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A recent study by Experian Health found that 62% of healthcare workers consider patient scheduling to be one of the areas hit hardest by staffing shortages. Labor gaps result in delayed patient care, staff burnout, additional hiring and training demands – not to mention snowballing overtime costs. Faced with wide-reaching financial and operational ramifications, healthcare organizations must make a strategic shift in how they manage patient scheduling. For Indiana University (IU) Health, the answer lay in using automation to handle increasing patient volumes with less staff. Justin Baur, Alex Nussman and Josh Brown of IU Health's Patient Access management team partnered with Experian Health to share how guided scheduling has allowed them to scale their operations, optimize staff efficiency and reduce scheduling errors, keeping both providers and patients happy. This article breaks down IU Health's key successes with Patient Schedule (including some that were unexpected), as discussed on the webinar. Discover how IU's strategic shift to automated scheduling not only scaled their operations and optimized staff efficiency, but also significantly reduced scheduling errors, keeping both providers and patients happy. “Guided scheduling helps us deliver better care, more efficiently” Like many healthcare organizations, changing market dynamics forced IU Health to find a fresh approach to patient scheduling. Competitor closures led to an influx of new patients, while the precarious labor market demanded a solution be found within the existing headcount. That solution was Patient Schedule, a digital scheduling platform that uses automation to support convenient patient self-scheduling, more efficient call center scheduling, and targeted patient outreach. IU Health piloted the platform across 52 service lines in 2023. Josh Brown, Program Manager for Provider Match at IU Health, outlined the key results: “We were able to accomplish some significant achievements to set our system up for success in 2024. We've booked over 230,000 patients through Patient Schedule and 35,000 through the Self Scheduling platform. It's as efficient as two schedulers doing similar work. We've had a 3% increase in one call resolutions and 16% growth in new patients since implementation. “Overall, guided scheduling has given us an opportunity to transform our operations by improving our patient access and reducing some administrative burdens. We've seen a reduction in no shows and an increase in patient engagement. By leveraging technology and data analysis, the guided scheduling platform has helped deliver better care more efficiently and effectively.” “Call Center Scheduling helps us minimize training and maximize referral capture rates.” IU Health's Patient Access Centre supports 31 specialties, 24 primary care clinics and radiology scheduling across Indianapolis, handling a total of 2.4 million calls in 2023. Finding innovative ways to meet growing demand was imperative. Justin Baur, Manager of Patient Access and Referral Management, described how Patient Schedule's Call Center Scheduling tool improves the workflow for call center coordinators: “Patient Schedule simplified processes in all our call centers so we can work with more patients and more service lines than before. Coordinators are onboarded quickly and can schedule for more service lines. Patient Schedule builds specialty considerations into the algorithm, reducing the need for subject matter experts. This increases scheduling accuracy, and reduces cancellation and reschedule rates, resulting in more effective visits between patient and provider.” The referral team also piloted Patient Schedule in urgent care and primary care facilities, successfully scheduling specialty referral appointments for patients before they leave their primary care provider's office. In the emergency department, providers can send messages to registration staff to schedule follow-up appointments. Baur says, “checkout staff can schedule patients' referrals within 3-5 minutes, instead of spending 30 minutes making follow up calls to reach those patients.” This reduces wait times, improves continuity of care, and streamlines the entire experience for patients and providers. “Self Scheduling does the work of two full time schedulers.” IU Health's pilot also involved using the platform to allow patients to book their own appointments. With Patient Schedule's Self Scheduling component, patients can make appointments online when and where it's most convenient. The sophisticated decision support technology means they only see relevant calendars and appointment types. During the pilot, almost 40% of patients opted to use self-scheduling, with 28% of those patients succeeding in booking an appointment online, significantly reducing the pressure on call centers. Josh Brown observed that “around 64% of our patients self-scheduled during non-business hours, so we're getting a lot of value-add when we're not at work. This gives us an opportunity to meet the patient when they're available. It enhances patient satisfaction and increases access to care. More than 35,000 appointments were booked using Self Scheduling, without any staff intervention, which Brown said equates to two full-time schedulers. He also observed that the platform is helping to grow IU Health's patient base and reduce no-shows: “We're seeing that the platform is very new patient-focused, with new patients accounting for over 59% of Self Scheduling bookings. With those bookings, we're seeing an 87% show rate.” Guided scheduling: the foundation of efficiency To close, the team explained how Patient Schedule had cut the time taken to secure appointments, by ensuring patients get the assistance they need and eliminating unnecessary paper-pushing. The next steps for IU Health are to roll out Patient Schedule across more specialties. They want to increase uptake of self-scheduling and ensure more patients can successfully book appointments using their preferred method. They also hope to implement location- and diagnosis-specific starting points for online bookings. By 2025, the team hopes to introduce a single phone number to cover scheduling needs across the whole state. Patient Schedule will form a key part of the solution by supporting efficient, centralized scheduling across four additional regions. Watch the webinar to hear examples on how guided scheduling was implemented in specific specialties, and find out more about using automated patient scheduling to create a resilient and efficient scheduling infrastructure that works better for patients, providers and staff.

There is growing concern that the healthcare industry needs more clinical and administrative staff to handle care demands. The crisis affects patients beyond treatment delays or lower care quality. Staff shortages in the revenue cycle create problems with patient engagement, billing, and collections. A recent Experian Health survey reveals unanimous concerns among providers about the challenges posed by workforce shortages. But what are the root causes of staffing shortages in healthcare? Is there a remedy for healthcare organizations struggling to find the talent they need? This article dives into the survey findings and the ways healthcare providers can address staffing shortages effectively. Finding 1: Staff turnover is a significant cause of healthcare staffing shortages. 80% of providers report turnover between 11-40%. Nearly one in 10 say turnover is between 41-60%. The causes of staff shortages were evident before COVID. A rapidly aging Baby Boomer population and limited availability of training in areas such as nursing led to predictions that looming staff shortages were on the horizon. The pandemic exacerbated the situation, leading to a mass exodus of workers and The Great Resignation. Some reports show healthcare lost 20% of its workforce, including 30% of nurses. Today, the average hospital turns over one-quarter of its staff annually, an increase of more than 6% from the prior year. As a result, the State of Patient Access 2023 reported nearly 50% of providers say access to care is worsening. Simultaneously, healthcare is bogged down with administrative tasks. Increasing evidence shows providers must turn to automation software to decrease human workloads and stretch small teams further. These automated tools can: Create a seamless registration process for patients to improve care access, reduce no-shows, and reduce provider administrative burdens. Provide 24/7 patient scheduling and put patients in charge with self-scheduling options Automate patient outreach to increase collections and improve communication. Improve claims management, reduce denials, and free up existing staff from manual tasks. Automation can improve the work-life balance of healthcare staff, potentially closing the revolving turnover door, one of the most significant causes of staff shortages. For example, IU Health implemented automated guided scheduling, which helped scale their operations, reduce scheduling errors and improve staff efficiency. Finding 2: Finding and hiring staff is an undue burden for healthcare providers. 73% of respondents said finding qualified staff is difficult. 61% reported that meeting entry-level staff's salary expectations is a challenge. Healthcare organizations feel the staffing crisis at every level. A recent Medical Group Management Association (MGMA) poll cited the difficulties in hiring revenue cycle staff: 34% of respondents stated hiring medical coders is their biggest challenge. 26% stated billers were difficult to find. One-third said finding schedulers and prior authorization staff is hard. Other hiring challenges included revenue cycle management (RCM) managers. When and if healthcare providers find staff, bringing them into the fold is costly. Experian Health's staffing survey showed most organizations struggle to meet the salary expectations of even the least experienced members of their teams. The causes of staff shortages can be remedied by leveraging new artificial intelligence (AI)-powered tools. Tools like AI Advantage™ can automate and transform claim denials management, a problem costing healthcare providers around $250 billion annually. Experian Health's State of Claims 2022 survey showed the most common causes of denied claims include: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Inaccurate medical coding. AI Advantage reduces denial rates by scrubbing claims and flagging errors before submission. After claim submission, the software prioritizes the most high-value denials for correction to maximize revenue generation. Organizations like Schneck Medical Center use these tools to reduce denials by 4.6% each month. The facility also increased the speed of claims submissions. Tasks that used to take 12 to 15 minutes to rework now process in less than five minutes, lessening the need for hiring more staff and improving the workloads of their existing team. Finding 3: Burnout is a top contributor to staffing shortages. 53% of poll respondents said staff burnout is a key cause of the current staff shortage. 48% said the new expectation for schedule flexibility and hybrid work models also contributes to the healthcare workforce shortage. Burnout is one of the most significant causes of staff shortages impeding high quality care and wreaking havoc on the revenue cycle. The latest data shows the percentages of clinical and administrative burnout in healthcare is approaching or exceeding 50% in most job categories: 56% of nurses report burnout symptoms. 54% of clinical staff. 47% of doctors. 46% of non-clinical staff. Cost-cutting and increasing care demands have led to increasing fatigue in healthcare staff. But technology exists to automate back office functions that could free up staff time. For example, organizations like Kootenai Health saved close to 60 hours of staff time in over 8 weeks by automating the presumptive charity process Patient Financial Clearance. Stanford Health used Collections Optimization Manager to cut 672 hours each month from overburdened back office staff. The COVID pandemic also changed expectations about how and where Americans should work. Remote work became normal; three years post-COVID, 58% of the American workforce report working remotely at least one day a week. The same data also shows that when workers have the chance to work virtually, 87% take it. Healthcare is not immune to the desire for more schedule flexibility. Becker's Hospital Review states, “Many workers desire the ability to work remotely, even if they only get the option a few days a week. Flexibility allows people to maintain work-life balance—and in a high-burnout field like healthcare, balance can be crucial.” Surveys show 31% of healthcare roles are remote full-time while 14% offer this flexibility part-time. The problem is that many healthcare positions cannot allow this flexibility—and the industry competes with others that do. To remain competitive, healthcare organizations must embrace technology to offer work flexibility. Cloud-based digital technology is beneficial in areas like the revenue cycle. For example, automated technology from Experian Health can: Use advanced analytics to streamline workflows. Facilitate patient self-service. Minimize staff time spent on manual tasks. AI-powered automation tools can lessen staff burnout by allowing them to work smarter. These tools provide the workforce with the scheduling flexibility they desire. Eliminate the causes of healthcare staffing shortages with better technology AI and automation technology in healthcare can lessen worker fatigue, lighten workloads, and give administrative workers the schedule flexibility they demand. Experian Health offers healthcare providers better technology to improve the lives of their staff, increase patient satisfaction, and generate more revenue. Download the survey or connect with an Experian Health expert today to learn how we can help your organization tackle the causes of healthcare staffing shortages effectively.

In a strategic move that will take claims management to the next level, Experian Health recently acquired Wave HDC, a healthcare technology company specializing in AI-guided data capture and curation. The acquisition brings together the two companies' capabilities to offer healthcare organizations faster and more accurate healthcare coverage identification. With this acquisition comes Patient Access Curator, a new solution that uses artificial intelligence (AI) to revolutionize the claims management process. Tom Cox, President at Experian Health, says, “With our vast clearinghouse data resources and Wave HDC's technology and expertise in insurance data capture processes, Experian Health now offers the best eligibility and insurance identification products in the market.” This article gives a run-down of Patient Access Curator and how it helps providers prevent claim denials in seconds. Hear our pre-recorded session from our annual Experian Health High-Performance Summit 2024 (HPS), featuring Exact Sciences and Trinity Health, as they reveal how Patient Access Curator helped their organizations automate eligibility, reduce denials, and more, all with a single click. This session offers live Q&A with Experian Health Product Leadership. Register now Prevent denials on the front end Managing claims effectively – or more specifically, preventing denials – is one of the biggest challenges for providers. In a 2022 survey by Experian Health, 72% of respondents said reducing denials was their top priority, citing reasons including payer policy changes, reimbursement delays, and a rise in the number of errors and denials. Most issues that lead to denials crop up early in the revenue cycle, when information is missed or captured incorrectly during patient registration. For this reason, it makes sense to focus denial prevention strategies on the front end. With so much data to capture, manual strategies are bound to stumble. Unfortunately, many digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility and check for any billable coverage that might have been missed. Experian Health's industry-leading claims management products are designed to simplify these processes. The integration of Wave HDC's AI-powered data capture technology strengthens that offer with capabilities previously not available. As Cox says: “Our mission is to simplify healthcare, and this move allows us to quickly scale our portfolio with advanced logic and AI-powered technology to help solve one of the biggest administrative problems providers face today, which is claim denials.” For Jordan Levitt, co-founder of Wave HDC, the merger is a chance to bring their unique technology to more healthcare organizations. “We believe this integration will have a powerful impact for the healthcare industry, improving financial solvency and efficiencies for providers through more accurate medical billing, resulting in potentially more reimbursement, faster.” Introducing Patient Access Curator: Claims management in a single click Wave HDC's technology captures and processes patient insurance data at registration using an “if-then” logic that returns multiple data points from a single inquiry, in 30 seconds. Through Patient Access Curator, registration staff can leverage this technology to collect and verify much of the information they need to compile an accurate claim, with just a single click. In a matter of seconds, they'll have a comprehensive readout of the following: Eligibility verification: PAC automatically interrogates 271 responses, flagging up active secondary and tertiary coverage information to eliminate coverage gaps; Coordination of Benefits (COB): Integrating with eligibility verification workflow, PAC automatically analyzes payer responses to find hidden signs of additional insurances that may be missed by a human eye, and triggers additional inquiries to those third parties to determine primacy, for faster COB processing; Medicare Beneficiary Identifiers (MBI): PAC uses AI and robotic process automation to find and fix patient identifiers so no one misses out on essential support; Coverage discovery and financial status: For patient accounts marked as self-pay or unbillable, PAC automates additional coverage searches, and provides insights into the patient's propensity to pay; Demographics: Lastly, but by no means least, the platform can quickly check and correct patient contact information. Providers can hear more about shifting denials management to the front end of the revenue cycle with Patient Access Curator on a recent on-demand webinar hosted by Jordan Levitt and Jason Considine, Chief Commercial Officer at Experian Health. On the webinar, Levitt explains that Patient Access Curator achieves such speedy results “because the underlying code acts like a Rosetta Stone, automatically translating the language of the user and the health system into the terms required by the payer.” This means data can be transferred easily between interfaces. “The answer isn't multiple clicks, running one transaction at a time. With Patient Access Curator, you can know everything about the patient to run a clean revenue cycle process and propagate only clean data downstream, all within thirty seconds.” Maximize dollars, minimize workload Patient Access Curator moves away from manual methods and verifies eligibility and coverage automatically, quickly and accurately. But the platform promises more than efficiency; with this technology, Wave HDC has prevented denials of over $1 billion since 2020. At a time when revenue cycles are under increasing pressure from changing payer rules, labor dynamics and operational constraints, the new integration offers a long-awaited boost to both reimbursement rates and productivity. Patient Access Curator is available now - learn how your healthcare organization can get started and prevent claim denials in seconds. Learn more Contact us

Artificial intelligence (AI) and computer automation are finally beginning to impact healthcare. Payers are implementing generative AI to improve the customer experience. Researchers at Stanford use AI to review X-rays and detect pathologies in seconds. Today, AI and automation can remind patients about appointments and even provide a portion of their treatment via robotic surgery devices. While groundbreaking AI and automation technologies are in the news, adoption by the majority of healthcare providers has been slow despite research showing these tools could eliminate up to $360 billion in spending. It's a startling statistic that illustrates the reality of AI and automation applied to the revenue cycle: These tools quite literally can pay for themselves. The case for applying artificial intelligence and automation in healthcare Successful revenue cycles depend on thousands of daily tasks, which means efficiency lies at the heart of these endeavors. However, there are a lot of improvement to be made. Experian Health's State of Claims Survey 2022 shows the current state of the average healthcare revenue cycle: Reimbursement cycles are running longer. Claim errors are on the rise. Denials are increasing. More than one-half of U.S. hospitals reported financial losses in 2022. A 2023 America Hospital Report (AHA) report showed: 84% of hospitals admit the cost of complying with payer reimbursement requirements is increasing. 95% report spending more time on pursuing prior authorization approval. Over 50% of hospitals and health systems have more than $100 million tied up in A/R for claims six months old. These challenges stem from the increasing complexities of working with third-party payers, but also the by-hand human workflows embedded within provider revenue cycles. The State of Claims Survey 2022 showed that 61% of providers say they rely too heavily on manual processes and lack the automation they need to streamline reimbursement. As costs rise and revenue cycles tighten, there is increasing pressure to do more with less—faster. However, chronic healthcare staffing shortages have only exacerbated how hard it is for providers to get paid. Technology solves many of the problems plaguing healthcare's revenue cycle. AI and automation offer better revenue cycle management tools with fewer errors, less manual work, and more streamlined processes. How AI and automation improves revenue cycles Increasingly complicated reimbursement processes are the perfect testing ground for new technologies. These tools can improve the revenue cycle from the first point of patient contact to collections long after the procedure is over. For example, AI and automation software can greatly reduce errors and increase the accuracy of claims information before submission. When billing becomes more accurate, it lessens the volume of rejected claims, which take up an inordinate amount of staff resources and lengthen the time from service delivery to reimbursement. But AI and automation also impact the backend of the patient encounter by helping collections teams prioritize accounts most likely to pay. Four applications for AI and automation in the revenue cycle include: 1. Applying automation to patient registration The revenue cycle begins at patient registration, and that's also where providers can begin to apply technology to increase cash flow downstream. Patient registration is often cumbersome, an in-person process tied to a clipboard, paper, and open office hours. Yet Experian Health's State of Patient Access 2023 report shows that 73% of patients want to handle these processes online. Self-scheduling offers patients more flexibility for scheduling appointments when they want and on their preferred digital device. It can remove the friction from a frustratingly manual paperwork process while decreasing no-shows with automated messaging by text and email. Experian Health's automated patient scheduling software reduces time spent on traditionally manual scheduling tasks by 50%. Providers that select these tools increase their patient show rate to nearly 90%. From a revenue cycle perspective, providers that implement online self-service scheduling can see up to 32% more patients each month—which is money in the bank. 2. Finding hidden financial resources to reduce bad debt Experian Health's Coverage Discovery® automates the insurance verification process to match patients' responsibility with the best financial resources possible given their policy limits. Coverage Discovery scans proprietary databases and historical information for primary, secondary, and tertiary coverage. The platform seeks to find all available financial resources to lower the volume of accounts that end up as write-offs or in collections. In 2022, Coverage Discovery found $64.6 billion in patient coverage. In 2023, this software discovered previously unknown financial options for 32.1% of patient accounts, giving these customers more options for reducing debt. 3. Preventing denials by improving data quality Many claims are rejected by payers each day simply due to human error. Some of the most common reasons for claims errors include missing or inaccurate information caused by manual processes. From eligibility verification errors to incorrect insurance details, when paperwork is still by hand and this complex, it's far more likely to make an error than not. Experian Health's Patient Access Curator software automatically verifies eligibility and coverage while scanning patient documentation for obsolete or inaccurate data. The software leverages artificial intelligence and robotic process automation (RPA) to apply computer rigor to previously manual workflows to reduce manual errors. Significantly, this new technology performs these tasks in seconds, freeing up staff time and improving the patient experience. 4. Using artificial intelligence to prevent and mitigate denials How much does the endless pursuit of denials management tie up potential revenue? One survey showed half of hospitals report more than $100 million in delayed or unpaid claims at least six months old. The good news is that 85% of the errors that lead to denied claims are preventable with the help of existing technology. Experian Health's AI Advantage™ solution works in two critical areas to prevent denials before they happen—and correct any denied claims quickly: At the front end of the claim, by correcting errors before submission. AI Advantage - Predictive Denials spots the submissions most likely to kick back from the payer. This early warning system reduces the volume of denials by flagging claims with errors stemming from human mistakes or payer requirements changes. At the back end of the claim, for those rejected by the payer. AI Advantage - Denial Triage takes the volume of claims rejections and prioritizes them by those with the highest ROI for the provider organization. Not all denials offer the same volume or potential for revenue collection. This solution helps prioritize the highest returns quickly to increase revenue collection. Benefits of applying AI and automation to healthcare's revenue cycle There is little argument across the healthcare industry that the strategies that once worked to create a healthy revenue cycle still apply. Fortunately, today's AI and automation software allow these organizations to modernize their approach to these complexities—and win the revenue cycle game. The benefits of applying modern AI and automation tools at every point of the revenue cycle are substantial: Faster and more accurate patient scheduling and registration. No more manual data searches that tie up staff time. Fewer data entry tasks that lead to errors. Fewer claim denials. Less time spent chasing claims. Fewer days in A/R. More cash on hand. A high-performing revenue cycle is possible with the latest technology tools. Experian Health offers a suite of technology solutions that utilize artificial intelligence and automation designed to get providers paid faster, free up staff time, and improve the patient experience. Improving the revenue cycle is a necessity, and Experian Health helps healthcare organizations achieve this goal.

As the saying goes, “what gets measured gets managed.” For healthcare providers, this is a reminder that optimizing the revenue cycle relies on monitoring and reporting on the right metrics. Claims, billing and collections teams will struggle to know which of their activities lead to improvements if they don't track key performance indicators (KPIs). The question, then, is how to choose the right KPIs. How can providers gain more visibility into their financial performance? Where are the pitfalls that limit the usefulness of the data? This article looks at how revenue cycle managers may find more opportunities to prevent revenue leakage by building a healthcare revenue cycle KPI dashboard populated with the right medical billing metrics. What is a revenue cycle KPI dashboard? A revenue cycle or medical billing KPI dashboard is part of a revenue cycle management (RCM) platform. It enables real-time visibility into metrics regarding billing and revenue and is customizable based on the KPIs that matter to each healthcare organization. It centralizes critical information related to patient access, healthcare collections, claims management and payer contract management. Challenges and pain points in revenue cycle management The first step in selecting the most relevant KPIs for a revenue cycle dashboard is to identify and understand the thorniest RCM challenges that could be causing dollars to slip through the net. Here is a run-down of some of the biggest obstacles to effective RCM and possible performance measures that may help track improvements: 1. Inefficient patient access for scheduling and registration Revenue cycle management begins in patient access. Unfortunately, so do many of the errors and inefficiencies that lead to claim denials and missed payment opportunities. Confusing and disjointed scheduling systems can lead to underutilization of services and no-shows, as well as falling short of consumer expectations for online booking methods.Online self-scheduling tools make it easier for patients to book appointments so they can start their healthcare journey quickly and conveniently. Cancelled appointment slots can be offered to other patients, to maximize clinician time. Here, it would be useful to track the percentage of unfilled appointments: an increase over time would suggest that patients are finding it easier to book appointments, and confirm better use of doctors' hours.Similarly, digital registration options can quell the frustrations that many patients feel when trying to fill out forms ahead of treatment. No-show rates, percentage of patients using online tools, registration error rates and patient satisfaction scores would all be relevant KPIs. 2. Claims and denial management processes that rely too heavily on manual work From checking payer updates to poring over billing codes, claims management workflows often involve manual tasks that put unwelcome pressure on already-overwhelmed staff. There are many opportunities for errors, which drive up denials and put the brakes on the organization's cash flow. An increase in clean claim rate and a reduction in the rate of denials would be KPIs to look for on the revenue cycle dashboard. An end-to-end claims management solution that uses automation and artificial intelligence (AI) to improve accuracy and lift the load on staff can alleviate these challenges. For example, AI Advantage™, leverages AI to predict and prevent denials using the organization's own historical claims data. 3. Patient collections practices are often inconsistent Patient responsibility for healthcare costs is higher than ever, so the consequences of poor billing practices are severe. Experian Health's State of Patient Access 2023 report found that 63% of providers believe patients frequently postpone care because they're worried about costs. If patients are unsure about what they owe, unable to find financial assistance, or unclear about how and when to pay, the provider is likely to see their accounts receivable metrics and collection rates heading in the wrong direction. Clear bills and convenient ways to pay are key to optimizing patient collections. Collections Optimization Manager supports better financial decision-making for both patients and providers by screening, segmenting and routing accounts based on payment probability. Users get tailored support from an experienced optimization consultant to select the right KPIs and turn insights into effective action. 4. Actionable insights are often out of reach RCM analysts may have a wealth of information to interrogate, but they are often tripped up by disparate systems and legacy processes. Critical information in patient access, collections, claims management and payer contract management may be held in different systems and formats, which makes it much harder to see connections. With revenue cycle analytics tools, providers can make sense of the information they hold, rather than drowning in data. A revenue cycle or medical billing dashboard can enable real-time visibility into the KPIs that matter most while tracking changes over time. What are KPIs for RCM?  Revenue cycle KPIs are quantifiable measures that illustrate the financial viability of an organization's revenue cycle. These metrics indicate if healthcare organizations are achieving their financial goals and are effectively managing revenue inflows and outflows. Specific KPIs will be tailored to the organization's particular goals, challenges and processes. The quality and availability of relevant data will also play into the selection process, to maximize visibility and insights into the revenue cycle. In addition to the suggested metrics discussed above, other common KPIs to feature in a revenue cycle dashboard include: Days in account receivable Aged accounts receivable rate Adjusted collection rate Clean claim rate Claim denial rate Claim appeal rate Bad debt rate Gross collection rate Net collection rate Importance of healthcare revenue cycle KPI dashboards A  revenue cycle KPI dashboard is more than just a handy way to present data. Monitoring an organization's financial health is critical to its ability to serve patients and attract and retain high-performing employees. A healthcare revenue cycle dashboard can enable providers to: Identify if revenue levels are sufficient to keep the organization afloat and know in advance if new strategies are needed to maintain cash flow Locate glaring operational efficiencies in RCM that are costing the organization time and money Forecast future revenue projections to determine the organization's ability to expand and invest Improve all financial decision-making through better use of data that is already being collected Boost patient satisfaction by highlighting opportunities to create a more convenient and transparent financial experience. Driving efficiency and success through RCM solutions Once the revenue cycle KPI dashboard is built, RCM teams can get to work on implementing the specific actions needed to tackle those thorny issues discussed above. With Experian Health's integrated RCM solutions, providers can bring together metrics such as financial performance, billing efficiency and collections rates into one place, to allocate resources more strategically, drive targeted improvements, and accelerate reimbursement. And with these insights, providers are not just managing revenue – they are optimizing for future financial stability. See how Experian Health's revenue cycle management solutions, dashboards and drill-down reports can uncover opportunities to prevent revenue loss and boost profitability.

The relationship between hospitals and payers has often carried an undercurrent of tension. Stacks of paperwork, complex claims rules and manual adjustments are a recipe for disrupted cash flow and time-consuming rework. With profit margins hanging in the balance, providers need the reimbursement process to move forward without a hitch. To the relief of revenue cycle managers, recent developments in digital technology are paving the way for more effective claims management. Case in point: Experian Health's recent acquisition of Wave HDC, which brings together a suite of advanced patient registration solutions for faster and more accurate claims management at the front end of the process. Shifting sands in the hospital-payer relationship could increase denials For healthcare organizations, getting paid in full- and on-time hinges on seamless communications with payers. Any missteps can lead to revenue losses, with denied claims and delayed payments being the outcomes providers most want to avoid. Payers will automatically deny claims that have errors or missing information, while disputes and slow processing times can seriously hamper a hospital's cash flow. The sources of potential conflict have been pretty steady over time, stemming from complex billing processes, frequent changes to payers' requirements, and a lack of standardization between payers.  Tension created by the cost of services and the need to control healthcare costs is a constant in the revenue cycle. Recently, a major shift in dynamics has occurred with the widespread adoption of artificial intelligence by payers. This enables them to process – and deny – claims with unprecedented speed and scale, leaving providers struggling to catch up. On a recent webinar, Makenzie Smith, Experian Health Product Manager for AI AdvantageTM, explained how this change was reshaping the relationship between payers and providers: “So many payer decisions are now being driven by artificial intelligence. Insurers are reviewing and denying at scale using intelligent logic, leaving providers fighting harder for every dollar… Many revenue cycle managers will stick in their comfort zone because operating margins are tight and changing course seems risky. But given this change in payer behavior, the cost of staying the course could put organizations at risk.” How AI-powered revenue cycle management solutions help close the gap between payers and providers Providers are increasingly leveraging digital technology to level the playing field with payers. Integrated software and automation give revenue cycle management teams the right data in the right format and at the right time to respond to queries promptly and accurately. These solutions enable teams to work more efficiently, so they can process more claims in less time. Experian Health's flagship AI-based claims management solution, AI AdvantageTM, is a prime example. This tool predicts and prevents denials by identifying patterns in payer behavior and flagging claims with a high probability of denial so specialists can intervene before the claim is sent to the payer. This works alongside ClaimSource®, which automates clean claim submissions at scale. Using a single application, all claims are prepared and submitted with all necessary documentation, reducing the risk of denial due to missing or inaccurate information. Integrating Wave HDC's data capture technology for comprehensive claims management In November 2023, Experian Health acquired Wave HDC, which specializes in using AI-guided solutions to capture and process patient insurance data at registration with unrivalled speed and accuracy. This gives Experian Health clients access to a single denial management solution, known as Patient Access Curator. This new technology is a single click solution that spans eligibility verification, coordination of benefits, coverage and financial status checks with near-100% accuracy in less than 30 seconds. Crucial registration data can be captured in real time as soon as the patient checks in for an appointment, with no need to chase and update data post-registration. A single inquiry can search for all the essential insurance and patient demographics instantly, enabling better use of staff resources and smoother communications with payers. Tom Cox, President of Experian Health, says the move “allows us to quickly scale our portfolio with advanced logic and AI-powered technology to help solve one of the biggest administrative problems providers face today, which is claim denials.” Accurate patient data from the outset is key to preventing downstream denials, many of which originate in patient access. By reducing errors and enabling faster processing times, this comprehensive approach to denial management will help strengthen the relationship between providers and payers, ensuring timely payments and clean claims. Contact Experian Health today to find out how AI and automation can help build a successful relationship between providers and payers – and drive down denials.

Contracts govern the revenue cycle, but negotiating contracts and ensuring compliance can feel increasingly unmanageable as mergers and acquisitions, ongoing staffing challenges, and the sheer volume of contracts, plans, and provisions make contract management a massive project for healthcare providers. Tricia Ibrahim, Director of Product Management at Experian Health, shares her insights on a challenging environment heading into 2024. Providers are grappling with mounting complexity, an explosion of data, and continuing pressure to maximize efficiency and revenue. But, according to Ibrahim, healthcare contract management software is evolving to meet these challenges—and helping providers find clarity amid the complication. Q1: What are the major challenges with healthcare contract management as we move into 2024? “I think what clients are most concerned with, especially leading into 2024, is the complexity of payer contracts,” says Ibrahim. A typical provider may manage hundreds or thousands of contracts, each one with a range of plans and provisions that affect the bottom line. “Being able to negotiate better contracts is a key concern,” says Ibrahim, “but clients increasingly feel outgunned and overwhelmed by the amount of information involved.” Accessing and analyzing data effectively is more critical than ever. “When providers come together with payers to negotiate contracts, it can be difficult for them to evaluate the contract that the payer is putting in front of them,” in part because it's hard to know how their current contract is performing or how contract provisions will play out in dollars and cents, Ibrahim explains. “Underpayments and denials are a constant struggle. Also, providers need to understand how volume and patient mix will factor in.” Contract management has a direct effect on revenue and the bottom line. Negotiated terms may or may not cover actual costs. A small change in terms might have an outsized effect due to high volume. Denied claims, underpayments, downcoding and late payments can slow the revenue cycle and reduce the amount of revenue providers receive. “At the same time, we're also starting to see a greater interest in collaboration between providers and payers,” says Ibrahim. “Having additional visibility allows both parties to have more meaningful discussions and move toward solutions that work for everyone.” Q2: What are providers doing to take on these challenges? “Many providers are investing in technology,” says Ibrahim. “A 2023 analysis by Bain & Company found that 80% of healthcare executives had accelerated software and IT investment over the past year in response to mergers and acquisitions, staffing shortfalls, and an increasing need for efficiency.” As contract management becomes more complex, providers are also reaching for more powerful healthcare contract management software tools to manage data—and leverage it to negotiate contracts effectively and monitor contract compliance over time. Q3: How can healthcare contract management software like Experian Health's Contract Manager and Contract Analysis help providers negotiate better contracts? “Having meaningful information backed by data changes the dynamic,” Ibrahim says. “It allows you to have a more strategic conversation. You can say, 'You're supposed to pay us 45 days from the receipt of the claim, but it's been taking 140 days.'” Data provides objective information and can point the way toward measurable improvements going forward. “Our Contract Analysis module allows for the provider to audit payer contract performance,” says Ibrahim. That's not only helpful for tracking what's happened to date; it's also useful for projecting how a new contract might work going forward. “We're able to use historical claims to create scenarios that show how a new contract would affect payment. Sometimes, payers will keep reimbursement rates the same where you have a lot of volume and give you an increase where you don't. When you use our solution to run these types of analyses, you get a more effective understanding of proposed terms.” Q4: Once contracts are in place, how can healthcare contract management software help providers improve compliance? “Detailed analysis is key, and small discrepancies can have a significant impact,” says Ibrahim. “One of our clients, a large academic provider on the medical group side, spotted a trend where they were being underpaid by 10 cents to 50 cents on their EKGs. These kinds of variances typically go unnoticed, but they found 20 or 30 claims to submit.” The payer acknowledged the underpayment and issued the few dollars' difference. “Then the provider decided to look at their contract to see how far back they could appeal. It turned out they were able to go back a significant amount of time. When they added up the underpayments, it equated to $850,000. They ended up settling for $750,000,” Ibrahim says. OrthoTennessee, a Knoxville-based orthopedic practice with multiple locations and more than 50 physicians, uses Experian Health's Contract Management software for healthcare to find inaccuracies, make appeals, and audit contracts at scale. Using Experian Health's Contract Management platform, OrthoTennessee had an 86% success rate for appeals in 2022. “That's the power of the solution: You can really identify trends,” says Ibrahim. Monitoring compliance is a continuous effort: “We’ve done a lot of work with our clients to understand what their evolving needs are. We’ve been named Best in KLAS [by healthcare IT research firm KLAS] multiple years in a row. That recognition has centered around engagement—being engaged with our clients, so we understand what the trends are, what challenges they’re facing, and how we can help solve problems in the most efficient manner.” Q5: What role do regulations play in shaping contract management solutions? “Regulation drives different reimbursement methodologies, [such as] bundled payments or value-based care,” says Ibrahim. “Part of our challenge is making sure we are always evaluating new regulations and ensuring that our system is agile enough to support these new methodologies. “Because regulation never stops, it actually drives a lot of the innovation we do. The No Surprises Act, which came into effect in 2021, requires providers to provide patients with a good faith estimate of costs. We've been able to help clients establish an estimated median rate, which can be useful for estimates that involve non-contracted payers.” As an additional benefit, healthcare contract management software also helps providers spot opportunities. “One of our clients identified 26 plans with enough volume to support additional contracts,” says Ibrahim.  “Providers can even use these solutions to evaluate whether a market exists for a new piece of technology to deliver state-of-the-art care. Understanding performance is a powerful tool.” Q6: Early in our conversation, you said there was a growing interest in collaboration among providers and payers. What does it mean to take a collaborative approach in this context? “I think it's really important for providers and payers to have collaborative communication, to engage in productive conversations where they can work together instead of against each other,” says Ibrahim. “That's how we're going to deliver more integrative care and reduce costs. It’s how we’re going to arrive at coverage options that work for all parties, by developing good relationships between providers and payers. “For our part, Experian Health is continuing to expand Contract Manager to provide data analytics that clearly show the cost of care and the expected reimbursement for various types of services, so providers can evaluate contract performance, identify potential areas of improvement, and have meaningful conversations with payers. “At the end of the day, we all have a common goal: delivering appropriate care at the right time for patients,” Ibrahim concludes. “To progress toward that goal, payers, providers and partners like Experian Health are going need to work together.” These conversations start with a common set of data, so that everyone at the table understands where the opportunities to collaborate and improve may lie—and where the path forward may begin. Learn more about Experian Health's Healthcare Contract Management software and how it can help your organization negotiate and manage contracts effectively and efficiently, even in an increasingly complex environment.

Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system and Contract Manager and Analysis product – for the second consecutive year. The rankings were revealed in the annual 2024 Best in KLAS Awards – Software and Services, published on February 7, 2024. The Awards recognize the top software and services vendors that are helping American healthcare professionals deliver the best possible patient care, based on feedback from thousands of providers. Experian Health topped the list in two categories: ClaimSource ranked #1 in Claims Management and Clearinghouse. This automated and scalable solution reduces denials and increases revenue through a single application. The addition of an artificial intelligence component this year (AI AdvantageTM) is helping providers cut denial rates to just 4%, compared to an industry average of more than 10%. Contract Manager and Analysis ranked #1 in Revenue Cycle: Contract Management. This product levels the playing field with payers by monitoring compliance with contract terms and recovering underpayments. It also arms providers with financial models of proposed contracts, so they can negotiate more favorable terms. Case study: See how Hattiesburg Clinic in Mississippi uses ClaimSource to automate claims management and reduce denials. The awards come as the industry grapples with ongoing staffing challenges and rising claim denials. In Experian Health's 2023 report on the healthcare staffing crisis, 100% of respondents saw staffing shortages affect revenue cycle management and patient engagement. As the pressure continues, revenue cycle technology offers a way to increase efficiency and improve financial performance.  “Healthcare professionals face immense pressures, ranging from financial strains to staffing shortages and the very real issue of clinician burnout,” says Adam Gale, CEO and Founder of KLAS Research. “We want to provide actionable insights that will ultimately alleviate burdens and enhance clinician success.” For Tom Cox, President of Experian Health, the awards reflect a continuing commitment to help providers optimize operations and patient engagement using data-driven insights and technology. “This recognition from KLAS recognizes our dedication to deliver innovative solutions that not only improve the financial health of providers but also the patient experience. Receiving this award two years in a row is an honor as we remain steadfast in our commitment to simplifying healthcare through technology.” Find out more about how ClaimSource and Contract Manager and Contract Analysis helps healthcare organizations increase efficiency and boost financial performance.

By all forecasts, the healthcare worker shortage isn't going away. More than 80% of healthcare executives admit talent acquisition is so challenging it puts their organizations at risk. The latest survey from Experian Health shows complete agreement across the industry—the inability to recruit and retain staff hampers timely reimbursements. The side effects of the healthcare worker shortage are increased errors, staff turnover, and lower patient satisfaction. With the healthcare worker shortage becoming a chronic red flag on the list of industry challenges, is throwing more revenue at hiring the best answer? Experian Health's new report, Short-staffed for the long term, polled 200 healthcare revenue cycle executives to find out the effects of the continuing healthcare worker shortage on the bottom line. Respondents unanimous agreed that healthcare's recruitment problem is limiting their ability to get paid. Could investing in better revenue cycle technology to automate manual human functions be the answer to the healthcare recruiting dilemma? Effect of the healthcare worker shortage on healthcare revenue cycle Result 1: Providers losing money and patient engagement simultaneously. 96% of respondents said the healthcare worker shortage negatively impacts revenue. 82% of survey participants said patient engagement suffers when providers are short-staffed. Experian Health's latest survey showed almost unanimous agreement that the revenue cycle suffers significantly when providers are short-staffed. The only area of disagreement among revenue cycle leaders is whether patient collections or payer reimbursements are affected the most by the industry's lack of human talent. As revenue cycle teams struggle to cover their workload, the need for speed increases manual error rates. The Experian Health survey showed that 70% of revenue cycle teams say healthcare worker shortages increase denial rates. This finding reinforces an earlier survey showing nearly three of four healthcare executives place reducing claims denials as their top priority. As errors snowball, patient engagement and satisfaction begin to decline. Data entry errors impact claims submissions, resulting in billing mistakes that confuse and frustrate patients. Data errors often start at patient registration and persist through claims submission, creating denial reimbursement snarls and tying up cash flow. With the average denial rate above 11%, that's one in every 10 patients facing uncertainty around whether their bill will be paid. What's worse is that Experian Health's State of Claims Report shows denial rates increasing. While providers are leaning into increasing recruiting efforts to find the employees they need, is staffing up even possible in an era of chronic labor shortages? Technology offers healthcare providers new ways to handle revenue cycles without hiring more staff. For example, patient access software reduces registration friction, where up to 60% of denied claims start. Patient scheduling software automates access to care and gives customers greater control over their healthcare journey. It's a digital front door that engages patients with online options for managing care. On the backend of the revenue cycle, automation also offers a way to decrease reliance on manual labor to handle claims submissions. Automating clean claims submissions alleviates the denials burden, freeing up staff time and provider revenue streams.  Result 2: Staffing shortages heavily impact payer reimbursement and patient collections. 70% of those saying payer reimbursement has been affected the most by staff shortages also agree that escalating denial rates are a result. 83% of those saying patient collections have been affected most by staff shortages also agree that it’s now harder to follow up on late payments or help patients struggling to pay. Addressing healthcare staffing shortages is crucial for providing quality patient care, maintaining financial stability, and maximizing reimbursement in the complex healthcare reimbursement landscape. Staff shortages lead to reduced productivity within healthcare facilities, and existing teams may need to take on extra work to fill the gap. Overworked staff may be more prone to errors, leading to claims denials. Medical Economics says manual collections processes suffer due to the healthcare worker shortage. They state, “Mailed paper statements and staff-dependent processes are significantly more costly than electronic and paperless options, yet the majority of physicians still primarily collect from patients with paper and manual processes.” Technology exists for self-pay receivables that allow patients easy online payment options. Experian Health's Collections Optimization Manager offers powerful analytics to segment and prioritize accounts by their propensity to pay and create the best engagementstrategy for each patient segment. Advocate Aurora Healthcare took control of collections by using this tool and automated their collections processes, so that existing staff could focus on working with the patients who had the resources to handle their self-pay commitments. The software's automation and analytics features allowed the provider to experience a double-digit increase in collected revenues annually. Patients also benefit from collections optimization software. For example, Kootenai Health qualifies more patients for charity or other financial assistance with Experian Health's Patient Financial Clearance solution. In addition to automating up to 80% of pre-registration workflows, the software uses data-driven insights to carve out the best financial pathway for each patient. It's a valuable tool for overburdened revenue cycle teams that struggle to collect from patients. Kootenai Health saved 60 hours of staff time by automating these manual payment verification processes. Result 3: Recruiting alone isn't solving the healthcare worker shortage. Healthcare hiring is a revolving door, with 80% reporting turnover as high as 40%. 73% said finding qualified staff is a significant issue. A significant contributor to the healthcare worker shortage is the grim reality that these organizations are losing human resources to burnout and stress. Being short-staffed drags down the entire organization, from the employed teams to the patients they serve. But it's impossible for recruiting alone to fix the problem when more than 200,000 providers and staff leave healthcare each year. A recent study suggests that if experienced workers continue to leave the industry, by 2026, more than 6.5 million healthcare professionals will exit their positions. Only 1.9 million new employees will step in to replace them. The news worsens with the realization that nearly 45% of doctors are older than 55 and nearing retirement age. Artificial intelligence (AI) and automation technology in healthcare can cut costs and alleviate some of the severe staff burnout leading to all this turnover. However, one-third of healthcare providers have never used automation in the revenue cycle. A recent report states that providers could save one-half of what they spend on administrative tasks—or close to $25 billion annually—if they leveraged these tools. For example, Experian Health's Patient Access solutions can automate registration, scheduling and other front-end processes. AI can also help increase staff capacity and output without adding work volume. Experian Health's AI Advantage™ solution works in two critical ways to help stretch staff and improve their efficiency: The Predictive Denials module reviews the provider's historical rejection data to pinpoint the claims most likely to bounce back before they are submitted. The tool allows the organization to fix costly mistakes before submission, eliminating the time spent fighting the payer over a denial. The claims go in clean, so the denial never happens. The revenue cycle improves, saving staff time and stress. Denial Triage focuses on sorting denied claims by their likelihood to pay out. The software segments denied claims by their value so internal teams focus on remits with the most positive impact on the bottom line. Instead of chasing denials needlessly, this AI software allows revenue cycle teams to do more by working smarter. Revenue cycle technology to fill healthcare worker shortage gaps There is no question that the healthcare worker shortage is causing a significant burden on patients and providers. Experian Health's Short-staffed for the Long Term report illustrated the effect of this crisis on the healthcare revenue cycle, patient engagement, and worker satisfaction. Technology can solve staffing challenges by allowing the healthcare workers we do have to spread further and work more efficiently. AI and automation technology in healthcare can cut costs, alleviate staff burnout and can even help healthcare providers retain their existing workforce. By implementing these new solutions, healthcare providers can help stop the bleeding of existing staff that contributes to the healthcare worker shortage, while improving the efficiency of the revenue cycle. These tools save time and money and improve the lives of everyone touched by the healthcare industry. Contact Experian Health to see how your healthcare organization can use technology to help eliminate the pressures of the healthcare worker shortage.