Tag: Collections Optimization Manager

Providers must adopt OBBBA preparation strategies and new technologies to brace for the impact of increased self-pay patients, who account for the highest percentage of bad-debt write-offs, as well as additional administrative and documentation requirements, such as stricter eligibility checks and reporting mandates.

Modern revenue cycle optimization leverages AI and automation to help healthcare organizations capture revenue and maintain a healthy cash flow. This article outlines proven strategies for streamlining operations across the revenue cycle — from patient access and collections to claims and payer contract management.

Propensity-to-pay models use predictive analytics to help healthcare organizations understand patient payment behavior. Learn how providers can leverage these tools to prioritize collections, improve cash flow and reduce bad debt.

Revenue cycle management (RCM) teams are facing a year of major change, with new regulations, tighter margins and the adoption of artificial intelligence (AI) increasing the pressure on workflows. This article outlines Experian Health’s five RCM predictions for 2026, along with tools to consider when building a resilient revenue cycle.

In this guide to healthcare revenue cycle management, learn how healthcare organizations can optimize the revenue cycle process at every stage of the patient journey to increase reimbursements and improve operational efficiency.

Propensity-to-pay models forecast which patients are likely to pay their bills, enabling smarter prioritization. By using data-driven automation, these tools help healthcare providers boost collections, reduce bad debt and improve overall revenue cycle efficiency.

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 on-demand 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

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

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. 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