Search Results for: artificial intelligence

Loading...

Key takeaways: Changes to Medicaid, Medicare and the Affordable Care Act provisions in H.R. 1 are expected to increase financial pressure across the healthcare system. Hospitals could face higher uncompensated care costs and a growing administrative burden as millions lose coverage and payer rules grow more complex. Revenue cycle leaders should focus on strengthening eligibility checks, improving claims accuracy, and automating operations to remain financially resilient. On July 4, the budget reconciliation bill known as the “One Big Beautiful Bill Act” was signed into law, introducing sweeping changes to Medicaid, Medicare and Affordable Care Act (ACA) marketplace plans. At almost 900 pages, H.R. 1 sets out new eligibility, coverage and funding rules that will reshape how hospitals are reimbursed. This article explains what revenue cycle leaders need to know about the reforms and offers practical strategies for maintaining financial stability. Understanding the healthcare implications of H.R. 1 The healthcare provisions in H.R. 1 reflect a broader push by lawmakers to contain federal spending and return more control to states. While the reforms are framed as efforts to improve fiscal sustainability, they also introduce new financial risks for hospitals, particularly those serving low-income and high-utilization populations. How does the Act affect Medicaid? Enrollment H.R. 1 makes major changes to Medicaid enrollment, with direct implications for hospital revenue and patient coverage. Starting in 2027, states will be required to run automated eligibility checks every six months for Medicaid expansion adults, and cross-check against federal databases to remove ineligible or deceased enrollees. The Act pauses implementation of a federal rule related to streamlining enrollment in Medicaid and the Children’s Health Insurance Program. Eligibility Eligibility rules are also changing. A new community engagement requirement will require some enrollees to demonstrate that they work, volunteer, or are in education for at least 80 hours a month, unless exempted. While aimed at reducing fraud, waste and misuse, changes to eligibility and enrollment could result in more patients losing coverage and increase churn and care gaps – particularly among vulnerable populations. Uncertainty around citizenship status could deter patients from seeking care, and even affect staffing in hospitals that serve immigrant communities. Cost-sharing and funding To ensure beneficiaries have a financial stake in their care, the law introduces cost-sharing requirements for some enrollees. Providers will need to be ready to help patients understand their costs and adjust collections workflows accordingly. There are also new financial penalties for states that fail to recover overpayments, and limits on how provider taxes and supplemental payments can be used to boost federal matching funds. Over time, these provisions could constrain how hospitals are reimbursed for Medicaid services, especially in non-expansion states. How does the Act affect Medicare? For Medicare, the Act offers some short-term financial relief along with longer-term reductions. Outpatient providers will see a 2.5% increase to the Medicare Physician Fee Schedule in 2026, partially offsetting inflation and COVID-related losses. However, spending cuts of 4% per year are projected to reduce Medicare funding by more than $500 billion over eight years, beginning in 2026. In addition, the law brings Medicare eligibility in closer alignment to Medicaid, by restricting access for individuals without verified lawful status or sufficient residency history. It also delays until 2035 a rule that would have made it easier for low-income beneficiaries to enroll in Medicare Savings Programs. The Congressional Budget Office (CBO) estimates that this means 1.38 million fewer beneficiaries  will be covered by MSPs. How does the Act affect the ACA? One of the most immediate concerns for hospitals involves the end of enhanced premium subsidies for low-income ACA marketplace plan enrollees. Unless Congress steps in, these will expire at the end of 2025, making coverage less affordable for many. This comes as insurers prepare to increase premiums by an average of 15% in 2026, the most significant rise since 2018. H.R. 1 also modifies eligibility and repayment rules around subsidies. Subsidies will no longer be available to individuals disenrolled from Medicaid due to immigration status. Starting in 2027, most enrollees in marketplace plans will need to verify their eligibility for premium tax credits each year, effectively ending automatic re-enrollment. Without these subsidies, over 4 million people are likely to be uninsured in 2034. For hospitals, this means more self-pay patients, delayed collections and higher uncompensated care, especially in areas with large working-age populations. Financial risks: Medicaid cuts and rising uncompensated care The CBO projects that over 10 million people could lose health coverage by 2034 due to combined Medicaid and ACA reforms. This is a major financial risk for hospitals, particularly safety-net and rural providers. The Center for American Progress suggests that uncompensated care costs could increase by at least $36 billion by 2034 – a figure that will be especially painful in the context of reduced federal funding. Some newly uninsured patients may not seek alternative coverage, potentially leading to higher emergency department use. Those with ongoing health needs are more likely to find new coverage, but hospitals could still see a smaller insured population overall, and it could well be one that is older, sicker and more expensive to treat. Revenue cycle teams should prepare for an increase in self-pay volumes and greater demand for charity care and financial assistance. Organizations in high-Medicaid regions may need to reassess cost estimation tools, financial assistance screening and collections workflows to manage the effects. Strengthening front-end access and eligibility workflows Jason Considine, President at Experian Health, says that providers can be proactive in ensuring their revenue cycle operations are ready to adapt and scale, if and when the time comes: “It’s an uncertain time. However, as we wait to see how the changes to coverage and reimbursement play out in practice, providers aren’t just looking for predictions. They need actionable strategies. Strengthening front-end eligibility and financial clearance processes is one of the most immediate ways to reduce risk and support patients through coverage transitions. Experian Health helps organizations do that by offering automated tools that uncover hidden coverage, verify eligibility in real time, and provide clear, accurate patient estimates.” Here are a few examples: Getting eligibility right. Patient Access Curator uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics and coverage discovery. Minimizing the risk of uncompensated care. Patient Financial Clearance uses real-time data to identify patients who may qualify for charity care and recommends suitable payment plan options, while minimizing manual work for staff. Helping patients figure out their financial obligations. Patient Payment Estimates draws on real-time data, including insurance coverage, payer contract terms and provider pricing, to give patients an accurate breakdown of their treatment costs. This improves transparency and reduces the risk of missed payments. Case study: Experian Health and Exact Sciences See how Exact Sciences added $100 million to their bottom line in just two quarters with Patient Access Curator. Optimizing claims and collections in a tighter reimbursement environment In addition to strengthening front-end processes, providers need to ensure their back-end operations are ready to handle the ups and downs. Denied claims are already a major challenge for providers: in Experian Health’s 2024 State of Claims survey, 73% said denials are increasing and 77% report more frequent payer policy changes. More than half have seen a rise in claims errors, highlighting an opportunity for improvement. As automation and AI continue to advance, healthcare providers have a chance to improve claims management and reduce denials. Embracing these solutions can reduce the costly burden of reworking claim denials and improve cash flow. If claims workflows are already struggling, providers can’t afford any extra friction. However, the H.R. 1 reforms will likely increase the administrative burden and make timely reimbursement even harder to secure. This makes digital transformation increasingly urgent. Some priorities to tackle with automation and analytics include: Improving first-pass claim accuracy.  AI Advantage™– Predictive Denials  uses artificial intelligence, machine learning and predictive analytics to scan claims before they are submitted to root out errors and flag high-risk submissions so they can be corrected. It analyzes historical payment data and real-time payer behavior to determine whether a claim is likely to be rejected, so staff can work faster and more efficiently to increase clean claim rates. Streamlining claims management. ClaimSource® helps providers manage the entire claim cycle from a single application. Voted Best in KLAS for Claims Management and Clearinghouse for the last two years, the platform automates claim submission to reduce manual work and support cleaner submissions. It performs customizable edits, formats and submits claims, and allows staff to create custom work queues for greater efficiency. Using data to optimize collections. Collections Optimization Manager uses data-driven insights to help revenue cycle management (RCM) teams focus on the right accounts and collect more, faster. By segmenting patients based on their propensity to pay and screening out accounts unlikely to yield returns (such as deceased, bankrupt or charity accounts) the tool helps reduce the cost to collect and saves valuable staff time. Case study: Experian Health and Weill Cornell See how Weill Cornell increased collections by $15 million with Collections Optimization Manager. Preparing for volatility with scalable technology Revenue cycle teams can’t control policy changes or budget decisions, but they can control the systems that keep their operations running. Experian Health’s end-to-end revenue cycle solutions are designed to support this kind of operational resilience. From coverage discovery to claims analytics, scalable platforms give providers the flexibility to respond quickly to financial disruptions using consistent and familiar technology. “When so much is out of your hands, the smartest move is to focus on what you can control. Scalable tech gives RCM leaders that control, so when payer rules shift or self-pay volumes spike, they’re ready to respond without slowing down,” says Considine. “It also helps them stay ready for compliance shifts and respond faster to regulatory changes without overhauling their workflows.” Blog: Revenue cycle management checklist - improve experience and profits Get a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Readiness today protects financial resilience tomorrow The H.R. 1 bill has introduced significant changes across Medicaid, Medicare and the Affordable Care Act. New eligibility requirements, adjustments to reimbursement formulas, reduced subsidies and greater administrative complexity are all expected to influence how patients access coverage and how care is financed moving forward. While the long-term impact will vary by market and patient population, disruption is coming. Hospitals and health systems that rely on outdated workflows or fragmented technology will face growing challenges in managing changing coverage patterns and rising uncompensated care. As the specific effects of the “One Big Beautiful Bill” become clearer, revenue cycle leaders will be tasked with making fast choices under pressure. How will coverage changes affect patient behavior? What happens to reimbursement if eligibility gaps widen? The focus won’t just be on protecting revenue, but also on supporting patients who may be confused or anxious about what the new rules mean for them. The ability to track changes and adapt accordingly will be a competitive advantage for providers looking to stay ahead. Find out how Experian Health can help hospitals prepare for reforms by modernizing revenue cycle operations and reducing exposure to revenue loss. Learn more Contact us

Published: August 4, 2025 by Experian Health

Healthy revenue cycles rely on efficient patient collections. Collections processes that drag on can frustrate both providers and patients, leading to delayed payments, a high administrative burden on staff and unpaid balances piling up. For many providers, adopting collections optimization technology is a proven strategy to make the collection process more efficient, compassionate and patient-centered.   What is collections optimization in healthcare?  The title says it all: optimizing patient collections. More specifically, collections optimization in healthcare refers to technology-based solutions that streamline the patient collections process to collect a greater percentage of the money owed. Using data-driven, patient-centric insights, collections optimization solutions allow billing staff to efficiently identify patient payment capabilities, focus collection efforts and improve patient communications. Collection performance metrics are often built into collections optimization platforms and help providers continuously improve collections strategies over time. So, it's not simply a process to collect, it's a holistic approach to improving a health system billing team's cashflow, in addition to capturing revenue that's owed to the organization.   Key components of the collections optimization process  The collections optimization process typically includes specific key components to help providers accelerate patient collections strategies. For instance, Experian Health's Collections Optimization Manager solution has six foundational areas that save time and accelerate payments:  Screening: Cleans up accounts receivable data by screening patient accounts for bankruptcy, deceased, Medicaid and charity so that staff can spend their collection efforts on accounts that have a higher likelihood of payment. Collections staff often spend time on accounts that are deceased, bankrupt, or eligible for Medicaid or charity—accounts unlikely to yield payment. This diverts attention from accounts with higher recovery potential, ultimately impacting overall cash flow. With Collections Optimization Manager, this AR becomes more manageable, and staff can work high-yield accounts in-house, while saving time and money.  Segmentation: Uses credit, behavior and demographic data to help providers identify which accounts are most likely to pay. Experian Health has robust patient data and powerful predictive analytics that reveal which accounts are most likely to pay. By leveraging propensity-to-pay scores, providers can prioritize efforts where they'll have the most impact. This targeted approach helps increase collections while reducing time and cost to collect.  Routing and reconciliation: A data-driven rules engine builds routing and recall rules that distribute accounts to the internal and external servicing channels that are most likely to collect the amount owed and reconciles provider and agency inventory  Agency management: Offers real-time insights into third-party collections agencies' performance with reports and dashboards. This puts a focus on key metrics, so teams can measure performance against industry standards to improve patient payment forecasting and successfully manage bad debt reserves   Monitoring: Monitors unpaid patient accounts for changes in a patient's contact information or ability to pay, and notifies in-house staff so that they can re-engage patients to collect their pending balances   Consulting and analytics: Collections consultants evaluate reports, suggest best-practice collections strategies and provide users with industry know-how. They can also provide quarterly performance reports to show performance and progress.  Discover how Weill Cornell Medicine and Experian Health implemented a smarter collections strategy that delivered $15M in recoveries — and how you can do the same. This webinar shows how to move faster, work smarter and collect more, without adding headcount. Watch now > The link between collections and financial success in revenue cycle management  Healthy revenue cycles rely on timely patient payments. With so many other financial pressures on patients today – paying for groceries, filling up the family car or basic home repairs - it can become overwhelming to manage it all. When bills are confusing, reminders are missed or affordability is a concern, it can result in late payments. Busy billing teams are then tasked with chasing down collections, leaving little time to focus on other revenue-generating activities. As collection timelines drag on, providers may experience cash flow issues, revenue losses and even bad debt. This can lead to disruptions in the revenue cycle, affect the bottom line and ultimately impact the quality of patient care.  Why collections optimization matters  Healthcare costs are rising, and Americans are carrying about $3,100 in medical debt on average, up from $2,000 the previous year. One in five patients report experiencing distress over healthcare costs they can't afford, and 15 million Americans have medical collections on their credit reports, according to 2024 data from the Consumer Financial Protection Bureau.   By adopting collection optimization solutions, providers not only strengthen the revenue cycle but also have the opportunity to improve the overall patient financial experience. Tools like Collection Optimization Manager help billing teams quickly understand their patients' ability and willingness to pay, identify charity eligibility and implement effective and compassionate patient billing outreach. Plus, performance analytics help staff assess performance over time and adjust collection strategies accordingly. Healthcare institutions aim to understand a patient's financial situation and take steps to assist them in their medical journey. This approach is central to their mission.  On-demand webinar: Boost self-pay collections - Novant Health & Cone Health's 7:1 ROI & $14M patient collections success Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager.  Key challenges    Maximizing patient collections is always a priority for providers. However, getting patients to pay their medical bills often comes with challenges, due to:    Poor financial insights: Billing staff may not have enough information about patients' financial circumstances to make predictions about how likely they are to pay. This can make prioritizing accounts and creating patient engagement strategies tricky. Collections staff may often spend time on accounts that are deceased, bankrupt, or eligible for Medicaid or charity – accounts unlikely to yield payment.   Ineffective outreach: Collections staff may spend hours calling patients with low collection yields.  Affordability concerns: Patients may be worried about how they'll pay for their bills, especially if they have a high-deductible healthcare plan. This can lead to late payments.  Insurance policy updates: Busy billing staff might not always be able to stay on top of frequent insurance changes and regulatory updates. This can lead to errors in patient billing or incorrect cost calculations, resulting in late or unpaid payments.   Lack of easy payment options: Patients want convenient, secure ways to pay on their time. When easy options like online and mobile payment methods aren’t available, it can lead to frustration and late payments.   Outdated manual processes: Valuable staff hours are often lost to cumbersome steps in the collections process, like phone calls and follow-up paperwork.   How technology is transforming collections ​​optimization  When implementing billing and collections optimization, today's providers are turning to technology that includes a growing range of automated solutions for more transparent billing, personalized payment options and increased efficiencies. Combining collections and automation enables a more transparent, user-friendly process that gives patients more financial control. Additionally, new technologies, like predictive analytics, machine learning and artificial intelligence, also help providers better understand their patients' financial needs so that they can deliver a more compassionate and supportive collections experience.   Case study: How Wooster Community Hospital collected $3.8M in patient balances with Collections Optimization Manager Read more about how automated collections strategies helped Wooster Community Hospital achieve a $3.8 million increase in patient payments.  Three best practices that accelerate collections A strong collections optimization solution should be able to accomplish the following:  Segment accounts based on propensity to pay  Billing teams can improve collections optimization by using automation and segmentation to obtain the data needed to prioritize high-value accounts. Collections Optimization Manager, for instance, uses multiple data sources to automatically screen and segment accounts based on propensity-to-pay scores.   Improve patient communication   Providers can use collections optimization tools and complementary automated patient outreach tools to foster better patient communication without putting additional strain on busy staff. Solutions like PatientDial and PatientText send patients timely bill reminders and self-pay options via voice or text message, while other financial assistance tools, like Patient Financial Clearance, assign patients to the correct financial pathway.  Benchmark performance  Billing teams can use their collections optimization tools to review comprehensive reports and scorecards on their agencies' performance. This allows healthcare organizations to compare performances across multiple vendors. Advanced reporting helps identify performance improvement opportunities, refine patient payment forecasts and manage bad debt. In some cases, such as with Experian Health's Collections Optimization Manager, users can also access expert consultative support to refine collections strategies further.   How can healthcare companies measure success?  Revenue cycle leaders know that “what gets measured, gets managed.” Using a collections optimization solution to monitor key performance indicators (KPIs) enables providers to fine-tune their collections process and assess performance over time. For instance, Experian Health's Collections Optimization Manager captures critical KPIs, such as accounts receivable days and collection rates. User-friendly dashboards and reports allow staff to measure performance against past metrics and industry trends. Plus, users benefit from consultants who can help choose the ​​right KPIs to track, evaluate reports and develop new collection strategies.  Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle management staff collect more patient balances.  Learn more Contact us

Published: July 16, 2025 by Experian Health

Key takeaways: As healthcare costs increase, the demand for patient financial assistance also rises as more patients find themselves without insurance coverage or facing economic hardship. Early identification of charity care eligibility reduces patient financial stress, makes the financial experience more compassionate, and protects providers from bad debt. Automated screening tools like Patient Financial Clearance, built on accurate, real-time data, are essential for flagging eligible patients before accounts go to collections and ensuring that no one misses out on vital support. Too often, patients who qualify for financial assistance aren't identified until after their accounts have been sent to collections. As healthcare costs increase and coverage becomes less certain, more patients will likely face financial challenges, making timely support even more critical. With estimated income data and financial behavior indicators, healthcare organizations can identify patient eligibility for charity care earlier, before the bills pile up. This article looks at how automated charity screening tools like Patient Financial Clearance can help providers support patients, protect revenue and remove the financial barriers that get in the way of care. The rising demand for patient financial assistance Demand for financial support is climbing quickly as economic pressures and policy changes make it harder for patients to keep up with medical costs. Nearly one in four adults are uninsured, often delaying or forgoing care because of high deductibles and out-of-pocket costs. Medicaid redeterminations have already resulted in more than 19 million disenrollments. At the same time, the Congressional Budget Office estimates that new federal spending provisions could push an additional 10.9 million people out of health coverage by 2034. As a result, revenue cycle teams will increasingly find themselves trying to collect payments from patients who are more likely to need financial help. "We're also seeing more states pass legislation that effectively mandates early screening for financial assistance before billing, such as Oregon's HB 3320," says Alex Liao, Senior Product Manager for Patient Financial Clearance at Experian Health. "These policies are becoming major drivers of financial clearance efforts. Identifying financial need early in the process helps patients avoid unexpected medical debt, and gives providers the insight they need to manage accounts appropriately and protect revenue." For providers, growing administrative costs, claim denials and underpayments mean less flexibility to absorb uncompensated care. Early screening protects against the burden of medical debt and facilitates the transparency and clarity patients need to manage their bills. Why does early identification of patient charity care eligibility matter? When charity care eligibility is missed or delayed, patients can quickly accumulate medical debt they can't afford. In an interview about the latest State of Patient Access survey, Clarissa Riggins, Chief Product Officer at Experian Health, explains why this is so important: "Cost is a major pain point," she says. "The report shows that 34% of patients struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care." Identifying charity care eligibility early on ensures these patients don't fall through the cracks. This reduces financial stress for patients and protects providers from avoidable write-offs and bad debt. When staff know which patients are likely to need support, they can have more compassionate and helpful financial conversations and connect patients with appropriate resources. Unlock patient charity care eligibility with automated screening  Manual charity care screening processes are often time-consuming and prone to delays, especially when staff have huge volumes of information to handle. Automated financial assistance screening tools use real-time data to identify patients who may qualify for charity care with greater speed and accuracy. For example, Patient Financial Clearance (PFC) helps providers screen patients earlier in the financial journey by automatically checking for eligibility at or before the point of service. It uses a range of estimated data points, including household income, household size and Federal Poverty Level (FPL) percentage, to assess whether a patient qualifies for charity care, Medicaid or other financial assistance. After calculating a risk score to evaluate the patient's propensity to pay, PFC can pre-fill application forms, reducing the need for staff input and accelerating enrollment. For those who may not qualify for charity care, PFC can recommend payment plan options that align with the provider's financial policies. This proactive, behind-the-scenes screening enables providers to flag eligible patients at multiple points in the care journey, ensuring more patients get the support they qualify for while minimizing manual work for staff. Case study: How UCHealth wrote off $26 million in charity care with Patient Financial Clearance See how UCHealth partnered with Experian Health to create a more streamlined approach to providing charity care to patients who needed it. Take a smarter approach to patient financial assistance with Experian Health Automated charity screening tools like Patient Financial Clearance are faster, more consistent and easier for staff to act on. But they'll fall short without reliable data. "Strong data practices are key," says Riggins. "That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records… By automating tasks traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can prevent billing and claim errors in the long run. Clean data makes everything easier, from billing to insurance verification to patient trust." She gives the specific example of Patient Access Curator, which uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics, and coverage discovery. When thinking about how to use data to find charity care eligible patients, tools like this lay the foundation for more proactive financial engagement. By cleaning up data and automating repetitive tasks, Experian Health's revenue cycle solutions enable providers to streamline their financial operations and give financial counsellors the details they need to engage patients at the right time and help them understand their options. The bottom line Automation and accurate data aren't just backend upgrades. They're essential to building a smarter, more compassionate financial experience, with fewer accounts going to collections. By embracing the best practices for identifying patients needing financial assistance, early action, better data quality, and automation, providers will be better placed to make sure no one misses out on the help they need. Find out more about how Patient Financial Clearance can help healthcare organizations automate financial assistance and identify patients eligible for charity care. Learn more Contact us

Published: July 7, 2025 by Experian Health

Managing claims efficiently—and reducing denials—remains one of the biggest challenges for healthcare providers. Statistics reveal that 46% of denials are caused by missing or inaccurate data, as highlighted by Experian Health's 2024 State of Claims Survey. For providers, these denials translate into endless follow-ups with patients, staff burnout, rising bad debt (which has increased by 7% year-over-year), and slim revenue margins. Reworking a denied claim costs providers an average of $25 and hospitals $181—an expense that is difficult to justify. Introducing Patient Access Curator: Automated claims accuracy from day 1 Fortunately, there is now a way to ensure claims are processed accurately from the start, without excessive effort: Patient Access Curator (PAC), Experian Health's groundbreaking new tool that uses artificial intelligence (AI) to revolutionize the claims process. As a central component of Experian Health's Patient Access portfolio, this innovative solution automates front-end processes, identifies incorrect data upfront, and resolves inaccuracies in real time, preventing costly claim denials before they occur. Introduced in early 2024, the curation tool is getting the attention of revenue cycle leaders at health systems and laboratories, with good reason.  This article gives a run-down of Patient Access Curator and how it helps providers prevent claim denials in seconds.  On-demand webinar: Reimagining patient access — AI at the epicenter of coordinated benefits management Explore how automation and AI are eliminating manual errors, reducing denials and unlocking millions in recoverable revenue. Built-in AI for more accurate data and seamless claims denial prevention Most issues that lead to denials crop up early in the revenue cycle, when information is missed or captured incorrectly during patient registration. For this reason, it makes sense to focus on denial prevention strategies  on the front end. With so much data to capture, manual strategies are bound to stumble. Unfortunately, many digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility and check for any billable coverage that might have been missed. Patient Access Curator takes on these tasks seamlessly, and right within Epic workflows. From patient demographics and eligibility checks to coordination of benefits (COB) primacy, Medicare Beneficiary Identifiers (MBI), and insurance discovery, the system automates these essential processes, providing precise data within moments. This solution ensures data integrity from the moment of registration by replacing manual guesswork with advanced AI-driven technology. This reduces the frequency of denials, minimizes A/R write-offs, and curtails vendor fees. Beyond enhancing efficiency, the tool safeguards the financial health of healthcare providers.  Jason Considine, President of Experian Health, says, "Our mission is to simplify healthcare. Patient Access Curator's advanced AI technology equips providers to address claim denials more effectively and efficiently than ever before."  Say goodbye to manual work with instant eligibility and insurance verification Patient Access Curator simplifies operations for billing teams, healthcare staff and patients. By removing administrative hurdles, staff can focus on patient engagement, rather than spending time on paperwork, phone calls and browsing websites for data. The outcome is improved satisfaction for both healthcare providers and their patients.  "We know this technology is revolutionizing the healthcare industry," shares Jordan Levitt, Senior Vice President at Experian Health. Levitt, who developed the AI-powered data capture technology, explains, "By delivering faster, more accurate results, providers can improve financial solvency while giving staff and patients a better experience."  Gone are the days of asking patients for insurance cards or verifying numbers and dates that might be inaccurate. With this solution, registrars and billing teams can be confident in the data they collect, right from the start.  PAC was created to replace the manual guesswork that often bogs down eligibility and insurance verification processes. From patient demographics and eligibility checks to COB primacy, MBI, and insurance discovery, this solution automates these critical touchpoints, delivering accurate data in seconds.  Fewer denials, faster reimbursements  The impact on denial prevention is unparalleled. Patient Access Curator ensures fewer claim rejections and faster payer reimbursements by identifying and correcting bad data across eligibility, COB, and discovery at the start of the revenue cycle. Providers are left with more retained revenue, which can be reinvested into what truly matters: patient care.  Patient Access Curator: Key features that set it apart Patient Access Curator differentiates itself as a comprehensive, all-in-one product that simplifies the most complex aspects of claims management. Key features include:  Real-time data correction: Fixes inaccurate data instantly without staff intervention.  Comprehensive coverage: Finds and corrects bad data across eligibility, COB primacy, MBI, demographics, and insurance discovery.  Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing  Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches Demographics: The platform can quickly check and correct patient contact information.  Seamless integration: Automatically updates host systems (Epic) with verified and corrected coverage data in seconds.  The results? Fewer clicks, faster workflows, and more accurate billing processes. PAC doesn't just prevent claim denials; it transforms how healthcare teams approach patient access and revenue cycle management.  Proven ROI: How Patient Access Curator delivers $100 million boost to Exact Sciences Explore how Patient Access Curator powered a $100M improvement at Exact Sciences by automating insurance discovery and reducing claim denials. Improve financial health by focusing on patient health By eliminating redundant administrative questions, Patient Access Curator allows patients to focus on their health rather than the complexities of billing and coverage. Meanwhile, healthcare staff enjoy a boost in morale, thanks to fewer manual tasks and more efficient workflows—a benefit that can lead to higher staff retention over time.  Patient Access Curator is more than a tool; it's a game-changer for healthcare organizations looking to protect their revenue while delivering a better, more seamless experience for both staff and patients. Say goodbye to manual guesswork and hello to a smarter, faster, and more reliable way to manage claims. With PAC, healthcare organizations can finally get claims right from the start, without the hassle.  Patient Access Curator is available now - learn how your healthcare organization can get started and prevent claim denials in seconds. Learn more Contact us

Published: June 30, 2025 by Experian Health

Key takeaways: The healthcare industry isn't necessarily recession-proof, but revenue cycle leaders can take steps to build financial resilience. Financial resiliency strategies in healthcare should include: diversified revenue streams, operational efficiencies and strategic financial planning. Leveraging technology to optimize patient collections helps providers enhance the collections process and improve financial resiliency now, and in the case of a recession. The relationship between economic downturns and the resilience of the healthcare industry is complex. Healthcare is an essential service, so whether the economy is considered good or bad, people still need to see their provider. However, with many economists anticipating a potential recession, it begs the question: is healthcare truly recession-proof? In this article, we'll explore healthcare's economic resilience and why financial resiliency and collections optimization may be the key to surviving the next recession. The healthcare sector's economic resilience: fact or myth? While not necessarily recession-proof, the healthcare sector has historically been more insulated against economic uncertainty than other industries. However, since healthcare delivery organizations, like hospitals, typically operate with narrow health margins to begin with, a recession could further compound the issue. Factors that already affect a hospital's everyday bottom line could significantly worsen during a recession. Today's hospitals are burdened by high fixed costs, staffing shortages, regulatory and compliance costs, value-based care pressures and the financial challenges of low reimbursement rates and insured patients. During a recession, even the slightest shift could potentially knock a healthcare delivery organization's revenue cycle off balance. The importance of financial resilience in healthcare Financial resilience is crucial for healthcare organizations that want to cultivate long-term stability, regardless of what's happening in the economy. To weather economic uncertainty, healthcare organizations must have a solid financial foundation. The cornerstones of creating financial resilience for healthcare organizations include: Diversified revenue streams: Providers that offer multiple service points have more opportunities to better serve patients. To attract and retain patients, healthcare organizations must stay nimble and invest in new revenue-generating services, such as virtual or outpatient care. Efficient operations: Streamlining every aspect of the revenue cycle — especially through technology like automation and artificial intelligence (AI) — not only eliminates costly, error-prone processes, but also bolsters the bottom line, prevents revenue leaks and allows for new investments. Strategic financial planning: The healthcare industry is constantly evolving, from automated patient collections technology to artificial intelligence (AI) in claims management. Revenue cycle leaders can use data-driven insights from these technologies to inform short- and long-term financial planning. Patient collections during a recession: a critical area of focus Accelerating patient collections is always a top priority for revenue cycle leaders, especially as patients shoulder an increasing financial burden for the cost of care. However, during a recession, the focus on patient payments becomes even more critical. Recessions often bring job loss, leaving patients without insurance or the income to pay their medical bills. This can leave providers scrambling to update insurance information, chasing patients for payment, sending unpaid bills to collections, or worse — getting stuck with bad debt. Healthcare organizations can improve patient collections and maintain steady cash flow during tough economic times by adopting technology to optimize the patient collections process. Tools like Experian Health's Collections Optimization Manager streamline the entire patient collections process without adding additional workload for existing staffing. Leveraging technology for recession-proofing healthcare operations Recessions often come with many unknowns, but healthcare organizations can take steps to help recession-proof their financial operations. Adopting healthcare technology, like collections optimization tools, can help providers in these key ways: Streamline collections Solutions like Collections Optimization Manager uses intelligent segmentation to help billing teams quickly prioritize high-priority accounts based on propensity-to-pay scores. This frees up busy staff from the burden of chasing accounts — and is especially beneficial with large accounts receivable volumes. Instead, billing teams can focus on a small amount of patient accounts that have a high propensity to pay and bring in high revenue. Additionally, costs are further reduced since these accounts don't need to be sent to an external collections agency. To further streamline collections, complementary automated patient outreach tools, like PatientDial and PatientText can send patients bill reminders and self-pay options via voice or text message. Patient Financial Clearance takes this a step further by helping providers run their presumptive charity process, which estimates a patients' Federal Poverty Level percentage (FPL%), to identify those who qualify for greater financial assistance. Enhance financial forecasting Collections Optimization Manager offers healthcare providers real-time insights into collection performance with reports and dashboards that focus on key metrics. Billing teams can see how their team measures against industry standards to improve patient payment forecasting and successfully manage bad debt reserves. Plus, users get access to an experienced collections consultant to evaluate reports and further refine collections strategies. Improve financial resilience Implementing billing and collections optimization gives providers more visibility into the collections cycle, allowing for improved short- and long-term strategic planning. This can be useful for healthcare organizations that need to make financial decisions to prepare for upcoming recessions or shift priorities as needs change mid-recession. Emerging technologies, like predictive analytics, machine learning and artificial intelligence also offer providers a deeper understanding of patients' financial needs, allowing for a more compassionate collections experience. In times of economic uncertainty, when patients may struggle to afford their medical bills, a supportive collections process can help improve collection rates and reduce the chance of bad debt. Building a recession-resilient healthcare organization While it may not be possible to fully recession-proof a healthcare organization, revenue cycle leaders can take proactive steps to make their organization recession-resilient. Turning to technology that leverages a growing range of automated solutions for clearer billing, personalized payment options and increased efficiencies is one way healthcare organizations can start to build financial resiliency for today – and for any future economic downturns. Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle leaders enhance the collections process and improve financial resiliency during challenging times. Learn more Contact us

Published: June 16, 2025 by Experian Health

Prompt patient payment after service is a key factor in keeping revenue cycles on track. However, patients don't always pay right away or in full. Despite around 90% of Americans having health insurance coverage, many patients still face medical debt. Unpaid patient bills often leave providers on the hook chasing patient collections and footing the cost for uncompensated care.   This article covers some of the key patient collections metrics to help revenue cycle leaders get insights on how to measure and improve revenue cycle collections.  Why measuring patient collections is critical in revenue cycle management  When protecting profits in today's increasingly challenging healthcare landscape, revenue cycle management (RCM) leaders know that “what gets measured, gets managed.” The first step to improve patient collections rates is reviewing current data for issues. To do this, healthcare organizations must identify key performance indicators (KPIs) for measuring patient collections in the revenue cycle. Patient collections metrics are quantifiable measures that illustrate if a healthcare organization is effectively optimizing its collections process. They provide RCMs visibility and insights that help indicate if the organization is achieving its goals and effectively managing inflows and outflows.   Key revenue cycle patient collection metrics  Streamlining revenue cycle collections often hinges on collecting patient payments — and quickly. Here are a few common ways healthcare organizations can measure patient collections in revenue cycles.    Days In Accounts Receivable (A/R) Rate - The days in Accounts Receivable rate is a metric that measures the average number of days it takes healthcare providers to collect payment for services — from both payers and patients. Lower days in A/R typically indicate an efficient billing and collections process. Days in A/R over 30 could lead to an increase in collections efforts, unloading to collections agencies, and even write offs to bad debt – all potentially resulting in cash flow issues and revenue loss.  Gross Collection Rate - The Gross Collection Rate, or GCR, shows the percentage of total patient balances collected and indicates the health of the overall effectiveness of an organization's billing and collections process. Healthcare providers generally strive to keep GCRs as high as possible to prevent cash flow issues. The industry benchmark is typically around 95%, but this can vary by provider.  Adjusted Collection Rate - Also known as the Net Adjustment Rate (NCR), this metric is shown as a percentage of the reimbursement healthcare providers collect in comparison to what they could have collected. It represents the amount of revenue healthcare organizations are losing, and a high NCR is typically an indicator of issues in the revenue cycle like uncollectible bad debt.  Patient Balance After Insurance Ratio - The Patient Balance After Insurance Ratio, or PBAI Ratio, is the percentage of financial responsibility that falls on the patient after insurance pays. Tracking PBAI Ratios closely helps providers identify trends early on to stay ahead of issues that could potentially impact cash flow. As today's patients shoulder more self-pay costs, keeping tabs on this metric can help providers prioritize billing and collections that are compassionate and simple to access.   Patient Contact Rate - The Patient Contact Rate measures how often a provider contacts patients with outstanding balances. Higher Patient Contacts Rates typically indicate high levels of engagement with patients about their unpaid bills that often leads to an easier collections process and improved cash flow. When Patient Contact Rates are low, providers may have an opportunity to increase patient communication efforts. Bad Debt Rate - The Bad Debt Rate shows providers how much patient debt goes uncollected and is written off as “bad debt” over a period of time. A high Bad Debt Rate often indicates a need to tighten up process improvements, like collecting more patient patients upfront. A good rule of thumb is to aim for a Bad Debt Rate of less than 5%. The lower the rate, the more efficiently the billing team collects patient balances. Cost to Collect - The cost to collect is a percentage-based metric that refers to the expenses healthcare organizations spend to recover payments from patients and payers. Many times, hospitals spend more to collect than what the patient owes, whether it's from time and resources calling unresponsive patients, paper statements sent to wrong addresses, etc., which makes this an important metric to track. Contingency Fees - When healthcare organizations turn to third-party agencies for their collections, a contingency fee is often paid for their services. This fee is usually a percentage of what the third-party agency is able to recover, and is often around 20-50% of the total amount. Some healthcare organizations work with multiple collections agencies, which can strain hospital cash flow even further. Hospitals must weigh the cost of outsourcing collections against maintaining in-house billing departments.  Strengthening the revenue cycle with effective patient collection metrics  Optimizing patient collections metrics helps strengthen the revenue cycle. Here are some strategies revenue cycle leaders can consider to help boost patient collections rates overall, improve patient engagement and lower bad debt rates:  Improve patient communication: Sometimes patients need additional reminders to pay their bills. Providers looking to raise their Patient Contact Rate might benefit from engaging more with patients. Strategies can include making additional phone calls or  sending monthly billing statements. Healthcare organizations that want to scale patient contact without adding to headcount may also benefit from tools like Patient Outreach Solutions, which increases collections through automated solutions like touchless text messaging, queue callback and bill reminders.   Make it easier for patients to pay: Providers can shorten the amount of time it takes to collect payment from patients by implementing billing and collections processes that make it simple for patients to know costs up front and pay their bills. With a solution like PatientSimple, patients get access to self-service account management tools, like secure self-pay and patient estimates. Tools that automate the payment process, like Experian Health's PaymentSafe®, further enhance the payment experience by helping providers collect more revenue earlier and creating a seamless payment experience.   Utilize data and analytics solutions to optimize patient collections: Experian Health's Patient Access Curator solution uses artificial intelligence (AI) to quickly verify patient insurance eligibility and coverage data in real-time. This can help ensure patient estimates and bills are accurate before the patient collections process even begins.  Segment and screen patients by propensity to pay: During the patient collections process, Collections Optimization Manager helps identify high-value patient accounts and screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility in advance. This solution segments patients by propensity of pay scores, and reduces the cost to collect. The Screening component of Collections Optimization Manager alerts staff to accounts that are not worth collecting from – whether it's a deceased or bankrupt, or charity care account. This saves valuable staff time and resources. Discover how Weill Cornell increased collections by $15M with Collections Optimization Manager. Gaining clear visibility in patient collections metrics  Patient collections metrics data must be current and easily accessible in order to provide healthcare organizations with the most valuable insights into billing and collections challenges and opportunities. However, RCM analysts are often tasked with compiling data from numerous legacy processes and disjointed systems. Bringing together critical patient collections information into a revenue cycle dashboard can help revenue cycle leaders track the KPIs that matter most and show changes over time. This visibility into trends can help RCM understand how what areas of patient billing and collections need the most attention to improve patient communication, create workflow efficiencies and reduce revenue leaks.  Learn more about how Experian Health's collections optimizations solutions can help healthcare organizations improve collections and increase their bottom lines.  Learn more Contact us

Published: June 12, 2025 by Experian Health

Key takeaways: Error-prone manual processes are a top reason for delayed reimbursements. Automation across the revenue cycle can help providers see quicker reimbursements. Many processes can be automated: patient estimates, eligibility verification checks, collections, claims management, and more. Prompt reimbursements are crucial for today's healthcare organizations. Delayed reimbursements can lead to a domino effect that impacts the entire revenue cycle. Provider productivity goes down along with quality of care, patients have poor experiences and the bottom line takes a hit. Reimbursement delays often stem from error-prone, outdated manual processes, overburdened staff and excessive administrative work. However, incorporating revenue cycle management automation can help providers overcome numerous reimbursement challenges and improve processes overall. With revenue cycle automation, providers can eliminate many persistent pain points in traditional revenue cycle management (RCM). Staff no longer lose time to tedious manual tasks, patients get their queries answered faster, and managers get the meaningful data they need to drive improvements. And the biggest win? It's easier for providers to get reimbursed for their services, faster and in full. What is revenue cycle automation and how does it work? Healthcare revenue cycle management knits together the financial and clinical components of care to ensure providers are properly reimbursed. As staff and patients know all too well, this can be a complex and time-consuming process, involving repetitive tasks and lengthy forms to ensure the right parties get the right information at the right time. This requires data pulled from multiple databases and systems for accurate claims and billing, and is a perfect use case for automation. In practice, revenue cycle automation involves using technology to complete tasks and processes that may have previously been manually completed. These tasks might include: Automatically generating and issuing invoices, bills and financial statements Streamlining patient data management and exchanging information quickly and reliably Processing digital payments Collating and analyzing performance data to draw out valuable insights. Understanding the challenges in traditional revenue cycle management When it comes to delayed reimbursements, providers lacking revenue cycle management automation typically face the following challenges: Inefficiencies in patient access According to The State of Patient Access 2025, front-end operations are still a source of friction for patients and providers. Four out of the five top patient access challenges reported by providers relate to front-end data collection. Top concerns include insurance searches, reducing errors, and speeding up authorization. Nearly 48% say data collected at registration is “somewhere” or “not” accurate, while 85% report an urgent need for faster, more comprehensive insurance verification. Rising claim denials due to manual errors The State of Patient Access also showed that manual, error-prone processes often lead to delays, claim denials and patient frustration. In fact, more than half (56%) of providers say patient information errors are a primary cause of denied claims. When claims are denied, reworks are often time-consuming, costly and place additional burdens on already overworked staff. Difficulty in managing patient collections Due to rising costs, confusion over estimates and a lack of patient payment options, providers are often left to deal with unpaid medical bills. According to Experian Health data, 29% of patients say paying for healthcare is getting worse. Affordability is a key factor, but patients are also struggling to understand how much their insurance covers and looking for convenient payment options, like payment plans. Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. Six ways revenue cycle automation accelerates reimbursements Revenue cycle improvement through automation can help speed up reimbursements for healthcare providers by: 1. Capturing accurate information quickly during patient access Gathering patient data manually is time-consuming. Errors in the process can lead to denied claims and roadblocks in patient care. Tools like Experian Health's Patient Access Curator use artificial intelligence (AI) to streamline patient access and billing, improve data quality and address claim denials from the outset. This solution also ensures that all data is correct on the front end by checking eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery. 2. Simplifying collections and focusing on the right accounts Healthcare collections are a drag on resources. Automating the repetitive elements in the collections process helps reduce the burden on staff. Collections Optimization Manager leverages automation to analyze patients' payment histories and other financial information to route their accounts to the right collections pathway. Scoring and segmenting accounts means no time is wasted chasing the wrong accounts. Patients who can pay promptly can do so without unnecessary friction. As a result, providers get paid faster. 3. Reducing manual work and staff burnout Chronic staffing shortages continue to plague healthcare providers. In Experian Health's recent staffing survey, 96% of respondents said this affected payer reimbursements and patient collections. While automation cannot replace much-needed expert staff, it can ease pressure on busy teams by relieving them of repetitive tasks, reducing error rates and speeding up workflows. 4. Maintaining regulatory compliance with minimal effort While regulatory compliance may not directly influence how quickly providers get paid, it does play a crucial role in preventing the delays, denials and financial penalties that impede the overall revenue cycle. Constant changes in regulations and payer reimbursement policies can be difficult to track. Automation helps teams continuously monitor and adapt to these changes for a smoother revenue cycle, often with parallel benefits such as improving the patient experience. One example is Experian Health's price transparency solutions, which help providers demonstrate compliance with new legislation and provide extra clarity for patients. 5. Improving the end-to-end claims process Perhaps the most apparent way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claims management solutions, like Experian Health's award-winning ClaimSource®, reduce the need for error-prone manual processes, while improving accuracy and efficiencies in the claims editing and submission process. Additional claims management tools, like Claim Scrubber, also help providers submit more complete and accurate claims. Other tools, like Denial Workflow Manager, can be used if claims are denied. With automation and its extensive data analysis capabilities, work lists are generated based on the client's specifications, like denial category and dollar amount, to identify the root cause of denials and improve upstream processes to prevent them. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI Advantage™ uses AI and machine learning to find patterns in payer behavior and identify undocumented rules that could lead to a claim being denied, alerting staff so they can act quickly and avert issues. Then, it uses algorithmic logic to help staff segment and rework denials most efficiently. Providers get paid sooner while minimizing downstream revenue loss. 6. Providing better visibility into improvement opportunities Finally, automation helps providers analyze and act on revenue cycle data by identifying bottlenecks, trends and improvement opportunities. Automated analyses bring together relevant data from multiple sources in an instant to validate decisions. Machine learning draws on historical information to predict future outcomes, so providers can understand the root cause of delays and take steps to resolve issues. A healthcare revenue cycle dashboard is not just a presentation tool; it facilitates real-time monitoring of the organization's financial health, so staff can optimize workflows and speed up reimbursement. Embracing automation for a more efficient revenue cycle Like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth and speed up reimbursements. Learn more about Experian Health's revenue cycle management technology and see where automation could have the biggest impact on your organization's financial health. Learn more Contact us

Published: June 5, 2025 by Experian Health

Revenue cycle management (RCM) plays a central role in healthcare, influencing both patient access and the financial well-being of providers. As healthcare organizations navigate growing costs, shifting patient expectations, and increasingly complex administrative tasks, they're finding themselves at a crossroads. Experian Health's State of Patient Access 2025 report offers a look at these challenges from the views of patients and providers, while showcasing how technology is changing the way we approach patient access and revenue cycle operations. In this interview, Clarissa Riggins, Chief Product Officer at Experian Health, shares key takeaways from the report, offers actionable solutions for providers, and outlines trends that are set to shape the future of RCM.  Q1: "Let's start with the big picture. What's going on with patients' access to healthcare right now?" Riggins says, "It's stabilizing, which is a good sign. According to The State of Patient Access 2025, 68% of patients and 43% of providers say access has stayed the same. That's the highest it's been since 2022. Only 15% of patients said it's gotten worse, and that's the lowest number we've seen in a few years."  Q2: "That's reassuring. But there are still challenges, right? What are patients struggling with most?"  "The number one issue continues to be wait times," explains Riggins. "About 25% of patients said getting in to see a provider quickly is still a major hurdle. On top of that, 22% reported delays because of insurance verification, and 20% said they ran into problems with errors in their medical records or billing information. So, while some things have improved, there are still gaps to close.”  Q3: "You mentioned insurance verification. How much of a barrier is that?" "It's a big one," she says. "When insurance verification isn't seamless, it creates a domino effect. That 22% figure I mentioned, those are people who had to wait for care because their insurance details weren't sorted out. Automating that part of the process can make a huge difference in getting people the care they need faster.” Q4: "Are digital tools making a difference in these areas?"  "They have the potential to, but adoption is a challenge. 37% of providers said one of their biggest obstacles is getting patients to actually use the tools available. And 55% said patients don't know how to navigate self-scheduling. We're seeing some resistance, but it's not because the tech isn't there. It's more about awareness and ease of use. She continues, "For example, going back to insurance eligibility, Experian Health's Patient Access Curator uses artificial intelligence (AI) to automatically check coverage in real time. This helps providers confirm benefits instantly and spot issues early. That kind of automation takes the guesswork and delays out of the equation, so patients can get the care they need without unnecessary holdups. It's not just more efficient for staff; it literally speeds up access to treatment."  Q5: "Let's talk about cost. How is that affecting access for patients today?"  “Cost is a major pain point," she explains. "The report shows that 34% of patients say they often struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care."  Q6: "What can providers do to improve the payment experience for patients?"  “It starts with transparency. Patients want to know what they'll owe before they get care. When 81% of patients say they feel more prepared after receiving an accurate estimate, it shows just how critical that upfront information is," Riggins notes. "Experian Health's Patient Estimates solution was built around this need. It allows providers to give patients clear, personalized cost estimates before they receive care, helping them feel informed and in control." "And 43% said they would consider canceling or postponing care if they didn't get that information," she continues. "That's huge. It proves this isn't just about convenience; it's about access. These tools help patients avoid financial surprises, which can be the deciding factor in whether they follow through with treatment." “This solution isn't just making billing easier. It's directly supporting better health outcomes by making care more accessible and less intimidating financially."  Q7: "So, it's not just about having the tools. It's about how they're used?"  "Exactly. Providers need to make sure the tools are easy to use and that patients understand how to use them. That means clear instructions, mobile-friendly interfaces, and support when people get stuck. If the experience feels complicated, people just won't engage." Q8: "What are patients looking for when it comes to better access?"  "Patients are very clear. They want convenience," Riggins says. "According to The State of Patient Access 2025 report:  82% don't want to complete forms multiple times if their information hasn't changed  80% want to be able to schedule appointments from their phone (via a browser or an app)  77% want a heads-up on insurance coverage before treatment  52% want more digital options, period  So, if providers listen to these preferences and meet patients where they are, access improves naturally."  Q9: "What about billing and patient record issues? How can providers avoid those mistakes?"  "Strong data practices are key. That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records. Adding tools like Patient Access Curator can really make a difference. It uses artificial intelligence to handle a bunch of tasks all at once – eligibility checks, COB, MBI, demographics, and insurance discovery. By automating tasks that are traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can help prevent billing and claim errors in the long run.  Clean data makes everything easier, from billing to insurance verification to patient trust," Riggins concludes.   Patient access is evolving, but not without its challenges. As the State of Patient Access 2025 report highlights, stability is improving, but issues like price transparency, low adoption of digital access tools and insurance verification continue to create friction. The path forward lies in listening to what patients are asking for: easy-to-use digital tools, clear pricing, and fewer administrative headaches. By utilizing automation and AI, providers can streamline access and build stronger, more trusted relationships with their patients.  Learn more about how Experian Health can help healthcare organizations improve patient access, and download the report for the full survey results.   Download now Contact us

Published: May 27, 2025 by Experian Health

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

Published: May 21, 2025 by Experian Health

Subscribe to our blog

Enter your name and email for the latest updates.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Subscribe to the Experian Health blog

Get the latest industry news and updates!
Subscribe