Tag: patient financial clearance

Self-pay collections are challenging for healthcare organizations of all shapes and sizes, but particularly for mid-size providers. Caught in an awkward middle ground, these organizations are often too large to operate with the agility and personal touch of small clinics, but too small to leverage the economies of scale available to large health systems. Revenue cycle managers must find the balance between operational efficiency, patient-centered services and financial constraints. With limited staff and resources, many mid-size hospitals feel like they're fighting an uphill battle to maintain cash flow and patient satisfaction as they contend with increasingly complex billing and insurance protocols. Implementing self-pay collections strategies tailored to mid-sized healthcare organizations can boost efficiency, reduce bad debt and create smoother patient billing processes. This article looks at practical strategies to help bring more dollars in the door without compromising the patient experience. Importance of effective self-pay collections in the mid-sized market Like other markets, mid-size providers are squeezed by self-pay collections on two fronts – the hospital's financial health and patient satisfaction. Finding the right collections strategy is vital to protect this “double bottom line.” Financially, failure to collect on bills seriously hurts cash flow. Unlike larger hospitals that might have more resources or smaller practices with fewer expenses, mid-size facilities often operate on tighter margins. Inefficient collections processes lead providers to risk revenue loss, which leads to cuts in services, staff and the ability to invest in new tech. At the same time, the way hospitals handle billing and collections plays a major role in how patients feel about their overall healthcare experience. Confusing bills or aggressive collections tactics can damage trust. An effective self-pay collections strategy that makes payments easy, straightforward and flexible contributes to a positive patient experience and will pay dividends in the long run. How to improve self-pay patient collections for mid-size hospitals and facilities Here is a breakdown of some key approaches and tools that can be adapted to suit the specific needs of mid-size providers and make billing and collections more efficient, patient-friendly and cost-effective: 1. Automate as much as possible One of the fastest ways to make better use of resources is with automation. Why have staff spend hours sending out bills and payment reminders by hand when this can be done automatically? Automated collections tools can also send email and text reminders to patients, set up auto-pay options, and guide patients to appropriate payment plans. Automatic alerts for overdue accounts can be used to help staff focus their limited time on high-value activities. This saves time, reduces errors and creates seamless patient experiences. Read more: Maximize patient collections with automated technology 2. Segment and conquer collections Every patient's financial situation is different, so why handle their accounts in the same way? Segmentation divides patients into groups based on their payment behaviors, financial situations and balance size so that providers can tailor their approach. Collections Optimization Manager screens and segments self-pay accounts to scrub accounts that need special handling (like bankruptcy, deceased status, Medicaid and charity) and focus on patients most likely to pay. Accounts are given a segment code based on the patient's propensity to pay, which then informs how the account is managed. For example, those who typically pay on time can get a simple text reminder, while those with larger balances or financial difficulties may need a more flexible payment plan. This solution can also be used with Patient Financial Clearance to create individualized payment plans for patients who may not qualify for charity care. A targeted approach to self-pay billing strategies for mid-sized healthcare facilities increases the chances of successful payments. 3. Implement interactive voice response (IVR) IVR systems allow patients to get important payment information through an automated phone system, without needing to talk to someone. Patients can receive automated voice messages or call in and follow prompts to pay their bills over the phone. Not only does this give patients far more flexibility to pay when convenient for them, but it also reduces the workload on staff, who don't have to handle so many incoming calls. Experian Health's cloud-based dialing platform, PatientDial, helps patients clear their bills quickly and conveniently, with minimal input from staff. In a single year, this tool helped clients collect over $50 million in self-pay collections and save 900,000 labor hours that would have been spent dialing manually. 4. Work with a dedicated collections consultant Bringing in a collections expert gives patient finance teams targeted support to improve collections rates while maintaining a positive patient experience. Clients who use Collections Optimization Manager get dedicated support from experienced revenue cycle consultants who can recommend the most appropriate collections strategies, evaluate opportunities to improve performance, and oversee scenarios to test and adopt new approaches. Some providers may find it more efficient to manage collections in-house, while others benefit from outsourcing to a specialist third party. Experian Health offers collections solutions to both, enabling mid-sized providers to choose the best fit. Collections Optimization consultants provide personalized attention and customized workflows tailored to the organization's needs, whether they're using Epic, Oracle, Meditech or other electronic health record platforms. Integrating patient-friendly billing practices Whatever the strategy, maintaining a positive patient-provider relationship through patient-friendly billing is essential. For example: Simplifying billing statements and using clear language reduces confusion and helps patients understand what they owe Running coverage discovery checks and offering upfront patient payment estimates gives patients greater clarity about their financial obligations Setting up automated reminders nudges patients to pay on time Highlighting available payment plans gives patients manageable options to reduce the risk of unpaid balances. Experian Health's data insights allow providers to better understand patients and develop strategies for proactive outreach before debts become unmanageable. Collection Optimization Manager's segmentation model draws together credit, behavior and demographic data, incorporating socio-economic modeling and income estimations to build a complete picture of each patient. Unlike traditional segmentation models that rely solely on payment history, the CO model includes estimated household size, income and federal poverty line analytics to generate a meaningful score without needing additional data. Automated communications such as PatientText and PatientDial make the billing and payment process less intrusive. Combining convenience and personalization builds trust and improves collections while supporting a more compassionate patient experience. Enhancing revenue for mid-sized medical groups with improved self-pay collections Going back to that “double bottom line,” Judy Wirtz, Senior Analytics Consultant at Experian Health, explains how Experian's collections toolkit helps mid-sized organizations boost financial performance while maintaining a positive patient experience: “Boosting self-pay collections for mid-size healthcare organizations doesn't have to be daunting,” she says. “Our goal is to simplify collections while keeping the patient experience front and center. We use industry-leading data, smart segmentation and dedicated support to help organizations customize their strategies based on their unique patient mix and resources. Other tools fill in different pieces of the collections puzzle, but Collections Optimization Manager is the only one to give providers the full picture. Our clients have seen an impressive 9:1 return on investment, so we're confident this approach makes a real difference.” Wirtz suggests that those who'd like to learn more about Collections Optimization Manager should watch Experian Health's recent webinar with Wooster Community Hospital. The hospital used CO to collect $3.8 million in patient balances. Find out more about how Collections Optimization Manager boosts self-pay collections for mid-size healthcare organizations. Learn more Contact us

Could healthcare organizations be doing more to open their digital front door? According to a 2024 study by HIMSS researchers, hospitals that embrace digital technology see stronger patient experience outcomes. This aligns with Experian Health's most recent State of Patient Access (SOPA) survey, in which patients and providers agreed that patient access had improved thanks to digital technology. Adoption of digital health technology accelerated in response to COVID-19, as healthcare organizations sought to manage demand and facilitate “contactless” access to care. Telehealth, mobile apps and patient portals gave patients more control over their health while allowing providers to deliver more personalized and efficient care. With over half of healthcare providers and nearly a third of patients acknowledging improvements in access since before the pandemic, it's clear that offering more digital options is a powerful strategy to improve patient engagement and streamline access. Progress is encouraging, but there are always opportunities to do more. What is healthcare's digital front door? Healthcare's “digital front door” includes all the digital channels through which patients access care, such as websites, patient portals, mobile registration and payment apps, telehealth platforms and online scheduling tools. The goals are to create convenient and user-friendly entry points for patients to engage with their providers, use online tools to expand access, improve patient satisfaction, and increase operational efficiency. Why a digital front door is crucial for healthcare providers When asked why they believe patient access has improved since before the pandemic, the top four reasons given by patients all relate to scheduling and registration processes: Being able to see a doctor quickly (72% agreed) Checking in and registration (61% agreed) Scheduling appointments (58% agreed) Finding appointments that work with their schedule (57% agreed). In other words, patient access improves when providers open the digital front door. Alex Harwitz, VP, Digital Front Door, at Experian Health, explains that for providers, this equates to two major benefits: 1. Improves patient engagement Harwitz says that putting access in the hands of patients gives patients more flexibility and choice about how and when they book appointments, fill out registration forms and pay for care. “There's a growing demand for easy, accessible healthcare, and opening the digital front door is how we meet it. Digital tools use automation and data analytics to create a more personalized and convenient patient experience, making it easier for patients to remember appointments, adhere to treatment plans and manage their financial obligations,” he says. “That's huge for busy households. The to-do list just got a lot shorter, so it's easier for them to engage.” 2. Streamlines patient access A second key benefit is reducing friction and bloat in patient access workflows. Harwitz says, “By expanding their online offerings, providers not only make it easier for patients to see their doctor sooner, but they also reduce demand on front office staff. Self-service options, performance reporting and data insights allow providers to allocate resources more effectively. It’s about making sure everyone gets the right support at the right time, whether that's online or in the office.” Getting the patient journey off on a strong footing also pays dividends throughout the rest of the revenue cycle: with fewer errors and faster throughput, collections and claims management improve, too. Read more: How patient access technology is transforming the healthcare revenue cycle Key components of a digital front door As more providers offer online patient access, competition for the digital front door is increasing. With 60% of patients looking for more digital and mobile options to meet with providers, schedule appointments, and manage bills and payments, these would be smart areas to prioritize for a competitive advantage. Here's what that might look like: 1. Cut paperwork and calls with self-service scheduling and mobile registration It should come as no surprise that a vast majority of patients say they do not like repetitive paperwork. Online and mobile-enabled scheduling and registration reduce form-filling and lengthy calls. For example, Patient Schedule gives patients a platform to book, cancel and reschedule appointments with ease, anytime and anywhere. Appointments are matched to patients' needs so no slots are wasted and patients see their doctor sooner. Mobile registration increases bookings further. With Registration Accelerator, patients receive a text that prompts them to scan their identity and insurance cards, so they don't need to wait in line to fill out forms. Validating their data from the start also improves billing accuracy and reduces the risk of downstream denials. 2. Make it easier to pay for care Simplifying the financial experience is a major component in opening the digital front door. Patients are worried about the cost of care and say that having accurate price estimates before treatment helps them plan for bills. With Patient Payment Estimates, providers can give patients accurate, upfront estimates of their out-of-pocket costs, while tools like Patient Financial Clearance can help direct them to appropriate payment plans. It's also important to make the actual payment process as straightforward as possible. Accepting payments 24/7 from any device allows patients to pay promptly and helps providers avoid bad debt. Checklist: 5 patient-friendly billing practices to accelerate collections 3. Communicate clearly for a great first impression At its core, opening the digital front door is about creating a welcoming first impression for patients. Patients don't want confusing instructions or radio silence when they have questions. They want proactive, helpful and clear communications. One of the benefits of digital tools is having the data and automation capabilities to send patients timely and personalized messages and reminders using their preferred channels. They can also drive targeted outreach campaigns using text messages and interactive voice responses to encourage patients to book appointments and make payments. The future of healthcare's digital front door These are just a few examples of how providers can expand their digital offerings to make it easier for patients to access care. But what will the digital welcome mat look like in the future? Advances in artificial intelligence, digital apps and wearable tech will transform the way patients interact with their providers. Hockey-stick growth in data generation will make data security and interoperability non-negotiable. It's a big ask of providers. Partnering with an expert third-party vendor will help digitally forward organizations remain responsive and adaptable. Find out more about how Experian Health helps providers open their digital front door with mobile scheduling, registration and payments.

“For too many, coverage is either unavailable or insufficient.” This is the harsh reality the American Hospital Association highlighted in a recent statement to the US Senate, urging action to address growing medical debt. Despite efforts to expand insurance coverage, hospitals continue to lose billions of dollars through unpaid bills. The statement notes that hospitals provided over $42 billion in uncompensated care in 2020 alone. Guiding low-income patients to appropriate charity care programs can mitigate a significant portion of this uncompensated care. Unfortunately, many eligible patients are either unaware of these options or choose not to apply, causing hospitals to waste time and money chasing bills from people who cannot afford to pay. Helping those patients find and apply for financial support is critical to reducing bad debt. But that's a challenging prospect without automation. Presumptive screening with Patient Financial Clearance offers a faster route to reliable charity care classifications and a reduction in uncompensated care. What is charity care? Charity care programs provide free or discounted healthcare to patients who can't afford to pay their bills, covering medically necessary inpatient and emergency room services. Typically, programs offer full or partial discounts to uninsured patients, but those with insurance may be entitled to assistance if their plan doesn't cover their care. Eligibility depends on the hospital's financial assistance policies and relevant state regulations. Hospitals do not expect to be reimbursed for charity care, though tax exemptions and government funding may offset some of the cost. In this way, charity care is distinct from “bad debt,” which refers to unpaid patient bills that hospitals expect to collect. Frustratingly, too many accounts that could have been eligible for charity care are written off to bad debt—perhaps because patients don't realize they're eligible, don't know how to fill out the application, or feel embarrassed to seek help. The problem is further exacerbated by the growth in high-deductible and “skinny” health plans, as patients without sufficient coverage assume support is only for the uninsured. Several states are tackling medical debt by bolstering charity care programs. For example, North Carolina plans to boost federal payouts to hospitals that agree to waive medical debt for low-and middle-income patients. In Milwaukee, County Supervisors are taking a preventive approach, using income data to automatically enroll at-risk patients into charity care programs to stave off bad debt before it takes root, in a process known as presumptive charity. What is presumptive charity? Checking eligibility and helping patients apply for charity care is predictably form-heavy. Patients must provide tax returns, pay stubs, and bank statements to confirm their household income and financial status. Manual reviews are time-consuming for providers, while the overall experience can feel intrusive or confusing to patients. Presumptive charity screening expedites charity care checks by automatically screening patients for financial assistance eligibility. It uses automation and data analytics to quickly evaluate the patient's credit information, financial data and demographic details to make a 'presumptive' determination of eligibility for charity care, regardless of coverage status. Better charity care classifications reduce bad debt Automated charity care checks mean more patients will be classified correctly so hospitals can confidently seek reimbursement from the appropriate source. This offers several advantages, such as: Reducing bad debt: Presumptive charity screening results in fewer eligible patients missing out on financial support, so they're less likely to be sent bills they can't pay. Increasing efficiency: More accurate screening allows staff to cut time spent on administrative tasks and stop chasing collections from patients who are unlikely to be able to pay. Expediting classification decisions: Automation means eligible patients don't have to wait for long periods to find out if they'll get financial support, which is especially important in urgent and high-volume services, such as emergency departments and large hospital systems. Improving the patient experience: Speedy systems with fewer forms reduce the patient's involvement to a minimum, contributing to a more convenient and compassionate financial journey. Maintaining compliance: Hospitals comply and maintain their non-profit status by providing charity care to their community. Supporting patients: Providing accessible healthcare to those who are low-income and are most vulnerable. How can Patient Financial Clearance help providers improve charity care classifications? Patient Financial Clearance (PFC) is a presumptive screening tool designed to help providers quickly determine which patients may be eligible for financial assistance. It then connects those patients with relevant charity care programs and automatically enrolls them, or establishes tailored payment plans for the amount they owe based on their financial situation. First, Patient Financial Clearance triggers automatic checks before or at the point of service to rapidly assess whether the patient qualifies for Medicaid, charity care or other financial assistance programs. It uses Experian Health's superior data and analytics to accurately estimate the patient's income, household size and Federal Poverty Line (FPL) percentage, and it calculates a Healthcare Payment Risk Score to predict their propensity to pay. Unlike alternative models which are built to estimate incomes for consumers with higher incomes, PFC's income estimates are optimized to predict incomes below 400% of the FPL. Then, if patients are likely to be eligible for charity care, the tool pre-populates application forms and initiates auto-enrollment to reduce staff manual input and the risk of errors. There needs to be a prompt process to help patients who do not qualify for charity care manage their bills. For patients who do not qualify for charity care, there also needs to be a prompt process to help. Patient Financial Clearance recommends optimal payment plan amounts per the organization's terms and policies. Staff can pull up summarized and detailed views of the patient's credit history and custom scripts to guide financial counseling discussions. Alex Liao, Product Manager for Patient Financial Clearance at Experian Health, explains how better charity classifications help reduce bad debt and increase collections: “The obvious benefit is that clients can accelerate the charity care application process and ensure eligible patients get assistance quickly. However, having a more accurate picture of patients' financial needs offers wider benefits across the revenue cycle: it ensures each patient account is handled appropriately to increase upfront collections and reduce bad debt. Those with a low ability to pay receive a payment plan they can afford, while those with a greater capacity to pay are not just paying the minimums.” Patient Financial Clearance in practice See how UCHealth used PFC to create a more streamlined approach to charity care classifications, resulting in: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). To hear more about how automating charity care classifications with Patient Financial Clearance could help your organization reduce bad debt, contact us today for a demo. Patient Financial Clearance Contact us

The fine line between getting paid what they're owed and delivering compassionate care puts patient collections among the top challenges for providers. Improvements to collections processes feature prominently in Experian Health's most recent State of Patient Access survey: 94% of providers pointed to the need for more accurate patient estimates, while equally many want faster, more comprehensive insights into what patients' insurance actually covers so they can make the billing process easier for everyone. The challenge is even starker when the patient's perspective is considered. More than four in ten patients are so worried about the bill that will later land on their doorstep that they’d avoid care altogether. Even those who have insurance are struggling: 53% of total bad debt write-offs in 2023 came from patients with some form of insurance. As healthcare becomes more expensive, insurance becomes more complex, and patients become more cost-conscious, providers must find ways to improve the patient collections processes. This article looks at how technology can bridge these competing demands. What are patient collections in healthcare? Patient collection processes cover all the steps involved in calculating, invoicing and obtaining payment for the amount the patient owes for their healthcare treatment. Figuring out the patient's financial responsibility starts when the patient registers for care and when the provider can check for active insurance coverage. Once verification and eligibility processes are complete and the provider knows how much of the total cost will be covered by an insurer (if any), they can estimate the patient's responsibility. The earlier this happens, the better. What makes the process so complex is the number of moving parts: Payer policies change regularly, and staff must keep up to date or there will be gaps and errors in claims submissions and patient estimates Healthcare costs are increasing, leaving providers with tighter margins and less room to maneuver Patients are increasingly worried about whether they can afford healthcare, as household bills continue to increase despite economic improvements Patients expect a wider range of payment options, with 72% of patients emphasizing the need for online and mobile payments to enhance their health experience. Billing staff cannot tell which patients are able and likely to pay due to insufficient data on patients' economic and credit history. Part of the problem for healthcare providers is that their systems are geared more toward traditional collections from government or private payers. Still, the average patient's responsibility is at an all-time high. For healthcare providers to increase the volume of revenues they collect from patients, they must invest in technologies that provide consumers with a frictionless payment experience. How can patient billing and collections be improved? One way to think about improving patient collections is to break it down into its parts: How to calculate and communicate more accurate, upfront estimates to patients How to figure out a patient's propensity to pay based on segmentation data How to compile and share clear and comprehensive bills and financial statements How to offer patients various digital and mobile options to make prompt payments. Advanced technology offers solutions for each step, while creating a seamless experience overall. In a recent byline, Clarissa Riggins, Chief Product Officer at Experian Health, says that manual systems can't cut it any longer: “It's time to move away from the notion of collections as a one-off, manual and labor-intensive process. Instead, let's view it as a part of an ecosystem that begins before patients receive treatment, starting with upfront, self-service payment options and early screening of patients for potential coverage. In this way, we can transform collections from a destination into a process—and perhaps, by doing so, we can even put our traditional collections departments out of business.” How does technology improve patient collections? Prompt and accurate patient estimates Almost nine in ten providers agree that providing accurate, up-front estimates improves patient collections success. Patient Payment Estimates give patients the expected cost of care ahead of time, so they're in a stronger position to plan – and providers get paid faster. Automated estimates increase revenue and help providers stay on the right side of compliance with rules and regulations. Analytics-based collections optimization When compiling accurate bills to patients and payers, providers have a wealth of technical options at their disposal. For example, Collections Optimization Manager uses in-depth data and advanced analytics so providers can identify patients most likely to pay and ensure patient accounts are handled most efficiently. Patients are segmented by propensity-to-pay scores based on behavioral, demographic and credit data. This supports tailored billing and collections strategies and improves financial outcomes by identifying patients most likely to pay and ensuring patient accounts are handled most efficiently. Case study: See how St Luke's University Health Network used Collections Optimization Manager to improve patient engagement and boost cash collections by 22%. Quick and convenient ways to pay Riggins says that improving payment processes is a significant step toward maximizing patient collections in healthcare. Previous research has shown that while credit and debit cards are the most popular payment methods, patients would use them less often if their preferred digital options were available. Providers should consider digital tools such as PaymentSafe® to offer patients fast, frictionless and secure payment options across multiple collection points, including interactive voice response, mobile, kiosks and patient portals. Automating patient outreach to increase collections Another use case for patient access technology is in facilitating direct and efficient communications with patients while reducing the workload for staff. Automated patient outreach tools such as PatientDial and PatientText send patients timely bill reminders and self-pay options via voice or text message to increase collections without the need for agent interaction. These tools bring more dollars in the door while reducing operational costs: PatientDial helped Experian Health's clients collect over $50 million in one year via automated call campaigns, saving many thousands of labor hours compared to manual outreach. Personalizing payment plans for every individual From the patient's point of view, a winning strategy calls for transparency and personalized support. Creating a collections process that accommodates patients' individual circumstances will increase revenue while improving the patient's financial experience. For example, Patient Financial Clearance analyzes each patient's financial situation and creates a personalized payment path that fits their needs. It screens self-pay patients to identify those who need extra support and reroutes them to the proper channels. Where relevant, providers can then offer the option to pay in more affordable installments or connect the patient to financial assistance programs. Together, these tools improve collections by streamlining how patients pay – and how providers get paid. Maximize patient collections with Experian Health Walking the patient collections tightrope demands that providers take bold action and experiment with new approaches. That might feel risky when the stakes are so high, but working with a trusted vendor with experience in delivering leading patient collections solutions should ease concerns. Experian Health's suite of collections management and secure, reliable payment solutions integrate easily with existing systems and processes for a seamless end-to-end collections experience. Contact us today to learn more about maximizing patient collections in healthcare with Experian Health's leading collections management technology.

With over $220 billion in medical debt, patients in the U.S. are burdened by substantial financial obligations. These numbers also distress healthcare providers, who face cash flow and other operational challenges stemming from unpaid patient bills—and debt collection can further strain the relationship between care providers and patients. An efficient financial clearance process at the beginning of each patient encounter can benefit the entire system. But what is healthcare financial clearance and how can providers achieve it? What is financial clearance in healthcare? Financial clearance in healthcare is an administrative process that ensures patients understand their financial obligations before service delivery. It's often a manual workflow that involves verifying insurance coverage, estimating out-of-pocket costs, and discussing payment options or plans. The main objectives of financial clearance in healthcare are to prevent unexpected financial burdens for the patient, reduce the risk of unpaid medical bills for the provider, and streamline billing and payment. Common challenges with healthcare financial clearance Complex insurance policies, inaccurate or incomplete patient information, and lack of patient understanding of their own policy requirements are just a few of the challenges healthcare providers face in financial clearance. Not all healthcare providers have access to advanced technology or automated systems to streamline financial clearance, leading to reliance on manual processes that are prone to errors. Determining eligibility for financial assistance involves navigating complex criteria, which include assessing individual income, household size, savings, and medical requirements. When patients need help understanding their policy requirements, the educational burden often rests on the healthcare provider. Traditional manual methods of collecting and analyzing this data are prone to inefficiencies and inaccuracies, leading to missed opportunities to provide necessary financial support to patients. This makes the financial clearance process even more time-consuming, requiring significant administrative effort to verify insurance details, secure authorizations, and communicate with patients and insurers. Verifying a patient's insurance details during financial clearance ensures that the provider has the correct information about the patient's coverage, reducing the risk of denials due to eligibility issues. Financial clearance involves confirming that the patient is eligible for the services under their insurance plan. If eligibility is not verified beforehand, providers may deliver services that are not covered, leading to denials. Financial clearance also involves estimating the patient's out-of-pocket costs and ensuring the patient understands their financial responsibility. This process helps reduce denials related to unmet deductibles or co-payments, as patients are informed about their financial obligations upfront. Enhancing the healthcare financial clearance process improves revenue cycle management and significantly boosts patient satisfaction. As reimbursement denials continue to rise, healthcare providers have a vested financial interest in minimizing the financial uncertainties patients face early on in their healthcare journey. The use of technology to automate many of these manual processes allows healthcare providers to focus on minimizing financial uncertainty for patients, thereby enhancing their overall experience. Improve revenue cycle with automated healthcare financial clearance Healthcare providers can use technology to understand patient payment challenges and recommend the best financial pathway during the registration process. Providers like UC Health in Colorado leveraged Experian Health's Patient Financial Clearance software to write off $26 million in charity care. The technology integrates cleanly with the provider's electronic health record (EHR) to lessen the back-and-forth between systems during patient registration. Identifying the patients who need financial assistance upfront lessens the time spent pursuing bad debt and connects those who qualify for financial assistance with the right programs. Experian Health's Patient Financial Clearance solution fosters clear communication between the healthcare provider and the patient regarding coverage, costs, and payment expectations. This transparency helps in addressing potential issues that could lead to denials before they occur. Automation reduces bad debt and improves the patient experience Technology answers the question of 'what is financial clearance in healthcare?' with outcomes that include higher patient satisfaction and a better bottom line. Patient Financial Clearance automates screening to determine financial and clinical eligibility for each person at the first point of service. It answers critical questions such as: Does the patient qualify for financial assistance? What constitutes a realistic patient payment plan? Notably, the software helps set the tone for the patient intake specialist, approaching payment terms proactively and empowering everyone to take on their financial responsibilities early in the care delivery process. Patient Financial Clearance automates and streamlines manual workflows to optimize the revenue cycle. For example, this software can: Automate screening prior to service or at the point-of-service to determine if patients qualify for financial assistance, Medicaid, or other assistance programs, without relying on patients for information Leverage Experian’s comprehensive data and analytics capabilities to calculate the patient’s optimal payment plan amount based on the patient’s unique financial situation Predict propensity to pay using Experian’s proprietary Healthcare Payment Risk Score The benefits of Patient Financial Clearance for providers include: Improved point-of-service collections Lowered bad debt write-offs Increased staff productivity IRS 501(r) compliance Improved patient and staff experience For patients, Experian Health’s Self-Service Patient Financial Clearance option enables patients to conveniently complete eligibility checks at their own pace. Through a mobile and web-based platform, patients can submit screening forms and upload necessary documents, receiving real-time updates without the need to contact their healthcare providers. All information is securely stored, allowing staff to access application statuses as required. Automating financial clearance in healthcare transforms an unwieldy process into an efficient way to manage the delicate relationship between providers and patients. Technology can free up intake specialists to concentrate on creating a better patient experience and eliminate the frustrations surrounding collecting payment after the service is complete. Learn more about how Patient Financial Clearance can help healthcare organizations reduce bad debt by automating the patient financial assistance process.

A recent Peterson-KFF brief found that around 20 million adults have unpaid medical bills, with 14 million owing at least $1,000. Data from the Survey of Income and Program Participation puts the total figure at more than $220 billion. Healthcare providers must find ways to streamline patient financial assistance screening, to help patients and prevent unpaid bills piling up from uncompensated care. Many patients who would be eligible for financial assistance miss out on much-needed discounts due to outdated screening processes, leaving their unpaid bills to linger in accounts receivable. Automated presumptive charity screening offers a cost-effective solution for healthcare providers to modernize the process and reduce avoidable write-offs. Patient financial assistance software can also aid providers in fostering compassionate patient experiences, by identifying individuals in need of help and efficiently guiding them towards appropriate financial assistance pathways. The hidden consequences of medical debt Rising costs, unexpected medical emergencies and lack of insurance are the main culprits in the growing problem of medical debt. Though uninsured rates have dropped, millions of insured Americans remain without adequate coverage: high deductibles and co-payments leave many individuals “underinsured” with out-of-pocket costs they cannot afford. Providers end up shouldering the costs, leading to revenue loss, operational strain, and impaired capacity to deliver high-quality care. In some cases, the burden of an individual's medical debt may be initially concealed from the health system, papered over with credit card bills and loans. But it does not remain hidden for long: medical debt becomes simply “debt,” as families cut back on food and clothing, fall behind on other household bills, or even declare bankruptcy. The repercussions can escalate for patients and providers as patients opt out of further care, which eventually causes their medical needs – and costs – to spiral. Creating a more compassionate financial experience for patients will help avoid these ripple effects, with benefits for providers, too. Who is eligible for patient financial assistance programs? Patients who cannot afford to pay may be eligible for support via a patient financial assistance program. These programs, offered by providers, charities and government agencies, alleviate the financial pressures on patients by covering some or all of the cost of care in the form of partial or full discounts. Providers can offer patients information and support early in their healthcare journey to help them access such programs. The challenge is figuring out who is eligible. Eligibility criteria for financial assistance is often complex, covering the individual's income, household income and size, savings and medical need. Gathering and analyzing this data using manual processes can be time-consuming and often lead to gaps and inaccuracies. These inadequate screening processes result in missed opportunities to connect patients with the financial assistance they need, and risk falling foul of charity care regulations and policies. On-demand webinar: Hear how Eskenazi Health boosted Medicaid charity approvals by 111% with financial aid automation. How to use data to identify patients eligible for financial assistance Instead of asking the patient to fill out a stack of forms and manually checking data against the Federal Poverty Level to determine eligibility for charity care, providers can get the answers they need using data analytics and automation. Patient Financial Clearance automates eligibility checks prior to service to see if patients qualify for financial assistance programs. It uses Experian data and analytics to predict the patient's ability to pay and calculate the best-fit payment plan based on individual needs and circumstances. It also generates scripts for staff to use when running the tool and helping patients find assistance, which makes for a more compassionate experience. Alex Liao, Product Manager for Patient Financial Clearance at Experian Health, says, “Many patients are unaware that they're even eligible for financial assistance and need help to navigate the process. Discussing personal finances can also be uncomfortable, so it's not uncommon for patients to avoid sharing information that could actually lead to them getting support. Automating presumptive charity screening is more efficient and reliable. It's also a lot more compassionate than the old way of collecting forms and documents. Patient Financial Clearance pulls together credit information and demographic data to determine whether the patient qualifies without long, drawn-out discussions. Patients get the help they need and providers can reduce bad debt without delay.” Case study: Discover How UCHealth wrote off $26 million in charity care with Patient Financial Clearance. Using patient financial assistance technology to create compassionate patient experiences As Liao notes, many patients feel awkward or hesitant when discussing their financial situation with a stranger. Additionally, patients are increasingly looking for digital channels to handle their administrative tasks. Experian Health's Self-Service Patient Financial Clearance option offers patients a simple and more private way to complete eligibility checks, whenever and wherever it suits them. Using a mobile and web-based platform, patients can fill out screening forms and upload supporting documents, then get real-time status updates without having to call up their providers. Information is stored securely so staff can check application status as needed. How Self-Service Patient Financial Clearance works Self-Service Patient Financial Clearance puts patients in control, so more individuals complete their applications and find out if they’re eligible for financial assistance. This frees up staff to focus on other revenue-generating tasks that require their attention. With a cost-effective, compassionate and convenient option on the table, is it time to say goodbye to paper-based presumptive charity checks? Find out more about how Patient Financial Clearance helps providers reduce bad debt and improve the patient experience by quickly and correctly checking eligibility for charity care.

“I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.”—Andrew Pederson, Director of Patient Experience, UCHealth Challenge UCHealth, in Aurora, Colorado, is an integrated system of 12 hospitals and more than 30,000 employees. When the state of Colorado released data on non-profit hospital charity care and community benefits, UCHealth's spending was lower than anticipated despite having policies on equitable charity care in place. Additionally, the state was about to implement new legislation on charity care, setting a cap on charges for low-income patients. UCHealth proactively sought to revamp how they handled charity care in preparation for higher patient volumes in the future. The organization decided to review its charity policy and processes. After examining other providers, UCHealth determined that it lacked presumptive charity functionality early in the patient encounter. New technology would help patients avoid the accrual of unpaid medical bills and keep UCHealth from accruing bad debt. Solution UCHealth added Patient Financial Clearance in 2023 after their favorable experiences with Experian Health's Coverage Discovery® and Insurance Eligibility Verification. Patient Financial Clearance allowed the provider a more nuanced understanding of each patient's ability to pay by going beyond their reported income to look at the Federal Poverty Level ratio and their propensity-to-pay. The technology used powerful analytics to create a Healthcare Financial Risk Score, encompassing historical credit activities, including payment of past medical bills. Importantly, Patient Financial Clearance helped UCHealth staff determine options for financial assistance automatically, without relying on the patients themselves. Automation in the platform reduces time spent per encounter, improving the patient and staff experience and, ultimately, the bottom line. Discover how UCHealth secured $62M+ in insurance payments with Experian Health's Coverage Discovery solution. Outcome Thanks to Patient Financial Clearance, UCHealth achieved the following results: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). Overall, Patient Financial Clearance helped UCHealth create a more streamlined approach to providing charity care to patients who need it. The technology integrates easily with the provider's electronic health record (EHR) system, eliminating the back-and-forth between multiple systems during patient registration. Identifying patients who need financial assistance saves the UCHealth team from misclassifying them as bad debt, minimizing financial losses on the organization while improving their overall experience. Andrew Pederson, Director of Patient Financial Experience at UCHealth, highly recommends this software and the team that provides it, stating, “I love the availability of the Experian team. They are quick to solve any issue and get you back up and running in no time.” For providers seeking to streamline the revenue cycle, Pederson says, “Get out of your own way and just do it.” Learn more about how Patient Financial Clearance streamlines patient charity screening while maintaining an outstanding experience at every step of the encounter.

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

Discovering that a patient's insurance doesn't cover planned care is frustrating for patients and providers. With revenue and patient satisfaction on the line, verifying active coverage should be simple and efficient. However, the process often involves digging through an ever-expanding mountain of data, which consumes valuable time and resources. Increasing patient volumes, frequent payer updates, and new demands for pre-authorization all play a role. Additionally, the impact of nearly 12 million Americans losing Medicaid coverage since April 2023 adds to the challenge.  It's unsurprising that many healthcare organizations no longer rely on manual processes to verify a patient's insurance details. To address these issues, many providers are turning to medical insurance verification software. The CAQH 2022 Index reports that automation of eligibility and benefits verification has increased by 25% over the last 10 years, as providers turn to medical insurance eligibility verification software for more reliable results. This article looks at how these tools are helping healthcare organizations increase their profitability and the questions to consider when selecting the right eligibility verification solution. What is medical insurance verification software? Medical insurance verification software automates the process of checking that a patient's insurance information is current and correct. With just a few clicks (or just a single click when using Patient Access Curator), the software collects data from multiple sources to confirm that prescribed services or treatment are covered by the patient's health plan. Unlike manual processes that involve checking individual payer websites and cross-referencing patient data by hand, an automated solution returns accurate information in an instant. Adoption of this software has grown significantly in recent years because of its ability to drive operational efficiency and reduce revenue loss. More than 90% of medical providers now opt for electronic eligibility verification, according to the CAQH 2022 Index. The report highlights this as a top savings opportunity for the industry, having helped providers avoid almost $81m in costs arising from manual transactions. It's particularly cost-effective for smaller organizations with tighter budgets. How it works: the eligibility workflow Here's what the insurance eligibility verification process looks like in practice: As soon as the user registers the patient, they can make an eligibility request and the software immediately determines whether the patient has coverage on file and whether that coverage has been verified. An optional MBI lookup service can be used to check transactions against MBI databases to see if the patient may be eligible for Medicare. If a patient is eligible for Medicare, the response will confirm the type of Medicare and flag up any missing patient information. If they are not eligible, the transaction will be routed through the regular verification process. For non-Medicare transactions, the software will confirm any other coverage found and provide subscriber details. Benefits of medical insurance eligibility verification software for providers and patients As with all data-driven revenue cycle processes, even the smallest eligibility verification errors can result in denied claims, wasted staff time and lost dollars. Automating the process minimizes the risk of incomplete patient data, outdated insurance information and simple human mistakes. But while accuracy is paramount, the benefits of insurance eligibility software go much further: Boost cash flow and cost savings: Identifying the correct insurance coverage improves the billing process to increase and accelerate reimbursement. With fewer denied claims, more revenue comes in the door and staff time need not be spent on costly rework. Increase operational efficiency: Software automates and streamlines the verification process, saving time and reducing the burden on staff. As labor shortages persist, fewer staff may be available, so any action that makes better use of resources will result in efficiency gains and let staff focus on higher-value tasks. Simplify workflows: Busy providers don't have time for lengthy onboarding exercises or training programs. An eligibility verification product with an intuitive interface that integrates with other information management systems can shortcut the learning curve, while alerts and smart work queues help staff prioritize the right tasks. Leave room to grow: Providers need solutions that can scale in step with increasing patient numbers and administrative complexity. Medical insurance eligibility verification software can adapt to changing needs with minimal disruption. Improve the patient experience: A more reliable verification process means providers can generate accurate and timely cost estimates for patients, which makes it easier for them to understand their financial responsibility and plan for bills. And by eliminating time-consuming manual tasks, software speeds up registration and gives staff more time to focus on patient care. Again, this means more dollars coming in the door. Key features to look for in medical insurance verification software When selecting a platform, healthcare organizations should consider the following questions: Does it pull from reliable data sources? Does the software integrate with existing payer and information management systems? Is the system easy for staff to use? Does it incorporate monitoring and reporting functions? Does the supplier offer ongoing support? Experian Health's Insurance Eligibility Verification solution was developed with these questions in mind. It gathers data from more than 900 payer websites, along with other sources, to generate detailed responses. Advanced search optimization increases the chance of a positive match, so no active coverage slips through the net, while the CAQH Coordination of Benefits Solution data feature gives access to real-time primary and secondary coverage data with 99.5 percent accuracy. Providers that already use Experian Health products, such as eCare NEXT®, can access Eligibility through the same interface, so staff can use it right away and generate combined performance reports. One of the major advantages of Eligibility is the optional Medicare beneficiary identifier (MBI) look-up service, as described below. And now, healthcare providers have an additional tool to add to their eligibility arsenal: Patient Access Curator. With Experian Health's recent acquisition of Wave HDC, users can leverage AI-guided data capture technology to quickly check and correct patient insurance information. Patient Access Curator not only verifies insurance eligibility, it also facilitates accelerated coordination of benefits processing, runs automated MBI checks, searches for missing coverage, and analyzes a patient's propensity to pay – all in a single click. Close the coverage gap with medical insurance verification software While insurance verification software improves eligibility review processes, one question remains: how can providers help patients who are found to have invalid coverage? One option is to help patients find alternative coverage, using a solution like Coverage Discovery. Similarly, Patient Financial Clearance can identify patients who may be eligible for Medicaid or charity assistance, and can point them toward manageable payment plans if they have a self-pay balance. In this way, automated solutions can go even further to help providers create a positive patient experience and ultimately reduce the burden of bad debt. As providers embrace the benefits of automation, selecting the right solution is crucial. Tools that integrate workflows throughout patient access and the wider revenue cycle will make it easier to manage change, maximize resources and boost profitability. Find out more about how Insurance Eligibility Verification helps healthcare organizations increase reimbursements with automated eligibility checks. Learn more Contact us