Tag: patient access

While the healthcare industry remains hesitant about automation, there's one area where digital tools have already proven their worth: patient intake. According to Experian Health's State of Patient Access survey, almost 90% of patients say they welcome digital patient registration, reflecting the growing demand for efficiency and convenience. Staff frustration with mounting paperwork and poorly coordinated manual systems also points to an urgent need for a better way of working. The case for switching from traditional to digital patient intake systems is pretty compelling, even before factoring in potential cost savings. For providers still taking a “wait-and-see” approach, it may be worth considering how digital patient intake could address some of the most common challenges associated with traditional registration methods, such as the following: 1. Online registration can prevent missed opportunities for patient bookings Patients' number one patient access challenge is seeing their doctor quickly. Too many are stopped in their tracks by slow and inflexible intake processes. Inconvenient booking protocols – often requiring phone calls during limited office hours – deter patents, resulting in sluggish scheduling rates and avoidable gaps in physician calendars. Moreover, traditional systems that treat scheduling and registration as two distinct activities miss the chance to accelerate intake because patients have to fill out the same information multiple times. Digital patient intake streamlines scheduling and registration so patients can book and manage appointments anytime, anywhere. With a mobile-first automated platform, patients can provide essential demographic and insurance information at the point of booking, and fill out remaining registration forms whenever it suits with a single click. When intake is easy, bookings increase. 2. Digital patient access can reduce high no-show rates Quick and convenient intake addresses the related challenge of no-shows, which lead to underutilization of services and delayed patient care. If canceling or rescheduling an appointment is easy, patients are more likely to make that little bit of effort to click the link instead of simply not turning up. With accurate patient data coming in at the start, providers can send automated appointment reminders and tailored messages to coordinate follow-ups, so patients are less likely to forget appointments or misremember referral instructions. 3. Digital patient intake can prevent payment delays and claim denials Inefficient registration means patient information passes through multiple hands, resulting in data entry errors that trickle through the revenue cycle. In a recent Q&A, Barb Terry, Product Manager for Registration Accelerator at Experian Health, talked about the importance of ensuring accurate data from the start: “Waiting until the patient's appointment to collect insurance information doesn’t give providers much time to verify insurance, or to determine the patient’s financial responsibility for copays, deductibles, and out-of-pocket expenses… In previous surveys, 40% of providers have said registration errors are a primary cause of denied claims. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.” With Registration Accelerator, patients receive a text to scan their identity and insurance cards, validating the data in real-time and automatically uploading it into eCare NEXT®. Experian Health's Eligibility Verification and Registration QA tools can then use the same verified data, reducing the risk of manual errors that lead to claim denials. 4. Reduce patient stress caused by unclear costs One of the clearest messages from patients in this year's State of Patient Access survey is the need for upfront, transparent information about costs. A disappointing 64% of patients did not get price estimates before care, and of those that did 14% said their estimates were inaccurate. It's extremely challenging for staff to compile all the data points necessary to calculate patient responsibility using traditional systems. Digital tools that automate patient data capture, insurance eligibility verification, coverage discovery and prior authorizations provide financial clarity quickly and accurately, giving patients peace of mind and reducing the burden on staff. By improving the patient billing and payment experience, providers can reduce financial stress for patients and get paid more promptly. 5. Digital patient intake reduces high operational costs and poor use of staff time Traditional registration systems are full of hidden costs, from the hefty price tags associated with paper forms, storage and printing to the time required of admin staff. These expenses are compounded over time by revenue leakage caused by errors in claim submissions and scheduling delays. Staffing shortages mean many providers simply don't have the human power to handle these challenges using manual systems alone. Again, automation comes out on top. Registration Accelerator eliminates the need to scan, fax and file forms and automatically handles patient check-ins, form returns and demographic updates. It is one of a suite of tools that feed into eCare NEXT®, automating up to 80% of the pre-registration process. A digital helping hand for faster, smarter, more accurate patient intake As patient intake challenges continue to grow, digital patient intake stands out as a practical and proven solution to streamline access to care and stabilize cash flow. With Registration Accelerator, staff can focus on critical tasks that drive revenue and make a positive first impression on patients who are looking for a convenient and compassionate healthcare experience. Find out more about how Registration Accelerator expedites patient intake and solves the operational and financial challenges that come with traditional systems. Learn more Contact us

Patients increasingly expect convenience and efficiency in all aspects of their lives, including healthcare. A study by Experian Health shows that 89% want the ability to schedule appointments anytime via online or mobile tools. The same survey showed providers are listening, with 63% offering self-scheduling and another 16% planning to go live with these tools in six months. That's good news for everyone, and not just because patients say they want more digital tools to manage their healthcare. Online scheduling addresses patient expectations by offering a range of benefits that traditional scheduling methods cannot match. However, these benefits aren't just for patients; healthcare providers that deploy online patient scheduling software experience four impressive benefits with a direct impact on their revenue cycle. What is online patient scheduling software? Online patient scheduling software is a digital tool designed to facilitate the appointment booking process for healthcare providers and their patients. This patient access technology replaces traditional over-the-phone scheduling methods with an efficient and user-friendly online system. The key features of patient digital scheduling platforms include: 24/7 appointment booking: Patients can schedule appointments at any time, day or night, providing flexibility and convenience that traditional methods cannot offer. Automated reminders: The software sends automatic reminders via email or SMS to reduce the likelihood of missed appointments. Real-time availability: Patients can view and select available time slots in real-time, ensuring they can find appointments that fit their schedules. Calendar integration: The software integrates with the provider's existing calendar systems to ensure that all appointments are accurately tracked and managed. Customizable scheduling: Healthcare providers can customize the software to reflect their specific scheduling rules, such as appointment types, durations, and provider availability. Manual scheduling frustrates patients and providers. Online patient scheduling allows patients to regain control while increasing their engagement in managing their health. Why do patients prefer online scheduling? Patients want online scheduling software because it aligns with their desire for convenience, efficiency, and control over their healthcare experience. One of the primary reasons to use online scheduling software is its round-the-clock availability. Patients can book appointments without office-hour restrictions. Online scheduling software allows patients to select time slots best suited to their schedules, minimizing the time spent waiting on hold during phone calls or in busy waiting rooms. Patients can easily see and compare availability, making planning their visits easier around personal and professional commitments. It also makes canceling or rescheduling appointments less of a hassle. One common issue patients face is forgetting about their appointments. Online scheduling software often includes automated reminders and confirmations via email or SMS, helping patients remember their upcoming visits. Some patients may also feel uncomfortable discussing their medical issues over the phone or in person at the front desk. Online scheduling offers a more private and discreet way to book appointments, allowing patients to select services without disclosing personal information to multiple people. Bringing digital efficiencies to healthcare scheduling leads to a more positive patient experience. One study showed that 28% of patients say care access has improved over the past year, even as more providers adopt these new technologies. But it's not just patients who benefit from online patient scheduling software. There are plenty of incentives for healthcare providers to adopt these tools. Healthcare providers benefit from online patient scheduling By adopting this technology, healthcare providers can streamline operations, improve patient satisfaction, and ultimately deliver higher-quality care. Experian Health offers online patient scheduling software that meets the needs of patients while benefiting providers. For example, Indiana University Health (IU Health) deployed the software across 16 hospitals and the largest network of physicians in the state. The organization leveraged the solution to increase patient volumes with minimal staff training, improving patient utilization by 114% within the first year. Today, four employees can handle patient scheduling for up to eight service lines. An unexpected benefit was the increase in referral management; the software enabled 600 monthly referral appointments, helping to generate new revenue for the system. These results are typical; most providers find the benefits of online patient scheduling software include: Reduced staff training time Improves the scheduling process for patients and providers Decreases patient no-shows Increases patient volumes and revenue Speeds up staff training One of the most significant challenges in any healthcare setting is training new staff quickly and effectively. Getting new staff up to speed rapidly is essential when severe staffing shortages are the norm. Experian Health's online patient scheduling software simplifies training. Its user-friendly interface and intuitive design reduce the learning curve for new employees to about an hour. The software provides guided workflows and real-time assistance, translating to less time spent on training and more time focused on patient care. Streamlines scheduling time Traditional scheduling methods can be time-consuming and prone to errors; 62% of providers say chronic staffing shortages exacerbate the problem. Online scheduling streamlines the entire process, cutting scheduling time in half over traditional methods. By allowing patients to book appointments online, the software reduces the back-and-forth communication typically required for scheduling. Automated reminders and confirmations ensure efficient appointment management. The calendar integration feature allows real-time updates and availability checks, providing a convenient booking process that enhances the patient experience. Improves patient no-show rates Patient no-shows can be a significant issue for healthcare providers, leading to lost revenue and wasted time. Experian Health's online scheduling software tackles this problem head-on. The software includes automated email or SMS appointment reminders, significantly reducing the likelihood of patients forgetting their appointments. Additionally, the ease of rescheduling allows patients to adjust their appointments without the hassle, further decreasing no-show rates. By keeping patients informed and engaged, the software helps ensure they attend their scheduled appointments, improving the clinic's efficiency and patient satisfaction. Josh Brown, Program Manager for Provider Match at IU Health, stated, “We've seen a reduction in no-shows and an increase in patient engagement. By leveraging technology and data analysis, the guided scheduling platform has helped deliver better care more efficiently and effectively.” Increases patient volumes and revenue Online patient scheduling directly contributes to increased patient volumes by improving scheduling efficiency and reducing no-show rates. More patients can schedule in less time, and the reduction in no-shows means fewer appointment slots go unused. The convenience of online scheduling can attract new patients who prefer digital interactions over traditional phone calls. These benefits lead to higher patient volumes and increased revenue for the healthcare practice. Today's digitally-savvy healthcare consumers require a different approach to scheduling services. Online patient scheduling offers them the convenience of DIY appointment setting and has some surprising benefits for healthcare providers, too, making these solutions a win for everyone. Ready to make the move to online scheduling? Contact Experian Health to get started! Improve patient scheduling Contact us

According to Experian Health's State of Patient Access Survey 2024, eight in ten healthcare providers plan to invest in patient access improvements soon. As they weigh up the pros and cons of different solutions, many will focus on two key areas: making scheduling and registration easier for patients, and streamlining financial processes to boost their profitability. This blog post examines how automated patient access solutions can help providers meet patient expectations and operational demands. Survey snapshot: what do patients want? Experian Health's annual State of Patient Access surveys are useful pulse checks on patient perceptions. What do patients find challenging about accessing care? Where are they bumping up against unnecessary friction? The 2024 survey offers a promising outlook: 28% of patients report improvements in access in the last year, up from just 17% in 2023. Still, there is room for improvement: patients' biggest challenge – seeing a practitioner quickly – has topped the list for the last four years. Other significant challenges include understanding the cost of care and scheduling appointments. One key takeaway from the survey is the role of digital technology. Both patients and providers find complex, repetitive and inefficient processes to be the most problematic aspects of patient access – ideal targets for digital tools. Indeed, patients specifically express a desire for online health management tools, while more than half of providers attribute improvements in patient access to automated processes. There's a solid business case for investing in digital patient access solutions to ensure that patients see their doctors quickly and providers get paid without delay. Patient access solutions can open the digital front door with online scheduling and registration The first area where providers may consider investing in digital tools is in the patient's first interactions with their facility. When patients can schedule appointments quickly and complete registration without boring and repetitive paperwork, they're more likely to report a positive patient experience. Survey data backs this up: 89% of patients say the ability to schedule appointments any time, via online or mobile tools, is important to them 89% of patients say digital or paperless pre-registration is important to them. Online self-scheduling gives patients 24/7 access to book, cancel, and reschedule appointments from any device. Based on scheduling rules, they're shown the earliest suitable appointment, which means they'll see their doctor as soon as possible. Patients can be sent automated reminders of upcoming appointments and health checks, which means show rates and health outcomes will be better. It also drastically reduces call volumes so staff can focus on other priorities. Similarly, digital registration lets patients avoid the most dreaded part of patient intake: filling out lengthy forms in the waiting room. Automated registration also ensures that patients (specifically their data) are correctly entered into the system, preventing downstream delays. With text-to-mobile registration, patients are sent a text message prompting them to scan their identity and insurance cards, which are then uploaded and validated against existing records. Securing correct information from the start lays the groundwork for the patient's healthcare experience and the provider's revenue cycle. Interestingly, despite patient demand, self-scheduling and registration did not make the cut for providers' top three priorities. This suggests an untapped opportunity for providers that choose to invest here. Patient access solutions can streamline insurance, eligibility and estimates A second opportunity lies in automating the patient access processes involved in revenue generation and claims submission. The revenue cycle is full of hidden costs for both patients and providers, often resulting from intake inefficiencies. Patients end up with bills that are higher than expected, while providers fall foul of changing payer requirements around prior authorizations and insurance eligibility verification, resulting in lost revenue. Improving upfront pricing estimates and clarifying insurance coverage ranked among the most urgent priorities for both groups in the survey. A few patient access solutions that can help here include: Patient estimates: When patients know in advance how much their care will cost, they can plan better. Web-based and mobile-enabled price transparency tools generate accurate estimates based on chargemaster data, claims history, patient insurance details and payer contract terms, and even account for payment plans and prompt-pay discounts. This improves the patient experience and increases collection rates while easing the burden on staff. Insurance eligibility verification: Manual processes for verifying active coverage are time-consuming and error-prone, causing staff burnout and patient confusion. Automating insurance verification checks at the time of service gives everyone greater certainty and prevents payment delays and claim denials. Personalized payment plans: By using their own data, along with third-party datasets, providers can leverage automation to offer alternative payment plans to patients who cannot pay the full amount right away. For example, PatientSimple® assesses each patient's propensity to pay and recommends the optimal financial plan that works for the patient's unique circumstances. Patients can check estimates and compare pricing plans on the self-service portal, giving them more control over their bills. These options promote financial sustainability by quickly identifying how much should be paid by which party and establishing processes to collect those amounts with minimal fuss. With ongoing staffing shortages, these time-saving tools are crucial for workforce resilience. Integrate patient access solutions with Patient Access Curator While providers may prioritize one of the above areas, the two are complementary: efficient scheduling and registration lead to better patient flow and accurate data collection, accelerating insurance and eligibility verification. This is more likely with an integrated “tech stack” across the whole patient access workflow. However, integration is a challenge for many providers. Nearly a quarter report that their biggest challenge in patient access is wrangling the multitude of tools needed to run pre-registration checks and gather the information necessary for claim submissions. Experian Health's newest patient access solution addresses this challenge by bringing together multiple insurance-related queries together into a single inquiry. With one click, Patient Access Curator automatically captures all relevant patient insurance data in less than 30 seconds. This includes: Eligibility verification, including billable secondary and tertiary coverage, chaining and primacy Coordination of Benefits, analyzing payer responses in real-time using AI to ensure no active insurance is missed Medicare Beneficiary Identifiers, using AI, automation and analytics to check and correct patient identifiers Patient demographics, using in-memory analytics and proprietary algorithms to ensure contact details are current Insurance discovery, for records marked as self-pay or unbillable, PAC automates additional coverage searches With over $1 billion saved in prevented denials by clients using Patient Access Curator, it's clear that investing in digital technology is a cost-effective way to address current challenges in patient access. By increasing capacity and reducing errors and delays, these tools not only enhance financial performance, but give providers a head start when it comes to delivering an outstanding patient experience. Learn more about how Experian Health's patient access solutions accelerate access to care and streamline revenue generation from the start. Learn more Contact us

If there's one topic that's sure to elicit groans from claims and billing teams, it's prior authorizations. Despite promising improvements overall, Experian Health's most recent State of Patient Access survey suggests that the efficient and timely management of prior authorizations remains a headache for providers, with 89% citing this as one of their top three improvement priorities in patient access. Obtaining pre-authorizations is time-consuming, often relying on antiquated manual systems that drag staff away from patient care. Ever-changing payer guidelines make an already frustrating process even more difficult. In this context, automating prior authorizations is an obvious choice for the 79% of providers who plan to invest in improving patient access in the near future. Why are prior authorizations required? Prior authorizations are when payers and providers determine in advance if the patient's insurance plan will cover a particular drug, medical item or service. Providers submit information about the patient's medical history and the rationale for the proposed treatment. The insurer evaluates this information and approves or denies the request. If a provider goes ahead without obtaining authorization, they are unlikely to be reimbursed for the cost of that care. The intention is to ensure that tests and procedures are safe, effective and high-quality. It's also a cost-control strategy, ensuring that expensive services are offered only to patients who really need them. Why do prior authorizations get denied? Insurers only approve prior authorization requests for treatment and services deemed medically necessary and aligned with their coverage policies. Authorization may be denied for several reasons: the treatment isn't covered by the patient's plan, the proposed treatment isn't considered medically necessary, or alternative, less expensive treatments are available. Denials often result from simple paperwork errors, such as incomplete clinical documentation or missed deadlines. Automating prior authorizations: an untapped opportunity The prior authorization workflow involves some of the most time-consuming and expensive manual processes in the revenue cycle, making it an ideal use case for automation. Yet, according to the Council for Affordable Quality Healthcare (CAQH), only 31% of providers use electronic prior authorizations. This contrasts with much higher adoption rates for other transactions: 94% use automation for eligibility checks, 98% for claims submissions and 90% for coordination of benefits tasks. With the amount spent on prior authorizations jumping by 30% between 2022 and 2023, switching to automated processes could save the industry hundreds of millions of dollars and many hours of staff time, among other benefits described below. Here are 5 benefits of automating prior authorizations: 1. Prevent costly claim denials and rework Without prior authorization, providers do not get paid. Failure to secure authorization was among the top three reasons for denied claims for almost half of the State of Claims 2022 survey respondents. Often, this is because the authorization does not cover all elements of a patient's treatment, or the information included in the claim submission does not match the original documentation that was authorized. With automation, it's much easier to ensure that all codes, documentation and records are accurate and complete, reducing the risk of claim denials. Automation also gives payers and providers a shared view of account information, minimizing the need for prolonged discussions about the status of authorization and rework requests. 2. Access a central payer database that automatically syncs with changing payer rules Revenue cycle management teams often struggle to keep track of changing payer requirements. Experian Health's prior authorization knowledge base solves this by collating real-time updates to payer requirements. Staff can check what's needed without needing to visit multiple payer websites and cross-check data by hand. Users also benefit from a guided, exception-based workflow, which notes whether submissions are pending, denied or authorized, and flags where manual intervention is required. 3. Improve operational efficiency Almost four in ten providers find timely and efficient management of prior authorizations challenging. Automating prior authorizations reduces the manual burden on staff, so resources and time aren't wasted on low-value activities. Providers can augment efficiencies by combining prior authorization software with other revenue cycle tools to create more coordinated and cost-effective processes. On a webinar about how AI and automation reduce claim denials, Skylar Earley from Schneck Medical Center commented specifically on how AI Advantage was facilitating more efficient prior authorizations: “[With AI AdvantageTM], we've seen the number of authorized outpatient visits increase by about 2.5%. For anyone that deals with prior authorizations and denials relating to prior authorizations, that's incredibly promising. Billers feel like they've got another tool in their belt. For people who spend hours on the phone with insurance companies, fighting for dollars and claims we believe should be paid, any leg-up is a big deal.” 4. Prevent dangerous delays to care with faster prior authorizations A 2022 survey by the American Medical Association showed that the authorization process leads to delayed and abandoned care and even severe adverse events, as patients and doctors wait to hear if paperwork is in order before proceeding with treatment. Automating prior authorizations helps ensure patients don't miss out on essential care because of administrative obstacles. Staff can shave an average of 11 minutes from each transaction, allowing them to initiate more authorizations in less time, and protect patients from the clinical consequences of rescheduling. 5. Deliver a better patient experience Aside from these obvious and significant health effects, the prior authorization workflow also influences patient perceptions overall: in the State of Patient Access 2024, just over a quarter of patients said authorizations were the main reason they considered patient access to be better or worse than last year. Automated prior authorizations free up staff to create a smoother clinical and financial experience for patients. Patients see their accounts processed quickly, with fewer errors and delays. When patients are certain that their insurer will cover their care, they can concentrate on their treatment rather than worrying about how and when it will be financed. Find out how Experian Health's automated prior authorizations help healthcare organizations get on the right path to reimbursement and make these benefits a reality in 2024.

Could patient text reminders play a key role in making healthcare more convenient and accessible for patients? Experian Health's latest State of Patient Access 2024 survey found that six in ten patients want more digital tools to manage their healthcare. Overall, it indicates a greater demand for more transparent, simpler processes. Patient text reminders make this a reality by reducing the cognitive load of scheduling and paying for care. With 98% open rates and an average response time of 90 seconds, text messaging is a simple but powerful engagement tool for providers. For the eight in ten providers gearing up to invest in digital patient access tools in the near future, sending patient text messaging reminders could be a smart choice. Here are three use cases to consider. Use case 1: Patient text reminders can boost patient collections For providers with squeezed margins, every cent counts. While healthcare affordability poses the biggest challenge for patient collections, outdated billing and payment processes hinder patient revenue overall. SMS (text message) reminders prevent unnecessary delays by gently prompting patients to settle their bills. They're direct, convenient and discreet, so they're more likely to be acted upon, as opposed to emails or phone calls that are easily ignored. Texting also supports a tailored experience. For example, Experian Health's PatientText solution integrates with Collections Optimization Manager to segment patients based on their needs and preferences. The Text-to-Pay feature sends patients personalized messages with secure links to payment options, so they can pay their bills when convenient without having to remember a username and password. Case study: See how St Luke's used Collections Optimization Manager and targeted patient outreach to increase average monthly collections by $1.7 million. Use case 2: Reduce no-shows with patient appointment reminders Almost 90% of patients say they want to be able to schedule appointments at any time via online or mobile tools. Automated text reminders ramp up the return on investment in online scheduling and mobile registration tools by reducing no-shows, optimizing patient flow, and ensuring patients get the care they need. Messages can include preparation instructions, so patients know exactly where to go and when, and if they need to fast beforehand or bring anything. It's much easier for patients to click a link in a text to confirm, reschedule, or cancel appointments, than to check their email or wait to speak to a call center agent. That's good news for call centers too – when more patients opt for self-service options, providers can scale targeted outreach while keeping call volumes manageable. Case study: See how IU Health transformed patient scheduling with self-service automation Use case 3: Patient text reminders increase patient satisfaction and care plan adherence with handy alerts Patients actively engaged in their health are more likely to follow through with treatments and care plans, leading to better health outcomes. Text messages can remind patients about post-appointment care, check-ups and medication refills to help them stay on track and reduce the risk of missed doses or appointments. Closing gaps in care and preventing avoidable complications is not just good from a medical perspective – it also reduces the risk of more expensive care being needed further down the line. However, one of the most significant advantages of using patient text reminders is creating a more organized and patient-friendly experience with little effort, benefiting patients and staff. Automated, timely messages through patients' preferred channels ensure they feel cared for and informed, without staff needing constant, high-touch follow-up. Staff members are free to focus on patient support and other revenue-generating tasks, instead of wading through endless admin. Read more: 5 benefits of automated patient outreach PatientText in practice: How one provider used targeted outreach to boost collections by nearly $2M One of Experian Health's clients offers a snapshot of what they've achieved in the year since implementing SMS-based patient outreach: $1.89M in patient collections via Text-to-Pay $168 collected per transaction on average 11K+ transactions via text These results show that offering patients the flexibility to engage with payment processes at their convenience leads to higher transaction amounts and more dollars collected overall. Take advantage of smartphone culture with patient text reminders Many patients have their smartphone with them 24/7, which gives providers a fantastic opportunity to improve patient engagement through automated text reminders. Whether the drive is to increase collections, improve patient flow, or create convenient patient experiences, it's clear that this relatively simple technology punches above its weight. Schedule a demo to see how Experian Health's patient text reminders solution, PatientText, can help your organization improve patient engagement and optimize collections.

The State of Patient Access 2024 marks the fourth installment of a series of surveys initiated in 2020, comparing patient experiences and providers' perceptions of those experiences. Experian Health's latest infographic highlights findings from the latest survey, conducted in February 2024, involving 200 healthcare revenue cycle decision-makers and over 1,000 patients. The study reveals an overall improvement in perceptions of access to care, indicating a positive trend in providers' efforts. However, there are still significant challenges ahead. Providers continue to believe access is better than what patients actually experience, a consistent finding across surveys. Check out the highlights in the infographic: Despite progress, there's a clear need to bridge the gap between patient experience and provider perception. How can providers turn their perceptions into reality for patients? Download The State of Patient Access 2024 report to gain deeper insights into patients' and providers' perspectives on access to healthcare.

“We are really happy with Experian. It takes away duplication of efforts and allows us to see the bigger picture. The eligibility solution works well for our team and patients.” —Emily Brown, Director of Operation Excellence at Providence Health  Challenge Providence Health is a leading health system comprising of 56 hospitals and over 1,000 physician clinics. With an annual patient volume of over 28 million, Providence strives to prioritize the well-being of their patients by providing convenient, accessible, and affordable medical services.   Because of high patient volumes, they faced issues with slow payer eligibility processes and increased eligibility denials, which meant their staff spent a lot of valuable time verifying eligibility manually.   Additionally, as Epic's payer plan table expanded, Providence Health needed an efficient way to consolidate and align the data pertaining to insurance plans, contracts, and reimbursement details. In order to streamline the process and keep their staff within the system, Providence Health sought to automate eligibility tracking.  Solution Providence Health implemented Eligibility Verification and leveraged the Bad Plan Code Detection tool, which identifies coding errors before they're submitted to payers. With this solution, the system immediately alerts users when an incorrect plan code is flagged, allowing users to fix any issues quickly and avoid costly claim rework. Additionally, integration with Epic facilitated seamless 1:1 plan mapping, and automated the creation of new coverage records in Epic based on responses received. This streamlined the process, eliminating guesswork for staff and ensuring accurate plan selection. Emily Brown, Director of Operation Excellence says, “Our search for a solution that seamlessly integrates with Epic led us to choose Experian Health as our preferred vendor, given their proven track record of working with Epic.” By working with Experian Health, Providence has uninterrupted service and connections to over 900 payers, with backup connectivity to 300 additional payers. Providence staff can utilize automated work queues fueled by response data and custom alerts, which allows them to work more efficiently.   Outcome Thanks to Eligibility Verification, Providence Health achieved the following results:  Found an average of $30 million in coverage annually   Saved $18 million due to decreased denial rates within five months  By automating eligibility checks for high patient volumes, Providence Health boosted patient satisfaction while significantly reducing staff workload. Partnering with Experian Health allowed them to identify an increased amount of active eligibility, ensuring accurate reimbursement and avoiding claim denials. Automation also eliminated time-consuming tasks, allowing staff to focus on providing better patient care.   “Checking if my insurance was accepted was a fast and friendly process. The staff even helped clarify which insurance was the right one for me since I had multiple cards.”   - Providence Health Patient  Learn more about how Eligibility Verification helps healthcare organizations access real-time insurance coverage data, improve reimbursement rates and avoid claim denials.  

What do patients and providers really think about patient access services in 2024? Drawing insights from more than 1000 patients and 200 healthcare executives, Experian Health's fourth State of Patient Access survey pulls back the curtain. Previous surveys revealed a persistent gap between patient and provider perspectives on patient access, but could the gap finally be closing? The State of Patient Access 2024 report suggests that while discrepancies remain, the two groups appear closer than ever. This article provides a summary of the State of Patient Access 2024 report, and gives a run-down of patient and provider perspectives on patient access, what they see as top challenges, where opinions diverge and the steps providers can take to continue building a positive patient access experience in the year ahead. How do patients feel about patient access? 1. More patients think access has improved compared to last year 28% of patients believe patient access has improved over the last year, which is up from just 17% in 2023. As in previous years, patients' perception of whether access has improved hinges on how quickly they can see their doctor. Anything providers can do to accelerate scheduling and registration will be a winner. 2. Patients welcome the efficiency and accuracy of digital tools Patients have noticed improvements in scheduling and registration processes. They welcome the ability to book appointments anytime and avoid unnecessary paperwork using digital technology. That said, financial considerations trump convenience: the ability to look up insurance coverage and obtain accurate price estimates before care have risen to the top of the list of what patients consider the most important aspects to improve. 3. Cost of care remains a concern Unfortunately, patient sentiment around healthcare payments has remained relatively flat since 2022. Slightly more patients are receiving upfront cost estimates compared to previous years, but accuracy appears to have dropped, with 74% of patients reporting accurate estimates compared to 78% in 2023. Patients must have faith in their estimates if they are to plan for upcoming bills with confidence, and providers should be able to provide transparent and accurate payment estimates. What do providers think about patient access? 1. Providers are again more optimistic about improvements than patients Like patients, providers are generally positive about the state of patient access, though they may be a little too optimistic about the effect of improvement efforts. Around twice as many providers think access is better than the previous year compared to patients (55% compared to 28%). For providers, perceptions of improvements in patient access are closely tied to the impact of staffing levels. 2. Self-scheduling is back in favor Providers are aligned with patients on the need for digital scheduling and registration options. Interestingly, after the urgency to implement contactless scheduling during the pandemic began to wane in 2022, the latest survey suggests that self-scheduling is back in fashion, with 63% offering self-scheduling compared to 40% in 2022. 3. “Dirty data” remains a stubborn challenge Data collection at patient intake is a persistent headache for providers. Almost half (49%) say that inaccurate patient information contributes to claim denials. Improving the speed and accuracy of resolving patient information prior to claims submission were frequently listed in providers' top three challenges. See how healthcare organizations are using AI AdvantageTM to improve data accuracy and reduce claim denials. Digital technology bridges the gap between patient and provider perspectives on patient access When asked for their top three priorities for improvement, both groups ranked accurate price estimates and efficient insurance verification among their top two. While they diverge on the third – access to online health management tools for patients, and automated pre-authorizations for providers – it's interesting to note that these both reflect a desire to use digital solutions for greater efficiency and convenience. The survey highlights several opportunities to use digital technology to address upcoming challenges and continue to close the gap. Key challenges in patient access in the year ahead 1. Improving accuracy of upfront price estimates The survey showed 79% of providers plan to invest in patient access improvements soon. Given shared concerns about patients' ability to cover the cost of care, and worrying hints that some may postpone care due to cost concerns, prioritizing and providing accurate patient estimates would be a smart choice. While patients and providers are in closer agreement that estimates are accurate most or all of the time (74% and 85% respectively), there's clearly room for improvement. 2. Accelerating insurance verification and claims submission processes Several of the providers' top challenges speak to how difficult it can be to collate accurate information prior to claims submission. The need for better insurance reviews, more efficient management of prior authorizations, and more accurate patient information all contribute to the overarching goal of getting properly reimbursed. Almost a fifth say that managing multiple tools to determine eligibility, coordination of benefits (COB), and other pre-service checks is a top challenge. Could a single solution be the answer? Experian Health's new Patient Access Curator solution checks eligibility, COB, Medicare and commercial coverage, demographics and financial status in less than 30 seconds. Staff can check off several of these tedious tasks with just a single click. 3. Bolstering workforce capacity with technology A final challenge in the year ahead is the ongoing impact of staffing shortages. For the of providers who feel that staffing levels are disrupting delivery of scheduling and registration services, technology may offer a way through. Automation and artificial intelligence not only reduce the burden on staff by eliminating time-consuming manual tasks, but also allow staff to work smarter and faster on remaining tasks by improving data accuracy and insights. Most importantly, digital technology can improve scheduling, registration and payment processes for patients – and bring the patient experience in line with what both groups aspire to see. Download the full report: State of Patient Access 2024, or contact Experian Health to learn how technology can help streamline patient access.

“Is this claim valid? How much is our financial responsibility?” These are the two big questions payers want to answer when adjudicating healthcare claims. Huge amounts of patient information, clinical data, diagnostic and billing codes, and policy specifications must be analyzed and cross-checked to verify that the right amount is paid to the right party. It's a complex process. Even the smallest error can result in a claim being rejected or denied, dragging out payment timelines and eating up provider profits. That's why healthcare providers should reevaluate their claims adjudication process. Experian Health is pleased to announce that we've ranked #1 in Claims Management and Clearinghouse, for our ClaimSource® claims management system, according to the 2024 Best in KLAS: Software and Professional Services report. Learn more The claim adjudication process is a pivotal step in the revenue cycle and determines a provider's reimbursement for services rendered. It's a complex process with many moving parts, which means errors or delays can occur at many points along the way. A smooth, streamlined system can reduce the amount of time and money spent on claims adjudication for both the payer and the provider. Here are six steps to improving claim adjudication processes for a better bottom line. What is claims adjudication? Claims adjudication is the process by which insurance companies thoroughly review healthcare claims before reimbursement or payout. During this process, they decide whether to pay the claim in full, pay a partial amount, or deny it altogether. If more information is needed, the claim will be rejected and marked as “pending.” Insurance companies employ this systematic procedure to determine the validity, accuracy, and eligibility of claims against the terms and conditions of their policy. During claims adjudication in healthcare, insurance payers assess the documentation provided by the service provider, examining factors such as the nature of the services, coverage details, and any applicable deductibles. The process can take weeks to resolve itself. This evaluative process ties up billions of dollars in an endless cycle of claims denials and resubmissions. Following this evaluation, the provider will reject or settle the claim. Additionally, claims adjudication may lead to partial settlements or modifications based on the assessment of the claim. By all accounts claims denials are exceedingly common; a recent Experian Health survey showed that these numbers have increased by up to 15% annually. Healthcare providers can implement several steps to mitigate the risk of denials, enhance the efficiency of claims adjudication and get paid faster. Steps to improving the claims adjudication process The healthcare reimbursement process is bogged down with manual tasks that create errors. Experian Health's State of Claims 2022 report revealed that the most common claims errors include: Missing or incomplete prior authorizations Failure to verify provider eligibility Mistakes in medical coding Yet providers have new technologies at their fingertips to improve how and when they get paid. McKinsey reports on data showing that applying the latest artificial intelligence (AI) and automation digital tools to the revenue cycle could save healthcare providers up to $360 billion annually. That makes these tools a kind of adjudication insurance to protect providers against costly claims denials. Here are six ways to apply technology to improve the claims adjudication process. Step 1: Invest in automation Some of the benefits of automating healthcare claims management include: Streamlined operations with fewer human errors. Less staff time tied up in claims adjudication. Better data with real-time insights into patient and payer trends. Faster claims processing—and faster payment. Better patient experiences. Happier staff. Applying AI and automation to claims management can eliminate errors by allowing the technology to validate and cleanse data at the point of entry. Tools like Experian Health's Claim Scrubber can thoroughly review each line of claim data in seconds. Alerts can flag a human attendant, allowing them to correct mistakes before claim submission. Automation technology like the Enhanced Claim Status streamlines the revenue cycle by tracking the claims adjudication process in real-time. Instead of submitting a claim and awaiting the payer's response, this technology provides claim statuses within 24 to 72 hours. Step 2: Prevent delays with front-end edits and save time spent in claims adjudication How much time could providers save by correcting front-end mistakes before the claims adjudication process begins? During claims adjudication, payers will compare claims data to payer edits, to make sure billed services are coded correctly. Therefore, providers must keep pace with current coding requirements and the universal, local and payer-specific edits that apply. If claims are not correct the first time, they'll fail the payer's initial automated review, and may be denied or pushed into a queue for manual review by a claims examiner, leading to inevitable delays. Front-end claims editing tools can find errors that might prevent reimbursement, such as missing prior authorization or coordination of benefits codes. Patient Access Curator, Experian Health's latest revenue cycle data curator package, helps healthcare providers eliminate errors quickly on the front-end. This solution uses AI to perform eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, preventing denials at the front end with a single click, within seconds. Experian Health's ClaimSource® solution allows organizations to implement customized edits and rules tailored to specific payer requirements. These edits help catch errors related to coding, billing, or other aspects of the claim, preventing inaccuracies from progressing to claims adjudication. While the industry average for claims denials is 10% and higher, Experian Health clients who use ClaimSource have a typical denials rate of just 4%. That's one reason Experian Health's ClaimSource solution earned the top KLAS ranking for the second consecutive year. Step 3: Streamline record-keeping and data management Electronic record keeping plays a pivotal role in ensuring accuracy in healthcare claims. These platforms allow centralized storage of patient data, including medical history, treatment plans, and billing information. Electronic record systems can enforce standardized coding practices, ensuring that medical codes used for billing and claims adhere to industry standards. They also maintain detailed audit trails, documenting all changes and updates made to patient records. This level of accountability enhances accuracy by allowing organizations to trace any modifications and ensure data integrity throughout the claims adjudication process. Notably, electronic record-keeping systems seamlessly integrate with healthcare claims management systems. Integration ensures that the information entered into electronic health records (EHR) automatically populates relevant fields in the claim, minimizing the need for manual data entry and reducing the risk of transcription errors. Step 4: Automatically review coding for accuracy Coding errors can result in claim denials and delay reimbursements to providers. For example, manual coding introduces the risk of typos or misinterpretation of the medical record. Because of the complexities of payer requirements, an incorrect procedure or diagnosis code could trigger claim rejection. Some procedures require supporting documentation or pre-verification before treatment. At the same time, ICD-10 (codes for patient diagnosis) and CPT codes (that identify services rendered) undergo regular updates. Failing to stay on top of these coding systems increases the risk of a rejected claim. The solution is to apply AI and automation to improve the chance of claims adjudication success. Two solutions from Experian Health include: AI Advantage™ - Predictive Denials uses AI to spot documentation errors before the claim goes to adjudication. The solution automatically flags claims with a higher potential for denial, allowing the revenue cycle team to fix errors before claim submissions. For claims that have already been denied, AI-Advantage Denial Triage identifies and prioritizes high-value denials, so teams can focus on remits with the highest impact. Denial Workflow Manager allows providers to quickly identify denied claims early in the claims adjudication process. Remittance details show providers the steps necessary to amend the claim quickly for a higher chance of reimbursement. Intelligent data-driven denial analytics spot the root causes of denials, so remedial action can be taken. Step 5: Create clear patient communication channels Clear patient communication channels are essential for preventing errors in healthcare claims adjudication. Incorrect patient information can result in claim denials, causing delays in reimbursement and impacting both patients and healthcare providers. Automated patient outreach technology significantly enhances communication while reducing the likelihood of errors. Solutions like Patient Access Curator also work to capture accurate patient data at registration - all in a single click. Electronic patient portals, powered by automation software, can also solve this challenge. These portals empower patients to update their information directly, ensuring the accuracy of data submitted with claims. Patients can verify and input their demographic details, insurance information, and other relevant data through user-friendly interfaces. Electronic patient portals significantly reduce the risk of errors in patient information by minimizing manual data entry and streamlining the information-sharing process. These tools enhance the efficiency of the claims adjudication process, reduce the likelihood of denials, and promote a smoother experience for patients and healthcare providers. Step 6: Advocate for policy change Moving towards claims adjudication automation with uniform industry standards can save providers and payers time and money. Currently, each payer operates within their unique silo of ever-changing reimbursement requirements. A lack of standardization means providers spend hours checking claims against payer requirements. The first step toward industry standardization requires automation technology to eliminate these time-consuming manual processes. Digital solutions like Experian Health's online prior authorization software update requirements directly from payer websites, giving providers a better shot at submitting a clean claim. Advocating for healthcare policy change toward greater automation and more uniform industry standards is a strategic move that will save time and money and foster a more efficient, transparent, and technologically advanced healthcare ecosystem. This transformation will improve patient care and overall system sustainability. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more Improving healthcare claims management with Experian Health Today, nearly 20% of all healthcare claims are denied, and 60% are never resubmitted. That ties up significant revenue in the claims adjudication process. However, better claims management processes can yield reduced denials and faster payments. Experian Health offers a complete ecosystem of tools to deliver cleaner claims and faster reimbursement. This suite of products creates an integrated technology ecosystem with a track record of increasing the speed at which healthcare providers get paid. Find out more about how Experian Health's Claims Management solutions can support a more streamlined claims adjudication process.