle,” says Dames. Nearly 90% of patients want an accurate estimate; only 29% get one Experian Health's 2023 State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. Although estimates are a requirement under price transparency laws, delivering an accurate estimate is difficult without the help of automated systems. Dames says, “Patients are anxious about the cost of care, and they can't estimate their own out-of-pocket costs. Accurate, transparent pre-treatment estimates are an important tool for building trust with patients. When providers offer real-time insurance verification and coverage information, they proactively help patients understand their own financial obligations. From there, providers can collect copays at the point of service and suggest options like payment plans or charity care, if appropriate.” Automated processes and tools like Patient Estimates improve staff productivity and speed up collections. As staffing shortages continue, streamlining back-office tasks improves efficiency and reduces frustration. Valuable staff members have more time to do the complex human work of talking with patients and solving problems. Real-world success story: Blessing Health Systems oversees two hospitals, a college of nursing, and a charitable foundation with nearly 3,000 total employees. Like many healthcare providers, Blessing faced challenges, including registration errors, inaccurate patient estimates, and collection difficulties. Blessing implemented an integrated suite of solutions including eCareNext®, Patient Estimates, Patient Self Service, Patient Statements, Payer Alerts, PaymentSafe®, Registration QA, and several financial clearance products. The results: Point of service collections increased by more than 80%. Clean claim rate increased from 63% to 90%. Denials decreased by 27%. Gross A/R decreased by an average of 28 days. “[Blessing now has the tools needed] to be successful in one, user friendly application,” says Jill Stroot, Director of Patient Access at Blessing. An integrated patient access solution allows Blessing to capture and verify important insurance information and catch registration errors in real time, resulting in less manual work, less rework, and a faster, better revenue management process overall. Best practices for implementing patient access technology Most providers are looking to improve and accelerate the revenue cycle. Many, too, are looking toward digital transformation as a long-term goal. But that means many are balancing the need for system-wide transformation against current realities. Incremental change allows providers to advance the ball now while preparing for further opportunities in the future. While providers weigh their options, here are a few best practices to help guide their thinking. Prioritize If doing everything at once isn't possible, providers can start with the processes that will have the greatest impact. Identify areas of greatest need. Look for the greatest ROI. Find quick wins that can be implemented with little change or investment. Choose solutions that integrate now Blessing Health Systems chose Experian Health solutions in part for their easy integration with Cerner. Finding solutions that integrate with existing systems is critical. Ultimately, solutions should also integrate throughout the healthcare revenue cycle. Choose a partner for the long haul Finding a technology partner that offers a full range of revenue cycle solutions—extending beyond patient access—helps ensure providers can continue their digital transformation journeys. Technology isn't the only factor to consider: Support and consultation along the way can help providers make the right decisions and maximize the value of new solutions as they're added. How to improve the healthcare revenue cycle Recent years have brought many new challenges to the healthcare space, but also new technology that can smooth out kinks in the revenue cycle. Providers that leverage patient access technology to deliver convenience and transparency to patients, and greater efficiency and cost savings internally, can look forward to better revenue cycle management while laying the groundwork for continued evolution. Learn more about how Experian Health's integrated suite of solutions can help with streamlining patient access.

After a brief hiatus, the COVID-19 virus is reemerging, just in time for cold and flu season. According to the Centers for Disease Control and Prevention (CDC) July numbers show COVID-related hospitalizations are ticking upward. A spokesperson from the agency said this is the first notable acceleration of the illness in 2023. In these challenging times, healthcare providers prepare for the next COVID-19 surge. While the American healthcare system struggled just three years ago to cope with COVID-19 as a black swan event, these organizations now have the perspective that comes from hard-earned experience. They also have the potential benefit of time. It makes sense to take the lessons learned from the 2020 crisis and apply best practices to prepare for a COVID-19 resurgence. A new survey shows healthcare teams still struggling with burnout from the last COVID uptick. By leveraging technology and implementing best practices, providers can streamline processes, improve patient access, and alleviate burdens on healthcare staff. Let's explore how digital solutions such as online self-service scheduling, mobile-first registration, and patient portals can help healthcare organizations prepare for the next wave of COVID-19. COVID lesson #1: Online self-service scheduling offers key benefits for patients and staff During the previous COVID-19 outbreak, online self-service scheduling proved to be crucial in mitigating the spread of the virus. Not only did it improve the experience for patients and healthcare staff, but it also reduced the volume of visitors to emergency rooms and prevented sick individuals from congregating in waiting rooms. While self-service patient registration isn't just for a pandemic, COVID-19 clearly illustrated the critical need for digital patient intake solutions. A recent Experian Health survey showed seven of ten patients prefer self-service appointment scheduling. Forbes says, “Scheduling options are now a must-have feature for hospital and health systems…Health systems that do not offer online patient scheduling will not only be left behind but will be left out.” With the potential for an additional COVID upsurge in the future, health providers must also consider the benefits for staff of offering online patient scheduling options. They include: Fewer manual tasks associated with patient registration Real-time scheduling information that streamlines workflows Reduced patient no-shows Improves team communication and closes care gaps Automates unnecessary administrative functions COVID lesson #2: Mobile-first registration increases patient access and satisfaction The Experian Health State of Patient Access 2023 shows increasing the convenience of patient access is the quickest way to improve customer satisfaction scores. The survey showed access to provider care is challenging post-pandemic; four in ten say access has worsened because of scheduling. These challenges are always more daunting during high utilization—such as during the COVID-19 pandemic. As healthcare providers prepare for a COVID surge during flu season, adopting a mobile-centric registration accelerator solution can empower patients and streamline the registration process. Patients can complete registration safely and conveniently in their homes without spending time in a waiting room. Providers benefit from this online solution with reduced paperwork, automation of manual tasks such as appointment reminders, and a lightened workload. Implementing mobile-first registration not only improves patient satisfaction but also eases the burden on healthcare staff. Patients that use these solutions reduce practice call volumes by 50%. COVID lesson #3: Patient portals streamline communication and engage patients Harnessing technology to streamline processes and alleviate burdensome tasks is crucial. Patient portals are revolutionizing healthcare by empowering patients and lightening the load on the system. The pandemic accelerated the use of patient portals. In 2020, the National Institute of Health (NIH) found less than half of insured adults used these tools. Today, the usage of online patient portals such as PatientSimple is much higher—and on the rise. A recent national survey shows even seniors are getting into online patient portals to access healthcare information; 78% of people aged 50 to 80 now use at least one of these online hubs. Five years ago, researchers say just 51% of this population used these tools. Leveraging a patient portal now before cold and flu season makes sense. Patients can use patient portals to manage common tasks such as: Pay balances up front with an on-file credit card Set up payment plans View test results Generate price estimates View statements and test results online Apply for charity care Communicate with providers The latest research from Experian Health and PYMNTS says two out of three consumers use patient portals to “streamline the medical journey,” while the remainder say they'd use these tools if their provider offered them. Online patient portals increase access and convenience for healthcare customers. However, there are just as many arguments in favor of providers investing in patient portals to benefit their staff.As COVID-19 cases rise, patient portals serve as critical information hubs, streamlining communication between providers and the patients they serve. Self-service portals ease pressure on overburdened care teams and upfront administrative staff. They also integrate with electronic health records (EHRs), streamlining the flow of personal health information (PHI) between providers and patients. It's a more engaging and effective experience for patients that lightens providers' workloads. As we move toward increasing COVID cases this fall, patient portals will be vitally important for everyone involved in the patient journey—including the patients themselves. Learn how Experian Health is helping care providers streamline their efficiencies with digital software and prepare for the next COVID surge.

Too often, resource pressures force providers to treat revenue cycle management as a reactive process. But with avoidable denials leaving thousands of dollars on the table, fixing problems after the fact is often a more expensive strategy. Investing in prevention on the front end can help providers minimize the risk of future revenue loss. This article looks at how providers can use automated prior authorizations to drive front-end revenue cycle growth, and fix revenue leaks before the denial dam bursts. Understanding the front-end of the revenue cycle Revenue cycle management includes all the activities involved in making sure hospitals and health systems get paid for their services. The front end of the revenue cycle includes the non-clinical processes that take place before a patient receives care, broadly referred to as 'patient access.' This can be broken into four stages: Scheduling and registering for care, including checking all patient information is current and correct Verification of insurance eligibility and benefits, to ensure planned services will be covered by the patient's plan Obtaining prior authorizations, to prevent claim denials Collection of co-pays and deductibles from patients before or at the point of service. Billing and claims management workflows must be set up so patients, payers and front- and back-office teams can share the information needed to expedite reimbursement. Accuracy and efficiency are essential at each stage of the front-end of the revenue cycle to prevent bottlenecks, errors and delays down the line. The longer errors lurk in the workflow, the more opportunities they have to damage the health system's financials. Front-end errors lead to denied claims later and more work for back-end staff Prior authorizations are a prime example: failure to secure the correct authorizations for treatment or services ahead of time can result in claims being rejected by payers. Time-consuming rework compounds the loss with hefty staffing and outsourcing bills. By the time the provider gets the amended paperwork in order, they've lost all leverage with the payer. It's a major concern as denial rates increase. Here are a few common prior authorization pitfalls to watch out for: The patient provides incorrect insurance information, which means the provider may fail to seek authorization from the right payer Inefficient operations and poorly defined processes allow inconsistencies and admin errors, such as wrong billing codes or misspelled names, to pass through the system undetected Frequent changes to payer requirements can be missed, so providers are working with outdated information Authorizations aren't obtained for the patient's entire treatment plan, leading to rework and treatment delays. A survey by the Association for Clinical Oncology found that 96% of respondents had seen a patient's care delayed because of prior authorization issues. Beyond these worrying harms to patients, the survey also revealed that 47% of practices spent more than 40 hours a week dealing with authorizations. Exploring solutions that will speed up prior authorizations can mitigate or eliminate these errors and delays. Front-end revenue growth starts with efficient prior authorizations As one of the top three reasons for denials given by providers in the State of Claims 2022 survey, prior authorizations are a logical target for front-end improvements. Prior authorization software helps providers get ahead of the above pitfalls by flagging authorization requirements early. Patient access teams can detect and resolve potential errors before they escalate, reducing the risk of rejected claims and appeals. Neeraj Joshi, Director of Product Management, at Experian Health, says that one of the big struggles for healthcare providers is that the prior authorization process is often still manual: “Automation has gained traction in many tasks within the revenue cycle, from patient access to claims management, but shifting to automated prior authorizations could offer one of the biggest returns on investment. Manual authorizations are time-consuming, error-prone and, all too often, a source of miscommunication. Shifting to automated authorization management can eliminate these obstacles and fuel revenue growth.” Experian Health's online prior authorizations solution automates 100% of inquiries, saving valuable staff time. Status checks happen without user intervention. Patient and payer data is auto-filled automatically, and users are guided through the workflow and prompted to make manual interventions only when absolutely necessary. Users can have confidence in the accuracy of the pre-filled data because the tool taps into Experian Health's Knowledgebase, which stores and updates national payer requirements in real-time. Users can also customize local and community rules, so no requirements slip through the net. By reducing costly denials and lowering labor costs, these set the stage for sustainable growth throughout the rest of the revenue cycle. How online prior authorizations can improve end-to-end revenue management Obtaining prior authorizations more efficiently is just the first step toward building a thriving revenue cycle. The promise of fewer denials might steal the headlines, but the benefits of automation resonate throughout downstream processes. For example, an automated online system enhances wider pre-registration processes by giving staff real-time visibility into the likelihood of a treatment being authorized. Staff can verify approval instantly, rather than turning patients away at check-in. This also makes it easier to generate accurate, upfront estimates of what the patient will owe, so they can plan for their own financial obligations. A positive patient experience can lead to faster patient collections and higher retention rates, which both boost revenue growth in the long run. Another ripple effect comes from the early verification of patient and payer information. These processes can surface data errors that, if left unchecked, could impede effective claims and billing workflows. This shows how a single authorization can have an outsized effect on overall revenue management performance – and why it's so important to get authorizations right the first time. Front-end efficiencies lead to a more predictable revenue cycle Providers that choose to use prior authorization software can amplify the benefits by integrating it with other online and automated solutions. Experian Health's prior authorizations tool fits seamlessly with the eCare NEXT® revenue cycle suite, which automates the entire revenue cycle workflow from insurance eligibility verification to secure patient payments. The interoperability of these tools means data can be shared from one system to another with ease, and reports can be generated and viewed on a single dashboard. With better data and analytics, users can make better predictions about their revenue cycle performance and find opportunities for further improvements. Similarly, providers can leverage the predictive power of analytics with AI-based technology. Experian Health's new AI-driven claims management solution, AI Advantage™, uses AI to predict claims that are likely to be denied, based on historical payment patterns. It checks for any undocumented payer adjudication rules, including prior authorization requirements, to make sure no essential information is missing before the claim is submitted. In a recent webinar on the future of claims management, Skylar Earley from Schneck Medical Center shared his experience with the new technology. He attributes the tool's success to its ability to make increasingly accurate predictions: “Since implementing this technology, we're continuing to see AR days decrease at our organization. One result that we're really excited about is seeing the number of authorized outpatient visits increase by about 2.5%. For anyone that deals with prior authorizations and denials related to prior authorizations, this is incredibly promising.” As authorization requirements increase in volume and complexity, providers need to be proactive in their response. Automation and digital technology can arm providers with the data and tools they need to speed up prior authorizations and drive revenue growth from step one in the revenue cycle. Find out more about how prior authorization software can support efficient front-end revenue cycle processes by creating opportunities to maximize cash flow from the start.

Could patient access software be the 'most valuable player' in healthcare? Experian Health's annual State of Patient Access surveys show an upward trend in the use of digital tools and software to help minimize the hoops patients must jump through to access care. In the most recent, 46% of providers said they expected to increase their digital investment over the next six months. The business advantages around increased capacity, reduced cancellations, improved data accuracy and higher patient satisfaction make a strong case for investing in patient access software. This article looks at how patient access tools can solve for some of the most stubborn problems in patient scheduling, registration and payments. Finding the formula for frictionless patient access Revenue cycle management comes down to minimizing service utilization while maximizing revenue potential. This starts with patient access. Efficient scheduling, intake and financial processes means more patients get better care, sooner – and providers get paid for their services without delay. Patient access software includes a range of digital and self-service tools that allow patients to complete administrative patient intake tasks with ease. Appointment management, patient registration, patient outreach, and patient estimates and billing are common use cases for patient access software. These solutions use in-depth data and automation to pre-fill patient information, check data for accuracy and completeness, tailor patient communications and accelerate workflows. Advances in AI and machine learning are creating new opportunities to remove obstacles in patient access and boost patient satisfaction. 5 problems that can be solved with patient access software 1. Painfully slow scheduling operations  Problem: Too often, patient access processes are complex and time-consuming. Over time, small frustrations from errors, delays, and repetitive manual tasks can cause a significant decline in the patient experience. It's unsurprising that 56% of patients want digital options to manage care and speed things up. Solution: Patient access software makes it easier for patients to see their doctor without delay. For example, rather than being forced to call the provider's office and wait for an agent to check for an available slot, patients can use online scheduling software to book, reschedule and cancel appointments whenever suits them best. This also alleviates call center volumes, easing pressure on staff. 2. Error-prone registration processes Problem: Manual intake and registration systems are vulnerable to quality issues, resulting in denied claims, increased admin costs and delayed access to care. Illegible writing, incomplete insurance information and missing forms mean patients and staff must spend more time going back and forth to find and fix mistakes. And at the extreme end of the spectrum, data errors can lead to medical errors, with life-or-death consequences. Solution: Automated patient registration can pull patient data from reliable sources and fill out basic details ahead of time, reducing the need for manual data entry. Preventing avoidable errors in this way improves communication, workflows and profitability. For example, Registration Accelerator is a text-to-mobile patient intake solution that allows patients to complete appointment registration from the comfort of home. The patient takes a photo of their insurance card and driver's license, and then optical character recognition (OCR) technology automatically enters the correct information for insurance verification. The patient can review and sign authorization and consent forms, and confirm their appointments all at once, with just a few clicks. 3. Excessive (and growing) admin burdens and staffing shortages Problem: Patient access is admin heavy. This wastes valuable staff time and resources and diverts attention from patient care. With healthcare staffing shortages reaching emergency levels and patient volumes on the rise, providers must find ways to manage workloads while maintaining output. Solution: By automating administrative tasks and expanding self-service options, patient access software takes the pressure off busy teams. In Experian Health's survey, 36% of respondents reported that technological improvements offset staff shortages, by making better use of staff time and lowering operational costs. Automated prior authorizations are a good example of how digital tools can help tame the admin burden. This software generates real-time updates for multiple health plans, so staff no longer need to cross-reference individual payer policies and websites. It uses exception-based workflows and guided work queues to help staff prioritize their activities. Patient access tools can also issue performance reports, so staff can continue to find ways to work more efficiently. Cutting-edge technology also offers a less obvious but equally important competitive advantage – helping providers attract and retain high quality staff. 4. A patient experience that falls short of expectations Problem: Unnecessary administrative obstacles, unclear communication, and slow processes result in subpar patient experiences. More than 6 in 10 patients don't think their experiences have improved much in the last few years, despite the wider availability of digital patient access tools. Providers need a solution urgently, given that 56% of patients would switch providers for a better patient experience. Solution: With automation and self-service digital tools, providers can finally put patients in the driver's seat and deliver the patient-centered experience that has been promised for years. Patients say they want access and payment experiences to be convenient and transparent, with specific examples including: Accurate pre-care estimates Payment plans Digital payment options A multi-purpose portal Mobile access for scheduling, registration, communications and care Alex Harwitz, VP, Digital Front Door at Experian Health, says that while this list may seem daunting, providers have reason to be optimistic about delivering a better patient experience: “Patients want a lot from the digital front door, especially younger and digitally savvy consumers. Speed, convenience and compassion are through-lines in our patient surveys. As expectations increase, so does the pressure on providers to deliver. But the good news is that technology is advancing too. There's a wealth of patient access software ready to help optimize the patient experience. And you don't have to implement them all at once: Experian Health's patient access tools are specifically designed to work independently or in combination, for hassle-free implementation.” 5. Missed revenue opportunities Problem: Missed appointments, billing mistakes and operational inefficiencies lead to avoidable revenue leakage. A significant portion of denied claims occur earlier in the revenue cycle, so improving patient access processes should be top of the list when it comes to optimizing revenue. Solution: Revenue loss in patient access comes down to data errors, poor analytics and workflow inefficiencies. By leveraging the right software, front- and back-office teams can collaborate to resolve issues and enhance decision-making. Digital tools can also improve the patient billing and payment experience, so providers get paid promptly. Upfront price estimates, payment plan recommendations and one-click payment options can make it easier for patients to understand and pay their bills. Implementing transparent and empathetic billing procedures not only enhances patient satisfaction but also accelerates the collection process. With Experian Health's Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Maximizing revenue opportunities while meeting the changing needs and expectations of healthcare consumers calls for smart patient access strategies. Find out more about how Experian Health's patient access software helps healthcare organizations lay the foundations for a solid revenue cycle and a positive patient experience.

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.