Tag: patient access curator

Revenue cycle management (RCM) plays a central role in healthcare, influencing both patient access and the financial well-being of providers. As healthcare organizations navigate growing costs, shifting patient expectations, and increasingly complex administrative tasks, they're finding themselves at a crossroads. Experian Health's State of Patient Access 2025 report offers a look at these challenges from the views of patients and providers, while showcasing how technology is changing the way we approach patient access and revenue cycle operations. In this interview, Clarissa Riggins, Chief Product Officer at Experian Health, shares key takeaways from the report, offers actionable solutions for providers, and outlines trends that are set to shape the future of RCM.  Q1: "Let's start with the big picture. What's going on with patients' access to healthcare right now?" Riggins says, "It's stabilizing, which is a good sign. According to The State of Patient Access 2025, 68% of patients and 43% of providers say access has stayed the same. That's the highest it's been since 2022. Only 15% of patients said it's gotten worse, and that's the lowest number we've seen in a few years."  Q2: "That's reassuring. But there are still challenges, right? What are patients struggling with most?"  "The number one issue continues to be wait times," explains Riggins. "About 25% of patients said getting in to see a provider quickly is still a major hurdle. On top of that, 22% reported delays because of insurance verification, and 20% said they ran into problems with errors in their medical records or billing information. So, while some things have improved, there are still gaps to close.”  Q3: "You mentioned insurance verification. How much of a barrier is that?" "It's a big one," she says. "When insurance verification isn't seamless, it creates a domino effect. That 22% figure I mentioned, those are people who had to wait for care because their insurance details weren't sorted out. Automating that part of the process can make a huge difference in getting people the care they need faster.” Q4: "Are digital tools making a difference in these areas?"  "They have the potential to, but adoption is a challenge. 37% of providers said one of their biggest obstacles is getting patients to actually use the tools available. And 55% said patients don't know how to navigate self-scheduling. We're seeing some resistance, but it's not because the tech isn't there. It's more about awareness and ease of use. She continues, "For example, going back to insurance eligibility, Experian Health's Patient Access Curator uses artificial intelligence (AI) to automatically check coverage in real time. This helps providers confirm benefits instantly and spot issues early. That kind of automation takes the guesswork and delays out of the equation, so patients can get the care they need without unnecessary holdups. It's not just more efficient for staff; it literally speeds up access to treatment."  Q5: "Let's talk about cost. How is that affecting access for patients today?"  “Cost is a major pain point," she explains. "The report shows that 34% of patients say they often struggle to pay for healthcare. That number is up from 23% last year. And nearly all patients, 95%, say they at least sometimes have trouble paying. It's clear that affordability is still one of the top reasons people delay care."  Q6: "What can providers do to improve the payment experience for patients?"  “It starts with transparency. Patients want to know what they'll owe before they get care. When 81% of patients say they feel more prepared after receiving an accurate estimate, it shows just how critical that upfront information is," Riggins notes. "Experian Health's Patient Estimates solution was built around this need. It allows providers to give patients clear, personalized cost estimates before they receive care, helping them feel informed and in control." "And 43% said they would consider canceling or postponing care if they didn't get that information," she continues. "That's huge. It proves this isn't just about convenience; it's about access. These tools help patients avoid financial surprises, which can be the deciding factor in whether they follow through with treatment." “This solution isn't just making billing easier. It's directly supporting better health outcomes by making care more accessible and less intimidating financially."  Q7: "So, it's not just about having the tools. It's about how they're used?"  "Exactly. Providers need to make sure the tools are easy to use and that patients understand how to use them. That means clear instructions, mobile-friendly interfaces, and support when people get stuck. If the experience feels complicated, people just won't engage." Q8: "What are patients looking for when it comes to better access?"  "Patients are very clear. They want convenience," Riggins says. "According to The State of Patient Access 2025 report:  82% don't want to complete forms multiple times if their information hasn't changed  80% want to be able to schedule appointments from their phone (via a browser or an app)  77% want a heads-up on insurance coverage before treatment  52% want more digital options, period  So, if providers listen to these preferences and meet patients where they are, access improves naturally."  Q9: "What about billing and patient record issues? How can providers avoid those mistakes?"  "Strong data practices are key. That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records. Adding tools like Patient Access Curator can really make a difference. It uses artificial intelligence to handle a bunch of tasks all at once – eligibility checks, COB, MBI, demographics, and insurance discovery. By automating tasks that are traditionally performed by human staff, healthcare organizations can save time associated with administrative intake and coverage verification. This also means solving for bad data in real-time, which can help prevent billing and claim errors in the long run.  Clean data makes everything easier, from billing to insurance verification to patient trust," Riggins concludes.   Patient access is evolving, but not without its challenges. As the State of Patient Access 2025 report highlights, stability is improving, but issues like price transparency, low adoption of digital access tools and insurance verification continue to create friction. The path forward lies in listening to what patients are asking for: easy-to-use digital tools, clear pricing, and fewer administrative headaches. By utilizing automation and AI, providers can streamline access and build stronger, more trusted relationships with their patients.  Learn more about how Experian Health can help healthcare organizations improve patient access, and download the report for the full survey results.   Download now Contact us

Healthcare providers have heard it before – high employee turnover and the constant need to train on new solutions can severely impact the efficiency of revenue cycle management (RCM) teams. As denials increase, the resources required to address them grow, putting additional strain on healthcare providers and their teams.  For decades, manual claim management has been the cornerstone of revenue cycle operations. However, with shifting payer algorithms, higher patient volumes, and evolving insurance coverages, this approach is no longer sustainable. Getting the highest percentage of claims paid with the exact amount of human capital is unachievable. Many health systems can't keep up, and RCM teams are experiencing burnout. There is a glaring need for the rapid adaptation of automation to improve front-end data collection, where reducing errors can have the highest impact on claims, and the teams responsible for them. According to Experian Health's latest State of Patient Access survey, 56% of providers say patient information errors are a primary cause of denied claims, 48% report inaccuracies in data collected at registration, and 83% emphasize the urgent need for faster, more comprehensive insurance verification.  Front-end operations are a major source of friction. Four out of the five top patient access challenges reported by providers relate to front-end data collection, including improving insurance eligibility searches, reducing errors and speeding up authorizations. Is it any wonder that these actions are typically performed by hard-working and taxed humans?   These inefficiencies don't just slow down internal workflows. Manual, error-prone processes lead to delays, claim denials and patient frustration, not to mention low morale with revenue cycle teams trying to find the errant data. Providers note that staffing shortages are compounding the problem, which suggests that tackling front-end workflows would be a strategic operational win.  How Patient Access Curator enhances revenue cycle efficiency  What if providers could take that manually laden process, integrate automation, and allow their staff to apply their revenue cycle experience, equity and strategic thinking in the right place?   Patient Access Curator (PAC) uses automation and artificial intelligence (AI) to streamline patient access and billing, address claim denials and improve data quality without the need for human intervention. This integrated solution performs rapid eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery checks to ensure that all data is correct on the front end, freeing teams up to focus on more strategic tasks.   It doesn't require the long training requirement of standalone products; it fits seamlessly into existing EHR systems, and works directly within the system, with no need for drawn-out onboarding programs.   According to one of the early adopters of the Patient Access Curator, their revenue cycle team is already seeing – and feeling – the results of automation.   A Senior Director of Revenue Cycle at a large Midwestern health system says, “One of the primary reasons we chose the Patient Access Curator was because it makes the normally manual work of revenue cycle much easier, which in turn improves productivity, empowerment and morale. Registrars are now able to make determinations right within the system. It's easy to use.” With so much data to capture, manual strategies are bound to stumble and apply downward pressure on those tasked with high-volume work. Patient Access Curator removes the need for manual checks on multiple payer websites and data repositories to verify insurance eligibility, and checks for any billable coverage that might have been missed. Experian Health's industry-leading claims management products are designed to simplify these processes. The  newest denial prevention technology  strengthens this suite with capabilities previously unavailable.  Efficient claims management with artificial intelligence and automation  Patient Access Curator captures and processes patient insurance data at registration using an “if-then” logic that returns multiple data points from a single inquiry, in seconds. Registration staff can leverage this technology to collect and verify much of the information they need to compile an accurate claim, with just a single click. In a matter of seconds, they'll have a comprehensive readout of:  Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps Coordination of Benefits: Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing Medicare Beneficiary Identifiers: PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support  Insurance discovery: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches Demographics: The platform can quickly check and verify patient contact information Patient Access Curator achieves such speedy results “because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer,” says Jordan Levitt, Senior Vice President of Experian Health. “This means data can be transferred easily between interfaces.” Hear how Columbus Regional Hospital has used the Patient Access Curator to simplify and streamline its revenue cycle operations. With Patient Access Curator, better data adds up to increased revenue cycle efficiency, along with the following:   Reduced errors: Automation minimizes human intervention in repetitive tasks.  Faster processing: Automated systems can handle large volumes of claims and payments much faster than manual processes, accelerating the reimbursement cycle, improving cash flow and reducing delays in revenue collection.  Enhanced compliance: Automation tools like Patient Access Curator are continually learning from inputs, and adapt to stay up-to-date with evolving regulatory requirements and payer policies. This ensures that claims are compliant, reducing the risk of denials and costly rework.  Improved denial prevention: Patient Access Curator identifies patterns in historical claim data, flagging or fixing potential errors before submission. This proactive approach helps in preventing denials and optimizing revenue recovery.  Streamlined workflows: Automation frees up staff from mundane tasks, allowing them to focus on strategic initiatives such as patient engagement and financial planning. This leads to more efficient use of resources and improved overall productivity.   At a time when revenue cycles are under increasing pressure from changing payer rules, labor dynamics and operational constraints, this new solution offers a long-awaited boost to both reimbursement rates and productivity. Patient Access Curator is available now – learn how it can help healthcare organizations boost revenue cycle efficiency and prevent claim denials in seconds. Learn more Contact us

Claim denials are skyrocketing, and so are revenue cycle leaders' stress levels. In our most recent State of Claims survey, 54% of respondents said their current claims technology is sufficient to address existing revenue cycle demands at their organizations. However, that number was 77% just two years ago. That's because denial management has long been a reactive strategy. Many organizations focus on addressing claim denials after services are rendered and information is sent to payers. However, this approach often leads to increased labor costs, delayed reimbursements, and a higher volume of denied claims. It's time for a paradigm shift towards claim denial prevention, a proactive strategy that addresses potential issues before they result in denials. To prevent claim denials, go on the defensive Jordan Levitt, Senior Vice President at Experian Health, sees it as playing defense. “We use a term called 'Perimeter Defense' - get the patient's information right on the front end, before it gets into the system,” says Levitt. “Denials are happening because incorrect or bad data gets in early, costing health systems time - and money – to fix on the back end. The mindset is moving from management to prevention.” The legacy denial management approach being used today involves significant manual intervention, including correcting errors, resubmitting claims, and appealing denials. The result is a costly and time-consuming process that diverts valuable resources from more strategic tasks. Denial prevention, on the other hand, focuses on addressing potential issues at the front end of the revenue cycle. By ensuring that claims are accurate and complete before they are submitted, organizations can significantly reduce the volume of denied claims. This proactive approach not only accelerates cash flow but also reduces the burden on billing staff and lowers contingency vendor fees. Bad patient data is like a virus “There's a revenue cycle adage often referred to as 'Know Thy Patient,'” says Levitt. “With the Denial Prevention philosophy, at registration and scheduling we need to know exactly who they are (e.g. John Smith or Jonathan Smith?), where they live, and how to reach them, in addition to all of their coverages, the order of billing - everything.” The inherent problem today, he continues, is that the first time incorrect or outdated patient data is ingested into a health system, it proliferates throughout the entire system. Electronic health records are great at keeping patient data together for a health system, but they don't distinguish between good data and bad data. It's all just data. “Whether a patient is coming by way of a physician's office, a business office or residence and the information is wrong, it populates throughout an integrated system - hospitals, urgent care, labs,” says Levitt. “Once you let bad data in the door, regardless of the origination point, it's like a virus. Each time that happens and you're building the work queues and you're building buckets of contingency funds if you can't solve it at the start of the process. Every action you take once bad data enters your system is wasting resources.” Fixing poor data on the front end is the key to preventing claim denials That seems like an obvious solution. However, throwing more people at the problem isn't the right answer when technology that is faster, more accurate and fully integrated into workflows is available. Solving for incorrect or missing eligibility, insurance coverage, Medicare Beneficiary Identifier (MBI), demographics and continuation of benefits is readily available with just a simple click. Experian Health's Patient Access Curator is a robust revenue cycle solution designed to prevent claim denials at the front end. It addresses bad data quality with real-time data correction, performing eligibility checks, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics, and discovery in a single solution. With a single click, Patient Access Curator ensures quick, accurate registration and scheduling, significantly reducing denial volumes and billing errors, including: Eligibility Verification: Automatically interrogates 271 responses to indicate any secondary or tertiary coverage data. Coverage Discovery: Works behind the scenes to minimize the cost of insurance discovery and streamline workflows, often generating additional insurance revenue missed by previous processes. MBI Correction: Continuously finds and corrects MBIs using artificial intelligence (AI), in-memory analytics, and robotic process automation. Demographic Updates: Automatically identifies obsolete or inaccurate data using proprietary algorithms. COB Analysis: Analyzes each payer response in real-time at the point of service and integrates directly into the eligibility verification process. Benefits of claim denial prevention By successfully transitioning to a denial prevention strategy, revenue cycle teams can: Reduce denial volumes: By addressing issues before claims are submitted, organizations can significantly reduce the volume of denied claims. Lower labor costs: Automation and real-time data correction reduce the need for manual intervention, allowing staff to focus on more value-added tasks. Accelerate cash flow: Faster, more accurate claims submission leads to quicker reimbursements and improved cash flow. Enhance patient satisfaction: Accurate and timely claims processing reduces the need for patient follow-up and improves overall patient satisfaction. Beyond denial management: The strategic shift to claim denial prevention The transition from claim denial management to denial prevention represents a significant shift in how healthcare organizations approach revenue cycle management. By focusing on proactive strategies and leveraging advanced technologies like Patient Access Curator, organizations can reduce the burden of denied claims, lower costs, and improve overall efficiency. Embracing denial prevention is not just a strategic advantage—it's a necessity in today's complex healthcare landscape. Watch the video to see how Patient Access Curator is evolving patient access at light speed, using the power of AI and machine learning.  Learn more about Patient Access Curator and contact us to see if you qualify for a free denial analysis. Learn more Contact us

Revenue cycle management (RCM) leaders feel it every day: financial pressures continue to mount, with hospital and laboratory operating margin compression becoming a challenge for even the most financially sound healthcare organizations. To combat claim denial pressures and strained lab and hospital profit margins, healthcare providers should start with the beginning in mind. Strained lab and hospital profit margins are particularly evident in revenue cycle operations, where every dollar billed to a payer needs to find its way back to the system. Rising labor costs, increased expenses for purchased services, and declining patient demand - plus inflationary pressures and labor shortages - have exacerbated these issues. As a result, many hospitals and health system leaders are struggling to maintain financial sustainability. The best revenue cycle leaders must deftly navigate a complex mix of denial management strategies and AI-based technology, like Patient Access Curator, to maximize revenue and improve operational efficiency. Payers aren't helping lab or hospital profit margins Payers, facing their own financial pressures, are tightening hospital operating margins even further, leading to increased claim denials, hyper-focused audits, and reduced reimbursement rates. These strategies create a series of cascading challenges for RCM teams, including increased administrative burdens and revenue leakage. According to a report by Healthcare Finance, 84% of health systems cite lower reimbursement from payers as a top cause of low operating margins. Additionally, 82% of CFOs have seen a significant increase in payer denials since pre-pandemic levels. Higher labor costs are another major driver of margin pressure, with 96% of CFOs reporting this as a significant issue. Healthcare leaders agree – strained profit margins are an ongoing struggle In Experian Health's own research, healthcare executives identified strained profit margins as their biggest challenge. The underlying struggle is about money—keeping cash flowing and supporting a healthy organization. One of the country's top health system CFOs stated that it's the first time in his 30-year career where his beds are full, but he has zero margin. This highlights the severity of the issue. Jason Considine, President at Experian Health, says, "We talk to healthcare leaders frequently and our survey and polling have revealed their primary concerns leading to strained margins – and a highly-pressured financial environment. Some of these reasons might be front and center [for a particular organization], others secondary or tertiary. But all of them are driving down margins across health systems: inpatient revenue erosion, cost of labor, rising staffing and supply complexity, delayed payer reimbursements, regulations, and a very fluid, shifting payer mix. It's consistent from system to system, hospital to hospital." Quick fixes only deepen the problem How have most healthcare organizations been playing catch-up? They throw various fixes at the problem, like cobbling together denial management teams, and adding more software, contingency vendors, and labor. However, those solutions can be a knee-jerk reaction, and only compress margins further. Take a look at coordination of benefits (COB) denials. Revenue cycle leaders often don't have the complete data picture when they look at a 271 response to establish primacy and ignore the “noise” of secondary or tertiary payers. Many don't truly know their system's current process for COB denials – nor that of the vendors or staff who try to 'fix' the problems. Bud Zuberer, VP of Sales at Experian Health, says, "On a daily basis we hear that COB denials, contingency fees, and labor costs are crippling revenue cycle teams. They're paralyzed with too many decisions to make. This collection of problems has led to a rise in denial management teams and personnel. We're witnessing the invention of companies to 'solve' the problem. But that's not the answer. The answer lies in ensuring the data ingestion is correct from the start.” Adding more solutions or software to an already full slate of vendors can also be problematic, as it requires more human touchpoints and capital investments. Ultimately, this affects cash flow, cash acceleration, and days in accounts receivable (AR). Prevention is the best medicine to improve strained lab and hospital profit margins The fastest way to ease the pain of rising claim denials and falling cash flow is denial prevention – fixing downstream problems upstream, before they occur. As Zuberer points out, clean data from the start will reduce denials and chasing cash on the back end. Experian Health's all-in-one Patient Access Curator prevents claim denials in seconds by solving bad data quality and real-time data correction, drastically cutting contingency vendor fees and accelerating cash flow. Some of the key benefits of Patient Access Curator include: Reducing billing errors: Artificial intelligence (AI) and machine-learning guided technology improve claim and data accuracy. Quick, accurate patient registration and scheduling: Streamlines processes. Lower denial volumes: Prevents claim denials at the front end. Decrease human resources related to denial management: Eases staffing shortages and frees up team members for higher-value tasks. Client success story Exact Sciences, one of the largest laboratories in the U.S., recently began using the Patient Access Curator in its revenue cycle operations. Thanks to Patient Access Curator, Exact Sciences achieved the following results: 15% increase in revenue per test due to accurate eligibility and fewer denials 4x business volume without increasing headcount 50% reduction in denials and major improvement in timely filings $100 million added to the bottom line in 6 months “You know when Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” - Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences Read the full case study or see what Kubisty had to say in a new testimonial: Prevent strained profit margins in the long run  Strained profit margins are a significant challenge for healthcare organizations, impacting revenue cycle operations and overall financial health. By adopting strategic approaches and leveraging technology, healthcare leaders can navigate these complexities and confirm every dollar is accounted for. In this evolving landscape, proactive and adaptive leadership is crucial for sustaining financial stability and delivering high-quality care. Learn more about how Patient Access Curator helps prevent strained lab and hospital profit margins by solving for bad data, all at once. Patient Access Curator Contact us

Patient access continues to improve, with both providers and patients reporting steady progress, according to The State of Patient Access 2025. Building on the momentum of the 2024 State of Patient Access survey (when 55% of providers reported better access), 36% now say it has improved even further. Around six in ten patients agree that the experience is the same or better than a year ago. Now in its fifth year, Experian Health's latest annual survey shows how patient and provider perceptions of patient access have changed, and where there's still work to do. In February 2025, more than 200 healthcare revenue cycle decision-makers and over 1000 healthcare consumers were surveyed about their experiences over the previous year. The findings point to three key opportunities for organizations looking to improve the patient experience and boost revenue, which are discussed below. Download The State of Patient Access 2025 report for a full run-down of patient and provider views about access to care. What patients and providers think of patient access (and 3 immediate opportunities) The overall sentiment is encouraging, but there's always room for improvement. The report gives a detailed breakdown of the reasons why respondents think access has improved – or not – and how many respondents gave those reasons. These insights will help providers target their improvement efforts where they matter most. Opportunity 1: Focus on the financial experience 29% of patients say paying for healthcare is getting worse 56% of patients say they need help from their provider to understand what their insurance covers 50% of providers say access is better because patients have more flexible payment options Financial concerns continue to shape the patient experience. Affordability is a key factor in whether patients think paying for care is getting easier or tougher, but it's not the only one. Patients who feel that paying for healthcare has improved cite reasons like being able to understand what their insurance covers, having payment plans that make costs more manageable, and being able to complete paperwork digitally prior to care. Conversely, those with a negative view mention confusion over what they owe, difficulty making payments, excess paperwork and lack of payment plans among their top concerns. To address these challenges, providers can turn to tools that streamline the financial journey from the start. Automating patient financial clearance helps get patients on the right financial pathway as quickly as possible, while segmentation data enables smarter and more personalized collection strategies. Offering flexible payment plans and convenient digital payment options rounds out a financial experience that's easier, more transparent and aligned with patients' needs. Case study: See how UCHealth used automated financial clearance to identify $26 million in charity care. Opportunity 2: Prioritize accurate price estimates 81% of patients say an accurate estimate helps them better prepare to pay 43% of patients say that without an estimate, they're likely to postpone or cancel care 88% of providers say there's an urgency to improve or implement accurate estimates Sticking with the financial theme, the findings suggest that despite ongoing efforts, price transparency in particular still needs some work. While more patients received estimates, accuracy has fallen for a third year in a row. As a result, patients are left uncertain about what they'll owe, prompting some to avoid care altogether. On the flipside, 38% of patients say that understanding the cost of care in advance of treatment made for a better payment experience. With 77% of patients saying it's important that their provider can explain what their insurance covers before treatment, there's a clear opportunity to help patients feel more in control. Not only will this reduce patient stress, but it also builds trust and increases the chance of prompt payments. Almost all patients say they struggle to pay for care at some point, so improving the accuracy of estimates should be an immediate priority for providers. Timely, personalized estimates that reflect the true cost of care will give patients early clarity and avoid surprises later. Experian Health's patient estimates tools use real-time data, including insurance coverage, updated payer contract terms and current provider pricing, to calculate accurate estimates before services are delivered. Patients can receive estimates sent directly to their mobile device or generate estimates through a self-service web-based portal. Opportunity 3: Use automation to improve front-end data collection 56% of providers say patient information errors are a primary cause of denied claims 48% say data collected at registration is “somewhat” or “not” accurate 83% say there's an urgent need for faster, more comprehensive insurance verification Front-end operations are a major source of friction for both providers and patients. Four out of the five top patient access challenges reported by providers relate to front-end data collection, including improving insurance searches, reducing errors and speeding up authorizations. These inefficiencies don't just slow down internal workflows. Manual, error-prone processes lead to delays, claim denials and patient frustration. Providers note that staffing shortages are compounding the problem, which suggests that tackling these front-end workflows would be a strategic operational win. It's also a financial opportunity. In the CAQH's latest Index Report, shifting from manual to electronic transactions for administrative tasks such as eligibility checks, insurance verification and prior authorizations could save the healthcare industry up to $20 billion. Patient Access Curator uses automation and artificial intelligence (AI) to streamline patient access and billing, address claim denials and improve data quality from the outset. This integrated solution performs rapid eligibility, coordination of benefits (COB), Medicare Beneficiary Identifier (MBI), demographics and insurance discovery checks to ensure that all data is correct on the front end. Case study: See how Exact Sciences boosted their bottom line by $100 million with Patient Access Curator The State of Patient Access: From survey to strategy The overall takeaway in The State of Patient Access 2025 is that while progress is heading in the right direction, meaningful opportunities remain, especially when it comes to improving the patient financial experience, price transparency and front-end operations. Going forward, patients want financial clarity and confidence when accessing care. Providers, facing ongoing staffing and operational pressures, need smart and scalable solutions to meet those expectations. Now it's time to take those findings and deploy the right tools and strategies to keep the good work going. Download The State of Patient Access 2025 report to get the full survey results and contact us to see how we help healthcare organizations improve patient access with automation, AI and digital tools. Download the report Contact us

Early diagnostics, remote patient monitoring and personalized care recommendations are just a few examples of how artificial intelligence (AI) is transforming the way healthcare is delivered. As technology advances, so do opportunities to optimize clinical and operational processes. With projected savings in the region of up to $360 billion annually, it's no surprise that 75% of healthcare executives believe AI has reached a turning point in their industry. Yet many providers are still just scratching the surface. Only a small percentage use AI for complex tasks like claim denial management, leaving the competitive advantage wide open. Understanding how these technologies work – and where to apply them for maximum impact – will be crucial to improve efficiency, remain competitive and above all, deliver excellent patient care.  The power of AI in healthcare As the name suggests, artificial intelligence refers to a machine's ability to perform cognitive tasks that would normally be associated with humans, such as problem-solving and decision-making. It can spot patterns, learn from experience and choose the right course of action to achieve a goal. Natural language processing, robotics and machine learning might all be in the mix. AI in the healthcare industry has been found to support applications like: Improving diagnosis through the analysis of medical images AI-powered wearables and virtual nursing assistants Patient data management Reducing and preventing insurance claim denials. Artificial intelligence in healthcare isn't a substitute for human contact, which underpins the best patient care. However, by increasing accuracy and reducing costs, it can help clinicians and healthcare administrators make better decisions that support a positive patient experience across virtually all healthcare settings. AI & automation in healthcare: key benefits  AI and automation deliver results in the three areas that matter most to healthcare organizations: improving the patient experience and care delivery, allowing staff to perform at their highest level, and increasing revenue. Boosting patient satisfaction through speed and accuracy Patient feedback has a few common themes: timely access to care, clearer communication and greater financial transparency. To meet these needs (and improve those feedback scores), healthcare providers should offer patients accurate, upfront information and reduce friction wherever possible. Tools like Patient Access Curator use AI to verify and update all necessary patient information at the front end, all at once, which drastically reduces the time and effort required to manage patient records. This streamlines patient intake and solves for bad data, which prevents claim denials and increases patient satisfaction. Bringing in more revenue by reducing claims errors The 2024 CAQH index estimates that 22% of current costs could be saved by shifting from manual revenue cycle processes to automated ones. Experian Health's State of Claims Survey 2024 suggests providers are eager to capitalize on this opportunity, with 51% seeking to reduce manual work. AI-driven solutions like Patient Access Curator and AI Advantage are designed specifically to meet these needs. Patient Access Curator automates insurance eligibility and coverage, scanning patient documentation for inaccurate information, and uses AI and robotic process automation to reduce manual errors. AI Advantage™ works to prevent denials before they happen, using predictive analytics to flag claims errors and alert staff to claims that fail to meet payer requirements. Improving staff performance by easing burnout The strain of manual processes doesn't just slow down operations. It's also a major cause of staff stress and burnout. Around half of healthcare staff report feeling burned out, costing the industry an estimated $4.6 billion each year. By taking repetitive tasks off busy employees' plates, AI can alleviate overwork and allow staff to focus on higher-value work, improving job satisfaction and productivity. In claims management, for example, AI Advantage, works in conjunction with ClaimSource®, to proactively identify claims with a high likelihood of denial prior to claim submission without staff intervention. This reduces the burden on staff while improving clean claim rates. How AI Advantage and Patient Access Curator improve patient care Experian Health's two flagship AI-based products go even further, offering new ways to use technology to improve patient care: Patient Access Curator uses AI and robotic process automation to streamline one of the most tedious parts of patient intake – verifying insurance eligibility and coverage. By automatically scanning patient records for errors and pulling up-to-date information from payer sources, it eliminates the guesswork and manual labor that bog down revenue cycle teams. The result is faster, more accurate eligibility verification and a smoother experience for both staff and patients. As Ken Kubisty, VP of Revenue Cycle at Exact Sciences, put it: “Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly.”  On the back end, AI Advantage – Predictive Denials acts as an early warning system for denials, scanning claims before they go out the door to catch errors and flag risky submissions so they can be corrected in time. Built on advanced AI and machine learning, the platform evaluates claims using historical payment data and real-time payer behavior. Its counterpart, AI Advantage – Denial Triage, picks up where Predictive Denials leaves off, sorting rejected claims according to their potential for reimbursement and prioritizing them based on financial impact. Together, they help providers minimize denials, resulting in faster reimbursement and freeing up resources that can be redirected to patient care. Case study: See how AI Advantage helped Schneck Medical Center achieve a 4.6% average monthly decrease in denials in the first six months. The future of AI in healthcare: what's next? As a quick glance at any newsfeed will confirm, AI's role in healthcare is only going to expand. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursements, while minimizing the burden on the workforce. AI's ability to continually learn and improve means providers that embrace AI will be better placed to make full use of their data and adapt to the trends and challenges that affect patient care. As expectations grow and resources shrink, AI is likely to be the only way to deliver the scalable, responsive, high-quality care patients deserve. Discover how solutions like AI Advantage and Patient Access Curator use artificial intelligence in healthcare to help reduce claim denials, improve patient access and more. AI Advantage Patient Access Curator

Medical billing errors are common problems that can lead to significant financial losses for healthcare organizations. While most medical billing errors are preventable, outdated systems, complex processes and human errors often result in delayed or denied claims. Faced with ever-increasing overhead costs, workforce challenges and growing volumes of data, healthcare leaders will need to implement modern medical billing software solutions to improve revenue cycle management (RCM) medical billing efficiencies, without adding costly headcount or overhead. This article reviews the role modern medical billing software plays in revenue cycle management and how RCM leaders can use it as a top defense to prevent costly claim delays and denials. What is medical billing software in revenue cycle management? Medical billing software is a critical tool healthcare organizations use to streamline patient billing and collections in revenue cycle management. Revenue cycle leaders know that outdated and complex billing processes can wreak havoc on the entire revenue cycle and waste valuable staff time. However, medical billing in revenue cycle management allows providers to optimize the entire revenue cycle — from pre-visit insurance verification and cost estimates through patient billing and collections. Automated medical billing processes in the revenue cycle can help improve efficiencies, reduce errors, and create more reliable collections processes. This allows healthcare organizations to deliver better patient care while protecting their bottom line. How software powered by artificial intelligence (AI) improves medical billing efficiency AI-powered software helps providers manage many types of complex revenue cycle billing processes — from claims management to collections. Providers that embrace AI often benefit from streamlined medical billing processes, fewer claim denials, real-time eligibility verification, better data insights and productivity boosts. For example, AI-powered software can streamline medical billing by automating repetitive tasks, like insurance verification checks, so providers can prevent and catch errors, speed up reimbursements and stretch strained resources. On the front end, with single-click AI-driven data capture technology, running multiple manual eligibility queries is no longer necessary. Now, with solutions like Patient Access Curator, patient details can be verified quickly and accurately. Patient Access Curator leverages AI and machine learning to automatically handle eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, insurance discovery and more, with just one click. This saves staff hours and reduces human errors that can lead to claims denials and costly delays later on. Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator helped their organization reduce claim denial errors and added $75 million in insurance company collections. AI-driven predictive analytics solutions, like AI Advantage™, can also help staff identify claims that may be at risk of denial, so potential issues can be handled before submission — saving even more staff time. When admin overhead is minimized, there's less burnout and less stress. Staff can focus on higher-priority tasks, and healthcare organizations can see productivity increase overall. Preventing claims denials with better billing solutions Claims denials are on the rise with healthcare organizations being left on the hook for delayed or unpaid claims. In the State of Claims 2024 report, 38% of survey respondents said that at least one in ten claims is denied. Some organizations see claims denied more than 15% of the time. That's a lot of cost in reworks and lost revenue. Nearly half of providers say patient information errors are a primary cause of denied claims. Errors are common during pre-visit insurance verification due to error-prone manual processes, but can happen at any point during the collection process. Medical billing software helps providers reduce errors and submit cleaner claims right from the start and catch errors before they become costly problems. Here are some of the key ways medical billing software like Experian Health's Patient Access Curator solution helps providers head off claims denials before they happen.   Eligibility checks: Automatically verifies patient eligibility and updates records in real-time to ensure patient information is accurate before claims submission. Coordination of Benefits (COB) verification: Discovers and verifies secondary and tertiary insurance coverage to reduce the risk of COB-related denials while using AI-powered technology to seamlessly integrate with a provider's eligibility verification process. Medicare Beneficiary Identifiers (MBIs): Updates MBIs to confirm patient records are correct and compliant with Medicare requirements while using AI-driven technology and automation to find and correct patient identifiers automatically. Demographics: Patient demographic information is corrected and updated using in-memory analytics and Experian Health's proprietary algorithm to accurately find and fix contact information. Insurance Discovery: Identifies and corrects missing or incorrect insurance information to ensure claims are submitted with the most accurate information available. Discover how Experian Health's revolutionary AI-powered revenue cycle solution is turning denial management into denial prevention. Patient Access Curator solves for missing or correct data in real-time at registration and scheduling, creating a smooth, clean claim process and lowering denials by double digits. Optimize efficiencies in claims management through AI Experian Health customers currently using ClaimSource® can now improve their claim management strategy — before claim submission and after denial. With AI Advantage™ Predictive Denials and Denial Triage, providers can leverage historical claims data and Experian's deep knowledge of payer rules to continuously adapt to an ever-changing payer rules landscape.AI Advantage's - Predictive Denials component reduces denial rates, detects payer changes and empowers staff to focus on highest-priority claims, while AI Advantage's - Denial Triage identifies denials with the highest reimbursement potential and uses AI to segment denials, eliminating guesswork for billers. Watch the video to learn more about the two components that make up AI Advantage, and how healthcare organizations can transform the reimbursement process and decrease claim denials for good. Medical billing software is only getting smarter and faster Upgrading outdated manual medical billing processes results in cleaner claims, improved staff efficiencies, better care and improved patient satisfaction. Today's AI-driven technology brings medical billing in RCM to the next level, enabling time-strapped providers to do even more with less. Now busy providers can streamline manual processes that used to take hours into just seconds. With this new technology, patient information is accurate when claims are submitted, eliminating the need for costly reworks and hits to the bottom line. As more providers adopt AI technology for RCM in medical billing and software solutions get more sophisticated, providers will see new success stories in its power to help healthcare organizations optimize the entire revenue cycle. Learn how tools like Patient Access Curator and AI Advantage can help healthcare organizations prevent claim denials and improve medical billing in RCM. Learn more Contact us

Finding missing health insurance is critical to keeping revenue cycles on track. Insurance eligibility verification is an important process providers use to confirm active coverage, including additional coverage a patient may have forgotten. According to Experian Health's State of Claims 2024 survey, almost a fifth of providers say missing coverage is a top reason for claim denials. It helps providers determine what insurance a patient has and what's covered and plays a key role in billing. When a patient has more than one type of active coverage, providers use insurance eligibility verification checks to determine how much should be billed to the correct payer and in what order. However, searching for missing coverage is often time-consuming and error-prone thanks to manual systems, disjointed databases and ever-changing payer regulations. When mistakes are made in the early stages of patient intake, it affects every step of the patient journey and revenue cycle. The struggles to confirm patient coverage are likely to worsen as patient volumes increase, medical needs get more complex and staffing shortages continue. Despite these mounting obstacles, insurance eligibility verification checks remain a critical first step to reducing claims denials, improving patient outcomes and minimizing lost revenue. This article explores why insurance eligibility verification checks matter and how providers can adopt new strategies and digital tools to find missing health insurance and prevent revenue from slipping through the cracks. The hidden costs of missing health insurance Today, more Americans are struggling to afford their medical bills — even with insurance. A KFF study reports that 48% of U.S. adults find affording healthcare difficult, while 25% say they or someone in their household had issues covering medical costs in the past twelve months. About half of those surveyed say paying an unexpected $500 medical bill would put them into debt. Insured patients aren't immune from the burden of high healthcare costs, though. Thanks to rising deductibles, co-pays and premiums, patients are taking on more financial responsibility, and 74% are worried about covering out-of-pocket costs. Nearly half of U.S. adults expressed concerns about affording their monthly insurance premiums. When medical bills go unpaid, provider revenue can take a serious hit. Uncompensated care is a huge financial burden for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. Patients often have additional insurance coverage that could help close the gaps, but they've either forgotten about it or are unaware of their eligibility. Finding missing coverage is a top priority for providers who want to ensure revenue streams stay in check — especially as healthcare costs continue to rise. Benefits of resolving missing health insurance issues Resolving missing health insurance issues has many benefits for both providers and patients, beyond verifying that services are covered and medical bills are paid. These include: Reduces claim denials: Claims denials are on the rise, and missing coverage is a top reason, according to Experian Health data. Incorrect or incomplete information can result in errors on claim forms or providers sending claims to the wrong payer. Finding missing coverage before claims submission reduces errors, denials, delays and rework. Minimizes wasted staff time: An eligibility recheck is needed when providers discover an incomplete claim, due to a change in active benefits after claims submission. With 43% of providers reporting that eligibility rechecks add at least 10 additional minutes per claim, finding missing coverage in advance is critical to freeing up valuable staff time. Improves the patient experience: Patients are often confused about what insurance covers and what they'll be on the hook for out-of-pocket. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care. When providers are able to find missing coverage during insurance discovery, patients are more likely to receive accurate upfront estimates. Complete and transparent pricing allows patients to prepare for the cost and avoid any surprises, while accelerating collections for providers. Tools and strategies to find missing health insurance Insurance eligibility checks help providers verify insurance status, coverage details and benefits in advance. However, performing insurance checks isn't always straightforward, and often requires searching for missing coverage. Patients sometimes forget to let providers know about secondary coverage or insurance changes. Or, coverage can be forgotten because a patient has moved to a new house, changed states, switched employers or signed up for a different policy. In some cases, patients may be misclassified as self-pay or have only one form of insurance. Providers can improve their insurance eligibility verification process and discover missing health insurance at every stage of the revenue cycle with the following strategies: Implement digital insurance discovery solutions Outdated manual systems are often error-prone and make finding missing coverage a labor-intensive task for already overburdened staff. Automated eligibility verification solutions offer a more streamlined approach to finding missing coverage faster with more accurate results. Tools like Experian Health's Coverage Discovery work across the entire revenue cycle and search government and commercial payers to find previously unknown insurance coverage. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Streamline patient intake and updates Matching patient information to payer databases starts at registration. However, patient information, including insurance coverage details, can change anytime. Patients may switch insurers, move states or change their contact information. Catching errors before a claim is submitted is key to keeping the revenue cycle moving and collections. Providers often can't keep up with changes or may struggle with tool overload, with nearly 60% of providers reporting using at least two different tools to gather the necessary patient information for claim submission. Digital tools, like Experian Health's Patient Access Curator, can help solve for bad data quality with real-time correction. This solution uses artificial intelligence (AI) and performs eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, to ensure that all data is correct on the front end. Patient Access Curator also interrogates 271 responses to indicate any secondary or tertiary coverage data. Other tools, like Registration Accelerator, puts the patient in control of inputting and updating information. Using an automated link, patients can enter their personal details and insurance information from their mobile phone or the web-based app, with no login required. Providers can prompt patients to complete registration details during the initial intake process and send reminders to update information that may have changed, like an address or insurance policy, when follow-up appointments are scheduled. Provide accurate upfront estimates The lack of accurate care estimates is an ongoing challenge for both providers and patients. According to Experian Health data, four in 10 patients report spending more on healthcare than they could afford. When providers don't have access to the most up-to-date patient insurance information, or coverage is missing, estimates are often incorrect and patients end up with surprise bills. Inaccurate estimates create a negative patient experience, resulting in unpaid bills and extra work for staff to resubmit claims or chase down collections. However, tools like Eligibility Verification can help providers easily confirm coverage, co-pays and deductibles at the time of service. When armed with real-time coverage data, providers can build more accurate estimates and help patients prepare for the cost of care. How technology makes finding missing health insurance easier 43% of Experian Health's State of Claims survey respondents say that eligibility checks take 10 to more than 20 minutes to complete. Eligibility checks are taking longer, are filled with more errors, and only 54% of providers feel their claims technology can handle current revenue cycle demands. Using technology at every step of the revenue cycle helps providers bridge the gap between front-end eligibility checks and back-end claims management. Digital tools, like Coverage Discovery, fit anywhere into the revenue cycle, allowing providers to easily check for health insurance through the patient journey, not just at registration. Emerging AI and automation tools also help providers find missing health insurance faster. Automated eligibility verification solutions, like Experian Health's Eligibility Verification, seamlessly check insurance benefits across 900 payers using advanced patient matching tools. Patient Access Curator uses AI-based data capture technology to return real-time data in a single click from hundreds of payer responses, allowing providers to quickly verify active coverage, billing information, plan level details, and more. Case studies: See health insurance discovery in practice How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Learn more about how automated health insurance discovery helps providers find missing health insurance, reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

“You know when the Patient Access Curator went live because you can see it in our stock price. It helped us drive a $100 million bottom-line improvement within two quarters.” —Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences Challenge Exact Sciences is a prominent cancer diagnostics laboratory with an annual net revenue of around $2.6 billion, that's best known for its flagship cancer screening test, Cologuard. After a period of rapid growth demand for its test, Exact Sciences faced the difficult task of collecting accurate patient data and verifying insurance eligibility at scale. Anticipating a 25% growth in annual testing volumes, Ken Kubisty, Vice President of Revenue Cycle at Exact Sciences, says the organization “needed an automated, real-time solution" to capture accurate data from the start. The company had four specific objectives: Improve the accuracy of patient insurance data to reduce errors and denials. Streamline processes to handle rising testing volumes without increasing headcount. Reduce claim denials to bring in more revenue (especially those related to eligibility and timely filing). Ensure accurate identity verification in lab settings, where patient, physician and lab data aren't unified within a single data management system. Watch the webinar: Hear our pre-recorded session from our annual Experian Health High-Performance Summit 2024 (HPS), featuring Exact Sciences and Trinity Health, as they reveal how Patient Access Curator helped their organizations automate eligibility, reduce denials, and more, all with a single click. Solution In need of a single solution to solve multiple challenges, Exact Sciences turned to Experian Health's Patient Access Curator. This new product provided the team with a way to run inquiries for eligibility, Medicare beneficiary identifiers, coordination of benefits, insurance discovery and demographic data with a single click. Instead of juggling multiple products and vendors, registrars would be able to capture and verify patient data in a single transaction. Through automation and machine learning, Patient Access Curator could deliver results in less than 30 seconds and help submit clean claims the first time – reducing the risk of denials even as volumes increased. Experian Health's implementation experts configured the tool to Exact Sciences' needs, integrating over 4,000 payer plans nationwide and customizing parameters for real-time eligibility checks and data validation. Experian Health also delivered staff training to support the transition to the new system. Watch the video: See how Experian Health's Patient Access Curator streamlines patient access and billing, addressing claim denials, data quality and real-time corrections to boost your business's bottom line. Outcome Thanks to Patient Access Curator, Exact Sciences achieved the following results: 15% increase in revenue per test due to accurate eligibility and fewer denials 4x business volume without increasing headcount 50% reduction in denials and major improvement in timely filings $100 million added to the bottom line in 6 months Ken Kubisty, VP of Revenue Cycle at Exact Sciences, shares how Patient Access Curator improved eligibility processes, reduced errors and more. Overall, Kubisty credits Experian Health's Patient Access Curator for helping Exact Sciences overcome critical pain points resulting from data errors and eligibility issues. Solving for bad data quality with real-time data correction freed staff from tedious manual work, ensuring faster, more accurate claims processing – all without growing headcount. After implementing Patient Access Curator, the company is ready to scale and handle growing volumes efficiently, say goodbye to late filing denials and scale smarter. For Kubisty, this highlights how technology drives efficiency and sustainable growth. Learn more about how Patient Access Curator helps patient access teams prevent claim denials by solving for bad data quality with real-time data correction. Learn more Contact us