At A Glance
Sweeping changes to healthcare coverage and reimbursement under the One Big Beautiful Bill Act (OBBBA) are set to put pressure on patient access. In the second webinar in Experian Health’s three-part OBBBA series, industry leaders discussed how automation and artificial intelligence (AI) can help protect revenue as coverage becomes more volatile.
Key takeaways:
- OBBBA moves revenue risk to the front end, as more frequent eligibility changes and stricter verification rules make coverage less predictable and increase the risk of denials.
- Front-end accuracy is now a revenue protection strategy, with providers needing to verify coverage earlier and reduce data errors that can cascade through the revenue cycle.
- Automation and AI are becoming essential to manage coverage churn by improving data accuracy and reducing manual effort.
Coverage, reimbursement and eligibility workflows will change significantly under the One Big Beautiful Bill Act. While the headlines focus on funding cuts, the real operational impact will be felt first in patient access. How should healthcare organizations prepare?
This was the focus of Experian Health’s second webinar in a three-part series on navigating OBBBA. Kate Ankumah, Product Director (Patient Access) at Experian Health, described how the new law is likely to affect front-end operations and what providers can do now to reduce revenue leakage before it turns into denials and bad debt. This article recaps the main messages.
Webinar 2: From Policy Shock to Operational Readiness – Tackling OBBBA’s Front-End Fallout
Watch webinar 2 of our three-part webinar series for practical steps to protect first-pass claim rates, reduce denials and strengthen pre-service clearance.
OBBBA recap: Key changes affecting patient access
In the first session of the OBBBA series, Joel White, national healthcare policy expert and Partner at Monument Advocacy, analyzed the new policy landscape, which is expected to result in Medicaid cuts of more than $914 billion and around 7.8 million people losing coverage.
| OBBBA reforms include: |
| – New Medicaid enrollment thresholds, state financing and redetermination rules that could increase uninsured and self-pay volumes |
| – More frequent eligibility redeterminations and stricter enrollee data verification requirements, resulting in administrative complexity for providers |
| – A move to “coverage in motion,” where coverage can change at multiple points in the patient journey, meaning eligibility cannot be treated as a one-time check. |
What this means for patient access teams
These policy changes will increase operational pressures at the front end:
- Data checks will carry more risk: Stricter rules around address validation, Social Security number cross-checks and multi-state enrolment make small registration errors more likely to result in failed eligibility checks.
- Front-end accuracy becomes revenue protection: Teams must confirm coverage earlier and more precisely to prevent denials.
- Tighter coverage means more uninsured and self-pay patients: Narrower immigrant eligibility may increase uninsured volumes in some markets.
“This elevates front-end denial risk and makes real-time eligibility verification mission critical,” said Rob May, Senior Director of Marketing, Experian Health.
“The message is really clear: as patient responsibility grows and payer scrutiny intensifies, revenue risk shows up earlier than ever.”
Rob May, Senior Director of Marketing at Experian Health
Best practices providers can act on now
| Ankumah highlighted several ways healthcare providers can prepare as OBBBA rolls out: |
| 1. Rerun Medicaid and Medicare checks closer to the date of service. |
| 2. Use automated discovery rather than relying on staff to search for additional coverage. |
| 3. Have a back-end safety net vendor to provide support as retroactive coverage windows narrow. |
| 4. Communicate clearly with patients so they understand how their coverage may change and what documentation they need to provide. |
| 5. Work closely with vendors as payer behavior evolves. |
These focus on the front end, but optimizing collections and claims workflows will be just as important. This will be covered in the third webinar in the series.
Register for Webinar 3: Defending margins under OBBBA
This session closes our OBBBA series by showing how leading health systems are using data and automation to protect margins in a high–uncompensated care environment.
Automation is the key to preventing front-end fallout
As providers adapt, one issue becomes clear: everything depends on getting patient data right the first time. Ankumah says, “Bad data is like a virus,” where errors don’t stay contained at registration but spread throughout scheduling, clinical workflows, the business office and collections.
Under OBBBA, that risk increases. In a more stable environment, incomplete data might still return coverage that’s “good enough” to get the claim filed or paid. But as coverage changes more frequently, missing or incorrect identifiers will make it harder to verify eligibility or find coverage at all. A legacy model that relies on staff to run and rerun checks will be harder to sustain.
“The OBBBA is going to expose how expensive this linear process is in terms of real dollars, time and labor, the earlier you can stop bad data from entering the system, the less expensive it is to fix.”
Kate Ankumah, Director of Product Management at Experian Health
May agreed that manual systems won’t cut it. “Organizations that invest in accuracy, automation and early intervention will be far better prepared to protect revenue while maintaining patient trust in a more volatile eligibility landscape.”
How Patient Access Curator mitigates OBBBA risk
The discussions turned to Patient Access Curator™ (PAC) as a potential solution to tackle bad data before it makes its way downstream. Ankumah explained, “It uses automation and machine learning behind the scenes to resolve missing or incorrect information in real time, and inside the existing workflow.”
By bringing together patient demographics, eligibility verification, insurance discovery, coordination of benefits (COB) and Medicare Beneficiary Identifier (MBI) lookup into a single process, it helps improve data accuracy, reduce the burden on front-end staff and prevent avoidable denials.
Ankumah pointed to MetroHealth as an example, where implementing Patient Access Curator led to a 44% reduction in COB denials, a 20% drop in registration denials and a 37% reduction in eligibility denials.
FAQs
What to prioritize in the next six months
Even modest improvements now could help reduce exposure later. The session wrapped up with a suggested six-month plan to make progress, outlining areas to focus on. Watch the full webinar for the details.
Find out how Experian Health is helping healthcare organizations prepare for OBBBA with front-end strategies and solutions such as Patient Access Curator.
