Tag: patient financial clearance

Key takeaways: Changes to Medicaid, Medicare and the Affordable Care Act provisions in H.R. 1 are expected to increase financial pressure across the healthcare system. Hospitals could face higher uncompensated care costs and a growing administrative burden as millions lose coverage and payer rules grow more complex. Revenue cycle leaders should focus on strengthening eligibility checks, improving claims accuracy, and automating operations to remain financially resilient. On July 4, the budget reconciliation bill known as the “One Big Beautiful Bill Act” was signed into law, introducing sweeping changes to Medicaid, Medicare and Affordable Care Act (ACA) marketplace plans. At almost 900 pages, H.R. 1 sets out new eligibility, coverage and funding rules that will reshape how hospitals are reimbursed. This article explains what revenue cycle leaders need to know about the reforms and offers practical strategies for maintaining financial stability. Understanding the healthcare implications of H.R. 1 The healthcare provisions in H.R. 1 reflect a broader push by lawmakers to contain federal spending and return more control to states. While the reforms are framed as efforts to improve fiscal sustainability, they also introduce new financial risks for hospitals, particularly those serving low-income and high-utilization populations. How does the Act affect Medicaid? Enrollment H.R. 1 makes major changes to Medicaid enrollment, with direct implications for hospital revenue and patient coverage. Starting in 2027, states will be required to run automated eligibility checks every six months for Medicaid expansion adults, and cross-check against federal databases to remove ineligible or deceased enrollees. The Act pauses implementation of a federal rule related to streamlining enrollment in Medicaid and the Children’s Health Insurance Program. Eligibility Eligibility rules are also changing. A new community engagement requirement will require some enrollees to demonstrate that they work, volunteer, or are in education for at least 80 hours a month, unless exempted. While aimed at reducing fraud, waste and misuse, changes to eligibility and enrollment could result in more patients losing coverage and increase churn and care gaps – particularly among vulnerable populations. Uncertainty around citizenship status could deter patients from seeking care, and even affect staffing in hospitals that serve immigrant communities. Cost-sharing and funding To ensure beneficiaries have a financial stake in their care, the law introduces cost-sharing requirements for some enrollees. Providers will need to be ready to help patients understand their costs and adjust collections workflows accordingly. There are also new financial penalties for states that fail to recover overpayments, and limits on how provider taxes and supplemental payments can be used to boost federal matching funds. Over time, these provisions could constrain how hospitals are reimbursed for Medicaid services, especially in non-expansion states. How does the Act affect Medicare? For Medicare, the Act offers some short-term financial relief along with longer-term reductions. Outpatient providers will see a 2.5% increase to the Medicare Physician Fee Schedule in 2026, partially offsetting inflation and COVID-related losses. However, spending cuts of 4% per year are projected to reduce Medicare funding by more than $500 billion over eight years, beginning in 2026. In addition, the law brings Medicare eligibility in closer alignment to Medicaid, by restricting access for individuals without verified lawful status or sufficient residency history. It also delays until 2035 a rule that would have made it easier for low-income beneficiaries to enroll in Medicare Savings Programs. The Congressional Budget Office (CBO) estimates that this means 1.38 million fewer beneficiaries  will be covered by MSPs. How does the Act affect the ACA? One of the most immediate concerns for hospitals involves the end of enhanced premium subsidies for low-income ACA marketplace plan enrollees. Unless Congress steps in, these will expire at the end of 2025, making coverage less affordable for many. This comes as insurers prepare to increase premiums by an average of 15% in 2026, the most significant rise since 2018. H.R. 1 also modifies eligibility and repayment rules around subsidies. Subsidies will no longer be available to individuals disenrolled from Medicaid due to immigration status. Starting in 2027, most enrollees in marketplace plans will need to verify their eligibility for premium tax credits each year, effectively ending automatic re-enrollment. Without these subsidies, over 4 million people are likely to be uninsured in 2034. For hospitals, this means more self-pay patients, delayed collections and higher uncompensated care, especially in areas with large working-age populations. Financial risks: Medicaid cuts and rising uncompensated care The CBO projects that over 10 million people could lose health coverage by 2034 due to combined Medicaid and ACA reforms. This is a major financial risk for hospitals, particularly safety-net and rural providers. The Center for American Progress suggests that uncompensated care costs could increase by at least $36 billion by 2034 – a figure that will be especially painful in the context of reduced federal funding. Some newly uninsured patients may not seek alternative coverage, potentially leading to higher emergency department use. Those with ongoing health needs are more likely to find new coverage, but hospitals could still see a smaller insured population overall, and it could well be one that is older, sicker and more expensive to treat. Revenue cycle teams should prepare for an increase in self-pay volumes and greater demand for charity care and financial assistance. Organizations in high-Medicaid regions may need to reassess cost estimation tools, financial assistance screening and collections workflows to manage the effects. Strengthening front-end access and eligibility workflows Jason Considine, President at Experian Health, says that providers can be proactive in ensuring their revenue cycle operations are ready to adapt and scale, if and when the time comes: “It’s an uncertain time. However, as we wait to see how the changes to coverage and reimbursement play out in practice, providers aren’t just looking for predictions. They need actionable strategies. Strengthening front-end eligibility and financial clearance processes is one of the most immediate ways to reduce risk and support patients through coverage transitions. Experian Health helps organizations do that by offering automated tools that uncover hidden coverage, verify eligibility in real time, and provide clear, accurate patient estimates.” Here are a few examples: Getting eligibility right. Patient Access Curator uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics and coverage discovery. Minimizing the risk of uncompensated care. Patient Financial Clearance uses real-time data to identify patients who may qualify for charity care and recommends suitable payment plan options, while minimizing manual work for staff. Helping patients figure out their financial obligations. Patient Payment Estimates draws on real-time data, including insurance coverage, payer contract terms and provider pricing, to give patients an accurate breakdown of their treatment costs. This improves transparency and reduces the risk of missed payments. Case study: Experian Health and Exact Sciences See how Exact Sciences added $100 million to their bottom line in just two quarters with Patient Access Curator. Optimizing claims and collections in a tighter reimbursement environment In addition to strengthening front-end processes, providers need to ensure their back-end operations are ready to handle the ups and downs. Denied claims are already a major challenge for providers: in Experian Health’s 2024 State of Claims survey, 73% said denials are increasing and 77% report more frequent payer policy changes. More than half have seen a rise in claims errors, highlighting an opportunity for improvement. As automation and AI continue to advance, healthcare providers have a chance to improve claims management and reduce denials. Embracing these solutions can reduce the costly burden of reworking claim denials and improve cash flow. If claims workflows are already struggling, providers can’t afford any extra friction. However, the H.R. 1 reforms will likely increase the administrative burden and make timely reimbursement even harder to secure. This makes digital transformation increasingly urgent. Some priorities to tackle with automation and analytics include: Improving first-pass claim accuracy.  AI Advantage™– Predictive Denials  uses artificial intelligence, machine learning and predictive analytics to scan claims before they are submitted to root out errors and flag high-risk submissions so they can be corrected. It analyzes historical payment data and real-time payer behavior to determine whether a claim is likely to be rejected, so staff can work faster and more efficiently to increase clean claim rates. Streamlining claims management. ClaimSource® helps providers manage the entire claim cycle from a single application. Voted Best in KLAS for Claims Management and Clearinghouse for the last two years, the platform automates claim submission to reduce manual work and support cleaner submissions. It performs customizable edits, formats and submits claims, and allows staff to create custom work queues for greater efficiency. Using data to optimize collections. Collections Optimization Manager uses data-driven insights to help revenue cycle management (RCM) teams focus on the right accounts and collect more, faster. By segmenting patients based on their propensity to pay and screening out accounts unlikely to yield returns (such as deceased, bankrupt or charity accounts) the tool helps reduce the cost to collect and saves valuable staff time. Case study: Experian Health and Weill Cornell See how Weill Cornell increased collections by $15 million with Collections Optimization Manager. Preparing for volatility with scalable technology Revenue cycle teams can’t control policy changes or budget decisions, but they can control the systems that keep their operations running. Experian Health’s end-to-end revenue cycle solutions are designed to support this kind of operational resilience. From coverage discovery to claims analytics, scalable platforms give providers the flexibility to respond quickly to financial disruptions using consistent and familiar technology. “When so much is out of your hands, the smartest move is to focus on what you can control. Scalable tech gives RCM leaders that control, so when payer rules shift or self-pay volumes spike, they’re ready to respond without slowing down,” says Considine. “It also helps them stay ready for compliance shifts and respond faster to regulatory changes without overhauling their workflows.” Blog: Revenue cycle management checklist - improve experience and profits Get a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Readiness today protects financial resilience tomorrow The H.R. 1 bill has introduced significant changes across Medicaid, Medicare and the Affordable Care Act. New eligibility requirements, adjustments to reimbursement formulas, reduced subsidies and greater administrative complexity are all expected to influence how patients access coverage and how care is financed moving forward. While the long-term impact will vary by market and patient population, disruption is coming. Hospitals and health systems that rely on outdated workflows or fragmented technology will face growing challenges in managing changing coverage patterns and rising uncompensated care. As the specific effects of the “One Big Beautiful Bill” become clearer, revenue cycle leaders will be tasked with making fast choices under pressure. How will coverage changes affect patient behavior? What happens to reimbursement if eligibility gaps widen? The focus won’t just be on protecting revenue, but also on supporting patients who may be confused or anxious about what the new rules mean for them. The ability to track changes and adapt accordingly will be a competitive advantage for providers looking to stay ahead. Find out how Experian Health can help hospitals prepare for reforms by modernizing revenue cycle operations and reducing exposure to revenue loss. Learn more Contact us

Key takeaways: Many eligible patients don't apply for charity care simply because they don't know it's available, leading to financial strain for patients and providers. Improving charity care communication helps patients understand their options early, builds trust and reduces uncompensated care for providers. Automating financial assistance screening with tools like Patient Financial Clearance supports compassionate financial conversations and ensures more patients are connected to support at scale. Patients face difficult choices when the cost of care feels out of reach. Some hesitate to proceed with planned services due to affordability concerns, even though financial assistance may be available. For providers, Medicaid rollbacks under the budget reconciliation bill could leave more patients without coverage, increasing the volume of uncompensated care and making revenue less predictable. Charity care programs provide a financial safety net – but only if patients know about them. This article looks at how improving charity care communication connects more patients to the financial support they need. Why clear communication about charity care matters Charity care programs are designed to remove financial barriers to care for those most in need. They provide full or partial discounts to uninsured or underinsured patients for medically necessary services, as set out in hospital policies and state-level regulations. However, according to a 2025 Lown Institute study, millions of eligible patients do not apply because they do not realize the support is available. This lack of charity care awareness could affect care decisions. Experian Health's 2025 State of Patient Access survey found that 43% of patients would consider cancelling or postponing care without an accurate cost estimate. Meanwhile, 34% report they often struggle to pay for healthcare, and 95% say they experience affordability challenges at least occasionally. Making patients aware of available support means they'll feel more confident about what they owe, build trust in their provider and reduce the risk of uncompensated care. The barriers patients face when learning about financial assistance Limited information isn't the only reason for low charity care uptake. Confusing eligibility rules and complicated application processes also make support harder to access. Socioeconomic factors, language barriers and poor digital literacy compound these obstacles. Without action, the challenge looks set to intensify. A Kaiser Family Foundation investigation found that hospitals in states with limited access to Medicaid generally had higher charity care costs. With the Congressional Budget Office projecting that changes under the “One Big Beautiful Bill” Act will result in a further 16.9 million Americans without insurance over the next decade, improving charity care and patient education is likely to become more urgent. Jason Considine, President at Experian Health, explains: “When coverage gaps widen, healthcare providers must be financial advocates for their patients. Hospitals can't afford to wait for patients to ask for help or default on bills. It will become even more important for providers to guide the financial journey. This includes helping patients qualify for financial aid or identify personal payment plans." He says, "Proactive financial screening must be embedded throughout the patient journey and providers need to take every opportunity to help patients understand their options. It's not just about protecting revenue, it's about ensuring that every patient has access to the care they need, regardless of their financial circumstances. That means offering clear education, transparent communication and robust charity care options at every touchpoint.” “When coverage gaps widen, healthcare providers must be financial advocates for their patients. Hospitals can't afford to wait for patients to ask for help or default on bills. It will become even more important for providers to guide the financial journey.”- Jason Considine, President at Experian Health How to build trust when discussing financial support to patients For many patients, discussing financial hardship can be uncomfortable. Providers must approach these conversations with empathy, clarity and consistency. When thinking about how to explain charity care to patients, staff should focus on using plain language, avoiding jargon and being as clear and compassionate as possible. Timing matters as much as tone: patients who understand their options early are more likely to meet their financial obligations. Alex Liao, Senior Product Manager for Patient Financial Clearance at Experian Health, says talking about financial support should be normalized as part of the standard intake process: "While we know a lot of patients worry about cost, there are also those who are unsure if it's okay to bring up,” Liao says. “When providers take the first step and lead the conversation, it takes the pressure off patients and gives them extra reassurance. They feel more comfortable having honest and judgment-free discussions about how to manage their bills." Strategies for improving charity care awareness and understanding Liao says that providers need practical strategies for holding compassionate financial conversations: “Compassion isn't just about how we speak to patients. It's about making sure they trust and process the information they're given, and can act on it,” he says. “That means meeting patients where they are – financially, culturally and technologically. Staff should be trained to explain assistance options confidently and consistently, using standardized messaging, multilingual materials and awareness of culturally appropriate messaging.” Technology can further close the gap. Patient portals, SMS tools and mobile apps can deliver personalized financial messages and guide patients through eligibility pathways in a way that's particularly convenient for younger or mobile-first populations. Integrating charity care communication with eligibility screening Of course, these conversations depend on knowing who needs support in the first place. Automated screening processes make it easier to identify patients who qualify for assistance. This should be done as early as possible, so patients get early clarity about any support that may be available. Embedding charity care screening directly into scheduling, pre-registration and intake workflows means staff can proactively flag patients who need help before balances become unmanageable. By identifying eligible patients upfront, providers can reduce downstream bad debt and avoid the costs of collections and write-offs. On-demand webinar: Hear how Eskenazi Health boosted Medicaid charity approvals by 111% with financial aid automation Discover how Eskenazi Health partnered with Experian Health to automate the entire financial assistance process. How Experian Health supports better charity care communication at scale As states mandate charity care screening, Liao says these processes should be scalable: “We're seeing more states pass legislation that requires screening for financial assistance in hospitals. With other bills like Oregon's HB3320 being enacted, more patients will need to be screened for charity care eligibility. Because more individuals may now qualify, healthcare providers will need an efficient way to screen at scale and make sure patients are informed about their options. A tool like Patient Financial Clearance does well with volume.” Patient Financial Clearance helps reduce the manual burden of screening patients for financial assistance by automatically estimating the patient's income, household size and Federal Poverty Line percentage, and then scoring their propensity to pay. It can pre-populate charity care applications and help suggest custom-tailored payment plans to make patient bills more manageable. Automating key steps and communicating options early in the process helps staff and patients have better financial conversations. Patient Financial Advisor builds on that by allowing providers to contact patients directly with clear, upfront cost information before their visit. It sends a pre-service text message with a secure link to real-time estimates based on current rates and benefits data. Patients can easily see what they owe, explore available assistance and make secure payments, all through an intuitive, mobile-friendly platform. On-demand webinar: The X Factor - Using Experian data to drive financial assistance automation Discover how your peers are automating processes to meet new state charity screening regulations and finding new efficiencies. Empowering patients through transparent financial communication Too often, patients miss out on financial assistance simply because no one told them it was available. That communication gap creates a risk for patients facing unexpected bills, and for providers managing uncompensated care. Transparent financial conversations help remove barriers to care and build trust between patients and providers. With more patients likely to fall into eligible categories in the coming months and years, healthcare organizations need to rethink how and when they talk about financial assistance. Experian Health helps providers take a more proactive and compassionate approach to charity care communication, with scalable strategies that leave no patient overlooked. Learn more about how Experian Health's financial assistance solutions simplify charity care communication, so more patients get the help they need. Learn more Contact us

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

Key takeaways: As healthcare costs increase, the demand for patient financial assistance also rises as more patients find themselves without insurance coverage or facing economic hardship. Early identification of charity care eligibility reduces patient financial stress, makes the financial experience more compassionate, and protects providers from bad debt. Automated screening tools like Patient Financial Clearance, built on accurate, real-time data, are essential for flagging eligible patients before accounts go to collections and ensuring that no one misses out on vital support. Too often, patients who qualify for financial assistance aren't identified until after their accounts have been sent to collections. As healthcare costs increase and coverage becomes less certain, more patients will likely face financial challenges, making timely support even more critical. With estimated income data and financial behavior indicators, healthcare organizations can identify patient eligibility for charity care earlier, before the bills pile up. This article looks at how automated charity screening tools like Patient Financial Clearance can help providers support patients, protect revenue and remove the financial barriers that get in the way of care. The rising demand for patient financial assistance Demand for financial support is climbing quickly as economic pressures and policy changes make it harder for patients to keep up with medical costs. Nearly one in four adults are uninsured, often delaying or forgoing care because of high deductibles and out-of-pocket costs. Medicaid redeterminations have already resulted in more than 19 million disenrollments. At the same time, the Congressional Budget Office estimates that new federal spending provisions could push an additional 10.9 million people out of health coverage by 2034. As a result, revenue cycle teams will increasingly find themselves trying to collect payments from patients who are more likely to need financial help. "We're also seeing more states pass legislation that effectively mandates early screening for financial assistance before billing, such as Oregon's HB 3320," says Alex Liao, Senior Product Manager for Patient Financial Clearance at Experian Health. "These policies are becoming major drivers of financial clearance efforts. Identifying financial need early in the process helps patients avoid unexpected medical debt, and gives providers the insight they need to manage accounts appropriately and protect revenue." For providers, growing administrative costs, claim denials and underpayments mean less flexibility to absorb uncompensated care. Early screening protects against the burden of medical debt and facilitates the transparency and clarity patients need to manage their bills. Why does early identification of patient charity care eligibility matter? When charity care eligibility is missed or delayed, patients can quickly accumulate medical debt they can't afford. In an interview about the latest State of Patient Access survey, Clarissa Riggins, Chief Product Officer at Experian Health, explains why this is so important: "Cost is a major pain point," she says. "The report shows that 34% of patients 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." Identifying charity care eligibility early on ensures these patients don't fall through the cracks. This reduces financial stress for patients and protects providers from avoidable write-offs and bad debt. When staff know which patients are likely to need support, they can have more compassionate and helpful financial conversations and connect patients with appropriate resources. Unlock patient charity care eligibility with automated screening  Manual charity care screening processes are often time-consuming and prone to delays, especially when staff have huge volumes of information to handle. Automated financial assistance screening tools use real-time data to identify patients who may qualify for charity care with greater speed and accuracy. For example, Patient Financial Clearance (PFC) helps providers screen patients earlier in the financial journey by automatically checking for eligibility at or before the point of service. It uses a range of estimated data points, including household income, household size and Federal Poverty Level (FPL) percentage, to assess whether a patient qualifies for charity care, Medicaid or other financial assistance. After calculating a risk score to evaluate the patient's propensity to pay, PFC can pre-fill application forms, reducing the need for staff input and accelerating enrollment. For those who may not qualify for charity care, PFC can recommend payment plan options that align with the provider's financial policies. This proactive, behind-the-scenes screening enables providers to flag eligible patients at multiple points in the care journey, ensuring more patients get the support they qualify for while minimizing manual work for staff. Case study: How UCHealth wrote off $26 million in charity care with Patient Financial Clearance See how UCHealth partnered with Experian Health to create a more streamlined approach to providing charity care to patients who needed it. Take a smarter approach to patient financial assistance with Experian Health Automated charity screening tools like Patient Financial Clearance are faster, more consistent and easier for staff to act on. But they'll fall short without reliable data. "Strong data practices are key," says Riggins. "That means better systems to catch errors before they become problems, regular staff training, and giving patients the chance to double-check their records… By automating tasks 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 prevent billing and claim errors in the long run. Clean data makes everything easier, from billing to insurance verification to patient trust." She gives the specific example of Patient Access Curator, which uses artificial intelligence to run multiple data checks at once, covering eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, demographics, and coverage discovery. When thinking about how to use data to find charity care eligible patients, tools like this lay the foundation for more proactive financial engagement. By cleaning up data and automating repetitive tasks, Experian Health's revenue cycle solutions enable providers to streamline their financial operations and give financial counsellors the details they need to engage patients at the right time and help them understand their options. The bottom line Automation and accurate data aren't just backend upgrades. They're essential to building a smarter, more compassionate financial experience, with fewer accounts going to collections. By embracing the best practices for identifying patients needing financial assistance, early action, better data quality, and automation, providers will be better placed to make sure no one misses out on the help they need. Find out more about how Patient Financial Clearance can help healthcare organizations automate financial assistance and identify patients eligible for charity care. Learn more Contact us

Key takeaways: The healthcare industry isn't necessarily recession-proof, but revenue cycle leaders can take steps to build financial resilience. Financial resiliency strategies in healthcare should include: diversified revenue streams, operational efficiencies and strategic financial planning. Leveraging technology to optimize patient collections helps providers enhance the collections process and improve financial resiliency now, and in the case of a recession. The relationship between economic downturns and the resilience of the healthcare industry is complex. Healthcare is an essential service, so whether the economy is considered good or bad, people still need to see their provider. However, with many economists anticipating a potential recession, it begs the question: is healthcare truly recession-proof? In this article, we'll explore healthcare's economic resilience and why financial resiliency and collections optimization may be the key to surviving the next recession. The healthcare sector's economic resilience: fact or myth? While not necessarily recession-proof, the healthcare sector has historically been more insulated against economic uncertainty than other industries. However, since healthcare delivery organizations, like hospitals, typically operate with narrow health margins to begin with, a recession could further compound the issue. Factors that already affect a hospital's everyday bottom line could significantly worsen during a recession. Today's hospitals are burdened by high fixed costs, staffing shortages, regulatory and compliance costs, value-based care pressures and the financial challenges of low reimbursement rates and insured patients. During a recession, even the slightest shift could potentially knock a healthcare delivery organization's revenue cycle off balance. The importance of financial resilience in healthcare Financial resilience is crucial for healthcare organizations that want to cultivate long-term stability, regardless of what's happening in the economy. To weather economic uncertainty, healthcare organizations must have a solid financial foundation. The cornerstones of creating financial resilience for healthcare organizations include: Diversified revenue streams: Providers that offer multiple service points have more opportunities to better serve patients. To attract and retain patients, healthcare organizations must stay nimble and invest in new revenue-generating services, such as virtual or outpatient care. Efficient operations: Streamlining every aspect of the revenue cycle — especially through technology like automation and artificial intelligence (AI) — not only eliminates costly, error-prone processes, but also bolsters the bottom line, prevents revenue leaks and allows for new investments. Strategic financial planning: The healthcare industry is constantly evolving, from automated patient collections technology to artificial intelligence (AI) in claims management. Revenue cycle leaders can use data-driven insights from these technologies to inform short- and long-term financial planning. Patient collections during a recession: a critical area of focus Accelerating patient collections is always a top priority for revenue cycle leaders, especially as patients shoulder an increasing financial burden for the cost of care. However, during a recession, the focus on patient payments becomes even more critical. Recessions often bring job loss, leaving patients without insurance or the income to pay their medical bills. This can leave providers scrambling to update insurance information, chasing patients for payment, sending unpaid bills to collections, or worse — getting stuck with bad debt. Healthcare organizations can improve patient collections and maintain steady cash flow during tough economic times by adopting technology to optimize the patient collections process. Tools like Experian Health's Collections Optimization Manager streamline the entire patient collections process without adding additional workload for existing staffing. Leveraging technology for recession-proofing healthcare operations Recessions often come with many unknowns, but healthcare organizations can take steps to help recession-proof their financial operations. Adopting healthcare technology, like collections optimization tools, can help providers in these key ways: Streamline collections Solutions like Collections Optimization Manager uses intelligent segmentation to help billing teams quickly prioritize high-priority accounts based on propensity-to-pay scores. This frees up busy staff from the burden of chasing accounts — and is especially beneficial with large accounts receivable volumes. Instead, billing teams can focus on a small amount of patient accounts that have a high propensity to pay and bring in high revenue. Additionally, costs are further reduced since these accounts don't need to be sent to an external collections agency. To further streamline collections, complementary automated patient outreach tools, like PatientDial and PatientText can send patients bill reminders and self-pay options via voice or text message. Patient Financial Clearance takes this a step further by helping providers run their presumptive charity process, which estimates a patients' Federal Poverty Level percentage (FPL%), to identify those who qualify for greater financial assistance. Enhance financial forecasting Collections Optimization Manager offers healthcare providers real-time insights into collection performance with reports and dashboards that focus on key metrics. Billing teams can see how their team measures against industry standards to improve patient payment forecasting and successfully manage bad debt reserves. Plus, users get access to an experienced collections consultant to evaluate reports and further refine collections strategies. Improve financial resilience Implementing billing and collections optimization gives providers more visibility into the collections cycle, allowing for improved short- and long-term strategic planning. This can be useful for healthcare organizations that need to make financial decisions to prepare for upcoming recessions or shift priorities as needs change mid-recession. Emerging technologies, like predictive analytics, machine learning and artificial intelligence also offer providers a deeper understanding of patients' financial needs, allowing for a more compassionate collections experience. In times of economic uncertainty, when patients may struggle to afford their medical bills, a supportive collections process can help improve collection rates and reduce the chance of bad debt. Building a recession-resilient healthcare organization While it may not be possible to fully recession-proof a healthcare organization, revenue cycle leaders can take proactive steps to make their organization recession-resilient. Turning to technology that leverages a growing range of automated solutions for clearer billing, personalized payment options and increased efficiencies is one way healthcare organizations can start to build financial resiliency for today – and for any future economic downturns. Learn more about how Experian Health's data-driven patient collections optimization solution helps revenue cycle leaders enhance the collections process and improve financial resiliency during challenging times. Learn more Contact us

Tracking down missing health coverage has always been challenging for providers, but proposed changes to the Affordable Care Act and Medicaid could make it even tougher. If the reforms take effect, as many as 13.7 million Americans could lose health insurance over the next decade. With more patients cycling in and out of coverage, many will turn up for care without knowing their coverage status, leaving them at risk for bills they can't afford and exposing providers to denials and revenue loss. Insurance verification has traditionally relied on Social Security Numbers (SSN). As the industry moves away from this approach, providers need faster, more reliable ways to confirm health insurance without SSNs. Health insurance without an SSN? The challenge of missing SSNs in patient records For decades, the SSN was a go-to data point for verifying insurance coverage. In the absence of a national patient identifier, it served as a consistent way to match individuals to their insurance records across health systems and payers. However, many patients do not have SSNs, and concerns about data privacy, duplication and identity theft led providers and payers to phase out SSNs. Although SSNs may still be collected during enrollment for administrative use, industry best practice now discourages using SSNs unless absolutely necessary. Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. For instance, in 2018, Medicare replaced SSN-based Health Insurance Claim Numbers with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person's identity for Medicare transactions like billing, eligibility status and claim status. Commercial health plans have followed suit, relying more heavily on member IDs and internal identifiers for billing and eligibility and avoiding SSNs in patient records in line with privacy rules set out in the Health Insurance Portability and Accountability Act. As a result, SSNs are disappearing from patient records and payer databases. The question for providers is how to accurately verify insurance without SSN access. The impact of unidentified insurance on claims and reimbursement When active insurance coverage is overlooked, providers lose the opportunity to bill for care. Some patients will be incorrectly assigned self-pay status, triggering unnecessary billing cycles or charity write-offs. Others get care without providing their coverage information at the time of care, especially in fast-moving outpatient and emergency departments. Either way, the revenue is at risk in situations like these. Providers lose time and revenue. Teams are forced to reprocess claims, track down retroactive coverage, and appeal denials that could have been avoided. Missed coverage also takes a toll on patients, who now owe more than $220 billion in medical debt. And with cost concerns prompting four in ten patients to consider skipping care when they don't receive a price estimate, missing coverage is more than a paperwork problem – it's a clear threat to health and well-being. Case study: How UCHealth saved over $3.5 million by reducing accounts sent to collections with billable insurance. Strategies to identify health insurance without an SSN As the use of the SSN in medical billing declines, providers are looking for new and better tools to find insurance coverage. Digital technology and data integration make it possible to verify insurance without SSN use. Here are a few of the most effective strategies: 1. Using probabilistic matching and third-party data Advanced coverage discovery platforms now use probabilistic matching to connect patients to payers. These tools analyze data points like name, address, date of birth and phone number to identify likely matches. Instead of needing a patient's exact identifiers, they calculate match confidence based on data quality and historical payer data. 2. Leveraging health information exchanges (HIEs) Another option is to connect to regional or statewide HIEs to check insurance details shared across health systems, payers and public programs. This is especially valuable for transient or underserved populations who often move between providers and may not always carry updated insurance cards. 3. Patient self-service portals with identity validation At the front end, patient self-service tools offer opportunities to collect insurance information before a visit. Identity validation technology helps confirm the person's identity without requiring an SSN. Patients can scan an insurance card, update coverage details or answer verification questions within the portal. This reduces the workload for front desk staff and ensures better data before the patient arrives. Automated tools to streamline insurance discovery While patient access tools help patients confirm their coverage details, automated back-end solutions are essential for identifying insurance when information is incomplete or missing. Intelligent coverage discovery platforms can predict and verify active coverage without relying on SSNs, using demographic inputs like name, address and date of birth. These platforms run real-time or batch searches across multiple proprietary databases, combining search best practices, historical claims data and payer response patterns to flag likely matches. At the point of scheduling or registration, automated eligibility checks help identify billable coverage early, reducing errors, manual work and missed reimbursement opportunities. Experian Health's Coverage Discovery® exemplifies this approach, uncovering commercial, Medicare and Medicaid coverage that may have been unknown or forgotten. By identifying primary, secondary and tertiary coverage, it flags accounts that might otherwise be written off or sent to charity. Not only does this help maximize reimbursement revenue, but it also automates the self-pay scrubbing process and reduces the number of accounts sent to bad-debt collections. In 2023 alone, the platform identified billable coverage in more than 30% of self-pay accounts, resulting in over $25 million in found coverage. This level of automation is especially critical as policy changes continue to disrupt coverage stability. Proactive alerts can flag patients previously marked as self-pay but now linked to valid insurance, helping providers course-correct before claims go unpaid. Better patient matching, better outcomes As insurance coverage becomes more complex, providers need smarter and more efficient ways to verify it. Automated platforms like Coverage Discovery identify active insurance using minimal patient data, improving accuracy and reducing dependence on SSNs. When active coverage isn't found, Patient Financial Clearance helps fill the gap, screening for Medicaid eligibility or identifying patients who may qualify for charity care. Together, these tools give providers a more complete financial picture and ensure patients are connected to the coverage or support they need. The result is not just cleaner claims and faster payments, but better patient and provider outcomes. With more than a fifth of patients experiencing delays in healthcare because of issues verifying insurance information, improving coverage accuracy is a win for everyone. Find out more about how Coverage Discovery can help healthcare providers reduce bad debt by verifying patients' health insurance coverage without SSNs. Learn more 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

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

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