Tag: Revenue Cycle Management

To meet evolving price transparency regulations, University of Tennessee Medical Center (UTMC) partnered with Experian Health to implement Patient Estimates. This integrated solution helped UTMC maintain compliance, increase estimate delivery and empower patients with clearer cost breakdowns.

AI is reshaping patient access by reducing manual errors and preventing costly claim denials. Tools driven by AI and automation can streamline eligibility checks and coordination of benefits — helping providers improve efficiency, cut costs, and deliver a better patient experience.

Denied claims are rising fast, putting revenue and patient trust at risk. Automated claims management and AI-enabled tools are becoming essential for providers to reduce denials, accelerate reimbursements and improve operational efficiency.

Automated authorizations software helped USA Health transform their prior authorizations process – streamlining workflows, decreasing errors and improving staff productivity.

Propensity-to-pay models forecast which patients are likely to pay their bills, enabling smarter prioritization. By using data-driven automation, these tools help healthcare providers boost collections, reduce bad debt and improve overall revenue cycle efficiency.

AI is modernizing healthcare revenue cycle management by automating manual tasks, improving data accuracy and reducing denials. This Q&A explores how healthcare organizations can utilize AI-driven tools to strengthen their financial performance.

Claim denials are increasing, putting pressure on staff and revenue. Experian Health's latest report outlines key factors driving denials today and how AI and automation can help providers strengthen claim accuracy and financial performance.

“Registrars used to wonder, ‘Do I run Coordination of Benefits? Which insurance is primary?’ Now Patient Access Curator does all that work and removes the guess work, and it does it in under 20 seconds.”Randy Gabel, Senior Director of Revenue Cycle at OhioHealth Challenge OhioHealth faced rising denial rates and inconsistent insurance discovery. Registrars relied heavily on what patients told them at check-in, without knowing if that information was complete or current. Forced to make judgment calls about whether to run Coordination of Benefits (COB) or check for Medicare Beneficiary Identifiers (MBI), staff could do little to avoid errors and denials. Randy Gabel, Senior Director of Revenue Cycle at OhioHealth, says, "We were sending claims with the wrong insurance simply because staff didn't know what to do next." They needed a reliable solution to identify coverage upfront – without asking patients to dig out old insurance cards or involving costly contingency vendors. OhioHealth's search became more urgent when a nationwide cyberattack hit the industry in early 2024. They needed a trusted revenue cycle partner to close the gaps in claims and eligibility workflows and prevent denials from the start. Solution To strengthen front-end revenue cycle operations, OhioHealth selected Experian Health's Patient Access Curator® (PAC). This all-in-one solution uses artificial intelligence (AI) and machine learning to check eligibility, COB, MBI, demographics and insurance discovery through a single process. This solution gave staff more accurate data in real-time. Although they had not worked with Experian Health before, the OhioHealth team was immediately convinced that Patient Access Curator fit the bill. Gabel says that during the evaluation, "Patient Access Curator discovered a whopping 18% more insurance on self-pay accounts than our current vendor. No other company or product found that much." PAC fits directly into existing workflows, so OhioHealth's 800+ staff members did not have to learn a new tool or change their daily processes. And with real-time insurance discovery and auto-population of coverage data into Epic, staff no longer needed to rely on guesswork and manual data entry. The tool's ability to automatically determine primacy and remove expired coverage meant staff could submit claims with confidence. "One of the primary reasons we chose Experian and Patient Access Curator was because it makes the manual work of revenue cycle much easier on the registration teams, which in turn improves productivity, empowerment and morale," said Gabel. Outcome When Patient Access Curator went live, the effects were felt almost immediately. Registrars who once spent valuable time debating which checks to run found that PAC handled those decisions automatically, and much faster. Manual searches were no longer necessary, and the system's accuracy drastically reduced the number of errors. These front-end improvements have boosted performance throughout the revenue cycle. Clean registrations meant fewer denied claims, less manual cleanup and faster reimbursements. PAC even uncovered insurance for accounts that had already been sent to collections, helping OhioHealth reduce reliance on contingency vendors and cut avoidable bad debt. PAC continued to prove its value long after it went live. Within the first year, OhioHealth achieved: 42% reduction in overall registration/eligibility-related denials 36% decrease in COB-related denials 69% drop in termed insurance-related denials 63% fewer incorrect payer-related denials $188 million in claims unlocked by reassigning staff and improving productivity What's next? Building on this success, OhioHealth's next steps are to expand their use of PAC by launching a patient financial experience initiative. This will allow patients to complete registration themselves and find their own coverage without waiting for a staff member to become available to help. Resolving more insurance issues upfront will deliver a faster, easier and more transparent registration experience from the start. With Patient Access Curator, OhioHealth has gone from losing time and money dealing with the downstream effects of claims errors to ensuring coverage accuracy at the source – while cutting denials by almost half. Along with a better experience for staff and patients, these gains have created a more resilient revenue cycle, ready to withstand whatever unexpected changes may be in store. Find out more about how Patient Access Curator prevents claim errors before they begin, helping teams submit clean claims and reduce denials. Learn more Contact us

Over the past two decades, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to the American Hospital Association. This burden continues to grow as hospitals struggle to verify active insurance. The task is made harder by patients frequently changing jobs, relocating and moving through a fragmented payer system that providers must track and interpret. The result? Missed billing opportunities, delayed payments and unnecessary write-offs threaten not only the hospital's financial stability, but also their ability to provide care to their communities.  Now, the newly enacted "One Big Beautiful Bill Act" adds even more pressure. With sweeping Medicaid cuts and stricter eligibility rules, millions of Americans could lose coverage — and hospitals may face a sharp rise in uncompensated care. Key provisions include:  More frequent eligibility reviews (every six months instead of annually) Higher out-of-pocket costs (up to $35 per doctor visit) New limits on state Medicaid funding (including bans on provider taxes) According to the Congressional Budget Office, an estimated 11.8 million people could lose Medicaid coverage by 2034.  These changes shift more financial responsibility to hospitals and patients.   But the impact isn't just financial. For patients, undetected coverage can lead to surprise bills, postponed treatment, or even collections, all of which erode trust in the healthcare system. Vulnerable populations, particularly those affected by the latest Medicaid changes, are at the greatest risk of falling through the cracks.   Hospitals are committed to serving their communities, including those who may not be able to afford to pay. To do this, they must recover every dollar they're entitled to. That means identifying coverage wherever it exists, even when it’s hidden, forgotten or misclassified.   That’s where Coverage Discovery comes in. Experian Health's solution uses proprietary data and advanced machine learning to identify unknown or forgotten insurance coverage across the entire revenue cycle — before, during, and after care. Unlike traditional eligibility checks, Coverage Discovery goes deeper. It scans commercial, government and third-party payers in real time; it uncovers primary, secondary and even tertiary coverage that might otherwise go unnoticed. This proactive approach helps providers bill the right payer the first time, which reduces denials, accelerates reimbursements, and minimizes bad debt.  Coverage Discovery identified over $60 billion in insurance coverage across 45+ million unique patient cases in 2024 alone, turning missed opportunities into paid claims. In a time of uncertainty, clarity is essential. Coverage Discovery empowers providers to take control of the coverage gap — not just react to it. By surfacing hidden coverage early and often, hospitals can protect their financial health while improving the patient experience.  Here's how it all comes together:  Learn more Contact us