Tag: Collections Optimization Manager

Key takeaways: Healthcare organizations are facing growing levels of bad debt and a sharp decline in collections. Propensity-to-pay models that utilize machine learning and robust data offer insight into a patient's likelihood to pay and allow staff to focus their collections efforts where they matter most. In 2024, Experian Health clients that implemented Collections Optimization Manager saw a 10:1 ROI. Some clients, like Weill Cornell Medicine, have seen up to $15 million in recoveries. Healthcare organizations are facing a sharp decline in collections and an increase in bad ​​debt. Rising self-pay costs and more patients struggling to afford their medical bills are contributing factors. Inefficient collections practices, reliance on third-party agencies that don't utilize propensity to-pay scores and manual processes are also key contributors to this growing market problem. Providers who adopt propensity-to-pay models that use data and automation to forecast the likelihood of payment often see both improved revenue recovery and patient satisfaction. Here's what to know about propensity-to-pay collections strategies in healthcare. Why propensity to pay matters in healthcare collections "Propensity to pay" is a data-driven model that identifies patient populations with the greatest likelihood of paying, to enhance existing collection strategies. When billing teams better understand a patient's propensity to pay, they can easily prioritize outreach and allocate collections resources effectively. This eases their workload, as they can focus their efforts where they'll have the greatest impact, and on accounts with the highest probability of payment. Keeping more collections in-house also reduces the reliance on expensive third-party agencies, while eliminating wasted effort on low-yield tasks – like repeated phone calls or mailed statements to accounts unlikely to pay. The need to adopt propensity-to-pay models has grown in recent years as patient volumes and the cost of care continue to grow. In the last 20 years, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to American Hospital Association data.American Hospital Association Rising healthcare costs and the newly enacted "One Big Beautiful Bill Act" are expected to shift even more financial responsibility to both hospitals and ​​patients. Unfortunately, many organizations still rely on inefficient collections processes, third-party agencies and medical billing practices that lack propensity-to-pay insights. The result? Disruptions to the entire revenue cycle, including lost patient revenue, wasted resource hours, increased costs to collect, and high vendor costs. Using outdated collections strategies also contributes to patient dissatisfaction and churn, causing even more revenue leaks. Why healthcare providers need propensity-to-pay analytics Limited staff capacity and high volumes of self-pay accounts further compound collections challenges for organizations that have yet to adopt propensity-to-pay analytics. As collections timelines drag out, providers can be left with cash flow issues, revenue losses and bad debt. This ultimately disrupts the revenue cycle and affects the quality of patient care – and the entire patient experience. By leveraging propensity-to-pay analytics, revenue cycle leaders can boost revenue cycle predictability and streamline collections efforts. Listen in as Weill Cornell Medicine and Experian Health discuss how a smarter collections strategy 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 > How propensity-to-pay models work in practice Propensity-to-pay models screen and segment patient accounts based on the likelihood of payment. Segmented accounts receive a propensity-to-pay score – from 1 to 5, with 1 being the highest likelihood to pay — and are then transferred to appropriate reconciliation channels. Experian Health's solution, Collections Optimization Manager, leverages machine learning, predictive analytics and data sources – like credit, behaviour and demographics – to identify which patient accounts have the highest likelihood to pay. It also automatically screens patient data for deceased, bankruptcy, Medicaid and ​​charity. Patient accounts are then sorted into pay groups through data-driven segmentation. This allows busy collections staff to quickly clean up accounts receivable and put their focus where it matters most – patient accounts with the strongest chance of paying their bill. With a clear picture of a patient's financial situation, healthcare organizations can improve patient communication and further boost collections efforts to maximize revenue. High-propensity accounts may receive light-touch reminders, like less frequent bill reminders. At the same time, alternative financial assistance, such as charity care or payment plans, can be made available automatically to low-propensity patients. Benefits of using propensity-to-pay models Propensity-to-pay models, like Experian Health's Collections Optimization Manager solution, offer numerous benefits to organizations that strengthen the revenue cycle. Higher collections rates: Using a propensity-to-pay model makes AR more manageable, especially for high-patient-volume organizations. Complimentary tools, like Experian Health's PatientDial and PatientText, easily send self-pay options via voice or text message, boosting patient engagement and building trust. Reduced bad debt: Propensity-to-pay models help identify patients with a low likelihood of paying their medical bills. Lower collections costs: Chasing payments on accounts that are deceased, bankrupt, or eligible for Medicaid or charity wastes valuable resources. With propensity-to-pay models, busy staff can efficiently work on high-yield accounts in-house, reducing the number of accounts that need to go to third-party vendors. Faster cash flow: Prioritize likely-to-pay patients early and shorten payment cycles, which can improve revenue cycle predictability.  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.  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. Implementing propensity-to-pay analytics: Best practices Healthcare organizations that implement propensity-to-pay analytics should consider the following best practices:  Choose the right partner. Look for a technology partner, like Experian Health, with extensive data assets and healthcare expertise. Automate patient communication. Reduce overhead and increase collections efforts with automated patient communication strategies. Ensure alignment with legacy technology. For real-time accuracy, choose a solution that integrates seamlessly with existing EHR and billing systems. Train billing staff. Provide comprehensive training to billing and collections teams on propensity-to-pay scores and how to communicate payment options with empathy. Automate the agency management. Reduce the manual workload of auditing agency remittances by automating the reconciliation process. Monitoring patient accounts. Look for a solution that regularly scans for changes or updates in a patient's ability to pay or contact information. Track performance. Monitor key performance indicators to fine-tune the collections process over time and improve forecasting. How Experian Health's solutions support better collections Changing longstanding collections practices is often a significant investment. Yet, the cost of inaction is often greater. Experian Health's Collections Optimization Manager uses propensity-to-pay models, driven by machine learning, and data-driven workflows to help healthcare providers improve patient collections. Our comprehensive industry-leading solution offers a smarter and faster way to collect patient payments, and Experian Health's experienced consultants are there every step of the way, as collections needs shift. 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

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

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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Missed payments, delayed reimbursements and rising debt are often symptoms of a struggling financial clearance process. According to Experian Health's State of Patient Access survey, more than six in ten patients say they'd feel more confident about covering their portion of healthcare costs if offered a payment plan. Still, many remain unaware of financial assistance that could further ease their financial burden. Automating financial clearance helps get patients on the right financial pathway as quickly as possible, resulting in streamlined collections and a better patient experience. In a recent on-demand webinar, Brandon Burnett, VP, Revenue Cycle at Community Health System, shared how his organization is using Patient Financial Clearance (PFC) for financial assistance automation, and to increase efficiency throughout the revenue cycle. By using Experian Health's data to quickly identify charity care eligibility and generate appropriate payment plans, they've been able to increase the amount covered by charity care by 30% and reduce bad debt without any additional staff. This article summarizes the key takeaways. Why automate patient financial clearance? Kim Berg, Director of Product Consulting and Optimization at Experian Health, set the scene by explaining how Patient Financial Clearance helps healthcare organizations assess patients' financial capacity and guide them accordingly. Using data like estimated income, spending habits and household size, the tool calculates Federal Poverty Level (FPL) percentages and assigns propensity-to-pay scores, so providers have a more realistic idea about what patients can afford. “We're not collecting pay stubs or tax returns,” Berg said. “We're using aggregated consumer data to estimate income and figure out the patient's ability and propensity to pay.” With this, health systems can quickly identify charity care eligibility and offer customized, affordable payment plans. “It's about understanding a patient's ability to pay and guiding them down the right financial path.” Using data to support state regulation compliance and automate financial clearance processes Rising healthcare costs and uncompensated care are the main motivations for improving presumptive charity screening. Berg noted that changes in state regulations add pressure, introducing additional checks for charity care eligibility before patients are sent to collections. “We're seeing more states passing legislation that introduces some kind of charity requirement,” she said. “We can provide the data to help prioritize those patients sooner in the process and work with you one-on-one to understand how the data can help you comply with state requirements.” Burnett said that automating presumptive charity screening with Patient Financial Clearance has helped his organization manage these changes, including California AB-1020. “We're using Experian's data to automate the decisions when patients apply. It means we don’t require any additional documentation or information.” It helps “move eligible patients out of accounts receivable and into charity approval faster.” Automating charity approvals to reduce manual work and bad debt Sharing a look inside Community Health System's financial clearance workflow, Burnett described how Patient Financial Clearance had led to a 30% increase in the amount approved in charity care compared to 2023, with no increase in bad debt. They comfortably handle an average of 1,400 applications each month, with only one to two full-time equivalent staff. “We've automated about 80-85% of our charity approvals,” he said. By integrating PFC data with Epic, the system automatically identifies charity-eligible patients and processes adjustments without staff intervention. “The adjustments happen automatically, the letters are generated, and nobody has to touch it. That's a huge efficiency gain for our charity team, because it's exception-based now,” he said. Finding additional efficiencies throughout the revenue cycle While Community Health System is also using Experian Health's Collections Optimization Manager to automate collections, they've also integrated PFC data into their broader collections workflow. “Using Collections Optimization Manager, we can identify patients through their propensity to pay, their presumptive FPL, and if they look like they would be approved for one of our financial assistance programs,” said Burnett. “We're also screening for bankruptcy and scrubbing to see if patients are deceased. So beyond PFC, Collections Optimization Manager is a great way to continue to leverage that data throughout your collection cycle.” He highlighted that Experian's support had helped them get even more out of automation. “Experian will come on-site and walk through the workflows. You don't always know what other organizations are doing or what's possible, so having that consultative approach has been so helpful.” These reviews helped uncover further opportunities to use PFC data, resulting in hundreds of staff hours saved. “We weren't even looking at these extra benefits at first,” Burnett said. “Experian pointed out that we could use the same data to automate more processes, and it ended up saving us hundreds of hours of staff time. That wasn't something we expected, but it's already paid for itself.” Using Patient Financial Clearance to improve patient experiences with self-service For Berg, two particular benefits of Patient Financial Clearance are worth highlighting for their impact on the patient experience. Firstly, it paves the way for more compassionate payment discussions with patients, by giving financial counselors a more complete picture of the patient's financial situation. “You can prioritize financial counselors' work queues to focus on certain patients first, because they're most likely to qualify for Medicaid or charity. You can offer estimates, and make sure patients understand their responsibility and their options,” she says. “If you understand your self-pay population sooner, you can guide them to the right path and free up more time. There's a lot of cost savings and resource savings downstream.” Secondly, Berg points out that many patients prefer to manage their financial assistance applications digitally, without recourse to a financial counsellor. “A lot of people want to handle everything on their mobile device or through a website,” she says. The recent State of Patient Access survey found that 56% of patients want more digital options for managing healthcare, while 67% want to be able to apply for financial assistance online. To support this, many Experian Health clients are using PFC's self-service options to allow patients to complete applications on their own, whenever and wherever it is most convenient. These include: Mobile links are sent via text message, with the option to submit an application through eCare NEXT® Websites and patient portals, where patients can apply and upload documents online. Offering these digital options meets patients' demand for more control over their financial journey, while reducing manual work for staff. “A great way to leverage data throughout the collections cycle” Community Health System's experience shows how automating financial assistance delivers value throughout the revenue cycle. Patient Financial Clearance helped accelerate and increase charity care approvals, reduce the administrative load for staff and lower bad debt, while ensuring patients receive the support they need. With a clearer understanding of each patient's financial capacity, Community Health System can proactively guide patients to the right pathway, making financial assistance more accessible and reducing friction when it comes to payments. The hidden benefits of using the same data to streamline collections are a strategic advantage for efficiency-conscious providers. As costs and complexities continue to trend upwards, data-driven automation is an increasingly useful way to improve financial health for both providers and patients. Learn more about how Patient Financial Clearance uses data to help healthcare organizations implement financial assistance automation, to improve patient satisfaction and increase collections. Learn more Watch the webinar

A positive patient experience can quickly sour when difficult financial conversations enter the picture. High out-of-pocket costs and confusing medical bills make payments a sensitive issue for many patients. For providers, the challenge is clear: how to improve patient collections while delivering compassionate care. This article considers proven strategies and best practices to simplify patient collections, maximize revenue, and keep the focus on patient-centered care. The importance of optimizing patient collections for healthcare providers For many patients, an unforeseen medical emergency can quickly become a financial one. According to a 2024 report by the Consumer Financial Protection Bureau, medical debt rose from an average of $2,000 per person to over $3,100 in a year, while 15 million Americans carry medical collections on their credit reports. Such financial strain erodes the patient experience, with one in five patients experiencing distress over healthcare costs they can't afford. Experian Health's State of Patient Access 2024 survey found that both patients and providers agree that understanding coverage helps patients manage their healthcare costs. Still, unpaid bills and aging accounts are a persistent concern for providers. Hospitals' operating margins may have rebounded, but remain extremely tight. Remaining alert to risks and opportunities in patient collections is essential for long-term financial health. As patients shoulder a greater share of their medical costs—and those costs continue to rise—efficient collections are critical for patient trust and financial resilience. Breaking down the patient collections process The patient collections process involves determining how much of the cost of care falls to the patient, and then billing and collecting the correct amounts. During registration, providers verify insurance coverage and eligibility to estimate what the insurer will cover. Accurate cost estimates can then be provided to patients upfront, giving them the option to make payments before or at the time of service. The bulk of billing and collections activities take place post-visit, sometimes involving third-party agencies. However, collections can be thwarted by several challenges. Staff must keep up with frequent changes in insurance policies to prevent errors in billing or cost calculations. Patients may worry about affordability, leading to late payments. Billing teams often lack information about patients' financial circumstances, making it hard to predict how likely they are to pay. On top of this, many patients expect more convenient payment options, such as online or mobile payment methods, and will express frustration if the process feels inconvenient. Proven strategies to collect more revenue, sooner Three ways to create a patient-friendly billing experience and ensure prompt payment include the following: 1. Reduce stress with clear pricing and flexible payment plans Patients want collections processes to be clearer and more transparent. The State of Patient Access survey found that more than four in ten patients say they would be more likely to cancel or postpone care without an accurate estimate. Six in ten say they'd be more confident in their ability to pay for care if they were offered a payment plan that took account of their financial situation. Automated patient estimates arm patients with accurate information about the expected cost of care in advance. They have more time to make their financial arrangements and are less likely to be surprised by a surprise bill. Providers can offer additional clarity and flexibility through tailored payment plans. Experian Health's Collections Optimization software uses advanced analytics and data to analyze individual patient accounts and determine their ability to pay. Patient Financial Clearance takes this a step further by helping providers run their presumptive charity process, which estimates a patients' Federal Poverty Level percentage (FPL%), to identify those who qualify for greater financial assistance. These solutions support more compassionate financial conversations, as staff can adjust their approach to suit each patient's financial situation. 2. Help patients find and understand coverage Relying on manual processes can slow down registration and miss potential payment sources. Since 2000, unidentified coverage opportunities have landed hospitals with more than $745 billion in uncompensated care. Given that patients are asking for help understanding coverage, it makes sense to build coverage discovery into the collections process. Experian Health's Coverage Discovery® automatically scans patient accounts throughout their care journey to uncover alternative payment methods and reduce financial strain. This has helped healthcare organizations like Luminis Health identify over $240k in active coverage per month, greatly reducing the financial risk for patients and providers. 3. Make payments easier to prevent delays Improving patient collections processes will be fruitless if patients can't easily make payments. Digital and mobile payment options are non-negotiable for today's digital-first consumers. Accepting payments at multiple collection points, including mobile devices, kiosks and patient portals, gives patients the convenience and choice they need to pay promptly. Best practices for patient collections management Aside from automation and digital tools, the strongest strategies for improving patient collections rest on one key ingredient: robust data. Collections software is only as good as the data behind it. With a tool like Collections Optimization Manager, providers can deploy advanced analytics to segment patient accounts so they can be handled appropriately. Using credit, behavior and demographic data, it applies a proprietary propensity-to-pay score to each account, so staff know which accounts to prioritize, write off or refer out. This approach has helped organizations like Novant Health and Cone Health bring in millions of dollars with personalized, patient-centric collections. On-demand webinar: Hear how Novant Health and Cone Health achieved 7:1 ROI and $14 million in patient collections with Collections Optimization Manager. Tracking patient collections success By monitoring key performance indicators like collection rates, accounts receivable days and patient feedback, providers can continue to fine-tune their processes. Collections Optimization Manager captures this data in user-friendly dashboards and reports, so staff can assess their performance against their own history and industry trends. Users also benefit from expert support from Experian Health consultants, who help teams evaluate reports and recommend the right collections strategies every step of the way. How to build a patient collection strategy that gets results For millions of Americans, medical debt isn't just a financial burden: it's a barrier to care. To overcome this challenge, providers need proactive collections strategies that prioritize patient well-being and financial stability. By incorporating automation, analytics, and digital tools, healthcare organizations can create patient collections processes that are clear, compassionate and effective, delivering better outcomes for both patients and providers. Find out more about how Experian Health's suite of healthcare collections products helps providers boost collections, cash flow and patient satisfaction. Learn more Contact us

“Our call strategies did not yield the desired outcomes, and we recognized the need for additional data to better support our goal. We were also mindful of the potential risk of staff burnout and the impact it could have on overall performance.”—Carey Lawrence, Revenue Cycle Administrator Customer Service and Self-Pay Collections, Weill Cornell Medicine Challenge Weill Cornell Medicine is a leading medical school and research institution with $1.3 billion in annual patient revenue. Facing $42 million in annual bad debt and rising call center demands, Weill Cornell needed to upgrade their collections strategy. Staff lacked real-time insights into patients' propensity to pay and often resorted to calling most patients — a frustrating and inefficient process. They needed a better way to verify insurance coverage, understand patient payment history and determine eligibility for Medicaid eligibility, charity care or other financial assistance. The company had three specific objectives: Increase net revenue by improving self-pay collections through better segmentation and prioritization. Optimize call center operations through automation and better communication with patients. Select the right partner with expertise to provide technical solutions, consultative guidance and process improvements. Solution Weill Cornell turned to Experian Health's Collections Optimization Manager to increase cash collections with smarter segmentation. The partnership provided access to dedicated support from an analytics consulting manager at Experian Health. Together, they used Collections Optimization Manager to create a more targeted collections strategy, and to automatically segment patient accounts based on propensity-to-pay scores. This allowed staff to focus on high-value accounts and stop wasting time on uncollectible accounts. They were able to use Collections Optimization to screen out accounts that weren't deemed collectible, such as accounts for deceased patients, those in bankruptcy, or those eligible for Medicaid or charity care. Access to better data also reduced manual workloads. Validating the database with their existing Epic data also helped catch and correct some missteps. “We were able to eliminate skip tracing, for example, because Experian's extensive data sources ensure our mailing addresses are up to date,” says Lawrence. To improve call center efficiency and deliver a more compassionate payment experience, Weill Cornell also implemented PatientDial, an automated dialer that uses the segmentation data from Collections Optimization Manager, to run targeted outbound patient call campaigns. The initial implementation of automated dialer campaigns increased net collections from 65% to 83%. Outcome Thanks to Collections Optimization Manager and PatientDial, Weill Cornell saw a 7:6:1 return on investment and achieved the following results: $15M collected in pending patient payments $7M reduction in annual bad debt placements 92% of recoveries trending at Champion Benchmarks Automating call campaigns also led to a noticeable improvement in staff morale. Lawrence observes that “staff are more satisfied with the new, automated processes because they can be more productive and don't have to guess at which accounts to call or when. Our operations are flowing more smoothly which decreases all our stress levels.” Lawrence also notes the power of good data: “The detailed, customized reports on our bad debt helped us identify issues early, allowing us to target collections more effectively. We reduced the number of accounts sent to agencies, ultimately saving time and money.” Looking ahead, Weill Cornell plans to explore new ways to use automation to improve management of Medicaid eligibility, presumptive charity and agency reconciliation. Discover how Collections Optimization Manager and PatientDial can streamline your collections process, enable higher collections rates and improve patient communications. Learn more Contact us

Collecting patient payments is an ongoing struggle. Bills are confusing, reminders go missed and patients can't always afford to pay. Rising self-pay costs, new medical debt mitigation regulations, Medicaid changes and staff shortages all put added pressure on billing teams. The result is often poor patient financial experiences, wasted staff time and bad debt. As revenue cycle managers figure out a path forward in today's complex – and costly – healthcare environment, analytics-based collections optimization could be the answer. Solutions like Collection Optimization Manager help providers quickly understand a patient's ability and willingness to pay with screening and segmentation models, identify charity eligibility and implement effective patient billing outreach plans. This article summarizes a recent webinar with two longtime users, Wendi Cardwell of Novant Health and Wanda Taylor of Cone Health, who have successfully partnered with Experian Health to streamline collections, increase self-pay revenue and humanize patient financial experiences through segmentation and automation. How collections optimization boosts revenue Cari Cesaro-Hoffman, Senior Director–Enterprise Consultant for Collections Optimization Manager at Experian Health, set the stage with observations on how collections optimization solutions, like segmentation and automation, help providers maximize collections and engage patients compassionately. “Segmentation is the driver of successful patient billing cycles. It guides the team to focus on collections with those patients or guarantors with a higher likelihood to pay while helping to create patient-centric, positive patient financial experiences. Automation and customized operational processes embedded within collections optimization enhance the process even further.” Having the right collections optimization partner is critical. Both Cardwell and Taylor agree that Experian Health's unique consultative approach and comprehensive technology have been key to their success. The technology integrates seamlessly with account receivable data, helps streamline collections processes and allows for quick pivots to meet ongoing regulation changes — all while adding humanization to the revenue cycle. How to optimize collections with patient-centric insights In collections optimization, segmentation and automation allow healthcare organizations to evolve their payment collection strategies to keep up with rising healthcare costs, meet new industry regulations and drive more self-pay revenue. By using sophisticated, patient-centric insights, providers can make informed decisions on which accounts to prioritize, write off or refer to collection agencies. Collections optimization solutions, like Experian Health's Collection Optimization Manager, use multiple data sources to automatically screen and segment accounts based on propensity-to-pay scores. With a better understanding of each patient's financial situation, staff can prioritize high-value accounts and increase collections revenue. Experian Health's collections consultants provide ongoing support and expert advice, while advanced reporting allows revenue cycle managers to easily benchmark performance, refine patient payment forecasts and manage bad debt. Patient collections processes can be further optimized by integrating complementary financial screening and patient engagement tools, like Patient Financial Clearance, PatientDial and PatientText. Key takeaways from 2 real-world examples of successful collection optimization Cardwell and Taylor share how they are using collections optimization to boost revenue in today's increasingly high-cost healthcare environment. Below are the key takeaways from their conversation about how segmentation and automation are helping streamline collections, improve the patient experience and meet ever-evolving regulations. Segmentation and automation improve collections performance Segmentation and automation drive the patient billing cycle and enhance collection efforts – especially for self-pay collections. With the help of Experian Health's Collections Optimization Manager, Novant Health and Cone Health are able to quickly identify those patients likely to pay their bills and implement patient-first collection strategies. Cardwell shares how segmentation helps personalize the patient collections experience. "If patients have a high propensity to pay their bill and it's a low balance, like $300, they may not need a call quite yet since they may immediately make a payment when they get their bill. But if it's a high propensity to pay their bill and it's $3,000, they may be sitting at home wondering, 'How am I going to do this?' So, they just need that little nudge by someone calling and saying, 'Did you know we have payment plans that are interest-free? Let's help you get set up on that.'" Taylor agrees, "The automation is just remarkable for the ability to give our patients that white glove treatment and to be able to either contact them in some way, talk to people that want to talk to us or offer the automation that others want." Cardwell and Taylor also note that collections optimization helps their billing teams easily integrate charity care and financial assistance processes more closely with collections and revenue cycle workflows. This allows both organizations to quickly adapt to industry changes and new requirements, like medical debt mitigation regulations. Optimizing collections delivers real-world results The successful implementation of Collections Optimization Manager for Novant Health and Cone Health serves as a model for other healthcare organizations looking to improve their collections and revenue cycle performance. To date, Novant Health has seen an impressive ROI of 9.5/1 with a $16 million combined lift across hospital billing and provider billing, while Cone Health cleared $14M in patient payments and a 6:1 ROI. Additionally, Caldwell and Taylor both report saving valuable staff time and resources. Automating some of the screening processes and routing through bankruptcy, deceased and return mail has resulted in more than 3,000 manual hours saved between the two organizations. Caldwell says working with Experian Health reduces IT hours, especially for organizations that outsource IT like Novant Health. For example, “If you decide you no longer need to use a particular vendor partner and need to send data to another vendor partner, Experian Health can quickly make that flip for you.” Successful automated call campaigns driven by segmentation have been another win. Taylor describes using segmentation to efficiently “run unattended call campaigns that push calls out to patients with payment plan reminders.” Caldwell agrees, and shares that Novant Health has seen similar successes with collections call campaigns. Novant Health is using the data to run automated Medicaid enrollment call campaigns and is “looking into doing mother-baby” call campaigns to remind new moms to enroll their newborns for insurance coverage. Choosing the right collections optimization partner matters For providers looking to evolve their collections strategies, both Cardwell and Taylor stress the value of working with a collections optimization partner that offers turnkey solutions for a positive patient financial experience, seamless data integration and up-to-the-minute regulatory knowledge. Cone Health first adopted Coverage Discovery® and ClaimSource® before adding Collections Optimization Manager and Taylor says, “It just came together seamlessly. We've successfully evolved those products into a multi-item suite of information that is seamless in passing information back and forth. Experian Health also has their ear to what's happening at the state level and in federal and regulatory matters. So anytime there are new things coming down that impact our functionalities, they are coming to us with solutions to keep us cutting-edge.” Cardwell elaborates on how collections optimization helps Novant Health foster a human-centric financial experience. She says, “When we look at engaging our communities, Collections Optimization Manager has enabled us to do that effectively and efficiently, allowing us to deliver on our brand promise to care for our patients, each other and our communities.” The future of collections cycle management is here Healthcare organizations are already making strides to adopt collections optimization strategies that improve patient collection rates and boost self–pay collections. In today's fast-changing healthcare environment, it's critical for revenue cycle managers to evolve collections strategies to keep pace with patient needs and regulatory requirements. Working with a partner like Experian Health can help healthcare organizations better fulfill their financial goals, meet the needs of the patient population and deliver positive patient financial experiences. Find out more about how Collections Optimization Manager is changing the future of healthcare collections and watch the webinar to hear the full conversation on 'Boost self-pay collections: Novant Health & Cone Health's 7:1 ROI & $14M patient collections success.' Learn more Contact us

Improved automation and data-driven solutions are optimizing the patient collections process, even as providers face rising costs, shrinking reimbursements, looming changes to credit reporting, and an ongoing push toward greater efficiency. How do current solutions stack up against these challenges? Matt Hanas, Lead Product Manager at Experian Health, shares responses to some of the questions he's hearing from around the industry.  Q: Automation continues to be a buzzword in 2025, but what does it mean day-to-day for patient collections? What can automation do for healthcare providers and hospitals in 2025?  “Automation can mean many different things,” says Hanas. “It might mean saving on full-time employee hours or the number of clicks made by a user with an EHR like Epic. It could mean removing human intervention from a process, or trusting a vendor to deliver results without needing oversight.”  “When deployed correctly, automation will either reduce waste or increase profitability---or both,” he continues. “Imagine being able to export AR files out of an EHR on a daily basis. Those files trigger multiple processes that check for missed insurance coverage, bankruptcy filings, bad addresses and charity qualifications, to name a few possibilities. That information can be scored and segmented to drive hands-off dialer and text campaigns, with results delivered back to the EHR automatically and used to populate work lists and queues for staff to review—or, better yet, to create additional automation rules within the EHR to perform automated tasks like adjustments and write-offs.”  “Collections Optimization Manager has the proven ability to automate workflows. It's used at hospitals around the country to discover overlooked Medicaid coverage, apply charity write-offs, utilize interactive voice responses (IVR) to collect payments, send out text message payment reminders and more,” Hanas says. “These are all key drivers behind a profitable and efficient healthcare organization. Thousands of hours are being saved, while hospitals and providers achieve greater efficiency and profitability.”  Q: Can segmentation increase collections and boost patient satisfaction? How does the power of intuitive segmentation improve the patient collections process?  “For certain, failing to understand patients' individual needs is not a recipe for improving collections or increasing patient satisfaction,” says Hanas. Healthcare costs are rising, physician reimbursement is decreasing, and many consumers are feeling an economic squeeze. A 2024 survey by Commonwealth Fund found nearly half of respondents (48%) had skipped care, declined to fill a prescription, or decided against seeing a specialist because of cost. In this environment, segmentation can help providers develop a more responsive process, which may help to facilitate patient collections.  “When providers use detailed, comprehensive segmentation, they can implement specific contact strategies, payment plans or even automatic write-offs based on a patient's unique financial status,” says Hanas. “They can ensure that each patient has the right number of touches and can offer them a range of possible payment options.” For example, Patient Financial Clearance can connect eligible patients with financial assistance or charity.   “There are various data models used across the industry,” Hanas explains. “They group patients by credit data, payment history, demographics, geolocation, and a variety of other factors. What makes Experian Health segmentation so powerful is that it includes all of these factors. Having many types of data come together via algorithms and analytic models helps providers better understand their patients' financial factors, patient by patient. With properly deployed and utilized segmentation, collections can become a better-informed interaction between a patient and their provider that benefits both,” Hanas says.   Q: Outsourcing the patient collections process is standard practice, but do most providers really know how their agencies are performing? How can providers optimize these important relationships?  “Once providers have done the time-consuming research and picked an agency to partner with, their challenge is knowing whether those agencies are performing to standards,” Hanas says. “With thousands and thousands of accounts flying back and forth between the hospital and the agency (or agencies), monitoring performance manually would take an unimaginable amount of time.”  Experian Health has tools to automate the process. “Collections Optimization Manager has an offering built into it that monitors agency performance on multiple levels,” says Hanas. “It includes details [like] whether an agency's license has expired, or whether they've had a complaint or lawsuit filed against them. Because money collected is the true performance metric, it also compares account balances for each provider account against what the agency says they've collected. These results are then reported on dashboards, reports and scorecards, so providers get easily digestible information.”   Data also helps providers compare performance between agencies. “Clients are using performance metrics from Collections Optimization to line agencies up against each other and compare,” Hanas says. “This 'challenger' technique allows providers to see which agency is delivering superior performance,” and then these providers can ultimately make decisions on how to allocate business going forward.  Q: In addition to keeping up with operational challenges and technology, providers are navigating changes in the regulatory space. How are fast-evolving state regulations around financial assistance affecting collections strategies?  “More and more states are passing financial assistance-specific regulations,” says Hanas. “Illinois, Oregon, Minnesota, Maine, California, and North Carolina are just a few of the states that have enacted such laws, and each state has its own rules around how financial assistance should be approached. These regulations affect when action can be taken before sending statements to patients or sending accounts to collections."  “For example, in Maine, individuals who are eligible for charity care – defined as being at or below 150% of the federal poverty line (FPL) – may not have their bills sent to collections. For individuals over 150% FPL, nonprofit hospitals must wait at least 120 days after they send the first post-discharge bill before sending the bill to collections, by federal law,” Hanas explains.  “In New York, a bill can be sent to collections if the patient has been provided written notification of the financial assistance program within 30 days of the bill being referred to a collector,” Hanas says. “However, for a hospital to participate in New York's indigent care pool, a hospital cannot send a bill to collections if there is a pending financial assistance application.  “In New Jersey, an individual can only be sent to collections for amounts that are determined to be not eligible for charity care,” says Hanas. “A hospital must give applicants written notice informing them about charity care, Medicaid, or NJ FamilyCare, or refer them to a medical assistance program within three months of the date of service. If they don't, then the hospital cannot pursue collections.  “Because every state has different laws, it can be very cumbersome and time-consuming for providers to comply with these changes,” Hanas concludes. “Finding and implementing the tools needed to carry out these requirements can be a challenge.”  Q: How can the right tools help providers meet regulatory requirements without disrupting collections?   “One common theme among many of these regulations is for states to require providers to screen patients at the start of the patient care cycle to make sure they're offered the proper charity care and financial assistance options they may be eligible for,” says Hanas.   “Here's an example,” he continues. “On January 1, 2025, North Carolina enacted the Comprehensive Medical Debt Relief and Reform Incentive Program. The program focuses on two main aspects---providing medical debt relief for patients and helping them access financial assistance by focusing on their presumptive eligibility for charity care. To achieve this objective, hospitals will start to automatically qualify certain patients for charity care by looking at the patient’s FPL to make sure that discounts or full write-offs are applied to their medical services as appropriate.   “This is where a comprehensive end-to-end solution can be of great value,” Hanas notes. “It allows hospitals to obtain the data they need to proactively offer and provide charity care and financial assistance options based on each patient's FPL, which is derived from household income and household size.   “The Collections Optimization solution at Experian Health not only focuses on the collections part of the hospitals' workflows but the charity care part as well. Collections Optimization can return FPL scores for each patient so that these patients aren't being moved further down the patient care cycle and placed into the collections stream if they're eligible for financial assistance or charity care. As a result,” Hanas concludes, “patients are well-served by financial assistance programs, while providers are empowered to implement their programs effectively as they comply with changing state laws.”  Find out more about how Collections Optimization Manager helps providers adapt to constantly evolving challenges with the patient collections process.  Learn more Contact us