Tag: Collections Optimization Manager

The ecosystem of healthcare revenue management involves the entire lifecycle of medical billing. It starts with patient scheduling to encounters, then moves to coding and medical billing. However, understanding the basics of medical billing isn't just for the back-office team: it's vital for front-office staff too, especially those dealing directly with patients. Many patients arrive with coverage from multiple payers and high deductibles, which makes claims and collections processes increasingly complex. Providers that get the billing basics right can deliver a better patient experience while setting themselves up for financial success. Discover the key steps in the medical billing cycle and learn how healthcare providers can improve efficiency, streamline collections, and increase profits from appointment scheduling to payment completion. What are medical billing basics? Medical billing is about ensuring providers get paid for the services they provide, whether that be submitting claims to payers or invoices to patients. The workflow may be broken down into three phases: Front-end medical billing: The process starts with patient intake and registration. During this process, staff collect relevant information about the patient, their coverage, and their diagnosis and treatment. They must know what payers require in terms of claims documentation so they can collect the right data upfront. At this time, staff will also inform patients of their financial responsibility, so patients are prepared for their upcoming bills, or can make payments before service.yr45 Back-end medical billing: This part of the cycle occurs after the encounter. Once it's documented, medical coders and billers use information obtained during registration to figure out who pays what toward the final bill. Coding rules and documentation requirements vary considerably, depending on payer type (commercial, government or self-pay) and individual payer policies, so many organizations use automation and artificial intelligence to increase medical billing accuracy and minimize denials. These tools also support the claims adjudication process. Patient collections: If there are any remaining balances after insurance reimbursement, healthcare organizations generate bills for patients. These detail the services provided, the amount already covered by insurance, and any outstanding balances owed by the patients. Increasing numbers of self-pay patients with high deductibles put new pressure on patient collections, and managing the workflow is challenging without technology, data and analytics. Healthcare organizations struggle to collect more than one-third of patient balances greater than $200, which makes understanding how to improve medical billing is essential. What’s the relationship between the medical billing revenue cycle, successful billing and patient collections? Within the medical billing revenue cycle, there are opportunities to maximize efficiency and accuracy, with tangible benefits for staff, patients, and those with an eye on profits. These opportunities rely on bridging the gaps between the three phases above with reliable data and integrated workflows. Some strategies and tools include: Find missing coverage: Proactively identifying billable government and commercial coverage is a huge relief for patients, who won't be billed for amounts that could be paid via alternative sources. Additionally, providers are more likely to be reimbursed. Coverage Discovery uses multiple proprietary databases to scan for missing or forgotten coverage throughout the patient journey. In 2023, this solution tracked down billable coverage in 32.1% of patient accounts, resulting in more than $25 million in previously unknown coverage. Tailored payment options for patients: Providing upfront pre-service cost estimates for patients gives them clarity about what they'll owe so they're less likely to be shocked when they receive their bill, and are more likely to pay on time. Patient Payment Estimates generates quick, accurate pricing estimates along with a clear breakdown of how the costs have been calculated and secure links to instant payment methods. Helping patients find financial assistance: From the first encounter, patient financial data can be interrogated to determine whether they may be eligible for financial assistance. Getting them on the right pathway from the start means they're less likely to delay and default on bill payments. Flexible payment plans: Research from Experian Health and PYMNTS shows patients are eager for flexible ways to pay. Rigid and protracted processes are inconvenient for patients and often end up multiplying medical debt, which is bad news all round. Simple self-service tools can meet patients where they are and help them manage their bills, whether they prefer to pay in full and up front, or they need to break it into more manageable instalments. This reduces payment delays and lessens the medical debt burden on all parties. Streamlined, secure payments: PaymentSafe® accepts secure payments anywhere, anytime, using eChecking, debit or credit card, cash, check and recurring billing – all through a single, easy-to-use web tool. Every patient encounter becomes an opportunity to collect payments with minimal fuss. Automated patient outreach: An easy win with automation is to issue appropriate reminders to patients about upcoming and overdue payments. Automated dialing and texting campaigns mean patients get relevant information through convenient channels, and staff can focus on more complex collections cases. Strategic collections management: Segmenting and prioritizing collections accounts based on propensity to pay allows staff to spend their time where it matters most. Automation and data analytics can be used to route accounts to the correct pathway, resulting in a more compassionate patient experience, better use of resources, and increased collections overall. Identifying inefficiencies in medical billing To select and implement the above strategies and RCM medical billing solutions, it's important to identify where inefficiencies and gaps are in the process. Some questions to consider are: Are we relying too heavily on manual entry in our billing activities? What are the root causes behind our medical billing errors? Are our tracking and reporting efforts throughout the billing lifecycle? How accurate are our payment estimates and eligibility verification processes? Are our current payment acceptance practices and plans effective? How successful and compassionate are our patient outreach efforts? By assessing each area, providers can pinpoint opportunities to simplify the medical billing workflow and use revenue cycle management technology to accelerate collections. Optimize patient collections with the Collections Optimization Manager One specific example of how healthcare organizations can improve patient collections is with Collections Optimization Manager, which uses data analytics to manage the medical billing basics and customize collections strategies. The platform streamlines patient collections by screening out bankruptcies, deceased accounts, Medicaid and other charity eligibility, so staff don’t waste time chasing payments. Remaining accounts are grouped and routed to the most appropriate pathway, so they can be dealt with quickly and effectively. Case study: See how St. Luke's University Health used Collections Optimization Manager to collect an additional $1.2 million in average monthly collections,, in the midst of staffing shortages. Explore more ways to use Collections Optimization Manager to streamline the medical billing basics and accelerate patient collections.

There is growing concern that the healthcare industry needs more clinical and administrative staff to handle care demands. The crisis affects patients beyond treatment delays or lower care quality. Staff shortages in the revenue cycle create problems with patient engagement, billing, and collections. A recent Experian Health survey reveals unanimous concerns among providers about the challenges posed by workforce shortages. But what are the root causes of staffing shortages in healthcare? Is there a remedy for healthcare organizations struggling to find the talent they need? This article dives into the survey findings and the ways healthcare providers can address staffing shortages effectively. Finding 1: Staff turnover is a significant cause of healthcare staffing shortages. 80% of providers report turnover between 11-40%. Nearly one in 10 say turnover is between 41-60%. The causes of staff shortages were evident before COVID. A rapidly aging Baby Boomer population and limited availability of training in areas such as nursing led to predictions that looming staff shortages were on the horizon. The pandemic exacerbated the situation, leading to a mass exodus of workers and The Great Resignation. Some reports show healthcare lost 20% of its workforce, including 30% of nurses. Today, the average hospital turns over one-quarter of its staff annually, an increase of more than 6% from the prior year. As a result, the State of Patient Access 2023 reported nearly 50% of providers say access to care is worsening. Simultaneously, healthcare is bogged down with administrative tasks. Increasing evidence shows providers must turn to automation software to decrease human workloads and stretch small teams further. These automated tools can: Create a seamless registration process for patients to improve care access, reduce no-shows, and reduce provider administrative burdens. Provide 24/7 patient scheduling and put patients in charge with self-scheduling options Automate patient outreach to increase collections and improve communication. Improve claims management, reduce denials, and free up existing staff from manual tasks. Automation can improve the work-life balance of healthcare staff, potentially closing the revolving turnover door, one of the most significant causes of staff shortages. For example, IU Health implemented automated guided scheduling, which helped scale their operations, reduce scheduling errors and improve staff efficiency. Finding 2: Finding and hiring staff is an undue burden for healthcare providers. 73% of respondents said finding qualified staff is difficult. 61% reported that meeting entry-level staff's salary expectations is a challenge. Healthcare organizations feel the staffing crisis at every level. A recent Medical Group Management Association (MGMA) poll cited the difficulties in hiring revenue cycle staff: 34% of respondents stated hiring medical coders is their biggest challenge. 26% stated billers were difficult to find. One-third said finding schedulers and prior authorization staff is hard. Other hiring challenges included revenue cycle management (RCM) managers. When and if healthcare providers find staff, bringing them into the fold is costly. Experian Health's staffing survey showed most organizations struggle to meet the salary expectations of even the least experienced members of their teams. The causes of staff shortages can be remedied by leveraging new artificial intelligence (AI)-powered tools. Tools like AI Advantage™ can automate and transform claim denials management, a problem costing healthcare providers around $250 billion annually. Experian Health's State of Claims 2022 survey showed the most common causes of denied claims include: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Inaccurate medical coding. AI Advantage reduces denial rates by scrubbing claims and flagging errors before submission. After claim submission, the software prioritizes the most high-value denials for correction to maximize revenue generation. Organizations like Schneck Medical Center use these tools to reduce denials by 4.6% each month. The facility also increased the speed of claims submissions. Tasks that used to take 12 to 15 minutes to rework now process in less than five minutes, lessening the need for hiring more staff and improving the workloads of their existing team. Finding 3: Burnout is a top contributor to staffing shortages. 53% of poll respondents said staff burnout is a key cause of the current staff shortage. 48% said the new expectation for schedule flexibility and hybrid work models also contributes to the healthcare workforce shortage. Burnout is one of the most significant causes of staff shortages impeding high quality care and wreaking havoc on the revenue cycle. The latest data shows the percentages of clinical and administrative burnout in healthcare is approaching or exceeding 50% in most job categories: 56% of nurses report burnout symptoms. 54% of clinical staff. 47% of doctors. 46% of non-clinical staff. Cost-cutting and increasing care demands have led to increasing fatigue in healthcare staff. But technology exists to automate back office functions that could free up staff time. For example, organizations like Kootenai Health saved close to 60 hours of staff time in over 8 weeks by automating the presumptive charity process Patient Financial Clearance. Stanford Health used Collections Optimization Manager to cut 672 hours each month from overburdened back office staff. The COVID pandemic also changed expectations about how and where Americans should work. Remote work became normal; three years post-COVID, 58% of the American workforce report working remotely at least one day a week. The same data also shows that when workers have the chance to work virtually, 87% take it. Healthcare is not immune to the desire for more schedule flexibility. Becker's Hospital Review states, “Many workers desire the ability to work remotely, even if they only get the option a few days a week. Flexibility allows people to maintain work-life balance—and in a high-burnout field like healthcare, balance can be crucial.” Surveys show 31% of healthcare roles are remote full-time while 14% offer this flexibility part-time. The problem is that many healthcare positions cannot allow this flexibility—and the industry competes with others that do. To remain competitive, healthcare organizations must embrace technology to offer work flexibility. Cloud-based digital technology is beneficial in areas like the revenue cycle. For example, automated technology from Experian Health can: Use advanced analytics to streamline workflows. Facilitate patient self-service. Minimize staff time spent on manual tasks. AI-powered automation tools can lessen staff burnout by allowing them to work smarter. These tools provide the workforce with the scheduling flexibility they desire. Eliminate the causes of healthcare staffing shortages with better technology AI and automation technology in healthcare can lessen worker fatigue, lighten workloads, and give administrative workers the schedule flexibility they demand. Experian Health offers healthcare providers better technology to improve the lives of their staff, increase patient satisfaction, and generate more revenue. Download the survey or connect with an Experian Health expert today to learn how we can help your organization tackle the causes of healthcare staffing shortages effectively.

By all forecasts, the healthcare worker shortage isn't going away. More than 80% of healthcare executives admit talent acquisition is so challenging it puts their organizations at risk. The latest survey from Experian Health shows complete agreement across the industry—the inability to recruit and retain staff hampers timely reimbursements. The side effects of the healthcare worker shortage are increased errors, staff turnover, and lower patient satisfaction. With the healthcare worker shortage becoming a chronic red flag on the list of industry challenges, is throwing more revenue at hiring the best answer? Experian Health's new report, Short-staffed for the long term, polled 200 healthcare revenue cycle executives to find out the effects of the continuing healthcare worker shortage on the bottom line. Respondents unanimous agreed that healthcare's recruitment problem is limiting their ability to get paid. Could investing in better revenue cycle technology to automate manual human functions be the answer to the healthcare recruiting dilemma? Effect of the healthcare worker shortage on healthcare revenue cycle Result 1: Providers losing money and patient engagement simultaneously. 96% of respondents said the healthcare worker shortage negatively impacts revenue. 82% of survey participants said patient engagement suffers when providers are short-staffed. Experian Health's latest survey showed almost unanimous agreement that the revenue cycle suffers significantly when providers are short-staffed. The only area of disagreement among revenue cycle leaders is whether patient collections or payer reimbursements are affected the most by the industry's lack of human talent. As revenue cycle teams struggle to cover their workload, the need for speed increases manual error rates. The Experian Health survey showed that 70% of revenue cycle teams say healthcare worker shortages increase denial rates. This finding reinforces an earlier survey showing nearly three of four healthcare executives place reducing claims denials as their top priority. As errors snowball, patient engagement and satisfaction begin to decline. Data entry errors impact claims submissions, resulting in billing mistakes that confuse and frustrate patients. Data errors often start at patient registration and persist through claims submission, creating denial reimbursement snarls and tying up cash flow. With the average denial rate above 11%, that's one in every 10 patients facing uncertainty around whether their bill will be paid. What's worse is that Experian Health's State of Claims Report shows denial rates increasing. While providers are leaning into increasing recruiting efforts to find the employees they need, is staffing up even possible in an era of chronic labor shortages? Technology offers healthcare providers new ways to handle revenue cycles without hiring more staff. For example, patient access software reduces registration friction, where up to 60% of denied claims start. Patient scheduling software automates access to care and gives customers greater control over their healthcare journey. It's a digital front door that engages patients with online options for managing care. On the backend of the revenue cycle, automation also offers a way to decrease reliance on manual labor to handle claims submissions. Automating clean claims submissions alleviates the denials burden, freeing up staff time and provider revenue streams.  Result 2: Staffing shortages heavily impact payer reimbursement and patient collections. 70% of those saying payer reimbursement has been affected the most by staff shortages also agree that escalating denial rates are a result. 83% of those saying patient collections have been affected most by staff shortages also agree that it’s now harder to follow up on late payments or help patients struggling to pay. Addressing healthcare staffing shortages is crucial for providing quality patient care, maintaining financial stability, and maximizing reimbursement in the complex healthcare reimbursement landscape. Staff shortages lead to reduced productivity within healthcare facilities, and existing teams may need to take on extra work to fill the gap. Overworked staff may be more prone to errors, leading to claims denials. Medical Economics says manual collections processes suffer due to the healthcare worker shortage. They state, “Mailed paper statements and staff-dependent processes are significantly more costly than electronic and paperless options, yet the majority of physicians still primarily collect from patients with paper and manual processes.” Technology exists for self-pay receivables that allow patients easy online payment options. Experian Health's Collections Optimization Manager offers powerful analytics to segment and prioritize accounts by their propensity to pay and create the best engagementstrategy for each patient segment. Advocate Aurora Healthcare took control of collections by using this tool and automated their collections processes, so that existing staff could focus on working with the patients who had the resources to handle their self-pay commitments. The software's automation and analytics features allowed the provider to experience a double-digit increase in collected revenues annually. Patients also benefit from collections optimization software. For example, Kootenai Health qualifies more patients for charity or other financial assistance with Experian Health's Patient Financial Clearance solution. In addition to automating up to 80% of pre-registration workflows, the software uses data-driven insights to carve out the best financial pathway for each patient. It's a valuable tool for overburdened revenue cycle teams that struggle to collect from patients. Kootenai Health saved 60 hours of staff time by automating these manual payment verification processes. Result 3: Recruiting alone isn't solving the healthcare worker shortage. Healthcare hiring is a revolving door, with 80% reporting turnover as high as 40%. 73% said finding qualified staff is a significant issue. A significant contributor to the healthcare worker shortage is the grim reality that these organizations are losing human resources to burnout and stress. Being short-staffed drags down the entire organization, from the employed teams to the patients they serve. But it's impossible for recruiting alone to fix the problem when more than 200,000 providers and staff leave healthcare each year. A recent study suggests that if experienced workers continue to leave the industry, by 2026, more than 6.5 million healthcare professionals will exit their positions. Only 1.9 million new employees will step in to replace them. The news worsens with the realization that nearly 45% of doctors are older than 55 and nearing retirement age. Artificial intelligence (AI) and automation technology in healthcare can cut costs and alleviate some of the severe staff burnout leading to all this turnover. However, one-third of healthcare providers have never used automation in the revenue cycle. A recent report states that providers could save one-half of what they spend on administrative tasks—or close to $25 billion annually—if they leveraged these tools. For example, Experian Health's Patient Access solutions can automate registration, scheduling and other front-end processes. AI can also help increase staff capacity and output without adding work volume. Experian Health's AI Advantage™ solution works in two critical ways to help stretch staff and improve their efficiency: The Predictive Denials module reviews the provider's historical rejection data to pinpoint the claims most likely to bounce back before they are submitted. The tool allows the organization to fix costly mistakes before submission, eliminating the time spent fighting the payer over a denial. The claims go in clean, so the denial never happens. The revenue cycle improves, saving staff time and stress. Denial Triage focuses on sorting denied claims by their likelihood to pay out. The software segments denied claims by their value so internal teams focus on remits with the most positive impact on the bottom line. Instead of chasing denials needlessly, this AI software allows revenue cycle teams to do more by working smarter. Revenue cycle technology to fill healthcare worker shortage gaps There is no question that the healthcare worker shortage is causing a significant burden on patients and providers. Experian Health's Short-staffed for the Long Term report illustrated the effect of this crisis on the healthcare revenue cycle, patient engagement, and worker satisfaction. Technology can solve staffing challenges by allowing the healthcare workers we do have to spread further and work more efficiently. AI and automation technology in healthcare can cut costs, alleviate staff burnout and can even help healthcare providers retain their existing workforce. By implementing these new solutions, healthcare providers can help stop the bleeding of existing staff that contributes to the healthcare worker shortage, while improving the efficiency of the revenue cycle. These tools save time and money and improve the lives of everyone touched by the healthcare industry. Contact Experian Health to see how your healthcare organization can use technology to help eliminate the pressures of the healthcare worker shortage.

Prospects for US hospitals that closed out 2022 at a financial loss looked brighter by the end of 2023, prompting cautious optimism heading into 2024. An industry analysis published in October 2023 found that most hospitals were back in the black from March 2023 onward, while the economy more generally ended the year with a strong finish. That said, healthcare margins remain slim, and expenses continue to grow. Finding efficiency savings across all operations remains a top priority. That's where revenue cycle automation comes in. With revenue cycle automation, providers can eliminate many of the 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 the services they provide – 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. Revenue cycle automation refers to the application of robotic process automation (RPA) to these repetitive, rules-based processes. In practice, this 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 useful insights. Common RCM challenges Automation is already making headway in tackling some of the most pervasive challenges, such as: Stemming the rise in claim denials: Experian Health's State of Claims 2022 survey found that a third of providers had around 10-15% of their claims denied. These often result from errors made earlier in the revenue cycle such as incorrect patient information or overlooked pre-authorizations. RCM automation reduces the propensity for errors significantly. Streamlining patient access: Without a welcoming digital front door, the revenue cycle gets off on the wrong foot. Automation can be deployed in patient scheduling and registration to ensure patient information is collected and stored quickly and accurately. Improving collections rates: Self-pay patients (who are increasing in number) want clear, upfront information about what their care is likely to cost. Providers can find themselves playing catch-up if patients are unsure about what they owe. Automated tools that generate accurate estimates and support pre-service payment can build a more resilient cash flow. Expanding access to data insights: One of the biggest ironies in revenue cycle management is that more data is collected than ever, but managers are struggling to digest it and uncover actionable insights. RCM automation helps identify patterns in claims and collections. Six ways revenue cycle automation accelerates reimbursements Let's break down these opportunities into six specific actions providers can take to improve their organization's financial health: 1. Capture accurate information quickly during patient access Victoria Dames, Vice President of Product Management at Experian Health, says, “Patient access is the first step in simplifying healthcare and revenue cycle processes. Replacing manual processes and disjointed systems with integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle.” Patient Estimates automatically compiles an accurate breakdown of what a patient is likely to owe before or at the point of service. It builds in prompt-pay discounts, financial assistance advice and instant payment links, so patients are more likely to pay sooner. 2. Simplify collections and focus 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 that can pay promptly are able do so without unnecessary friction. As a result, providers get paid faster. 3. Reduce 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 was affecting 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. Hear Jonathan Menard, VP of Analytics at Experian Health talk to Andrew Brosnan of Omdia about how AI and automation are addressing staff burnout and improving revenue cycle efficiency. 4. Maintain 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 surprise billing legislation while boosting patient loyalty via a more compassionate financial experience. 5. Improve the end-to-end claims process Perhaps the most obvious way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claim scrubbing, real-time eligibility verification, more reliable coding, and easier status tracking all improve the chances of a provider being reimbursed promptly and fully. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI AdvantageTM uses 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 in the most efficient way. Providers get paid sooner while minimizing downstream revenue loss. 6. Get 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 make predictions about 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. Revenue cycle automation is the solution Just like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Together, these six revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth. 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.

More than 13 million Americans have lost Medicaid coverage since continuous enrollment came to an end in April 2023. Unwinding the emergency provisions requires states to determine which individuals remain eligible for Medicaid, leading to widespread disenrollment. The Medicaid redetermination process created a major admin burden for agencies and providers, and now, the impact of that burden on patients has become clear: more than 7 million of those who lost coverage were disenrolled because of administrative processes, and not due to ineligibility. While some will find coverage elsewhere, many will be left without insurance. These coverage gaps disrupt health services with adverse effects for patients and providers. In a recent webinar, Kate Ankumah and Mindy Pankoke, Product Managers at Experian Health, reflect on the Medicaid redetermination process and discuss how providers can mitigate the effects of redetermination heading into 2024. Recap: Medicaid continuous enrollment provision timeline How does the Medicaid redetermination process work? The redetermination process, led by state agencies, involves reviewing Medicaid rosters and automatically renewing coverage for individuals that still qualify, based on benefits or other government data. When coverage cannot be confirmed automatically, states need to reach out to patients to fill in the gaps. If the individual is no longer eligible (or does not provide the necessary data), they will be removed from coverage lists. Many patients are confused about the process and may not even realize they're no longer covered, leading to delays and distress when they try to access care. This blog post breaks down the 5 things providers can do if a patient loses Medicaid coverage. 1. Tighten up insurance eligibility verification processes During the webinar discussion, Kate Ankumah explains that implementing a reliable eligibility verification tool is essential to reduce financial risk, increase revenue and streamline staff workflows: “With our Eligibility product, we connect to more than 900 payers with search optimization. Providers don't need to send the same information over and over – we'll run through the search options ourselves and find the information as quickly as possible. Then we standardize the data so front desk staff can read all the responses in the same way. We also build in alerts. A couple of clients have alerts set up for Medicaid redetermination dates that pop up if a patient is due for redetermination so the front desk staff know to have a conversation with them about it.” Eligibility also includes an optional Medicare beneficiary identifier (MBI) lookup service, to check if any patients who may have been disenrolled from Medicaid are now eligible for Medicare. 2. Find missing coverage with Coverage Discovery Providers may also want to automate the search for any active coverage that may have been overlooked. Coverage Discovery searches for possible billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient's status changes, their bill won't be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 3. Quickly identify patients who may be eligible for Medicaid and financial assistance The lack of clarity around enrollment and eligibility is disruptive for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Denial rates are already a top concern for providers, and staff cannot afford to waste time seeking Medicaid reimbursement for disenrolled patients. Patient collections also take a hit when accounts are wrongly designated as self-pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient's ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps secure reimbursement and means patients are less likely to be chased for bills they can't pay. 4. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, but particularly now that federal support has ended. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. Drawing on Experian's consumer credit data, Collections Optimization Manager's segmentation models are powered by robust and proprietary algorithms. These models screen out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Case study: See how University of California San Diego Health (UCSDH) increased collections from around $6 million to over $21 million in just two years using Collections Optimization Manager. 5. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they'd struggle to pay an unexpected medical bill of $500, providers should make it easier for patients to gauge their upcoming bills. Patient Financial Advisor and PatientSimple® can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage Medicaid changes efficiently and offer extra support to patients who may be facing disenrollment. Watch the webinar to see the full discussion on how Medicaid redetermination is affecting providers and find out how Experian Health's digital solutions can help healthcare organizations quickly and easily verify insurance coverage.

For many Americans, access to healthcare is increasingly a question of affordability. There's no room for error when it comes to determining a patient's medical bill. Helping patients understand and plan for medical bills starts with calculating patient responsibility quickly and accurately. Incorrect charges, unexpected costs and confusing payment processes create poor financial experiences for patients. According to research by Experian Health and PYMNTS, patients are increasingly worried about their healthcare costs. 46% of those surveyed had canceled care after receiving a high-cost estimate, while 60% of those with out-of-pocket expenses said inaccurate estimates or an unexpected bill would prompt them to consider switching providers. As the stakes get higher, providers must reexamine how to calculate patient responsibility in medical billing so all parties are clear about who will pay for what. Providing that clarity will improve the patient experience, streamline patient collections and protect the organization from bad debt. What is patient responsibility? Responsibility for paying medical bills is apportioned between the patient who receives care, their insurance provider (if they have one), and government payers like Medicare and Medicaid (if the patient is eligible). “Patient responsibility” refers to the portion of the bill that should be paid by the patient themselves. Getting these calculations right is critical to the provider's revenue cycle. Determining patient responsibility starts during patient registration. Here, providers have their first opportunity to check that insurance details are up to date and ensure that the patient has not overlooked any active coverage. If the patient does not have coverage, they'll be liable for the whole bill (or will have to find charity assistance). If they do have insurance, the provider will liaise with their payer to check that the proposed care is covered under the patient's plan and establish any prior authorization requirements. Then, the provider can estimate how much of the cost of care should be reimbursed by the payer, and how much will fall to the patient. The amount paid by patients includes the following categories: Co-payment – this is a fixed, flat fee the patient pays toward their medical care at the time of service. If providers do not have accurate co-pay information available at the time of the visit, they may need to bill or refund the difference later. Not all health plans include co-payments, and those that do often specify exceptions. Deductible – this the total amount the patient must pay toward medical care each year before the payer contributes. For example, if a patient has a $1000 deductible, they must pay the first $1000 of medical bills that year, and any eligible costs on top of that will be covered by their payer or shared between the patient and payer. High-deductible health plans are attractive to patients who don't think they're likely to need care, as these plans often come with lower monthly premiums. However, if the patient does need care, they'll be left footing a greater portion of the bill. Coinsurance – this is the patient's share of remaining medical costs after paying their deductible. Out-of-pocket maximum – some health plans set an annual limit to the amount a patient needs to pay toward care, including co-payments, deductibles and coinsurance. Once that limit is reached, the payer will cover the remaining eligible expenses for the remainder of the period. Clearly, this is a complicated formula. To bill correctly, providers need to know whether the proposed treatment is covered by the patient's plan, how much the payer has agreed to pay for specific services, and whether individual service providers involved in the patient's care are in-network or not. Claims will only be reimbursed if all necessary coding and payer policy requirements have been met. Revenue cycle management tools to calculate patient responsibility Traditionally, providers have relied on teams of hard-working coders and billers to manually compile and review each claim. But with so many moving parts – not to mention frequent payer policy changes and staffing shortages – manual processes are no longer viable. When determining how to calculate patient responsibility in medical billing, providers should turn to automation and digital tools. This can help them augment their staff's capacity to calculate patient responsibility more efficiently and accurately and optimize patient collections. Here are a few examples of how they might do that: Automate insurance eligibility verification - Without understanding exactly what the patient's active coverage includes, providers will remain one step behind in the medical billing and claims management process. Payers are already using automation and artificial intelligence to fulfil their side of the equation, and providers cannot risk being left behind. Automating the verification process allows providers to capture up-to-date eligibility and benefits data, including the patient's co-pay and deductible amounts, to calculate the patient's responsibility pre-services. Find missing and forgotten coverage - As more patients switch health plans, more payers join the Affordable Care Act marketplace, and employer-based insurance changes, it's increasingly likely that the patient may not be 100% sure of their active coverage. With Coverage Discovery, providers can run quick, automated and repeated checks to see if any active coverage has been overlooked. This could drastically reduce the patient's responsibility, leaving them with a more affordable bill. Automate prior authorization - Many health plans require specific services to be authorized by the payer before being administered. Providers must check these requirements pre-service, or face a denied claim which could affect the patient's bill. Obtaining authorization from health plans before administering services can be slow and expensive, and often delays care. The Council for Affordable Quality Healthcare (CAQH) states that automating prior authorizations could save the medical industry $449 million per year (or 11 minutes per transaction). Automated prior authorization software gives providers real-time insights into payer requirements, so they can speed up reimbursement and give patients clarity over what they'll owe. Why use a patient cost estimator? With the necessary insurance information at their digital fingertips, providers can then use a patient responsibility pricer to calculate the patient's co-pays, deductibles and other out-of-pocket expenses. For example, Patient Payment Estimates is a web-based price transparency tool that generates personalized estimates for patients before and at the point of service. Patients get a comprehensive breakdown of what they'll owe, so they can plan for upcoming bills or even pay upfront. Patient liability estimator tools give patients more financial clarity, saving staff time and encouraging prompter payments. They're also an important compliance tool, and are specifically recommended in CMS advice on compliance with the Hospital Price Transparency Final Rule. Accelerate and streamline patient collections Early financial clarity encourages patients to pay sooner. This means it's more likely that those bills are paid in full, instead of lingering on the aged receivables list. In addition to upfront estimates, providers should make the payment process itself as easy as possible. This might include directing patients to payment plans or charity assistance, and connecting patients to convenient payment tools at any point in their healthcare journey. Inevitably, there will be some patients who simply cannot pay their bills. Collections Optimization Manager shows staff which accounts, so they don't waste time chasing the wrong accounts. By scoring and segmenting patient accounts based on the likelihood of payment, and adjusting as the patient's situation changes, Collections Optimization Manager helps providers manage resources more efficiently, while supporting a more compassionate patient financial experience. It also enables more effective use of collections agencies to minimize the cost to collect, and incorporates reporting and benchmarking tools to identify improvement opportunities. Find out how Experian Health's revenue cycle management tools can help providers calculate patient responsibility in medical billing, for a more compassionate patient experience and streamlined collections process.

Between November 2022 and September 2023, St. Luke's University Health Network (SLUHN) saw a 22% uplift in self-pay collections, amounting to an additional $1.2 million in average monthly collections. What makes this particularly noteworthy is that they achieved this during ongoing staffing shortages. It's an encouraging result for providers facing similar challenges, so how did they do it? On a recent webinar with Experian Health, Cindy Samuels, Senior Manager of Patient Revenue Services at St. Luke's, and Rich Wade, Strategic Product Consulting Director at Experian Health (and the Patient Revenue Services team's designated consultant), share how Collections Optimization Manager and PatientDial allowed St. Luke's to automate and optimize their collections efforts. How staffing shortages wreak havoc on the collections process Revenue cycle managers are all too familiar with the downward trend in collections recoveries over the last few years, which is exacerbated by labor shortages and rising self-pay balances. In Experian Health's August 2023 survey, Short-Staffed for the Long Term, 100% of respondents said that staffing shortages had affected revenue cycle management. Many reported that resource shortages in patient collections made it harder to follow up on late payments or help patients who were struggling to pay. With six vacancies in their own Patient Revenue Services team, St. Luke's needed a way to improve efficiency. Cindy Samuels says, “more and more dollars were falling to the patient. I had a team of folks making outbound phone calls to collect outstanding dollars, but staff were leaving messages all day long and our cash wasn't increasing. Outsourcing wasn't an option that we wanted to pursue, so we looked at technology automation.” Since St. Luke's were already using Experian products in other parts of the revenue cycle, replacing their outdated call center platform with an Experian Health solution made sense. Developing a successful strategy for collecting self-pay balances To handle increasing self-pay balances with limited staff resources, St. Luke's used Collections Optimization Manager to generate a daily accounts receivable (AR) file and then screen, segment and monitor accounts so they could be managed in the most efficient way. Samuels explains: “Every active self-pay account goes through [Experian's] scrubbing system, so they're finding medical assistance, presumptive charity, deceased bankruptcy, and other types of insurance. So, we know to set those accounts aside. The rest are segmented into five segments [based on propensity to pay] so I know where to put my resources when it comes to reaching out to patients.” With the help of an Experian Health consultant, Collections Optimization Manager users can then implement specific collections strategies that are tailored to each segment. For St. Luke's, this included automating patient calls using PatientDial, a cloud-based call system that facilitates inbound, outbound and blended call environments to help collect patient balances. The combination of segmentation and automation allows St. Luke's to have multiple call campaigns running at once, so more patients can be contacted and in a way that is more likely to lead to payment. Maximizing collections by shifting focus from “high dollar” to “ability to pay” Typically, collections teams focus on aged accounts with the highest dollar amounts. Unfortunately, this can result in staff chasing accounts that are unlikely to be paid. Collections Optimization Manager's segmentation strategy means accounts are sorted according to likelihood of payment, and treated in a way that is more likely to yield results without wasting staff time. With Collections Optimization Manager and Patient Dial, patients that are more likely to pay can be allocated to an unassisted call campaign and given an automated reminder about their balance at the appropriate time. It may not make sense to have staff spend time calling patients at the other end of the spectrum who are unable to pay or even engage with the process. An automated message with information about financial assistance may be a more appropriate approach. St. Luke's focused their resources on the segments in the middle, who are likely to be engaged but may have specific issues to resolve, such as needing details of payment plans or updating a credit card. This approach has helped the team reach more patients than ever and maintain an abandon rate of below 1.2%. Samuels says, “not only have we been able to collect more cash, but we've also been able to resolve more accounts, because with segmentation we've been able to clean up the AR that don't belong in the collections world. We can also help patients go down the financial assistance road if that's what they need. So maybe not every call results in cash, but at least we've been able to speak to patients and help them resolve any questions or concerns.” Boosting staff efficiency through automation Around 90% of St. Luke's Patient Services Team work remotely. This adds a new challenge for managers, who need to be sure that staff have the information they need to work confidently and effectively, while being able to monitor workloads and maintain productivity levels. While the increase in call volumes and collections speaks to the boost in productivity, PatientDial's reporting function has made it possible to generate a scorecard for each representative to measure performance. This allowed Samuels to identify potential training needs and foster knowledge exchange, especially when remote working means staff can't simply ask the person next to them for help. Samuels says her staff have welcomed the ability to handle more calls, more efficiently, without having to redial patients several times. PatientDial provides user-friendly dashboards, so call center agents have all the necessary details at their fingertips. Staff have said they find it motivating to be able to help more patients, which is reflected in high employee satisfaction scores in St. Luke's annual employee engagement survey. A snapshot of success In addition to increasing average monthly collections by $1.7 million in a little under a year, St. Luke's has seen the following results:     “We have increased our outbound call volume by 274% since last November, so we're reaching more patients. If we're not reaching them, we're leaving more messages. The dialer has also saved 740 hours monthly because staff are no longer dialing numbers and getting nothing. And we’re using an interactive voice response (IVR) campaign for payments, so we've saved around 253 hours each month, because patients make their payment electronically over the phone with no need to speak with a representative. It was a very positive thing for us.” Cindy Samuels provides more details of their approach on the webinar, plus her tips for others who may be considering implementing Collections Optimization Manager and PatientDial in future. Watch the webinar for full details on how St. Luke's increased collections despite staffing shortages, or contact us to learn how Experian Health can help optimize your collections efforts.

The media has extensively covered the healthcare workforce shortage and its impact on patient care. It's a chronic, dangerous problem that seems to worsen, despite the industry's efforts to staff up. A recent Experian Health survey found severe and long-term implications for revenue cycle management and its impact on provider and patient care. 100% of revenue cycle leaders surveyed agree the pervasive healthcare workforce shortage impacts their facility's ability to get paid. The problem isn't going away; most survey participants (69%) expect recruiting challenges to continue. Furthermore, nine of 10 survey participants admit to a double-digit turnover rate. However, the shortage of qualified labor is impacting healthcare in other areas beyond patient outcomes. The report shows the bottom line is clear: The healthcare workforce shortage impedes the industry's ability to get paid. How can providers solve this? Experian Health's survey, “Short Staffed for the Long-Term,” polled 200 revenue cycle executives to understand the impact of the hiring deficit's impact on provider cash flow. Survey Finding #1: Staffing shortages impede payer reimbursements and patient collections. 32% of survey participants said patient collections is the revenue cycle channel most impacted by healthcare workforce shortage. 22% said payer reimbursements are most affected by staff shortages. 43% said both channels were equally impactful to the healthcare revenue cycle. There was little disagreement in the survey around whether provider revenue cycle suffers from a lack of qualified staff. The debate centered on which reimbursement channel took the biggest hit. Experian Health's staffing survey revealed revenue cycle executives agree that collecting late patient payments is much more complicated now. The worker shortage impedes the ability to manage this process. In an era when many patients put off care due to high out-of-pocket costs, maximizing collections is more important than ever. Short-staffed, overworked healthcare collections teams require the time and tools to optimize the collections process by identifying the accounts more likely to pay. Patient collections teams could also benefit from software that finds financial assistance that could ease self-pay burdens. Collections Optimization Manager saves staff time by automatically determining the most suitable patient collections approach. The University of San Diego California Health (UCSDH) uses this software to segment patients by propensity to pay. It allows collections agents a more efficient, personalized approach to improve the revenue cycle and the patient relationship. From 2019 to 2021, UCSDH increased collections from $6 million to more than $21 million with this solution. Patient Financial Clearance automates screening prior to service or at the point of-service to determine if patients qualify for financial assistance, Medicaid, or other assistance programs. Kootenai Health leverages the software, which increased the accuracy of determining patient financial assistance by 88%, and saved 60 hours of staff time through automation. Together, these tools can ease the healthcare workforce shortage by optimizing and streamlining collections. Survey Finding #2: The healthcare workforce shortage contributes to increasing denial rates. 70% say escalating staff shortages increase claims denials. 92% report new staff member errors are a significant factor in delayed or declined reimbursement. Today, healthcare providers are seeing claim denials increase by 10 to 15% year over year. A lack of qualified revenue cycle staff costs billions annually in preventable revenue cycle errors. 35% of healthcare leaders admit losing more than $50 million yearly on denied claims. The complexities of the revenue cycle particularly challenge new staff; 92% of survey respondents say errors are common. Denied claims ripple across the revenue cycle, tying up staff time and provider cash flow. Ultimately, it is patients and staff who suffer. When hospitals experience restricted cash flow, it can hamper their ability to effectively deliver the highest quality care. When staff stretch to their limit due to the healthcare workforce shortage, they may make more errors, burnout, or quit. Automating the claims process is a necessity in this challenging environment. Tools like ClaimSource® and Claim Scrubber can catch errors before submission, reducing undercharges and denials. Franklin Healthcare Associates, a 100-provider, four-location practice, used Claim Scrubber to reduce accounts receivable (A/R) by 13%. As claims volume grew, the practice decreases its full-time employee (FTE) requirements by leveraging this automated tool. It's one clear example of how technology can stretch staff farther to improve the bottom line. Survey Finding #3 Staffing deficits aren't going away. Close to 70% of respondents believe revenue cycle staffing levels will continue as a problem into the future. Staff turnover is a contributing factor; 80% said their organization's turnover revenue of cycle management staff is between 11-40%. Experian Health's survey confirms that healthcare teams struggle to find qualified staff. Staff turnover is a significant contributor to a revolving hiring door. One survey showed the average hospital turnover rate is 100% every five years. Traditional solutions to the problem include throwing more money into salaries, bonuses, or other perks. Overtime is a go-to remedy for the chronic healthcare worker shortage. But these approaches strain the provider bottom line. A recent Kauffman Hall survey shows: 98% of healthcare providers have raised minimum wage or starting salaries. 84% offer signing bonuses, and 73% offer retention bonuses. 67% experienced wage increases of more than 10% for clinical staff. The American Hospital Association (AHA) states, “Hospitals also have incurred significant costs in recruiting and retaining staff, which have included overtime pay, bonus pay and other incentives.” But what if recruiting isn't the answer to the healthcare workforce shortage at all? Artificial intelligence (AI) and automation software can help cut costs and lessen the workload of existing staff. The latest data suggest providers could save close to $25 billion annually (one-half of what they spend on administrative tasks) if they leveraged these tools. Experian Health's  AI Advantage™ uses powerful algorithms to automate manual claims processes to reduce denial and lessen the volume of tasks for revenue cycle staff. The software works in two critical areas: Predictive Denials proactively cleans claims before they are submitted. The software flags claims at risk of denial, allowing manual intervention for a clean submission—with no denials. Denial Triage manages denied claims by identifying the highest value reimbursements to maximize cash flow. Instead of chasing low-value claims or those least likely to pay, the software prioritizes where revenue cycle staff should spend their time for the greatest return. Schneck Medical Center saw significant ROI from this software in just six months. AI Advantage helped the facility reduce denials by an average of 4.6% per month. Claims corrections that took up to 15 minutes in the past now take under five minutes. Better software can do more than help hospitals get paid faster. Automating revenue cycle management processes frees up staff time. More time and less pressure mean fewer mistakes. Automation can ease the impact of the healthcare workforce shortage Two of the most pressing problems hospitals face today are the healthcare workforce shortage and revenue cycle impediments that keep them from getting paid. These challenges interconnect, and providers can solve them both with better technology to automate time-wasting manual functions. AI and automation in healthcare can cut costs and reduce staff burnout. Deploying revenue cycle software to automate billing, claims management, and collections could save $200 billion to $360 billion in spending in this country. These numbers are real. But so are the numbers showing increasing claims denials, staff burnout, turnover, and difficulties recruiting in the healthcare field. Today, the answer for hospitals to get paid faster is to leverage modern technology to improve the revenue cycle. Learn more about how Experian Health's revenue cycle management solutions can help automate common processes, and download the new survey to see the latest healthcare staffing shortage stats.

Could common revenue cycle management (RCM) myths be preventing healthcare organizations from getting paid in full? Does what constituted best practice a few years back still apply to revenue cycle operations today? Many providers are embracing new technology to strengthen their RCM processes, using automations and software to create more accurate and efficient billing and claims management workflows. But if these processes are built on shaky assumptions, the results will be sub-optimal. As year-end financial reviews get under way, there is a prime opportunity to re-evaluate some long-standing beliefs about billing, collections and payments that, if not set straight, could limit financial performance in the year ahead. This article examines four of the most common revenue cycle myths and considers what providers can do to make financial growth a reality in 2024. Revenue Cycle Myth 1: All patients are equally likely to pay Reality: No two patients are alike – whether in their medical needs or financial circumstances. Providers know this, yet many rely on revenue cycle management solutions that lean toward a one-size-fits-all approach to patient payments. Instead, providers should consider RCM tools that use data and analytics to segment patients according to their individual financial situation, to create a more personalized and proactive approach to collections. This should take account of both the patient's ability to pay (i.e., whether they can afford their bills), and their likelihood to pay promptly, which may be enhanced by offering payment options that are convenient and aligned to their personal preferences. Collections Optimization Manager analyzes patients' individual payment history and demographic information so their accounts can be routed to the most appropriate collections pathway from the start. Patients that are likely to pay quickly can be sent billing information automatically and presented with self-service payment options. Alongside this, Patient Financial Clearance pulls together credit and non-credit data to help providers identify patients who may need a little more guidance and connect them to suitable payment plans. It catches any individuals who may be eligible for Medicaid or charity support. Staff get accurate, at-a-glance data to help them have sensitive financial conversations with patients, and can avoid losing time chasing collections from patients who would never have been able to pay. Case study: See how Stanford Health Care improved collections with a tailored, patient-focused approach to healthcare collections. Myth 2: It's hard to have meaningful pre-service financial conversations with patients Reality: Contrary to popular belief, most patients are receptive, and even eager, to have financial discussions with their provider as soon as possible. Doing so need not be challenging. In the past, providers may have worried that broaching the money question could deter patients from seeking necessary care, or simply not prioritized such discussions. Billing and insurance can also be highly complex, which may lead staff to assume that patients would find conversations about these issues to be confusing or overwhelming. But it is for these exact reasons that providers should have financial discussions with patients as early as possible. Experian Health's 2023 State of Patient Access survey found that almost 90% of patients wanted upfront pricing estimates so they could plan ahead for their financial obligations – yet less than a third received one. Tools like Patient Payment Estimates and Patient Financial Advisor can calculate cost estimates, taking account of the patient's claim history, deductibles and other insurance information, and automatically send these to patients before treatment so they know what to expect. These can also be combined with quick payment links so bills can be cleared before care. Giving patients consistent information through whichever digital channel they prefer means they will be better positioned to make informed decisions and discuss their situation with patient access staff if necessary. When patients are better informed and supported, they're also less likely to end up postponing care due to cost concerns. And with the same accurate data at their fingertips, patient access staff can serve as financial concierges, helping patients to understand coverage and copayments and check eligibility for relevant financial assistance programs. In addition to user-friendly data tools, providers should consider whether staff would benefit from additional training to bolster their confidence in leading compassionate financial conversations. Myth 3: It's impossible to know what patients owe across a system with a single look-up Reality: Thanks to data analytics and digital payment technology, it is now pretty straightforward to consolidate a patient's outstanding balance information from across an entire health system, and debunks common revenue cycle myths. Patient access staff can view a comprehensive summary of a patient's insurance status, estimated liability and open balances from multiple providers, enabling them to have meaningful financial conversations with patients. Even if these discussions do not lead to immediate payment, they can still act as a reminder to nudge the patient to act soon, thus accelerating the payment process. Selecting RCM tools from a single vendor makes it easier to integrate data from multiple workflows and generate a unified view of what a patient owes. When systems talk to each other, it's possible for a single tool to leverage the data and create a better experience for patients and staff. For example, PaymentSafe® automatically brings together data gathered throughout the revenue cycle to streamline what was previously a disjointed and time-consuming process. With point-to-point encryption, it accepts secure payments at any point in the patient's journey, using cash, check, card payments and recurring billing, through a single web-based application. Myth 4: Revenue cycle management is “set-and-forget” Reality: Revenue cycle managers may dream of setting up a system once and then forgetting about it, but the reality is that managing billing, claims and collections is an ongoing and evolving process that needs constant attention. Healthcare organizations must regularly review and adjust their RCM strategies to prevent missed revenue opportunities, manage compliance risks and promote operational efficiencies. That said, data analytics and automated revenue cycle management tools do make it far easier for providers to stay on top of RCM demands. These tools help providers with everything from monitoring payer policy changes and identifying billing errors to personalizing patient communications and generating monitoring reports. Artificial intelligence takes it a step further, for example, by preventing and predicting claim denials. In this way, these tools reduce the need for extensive staff input, so staff can spend more time focusing on the issues that need more human attention. With up-to-the-minute reports covering multiple RCM processes, staff also have the information they need to optimize performance and find opportunities to boost reimbursement that may have been previously overlooked. So, while RCM is not quite a “set-and-forget” process, automations and analytics can simplify it significantly, so it's less labor-intensive for staff and more efficient overall. Debunk revenue cycle myths and proactively challenge assumptions to increase profitability Debunking these revenue cycle myths is simple and achievable with tools that integrate a patient's clinical and financial data for a fuller picture of what that patient needs. This is crucial as changing consumer expectations, economic drivers, and new technology reshape how patients, providers and payers interact with one another. Checking underlying assumptions in any RCM process is essential to root out potential misunderstandings and outdated thinking. Not doing so leaves providers vulnerable to inaccurate financial projections, mismatched strategies and poor patient experiences. See how Experian Health's industry-leading Revenue Cycle Management Solutions make streamlined billing and collections a reality.