Tag: claims management

In 2009, processing claims was listed as the second greatest contributor to “wasted” healthcare dollars in the US, at an estimated $210 billion. A decade later, that amount was estimated at $265 billion. Today, healthcare providers are still grappling with denied healthcare claims, with both challenges and solutions accelerated by the pandemic. To put the scale of operational and delivery changes into perspective, Experian Health recorded well over 100,000 payer policy changes for coding and reimbursement between March 2020 and March 2022. The implications for claims processing are immense, which is why healthcare providers need to reevaluate their denial management strategies and invest in new technology that can help increase reimbursements. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand how they feel about the current situation. What are the priorities of those on the front line of denials management? And how can technology contribute to improvements? This article breaks down the key findings. Takeaway 1: Denials are increasing and reducing them is priority #1 30% of respondents say denials are increasing by 10-15% Nearly 3 out of 4 respondents say that reducing denials is their top priority For most respondents, claims management is more important now than it was before the pandemic, because of payer policy changes, reimbursement delays and increasing denials. Respondents attribute this to insufficient data analytics, lack of automation in the claims/denials process and lack of thorough staff training. When it comes to improving denial rates, staffing seems to be the greatest challenge. More than half of respondents say staff shortages are slowing down claims submissions and hampering efficiency. Shrinking offices mean there is less staff to handle the growing volume and complexity of claims. It’s no surprise, then, that around 4 in 10 respondents are also concerned about keeping up with rapidly changing payer policies and keeping track of pre-authorization requirements. Providers recognize that technology can help reduce denials while easing the burden on staff. A tool like ClaimSource manages the entire claims cycle using customizable work queues that make it easy to prioritize accounts, saving staff time and avoiding the errors that lead to denials. This also incorporates payer edits to ensure that claims are clean before being submitted to the payer. And if claims do end up needing further attention, Denials Workflow Manager eliminates time-consuming manual processes and allows providers to attend to high-risk claims quickly, so there’s less chance of delayed reimbursement. Takeaway 2: Automating denials management in healthcare is critical 52% of respondents upgraded or replaced previous claims process technology in the last 12 months 51% are using robotic processes, including automation, but only 11% are using artificial intelligence Prior to the pandemic, automation was sometimes perceived as a threat to jobs. But with changing employment patterns and evidence of the broader benefits of automation, attitudes are shifting. Automation can make life easier for staff by removing manual tasks to allow them to focus on other priorities. It speeds up the healthcare claims processing workflow, reduces the risk of errors, and enables better communication between providers, patients and payers. Providers recognize that automation drives more efficient claims management. The survey revealed that 45% of respondents turned to automation to keep track of payer policy changes, 44% had automated patient portal claims reviews, and 39% had digitized patient registration in the last year. Automation supports all stages of the claims management process, from auto-filling patient data during registration, to generating real-time claim status reports for back-office staff. Payer authorizations were a common challenge for providers, and a perfect fit for automation. Experian Health’s Prior Authorizations solution eliminates the need for staff to visit multiple payer websites, automates inquiries, and offers real-time updates on pending and denied submissions so staff knows when to intervene. Takeaway 3: Providers are searching for denial management solutions that will achieve the greatest ROI 91% of those likely to invest in claims technology say they will replace existing solutions if presented with a compelling ROI The majority of providers may be on the lookout for better claims management solutions, but they vary in how they measure ROI. Predictably, one of the most common metrics is how much staff time can be saved, with 61% concerned with hours spent appealing or resubmitting claims, and 52% looking at time spent reworking claims versus reimbursement totals. Rates of clean claims and denials were also popular metrics, at 47% and 41%, respectively. Using Denials Workflow Manager and ClaimSource alongside additional claims management solutions like Claim Scrubber and Enhanced Claim Status can deliver an even stronger performance against the above metrics. Each solves a specific challenge within the claims management workflow, but when used together, the ROI is multiplied. Overall, there’s optimism that digital technology and automation can help healthcare providers improve claims and denial management and reduce the amount of “wasted” dollars. This survey shows that providers are keen to grasp the opportunities offered by automation to optimize the reimbursement process and get paid sooner. Download the report to get the full results on the State of Claims 2022, and discover how Experian Health can help organizations with their denial management strategies.

When it comes to medical coding and billing, accuracy is everything. Even the smallest error can result in a claim being bounced back by the payer, causing delays and missed revenue opportunities. Coding requirements change frequently, and with denials totaling billions of dollars per year, providers can’t afford to risk under- or over-coding or relying on outdated codes. Automation and software-driven solutions can uncomplicate the complex world of medical coding. Getting claims right the first time accelerates the adjudication process, leading to faster and higher reimbursements. Providers can make more reliable financial forecasts, avoid losing time reworking rejected claims, and give patients greater clarity about what they’ll owe. For this reason, providers should brush up on medical coding and billing best practices to improve claims management and maximize reimbursements. Here are 7 areas to focus on: 1. Stay up-to-date with coding changes Medical codes convert information about the patient’s healthcare encounter into an electronic format that payers use to adjudicate claims for reimbursement. If a claim includes outdated, incorrect or missing codes, then it will be denied. The most common medical coding systems include: International Classification of Disease 10th edition (ICD-10) codes: these codes denote the patient’s diagnosis or condition. The 11th version was published in January 2022, and while the implementation timeline in the US remains unclear, providers will need to be ready to adapt. Current Procedural Terminology (CPT) codes: Where ICD codes describe the patient’s symptoms, CPT codes record their treatment. If there’s a discrepancy between diagnosis and treatment, the claim is likely to be denied. Healthcare Common Procedure Coding System (HCPCS) codes: the Centers for Medicare and Medicaid Services (CMS) use these to apply CPT codes to procedures, services, products and equipment offered to Medicaid and Medicare patients and those covered by private insurance. These codes are constantly being revised and are often recycled, so coders must pay close attention to avoid errors. National Drug Code (NDC): claims need to include NDC codes when the patient is taking prescribed or over-the-counter medications. The NDC directory is updated daily. Diagnosis-Related Group (DRG) codes: these combine ICD and CPT codes to determine the final amount that a hospital can be reimbursed. CMS assigns annually calculated weightings to DRGs based on severity and length of illness, treatment trends and other factors. There are also multiple coding directories for different specialties, such as dental care, mental health and patients with disabilities. With hundreds of thousands of constantly-changing codable terms to consider, medical coders face a daunting task. In the past, coders would rely on manual coding directories to find the right codes, but today, most use digital encoders and digital coding libraries to generate electronic codes. For example, Experian Health’s claims management software integrates government and payer edits so that no changes to coding requirements are missed. Each patient encounter can be processed in real time and incorrect codes can be flagged before the claim is submitted. 2. Automate the claims management process to increase medical billing and coding accuracy Manually matching each patient encounter to a specific set of codes is time-consuming and vulnerable to errors. Software programs improve the process by analyzing unstructured clinical charts and notes to draw out information relevant to the claim. They can cross-reference multiple coding directories in an instant to identify the correct code. They also compile data in standardized, interoperable formats so information can be exchanged between coding and billing teams, clearinghouse staff and payer systems with ease. While some of the output generated by machine learning systems still needs to be checked by human eyes, automated solutions drastically reduce the burden on staff and ensure greater accuracy. With automated claims management, medical coding and billing teams can optimize their workflows, submit cleaner claims, and get insights into the root causes of denials. Case study: see how Summit Medical Group Oregon – Bend Memorial Clinic used automated claims management technology to achieve a primary clean claims rate of 92%. 3. Eliminate workflow inefficiencies to save time According to the Council for Affordable Quality Healthcare (CAQH), automation could save more than an hour of staff time for every three claim status checks. Automation frees up staff to focus on the highest priority tasks that require a human touch. Fewer errors mean less time spent on reworking denied claims. And if claims are processed more quickly, this means that they reach the payer adjudication stage sooner which ultimately will result in faster payments. The medical coding and billing process takes anywhere from a week to a few months, so every hour saved makes a difference. To this end, Enhanced Claim Status monitors how claims are progressing through the claims adjudication process, reducing the amount of time staff need to spend interacting with payers. It eliminates manual follow-up and allows teams to address pending, returned, denied and zero-pay transactions before the Electronic Remittance Advice and Explanation of Benefits are processed. Worklists are generated based on actionable data so staff can work more productively, and claims get settled sooner. 4. Customize claims edits to your specifications One way to drive up medical coding accuracy is to use customized claims edits. Some claims management software solutions only apply updates using universal claim edits or using groups of edits. This doesn’t work for large medical groups that need to cover multiple combinations of payer, specialty and geographical edits. Since no two payer policies are the same, claims edits would need to be checked manually to make sure nothing has been missed. Experian Health’s claims management software solves this by incorporating government and commercial edits alongside client-specific customized edits. Providers can keep pace with changes and capture the requirements of all reimbursement policies that are relevant to a particular claim. For example, ClaimSource runs front-end claims editing to coordinate federal, state and commercial payer edits together with customized provider edits to avoid coding errors. Similarly, ClaimScrubber automatically reviews and adjusts claims, helping medical groups streamline claims submissions. 5. Upgrade record-keeping technology to maintain medical billing and coding accuracy If patient records are peppered with typos and outdated contact information, then it’s highly likely that errors will be inherited on claims forms. A fifth of patients have spotted errors in their health records, including incorrect details about diagnoses, medications and test results. Preventing these errors is key to maintaining medical billing and coding accuracy. Interoperable electronic patient records protect against inaccuracies by creating a single, complete record for each patient. With a tool such as Universal Identity Manager, patient data is matched against multiple data sources to verify that the record is complete and accurate. Staff can have confidence that all information held on a patient will be taken into account when their medical encounters are coded, and avoid coding discrepancies that can occur when a patient’s treatment doesn’t seem to match their diagnosis. 6. Double-check claims before submitting  Running a line-by-line review of each claim before it’s submitted means errors can be found and fixed before they result in financial losses. This would be a painstaking task to do by hand, but with tools such as ClaimSource and ClaimScrubber, hospitals and medical groups can audit claims automatically to check for coding discrepancies or missing patient information. A streamlined claims cycle benefits payers and patients too. Payers can adjudicate accurately coded claims more quickly without pushing them into a queue for manual review, and patients get earlier clarity about how much they’ll owe. 7. Audit the claims management process to spot medical coding inaccuracies Finally, it makes sense to undertake regular audits of the medical coding and billing procedures to weed out any recurring issues. While a coding audit will focus on coding accuracy and compliance, a billing audit can investigate the systems and processes involved in everything from patient eligibility verification to patient collections. This helps uncover recurring issues with under- and over-coding, use of redundant and retired codes, non-compliance and poor documentation. Again, maintaining robust, quality data and records will make this process easier. Partnering with a single, trusted vendor to deliver an end-to-end claims management solution can help achieve this. Find out more about how Experian Health’s automated claims management solutions can help healthcare organizations maintain medical billing and coding accuracy, drive down denials and create a more predictable revenue cycle.

Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily increasing over the last few years. An MGMA Stat survey found that nearly seven in ten providers witnessed a jump in denials during 2021, although the trend took hold even before COVID-19 hit. If providers rely on outdated systems and tools to process the growing volume of claims, it's inevitable that denial rates will continue to climb. It's not surprising then that a new Experian Health survey revealed almost 3 in 4 providers stated that reducing claim denials takes precedence over other priorities. Getting claims right the first time is no easy task. Traditionally, the claims management process has been labor and time intensive. Claims teams spend hundreds of hours gathering documentation, preparing claims for submission, engaging with medical clearinghouses, and then monitoring claims adjudication while they await the payer's verdict. Should a claim be denied, more staff hours may be required to rework it for a second attempt at reimbursement. Even if administrative budgets and staffing numbers increased in line with demand, inefficient manual systems can no longer bear the burden of data to be managed. With more providers heading into the danger zone of claim denials, automated claims processing tools are growing in popularity. These enable more efficient claims management, boosting productivity, easing pressure on staff, and above all, minimizing denials. Experian Health's survey found that 78% of providers are open to replacing current technologies if they are presented with compelling ROI projections, reflecting the urgency of the situation. What is automated claims processing? Automating claims involves the use of digital technology, software, machine learning and advanced analytics to optimize healthcare claims management. This can include: pre-filling data into digital forms to avoid data input errors using intelligent document processing to pull unstructured information into a single, usable format comparing data from multiple sources and flagging inconsistencies providing real-time insights and status updates allowing multiple parties to work from interoperable data Tools such as robotic process automation (RPA) can be used to replace manual activities, using data, logic and business rules to make decisions within certain parameters. This eases pressure on busy staff and improves efficiency, for example, when prioritizing claims to be reworked. Imagine how much faster a software program can synthesize hundreds of current and historical data points, compared to a human trying to do the same job. There are opportunities to automate just about every stage of the claim lifecycle, from the patient's first interaction with their provider to reimbursement. For example, automation can be used to: Streamline patient onboarding and automate identity checks to avoid errors in patient information Verify insurance eligibility and run continuous coverage checks to see if the patient's status has changed Maintain a complete electronic health record that follows the patient throughout their healthcare journey, so claims contain correct information Track payer policy changes and apply custom edits so that coding information is correct Scrub claims to find and fix any errors before they are submitted Submit claims to payers and monitor the claims adjudication process Optimize the denials management workflow and prioritize denied claims for resubmission Verify reimbursements and initiate patient billing processes. Virtually any repetitive, process-driven, or paper-based task from claim creation to claim reimbursement is an opportunity for automation. As technology advances, so do the opportunities to streamline operations, reduce time to reimbursement, optimize decision-making, reduce costs and improve the patient experience. Here are the 5 benefits of automated claims processing: 1. Automated claims processing streamlines operations Automation's number one benefit is allowing providers to move away from inefficient and error-prone manual processes. Staff no longer need to sift through disparate and complex coding lists, medical records and payer edits looking for the correct information to attach to a claim. Together with electronic records management, automation allows for standardized workflows, so the entire claims cycle is more consistent, and decisions are based on real-time accurate data. It helps to eliminate time spent searching for missing information, reformatting data to meet payer requirements, and trying to figure out which claims are worth reworking. Multiple digital tools are available to optimize different tasks within the claims processing workflow. But for maximum efficiency, providers should look for solutions that work together within an integrated system. Using a single vendor makes it easier to manage data consistently and simplifies system-to-system interactions. A comprehensive claims management solution also creates a smoother user experience, for example, by allowing staff to check real-time insights within one dashboard, using one log-in. Experian Health's suite of healthcare claims management solutions connects each step in the claims workflow to speed up claims processing. For example, ClaimSource manages the entire claim cycle in a single, scalable online application that serves individual hospitals and physician practices through to large multi-facility health systems. It creates custom work queues and integrates electronic remittance data directly, to allow staff to prioritize high-impact claims and speed up reimbursement. 2. It saves staff time and resources Outdated and clumsy processes can contribute to staff burnout, poor performance and difficulties attracting and retaining top talent, even more so as patient volumes return to pre-pandemic levels. By removing many time-wasting manual tasks, automated claims processing allows staff to use their time more productively. It's particularly important amidst ongoing staffing shortages, which put additional strain on existing staff. Some of the most time-consuming manual activities occur in the prior authorization workflow. Prior authorizations are also a common cause of claim denials. Because payer requirements around prior authorizations change frequently, staff must painstakingly check each payer's website before submitting authorization requests to ensure that the necessary documentation is in place. Once submitted, they must log in to different payer portals to track progress. According to the American Medical Association, some physician practices spend more than two full days processing prior authorizations each week. But with automated prior authorizations, staff can prevent delays and denials. Online prior authorizations automate inquiries and submissions without the need for user intervention, instead drawing on payer data that are already updated and stored in the system. It auto-fills the necessary information and flags where manual intervention is required. It can initiate more authorizations in less time, and guide staff to the highest-priority tasks using dynamic, exception-based work queues. By reducing the error rate, automation also facilitates faster claims processing, which means payments can be processed and issued more quickly. 3. Automation generates more accurate and actionable insights Automation doesn't just save time; it also gives staff greater clarity and control over the claims process. Automated digital solutions facilitate more reliable data management to reduce errors, and generate real-time insights based on accurate information. A large proportion of claims are denied because patient information doesn't match the payer's records. This can be easily avoided using robust electronic medical records that hold data in standardized formats and automatically populate forms with the correct information. Electronic data management also gives staff richer and more reliable insights, by pulling together all the information they need into a single, accessible interface. Using an automated tracker such as Denial Workflow Manager makes it easy for staff to monitor claims, denials and remittances in one place. Not only does it track denials, holds, suspends, zero pays and appeals, but it also provides detailed analysis to help root out the causes of denials, so they can be avoided in the future. Staff can immediately see which claims need attention and resolve them much more quickly, as opposed to using manual processes. Enhanced Claim Status complements Denial Workflow Manager by automatically generating work lists for staff, complete with actionable data to help them check off the tasks quickly and accurately. The software sends automated status requests based on each payer's claims adjudication timeline, to see if claims are pending, denied, returned-to-provider or zero-pay transactions. This takes place before the Electronic Remittance Advice and Explanation of Benefits are processed, so staff can respond quickly and avoid unnecessary denials or delays. 4. Faster claims processing equals faster payment According to the Council for Affordable Quality Healthcare (CAQH), the time saved by switching from manual to electronic claims processing could save the medical industry up to $1.7 billion each year. The increase in accuracy leads to more first-time pass-through rates and optimized decision-making around which claims to rework. While automation requires some upfront investment, the output tips the balance in favor of faster, higher reimbursements. Experian Health's Claim Scrubber solution is one example of how automated claims processing can reduce undercharges and denials, optimize staff time and improve cash flow. This program reviews each pre-billed claim, line-by-line, to check that coding details are accurate. It then applies general and payer-specific edits and verifies that the claim is free of errors before it's submitted to the payer or clearinghouse. As a result, more claims are correct – and therefore paid – the first time, and staff can spend less time chasing old accounts receivable. Case study: Read how Summit Medical Group Oregon – Bend Memorial Clinic reduced A/R days and volume by 15%, and achieved a 92% clean claims rate with Claim Scrubber and Enhanced Claim Status. 5. Automation can transform the patient experience Getting claims right the first time starts at the beginning of the patient journey. A digital patient access experience is more convenient and satisfying for patients and helps prevent errors that can lead to denied claims later. Patient contact information can be automatically pre-filled so the patient can check for errors. If a patient adds new data when they're scheduling or registering for care, that information can be automatically checked against the data already on file, and flagged if there are inconsistencies. Further along, the efficiencies afforded by claim process automation mean patients don't have to wait so long for confirmation that their medical expenses have been handled. Or, if they have an out-of-pocket amount to pay, they'll get clarity about their financial responsibility much sooner. Patient portals are a great tool for helping patients track claims when and where it suits them, rather than having to wait to speak to a call center agent. And by making the claims process more efficient, automation also releases staff from time-consuming repetitive administrative tasks so they're free to support patients with more complex queries. Automation can elevate the customer experience with personalized communications and simplified transactions, from patient access to patient payments. Transitioning to automated claims management As the volume and complexity of claims to be processed increases, providers need to find ways to manage the workload, alleviate pressure on staff and prevent unnecessary revenue leakage. Working with a trusted vendor can ease the transition to automation and maximize potential cost savings. Experian Health provides industry-leading software solutions to improve healthcare claims and denials management so that more claims are clean the first time. In fact, Experian Health was voted as the top claims vendor for hospitals in the 2022 Black Book vendor survey, for the second year in a row. Find out more about how Experian Health's suite of healthcare claims management products can help providers reduce denials, rebilling and drive up reimbursements with automated, clean and data-driven claims processing.

On July 28, the US House of Representatives voted in favor of extending Medicare telehealth flexibilities after the COVID-19 public health emergency ends. If enacted, the Advancing Telehealth Beyond COVID-19 Act will allow beneficiaries to continue to access telehealth services at any site, including their home, until December 31, 2024. Coverage for a wider list of telehealth practitioners, delivery at specific clinics, audio-only telehealth, and remote behavioral health and hospice care would also continue. After a quick implementation period at the start of the pandemic, providers spent the last two years refining telehealth delivery. However, a question mark remained about telehealth’s post-pandemic prospects. The new legislation offers welcome certainty around reimbursement, at least until December 2024. More significantly, it’s further confirmation that telehealth is likely to become a permanent fixture in modern healthcare delivery. What does that mean for providers? Telehealth is here to stay Throughout the pandemic, remote and virtual care proved an effective way for providers to maintain relatively stable service delivery and limit gaps in care. It even helped to tackle inequitable access to care by making it easier for rural and underserved communities to speak to their doctor. Now, patients and providers alike are familiar with the benefits of telehealth. It’s an expected component of the overall healthcare experience. For the American Telehealth Association, the vote is “a significant step forward in providing much-needed stability in access to care for millions of Americans… We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent.” As telehealth is gradually stitched into the fabric of the US healthcare system, providers should consider the following three actions to maximize the opportunities that come with delivering virtual and remote care: 1) Review the digital patient journey and increase telehealth access Telehealth is more than just a video visit – a truly virtual patient care experience starts from the moment the patient books their appointment all the way through to patient billing. 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, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Prioritizing the use of digital channels could therefore boost patient attraction and retention, as well as efficiency and productivity. Integrating telehealth platforms with online scheduling software means patients can choose how and when to book their appointment, and appointment options are synced with physician calendars for maximum efficiency. Similarly, providers can ease friction when patients are registering for a telehealth visit by offering digital, automated and mobile-friendly registration. 2) Prioritize personalized patient outreach and engagement While many patients are now familiar with telehealth services, many may not be aware that it’s an option or may be unsure of how it works. Patient engagement strategies are essential in communicating to patients that telehealth services are available. By providing clear information about how the visit will work, how to use the technology and how to prepare, providers can help patients understand the process more clearly so they get the most out of their visit. This is especially important for patients who may be unable to attend in-person visits (e.g., due to location, disability, or lack of transportation or childcare). Telemedicine helps these patients take a more active role in their health and healthcare journey, in turn closing gaps in care. It also creates opportunities for remote patients to access experts that they’d otherwise be unable to see. Consumer data helps providers build patient engagement and outreach strategies based on reliable demographic, behavioral, psychographic and financial information. As telehealth services grow, a tool like ConsumerView enables providers to segment, identify and communicate with different audiences so that patients receive the most relevant message at the most useful time. 3) Explore automation for efficient telehealth billing Keeping track of telehealth reimbursement regulations has been one of the key challenges for providers as telehealth services have expanded. Flexibility reduced some of the barriers to scaling telehealth services, but did leave the door open to variation in payer requirements, coding changes and geographical coverage. The new legislation would maintain the status quo for a while longer. But looking ahead, any further changes to telehealth reimbursement rules, combined with greater telehealth utilization, could leave providers with an administrative mess to clear up if they don’t have robust processes in place. Those that utilize claims management and billing tools now will be best placed to manage what may follow. Automation can ease the burden in several ways. For example, with Coverage Discovery and eligibility verification solutions, providers and patients can confirm coverage eligibility early, which will speed up collections further down the line. Another option is to use automated healthcare claims management software to ensure every telehealth claim is submitted correctly the first time. With Experian Health’s customization function, telehealth alerts can be automatically checked so providers know whether the patient is covered for virtual care. As telehealth services gain a permanent place in the healthcare ecosystem, providers should act now to optimize patient-facing services and back-end processes. Failure to do so could cause patients to look elsewhere for the healthcare experience they desire and lead to lost revenue opportunities. Contact Experian Health today to discover how data-driven insights and automation can help providers bolster their telehealth offerings to maximize reimbursements.

The repercussions of errors on the healthcare claims processing workflow can be major and wide-ranging. It slows the revenue cycle, interrupts cash flow, consumes staff hours, creates frustration for staff and patients, and, in the worst cases, sacrifices revenue. Errors are a perennial—maybe even inevitable—problem but understanding some common reasons behind these mistakes can help. Additionally, digital claims management tools can help you automate claims processing to reduce claims errors, submit cleaner claims, and get paid successfully. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand the current state of claims management. Watch the video to see the results: Any number of claim errors can lead to denials: incorrect medical coding, missing prior authorizations, clearinghouse issues and more. Here are 7 of the most common reasons for claim errors: 1. Claim errors can be caused by missing and inaccurate data “The number one denial issue most providers encounter is eligibility,” says Rob Stucker, Senior Vice President at Experian Health. “These issues begin upstream from the claims process during registration or pre-registration when the patient information that’s collected is either inaccurate or incomplete. It may be as simple as a patient giving their name as Rob instead of Robert, or the registration staff selecting Medicaid as the payer, instead of Medicaid Managed Care. If the eligibility information is even slightly off, the claim will come back as denied.” Collecting accurate demographic and insurance information up-front using digital patient intake tools opens the digital front door and can help eliminate errors during the healthcare claims management process. 2. Manual processes and disparate systems Wherever claims processes are not automated, human error and delays can set in. In addition to typical random glitches and mistakes, many healthcare providers struggle with disparate systems from multiple vendors, in which the front-end and back-end do not communicate seamlessly. Using a single vendor with solutions that manage the entire claims processing cycle can provide holistic help. ClaimSource manages eligibility validation by repurposing Experian eligibility transactions that providers have already run at registration and editing them against the claim.  This process allows providers to double-check the eligibility of the claim before it gets submitted, at no additional cost. In addition, it also does extensive claim editing, submissions, reconciliations, and reporting. This solution creates prioritized workflows and provides access to a national library of documented government and commercial payer edits, as well as custom edits, to meet individual provider needs. 3. Changes in payer requirements can cause claims errors “Providers tell us that a major pain point is constantly changing payer rules,” says Stucker. “Providers are confident that their claims are good, but the payers’ adjudication rules may have changed without prior notice.” The problem here is exponential: voluminous changes multiplied by a range of communication channels (or faulty communication) multiplied again by a proliferation of payers and policies. Keeping pace with these changes is difficult without partner support. “We continuously monitor hundreds of thousands of payer website pages each night for updates,” says Stucker. “When a change is flagged, an analyst looks at it and decides whether it should be added as an edit. We update our huge global library of edits on a weekly or even daily basis. These edits enable ClaimSource and our pre-837 editor, Claim Scrubber to automatically review claims for errors using the most recent payer updates. 4. Prior authorizations Pre-authorizations present challenges at many levels. 8 in 10 providers saw prior authorization requirements increase during 2021. Providers must track changing requirements, obtain authorizations prior to treatment or claims submission, and complete claims that meet complex requirements. When prior authorization requirements aren’t met, appealing a denial can be complicated at best, and many times prove to be irreversible. According to Medical Group Management Association data, a simple denial takes a seasoned biller two to eight minutes to work, but a complicated denial involving prior authorization requirements can take up to an hour to work, largely thanks to time spent on hold. Ensuring claims are completed as required in the first place using a pre-authorization tool, in combination with a claims editor that validates against pre-authorizations, saves valuable time and stress. 5. Short staffing and new trainees Staff hours and expertise are both in short supply, as many providers struggle to retain experienced staff and bring new hires up to speed. Having an automated process with built-in review and analytics can help ensure that claims are completed accurately and quickly. A Council for Affordable Quality Healthcare study found automated claims take 25% less time to process than manual claims, boosting productivity and freeing staff up for the more human-intensive aspects of their work. However, the key is “accurate and user-friendly” automation. A claims vendor should be keeping edits up to date, submitting claims timely and accurately to the correct payer, keep organizations informed on the claim’s status throughout the adjudication process, retrieve electronic remit files, link them to the correct claims, and establish a denial workflow to automatically show denials. This should all be done in an extremely easy to use user interface or directly back into Patient Accounting/Practice Management Systems. If vendors aren’t doing this, then staff will just be working harder instead of smarter. 6. Slow response and follow-through can lead to claim errors  Although delays themselves don’t necessarily cause errors, they can make resolution difficult and time-consuming. Time is always an issue for providers as claims must be submitted in specific time frames from the date of service. Therefore, getting the claim created, processed through a claims vendor and submitted to the correct payer must be done efficiently, or timely filing deadlines are missed.  The same is true for identifying and re-working denials. Denial backlogs quickly become overwhelming, increasing the odds of items slipping through the cracks or re-submission/appeal deadlines being missed. Automating status updates with enhanced claim status monitoring can relieve time-strapped staff of having to contact payers manually for the latest information on claims to find out which ones are being paid or denied. Enhanced Claim Status submits automatic status requests based on each payer’s adjudication timeline from the date of claim submission, returning the payer’s proprietary responses weeks before the Electronic Remittance Advice or Explanation of Benefits are processed. This gives staff a huge head start on working denials. 7. Difficulty managing denials When errors cause claims to be denied, a response is critical. A denials workflow management solution can optimize follow-up by identifying claim denials, holds, suspensions, zero-pays, and prioritizing denials that need the fastest attention. Denial Workflow Manager also allows organizations to track root causes, which in turn can identify operational changes that can be made upstream, and reduce the denials from happening to being with. Automation is the future of effective claims management Claims management is becoming more complex and demanding, but the digital tools that automate and improve processes can help providers rise to the occasion. It’s now possible to capture and use accurate data, integrate systems and processes to work together, stay up to date on payer requirements, track claim status, and even manage denials efficiently with the help of technology. Learn more about other solutions that can help healthcare organizations with claims management.

An efficient revenue cycle management (RCM) system is a win-win for patients and providers. Friction-free solutions that cover everything from booking appointments to paying bills create a more satisfying patient experience and allow patients to focus on their health. Providers can lower administrative costs and generate more revenue from data-driven billing and collections operations. To ensure the patient’s financial journey goes ahead without a hitch and avoid revenue leakage, the RCM system can’t skip a single step. Experian Health’s 10-step healthcare revenue cycle flowchart sets out the necessary ingredients for success. See the healthcare revenue cycle flowchart below: Step 1: Patient registration The healthcare revenue cycle flowchart begins with the patient’s first interaction with the healthcare organization. First impressions count. Patients want to be able to book appointments and complete registration quickly and easily, and providers that offer patient portals are seen as more attractive. Opening up the digital front door with online self-scheduling and self-service registration also helps providers increase operational efficiency and minimize manual errors that could lead to claim denials. Reliable patient intake software can verify patient identities, reduce manual processes and deliver a flexible patient experience – laying the groundwork for the entire RCM process. Step 2: Eligibility and benefits Next, providers need to check whether the patient’s insurance plan covers their expenses. To increase the likelihood of reimbursement, providers should give patients clarity about their coverage status and be vigilant about locating any missing or forgotten coverage. Coverage Discovery allows providers to check for undisclosed coverage at every patient touchpoint. By quickly uncovering previously unidentified coverage, bills will be cleared sooner with fewer write-offs to bad debt. This part of the RCM process is also a good time to help patients plan for their financial obligations. Patient Payment Estimates gives patients accurate estimates and links to financial assistance and easy payment methods, straight to their mobile device. With the right data and digital tools, providers can deliver a transparent, compassionate and convenient patient payment experience that encourages payment earlier in the revenue cycle and supports a healthy cash flow. Step 3: Data entry With RCM processes relying on data like never before, maintaining accuracy is paramount. Providers must be able to verify and protect patient identities to ensure the right information is linked with the right patient. Accurate data entry decreases the costs associated with medical billing errors, and improves interoperability as more patient data is created, collected and shared. A digital patient identification solution can build a single, accurate view of each patient, using a unique patient identifier to hold the information together like a golden thread. Automated patient enrollment using PreciseID® allows existing data to be auto-filled, while tools such as Universal Identity Manager maintains data in an interoperable format, to further protect against errors. Step 4: Prior authorizations Before treatment begins, providers must determine if prior authorizations are needed. If so, they must submit a request to the payer. Without prior authorizations, providers may see their claims denied, which increases costs, causes time-consuming rework, and creates a stressful experience for patients. With online prior authorizations, providers are guided through a workflow that automates inquiries, status checks and submissions. It auto-fills payer data using real-time information about each payer’s prior authorization requirements, stored in Experian Health’s pre-authorization knowledgebase. Prompts for manual involvement ensure the process is as efficient as possible, to expedite treatment and secure timely payments. Step 5: Patient encounter At the time of treatment, information about the services a patient receives will be added to their patient record. This sets the stage for accurate coding and billing. To ensure no essential information is omitted, providers must keep up to date with regulatory changes. For example, the Appropriate Use Criteria program introduces new requirements for providers ordering diagnostic imaging services. Providers should examine their workflows in advance to avoid any costly compliance errors. The patient encounter is also an opportunity to double down on creating positive patient experiences, and to anticipate any potential RCM issues. Communicating clearly about any changes to medical bills and checking again for coverage will keep the revenue cycle moving. Providers may also consider incorporating data on the social determinants of health to support efficient discharge planning and prevent high-cost readmissions. Step 6: Charge posting In the next step of the healthcare revenue cycle flowchart, providers must submit the claims to the relevant payer using the appropriate charge posting or charge entry process. Documentation must include a detailed breakdown of all the services provided to the patient, alongside patient information, history and insurance or payment plan status. Again, getting every detail right will secure more timely payments that match the expected amounts. Step 7: Coding and billing Before patient billing gets underway, providers must check payer codes for the services that have been delivered. Payers use diagnostic (Dx) codes, place of service (POS) codes, current procedural terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and others to determine payable amounts. If codes are not inputted correctly, claims are likely to be denied. Automated claims management software can check that every claim is clean and error-free before being submitted. Experian Health’s claims management software incorporates standard government and commercial payer’s global edits as well as client-specific customized edits so providers can submit claims with confidence. J. Scott Milne, Senior Director of Product Management at Experian Health, says providers can leverage tools such as Claim Scrubber and ClaimSource to automate and prioritize claims to maximize reimbursement: “Both of these solutions are focused on the most important revenue cycle goal – to submit the claim correctly the first time. With the combination of Claim Scrubber and ClaimSource, healthcare organizations give themselves the opportunity to decrease denial rates, increase cash flow and decrease the overall accounts receivables.” Step 8: Claims management After the claim has been filed, the payer’s claims adjudication process begins. Payers will check eligibility, benefits, coding and contract rules to determine their financial responsibility. They may decide to pay in full, pay a partial amount, or deny the claim, with the reasoning set out in an Explanation of Benefits (EOB) statement. If the claim is denied, the provider needs to decide if it’s worth reworking and resubmitting the claim. Rework is expensive and time-consuming, so many providers use a healthcare clearinghouse to check claims before they’re submitted. Providers may also consider using a tool like Enhanced Claim Status, which submits automated status requests based on payers’ individual timelines, and provides responses that include the payer’s proprietary codes and descriptions. This facilitates early intervention into claims that are flagged for denial, which improves productivity and faster reimbursements. Providers also get detailed denial analysis and monitoring reports to pinpoint the root cause of denials, so they can be fixed promptly. Step 9: Payer Contract Management The complexity and volume of payer contracts can leave providers with little negotiating power when it comes to querying and collecting underpayments and delays. Providers need robust processes to audit payer performance and keep track of changing payer requirements to ensure timely reimbursements. Experian Health’s Contract Manager helps providers stay on top of changes to payer payment policies, identify patterns of non-reimbursement, and appeal denials in the most effective way. It identifies inconsistencies between pricing claims and paid amounts, so providers avoid missed revenue opportunities. Positive provider-payer relationships make the revenue cycle management process easier for everyone. With reliable contract management tools, communication and two-way accountability are much more effective. Step 10: Patient Billing and Collections The final step in the healthcare revenue cycle management flow chart is to bill patients for the remaining amount they owe. Balances are collected by in-house collections teams or outside collections agencies. Revenue cycle management software makes this process smoother and more efficient. For example, Patient Financial Clearance assigns each patient to the appropriate financial pathway based on their individual circumstances, while Collections Optimization Manager can be used to build custom segmentation models and workflows. That way, resources can be focused on the accounts most likely to yield revenue. Then, once the patient’s bill has been issued, collections software can be used to create a compassionate and convenient payment experience and complete the revenue cycle. Find out more about how Experian Health’s Revenue Cycle Management Solutions help healthcare organizations deliver outstanding patient financial experiences, optimize RCM workflows and increase cash flow.

Navigating an increasingly complex reimbursement landscape remains challenging for today’s healthcare providers, with too many claims still underpaid, delayed or outright denied. In fact, nearly 70% of providers said the problem of denied claims had worsened during 2021. Naturally, relationships with payers suffer, adding friction to the process. To this end, revenue cycle leaders are relying on claims management software to create more visibility into complex contract and claims management processes. These data tools can resolve or prevent the snags that often interfere with claims processing and billing workflows, which allow providers to streamline claims processing, improve communication with payers and accelerate a patient’s payment lifecycle. The path through that bureaucratic jungle requires high-quality information at every step. Accurate patient data, error-free clinical documentation, up-to-the-minute payer policy updates, and verified billing software and claims edits are all essential to help reduce denials and ensure faster-flowing payments.  With so many options on the market, providers should look for healthcare claims management software that provides support in four critical areas. 1. Simplified contract management Managing and understanding the tangled web of payer contracts, insurance rules and regulations can be time-consuming and overly complex. Keeping up with ever-changing reimbursement methodologies is resource-intensive for teams that are already suffering from staffing shortages. A system like Contract Manager and Contract Analysis can ease the pressure by streamlining workflows and showing revenue cycle management teams how payers are performing against agreed-upon terms. Contract Analysis seamlessly integrates with Contract Manager to provide all the data needed to make informed decisions about whether potential contract terms are in line with business goals – before any commitments are made. 2. Claims management software should help with error-free claims submissions In a perfect world, all claims would be completely accurate every time. But errors inevitably do creep in, leading to confusion, delays, and non-payments. Healthcare providers lose massive sums of money each year due to inaccurate claim submissions, denials, corrections, and rebilling. A good claims management strategy ensures that claims are error-free before they’re submitted. Claim Scrubber is an automated solution that reviews every line of each pre-claim and verifies that it is coded with the correct information before being sent to your claim’s clearinghouse. The result? Fewer undercharges and denials, optimized staff time and better cash flow. 3. Visibility of submitted claims With multiple steps, stakeholders, and milestones, keeping track of what’s happening with a claim can be cumbersome. Regardless of the workplace setting – individual hospital, large physician practice or a multi-facility Centralized Business Office – revenue cycle leaders need streamlined workflows, custom provider and payer edits, and superb customer support. ClaimSource is a solution that ensures all hospital and physician claims are clean before submission to government or commercial payers and creates custom workflows for easy prioritization and organization. With ClaimSource, providers can manage the entire claims cycle, from eligibility validation, claims editing, claims submission to the payers, claim submission reconciliation, remit retrieval, and reporting, in a single online application. 4. Claims management software should help prevent claims denials Denial rates vary widely between issuers. One 2020 study of HealthCare.gov issuers found that 1% to 57% of in-network claims were denied, while over 70% of major medical issuers had a claims denial rate of over 10%. Many reported denying one-third or more of all in-network claims. A tool such as Enhanced Claim Status makes it easy to respond early and accurately to denied, zero-pay, pending or returned-to-provider transactions before the Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) get processed. By removing the need for manual follow-up tasks and automatically submitting status updates based on each payer’s adjudication timeframe, providers can improve productivity and get paid the correct amounts faster. The claims management process is fraught with challenges. But with the right tools, data and analytics, these hurdles can be overcome. By integrating pre-claim (encounters) and post-claim (837) claims management software into the revenue cycle workflow, it's easy to review every line of every encounter. In this way, providers can verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement. Simply getting paid may not yet be as easy as providers would prefer, but technologies like Contract Manager and Contract Analysis, with their reliable customer support, can certainly oil the wheels. Find out more about how Experian Health’s Claims Management solutions with global payer edits and custom provider edits can help providers streamline the payment process and improve efficiencies, simplify the process and ensure speedy and accurate reimbursements.

The Appropriate Use Criteria (AUC) program is due to come into full effect in January 2023 at the earliest. The program was established by the Centers for Medicare and Medicaid Services (CMS) to help providers order the most appropriate diagnostic imaging services. Failure to comply may result in claims denials. Any provider that offers these services to Medicare beneficiaries should amend their clinical and revenue cycle workflows now, to avoid payment penalties when the AUC testing period comes to an end. This article sets out what providers can do to learn, test and prepare for the AUC program, and what Experian Health is doing to help healthcare providers manage these changes and minimize the risk of denied claims. What is the Appropriate Use Criteria program? The AUC program was created through the Protecting Access to Medicare Act of 2014 to help ensure that diagnostic imaging services would only be provided where medically necessary. No one would argue against evidence-based care. However, accessing that evidence can be challenging. Easy-access online tools are intended to make this easier. They have also been shown to reduce the overutilization of high-risk, high-cost imaging services. Under the program, any time a physician (or a member of their clinical staff) wants to order imaging services such as magnetic resonance imaging (MRI) or computed tomography (CT) for certain Medicare patients, they’ll need to consult an electronic Clinical Decision Support Mechanism (CDSM). This is especially important in an academic teaching environment. This online portal will check the patient’s electronic health record (EHR) and determine whether the order adheres to AUC or not, or whether the AUC consulted was not applicable. After consulting the CDSM, the ordering physician will need to include the following data on the order they send to the imaging services provider: the CDSM they consulted the ordering provider’s National Provider Identifier whether the service adhered to the applicable AUC or not, or whether no criteria in the CDSM were applicable to the patient’s clinical situation. Any ordering professionals deemed to be outliers will be required to seek prior authorization. When the program is fully implemented, imaging service providers will need to ensure they have a certificate of compliance to secure reimbursement. Who will be affected by the AUC program? The program applies to any provider that orders advanced diagnostic imaging services that are delivered in physician’s offices, hospital outpatient departments, ambulatory surgical centers (ASCs) or independent diagnostic testing facilities. It applies to those that are paid under the Medicare physician fee schedule, hospital outpatient prospective payment system or ASC payment system. It does not apply to Medicare Advantage beneficiaries. Emergencies, inpatient services and certain hardship exceptions are exempt. If any of these exceptions apply, the ordering physician must record them on the claim using the appropriate modifier code. When do providers need to implement it? CMS confirmed that there will be no payment consequences for failing to include AUC data until the later of January 2023 or the declared end of the COVID-19 public health emergency. In the meantime, providers are encouraged to implement the program on a voluntary basis, which will help identify pinch points in the claims management workflow. Claims submitted before full implementation may still be subject to denial, so it’s worth getting the process right now to avoid unnecessary rework later. How can providers “learn, test and prepare” for the AUC program? Healthcare organizations that may be affected by the AUC mandate should consider the following actions to ensure they are fully prepared by the time the program is fully implemented: Check the AUC program requirements and identify which service lines and vendors will be affected. Choose an appropriate Medicare-approved CDSM that closely matches existing EHR and claims management processes. Most EHR vendors will recommend a CDSM that fits seamlessly with their solution. CMS has also provided a list of certified CDSMs, which includes free options. However, these operate as stand-alone systems that will be more challenging to integrate with existing workflows. Communicate changes to staff. Ensure all referring and rendering providers are aware of and trained on the requirements and encourage dialogue to clarify new ways of working. Consider the impact on claims management teams, and ensure staff are trained on the new requirements. Healthcare Common Procedure Coding System G-codes and modifiers must be reported in claims alongside primary and secondary diagnosis and procedure codes. Are staff aware of the new codes? Are additional staff needed to process claims and potential rework that may be required after the AUC program is implemented? Build in time for review, to check that new processes are compliant. Ideally, the CDSM solution will include reporting functions to monitor progress and identify potential outliers that may be subject to prior authorizations later. If the furnishing provider is different from the ordering provider, the furnishing provider should have a workflow to confirm AUC adherence. How can digital tools and automation help providers ensure compliance with Appropriate Use Criteria? While the goal of the AUC program is to improve patient care and help manage the cost to the public purse, there will be an administrative burden for staff. The growing volume and complexity of claims overrule any attempt to manage this manually. Instead, healthcare organizations should look at automating the compliance process to ensure accuracy, prevent denied claims and reduce staff costs. To help healthcare providers manage these changes, Experian Health enhanced the Medical Necessity application to generate informational alerts when a procedure needs to adhere to AUC or prior authorization for Medicare patients. Users will be able to use this alert as a sign to check the AUC has been adhered to. These tools also fit well with Claim Scrubber, which reviews every line of each claim to verify that it’s coded correctly and isn’t missing any vital information, before being submitted. Claim Scrubber has also been enhanced to incorporate billing modifiers that will help with overall compliance requirements under the AUC rules. Preparing for what’s to come Access to medically necessary services is at the heart of evidence-based care. However, in promoting this, the Appropriate Use Criteria program creates additional tasks for staff that need to be understood and managed efficiently. While there are currently no penalties for non-compliance, providers should use the testing period to proactively implement new processes to determine their efficacy. As healthcare regulation continues to evolve, healthcare organizations should take a holistic approach to the exchange of information between clinical decision-makers, service providers and payers to lay the groundwork for consistent, accurate and reliable claims. Find out more about how Experian Health’s Medical Necessity and Claim Scrubber solutions support the claims management process and help healthcare organizations adhere to the Appropriate Use Criteria program.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.