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For Michael Smith, it all began with seemingly innocuous text messages from a PA University Hospital, indicating a wait time for an emergency room visit. A peculiar situation for someone who no longer resided in Philadelphia and hadn't used the hospital system for years. Initially dismissing it as spam, Mike's skepticism deepened when a hospital staffer named Ellen reached out to discuss diagnostic results from an ER visit, he never made.  The revelation was unsettling - someone had registered with Smith's name, and the lack of ID verification raised eyebrows. While the recorded name and date of birth were accurate, the address associated with the account was outdated. A discrepancy that hinted at a more insidious problem.  Undeterred, Smith took matters into his own hands. Following an unsatisfactory conversation with the hospital's billing department, he penned a letter to the privacy officer, expressing his concerns about potential fraud. In his words: "I think there's something going on, that someone is using my information, and the visit and the charges appear to be fraudulent."  Smith's proactive approach sheds light on a crucial aspect of dealing with medical identity theft - swift and assertive action. As cyberattacks on healthcare institutions escalate, individuals must be vigilant in protecting their personal data.   Everyone shares the burden  Whether enrolled in employer-sponsored health insurance or securing coverage through HealthCare.gov, or the individual market, instances of healthcare fraud invariably translate into heightened financial burdens for consumers. Such malfeasance results in elevated premiums and increased out-of-pocket expenses, often accompanied by diminished benefits or coverage. In the realm of employers, both private and governmental entities, healthcare fraud escalates the costs associated with providing insurance benefits to employees, consequently raising the overall operational expenses. For a significant portion of the American population, the augmented financial strain stemming from fraudulent activities could be the decisive factor in realizing or forgoing health insurance.  Yet, the financial ramifications are merely one facet of the impact wrought by healthcare fraud. Beyond monetary losses, this malpractice carries a distinctly human toll. Individual victims of healthcare fraud are distressingly prevalent, individuals who fall prey to exploitation and unnecessary or unsafe medical procedures. Their medical records may be compromised, and legitimate insurance information can be illicitly utilized to submit falsified claims.  It is crucial not to be deceived into perceiving healthcare fraud as a victimless transgression, as its repercussions extend far beyond financial considerations, undeniably inflicting devastating effects.  Healthcare fraud, like any fraud, demands that false information be represented as truth. An all-too-common healthcare fraud scheme involves perpetrators who exploit patients by entering into their medical records' false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. This is done so that bogus insurance claims can be submitted for payment. Unless and until this discovery is made (and inevitably this occurs when circumstances are particularly challenging for a patient) these phony or inflated diagnoses become part of the patient's documented medical history, at least in the health insurer's records.  How does medical identity theft happen?  Medical identity theft involves someone using another patient's name name or insurance information to receive healthcare or filing fraudulent claims, posing significant financial and health risks. It can result in bills for procedures the patient has never had, inaccurate medical records, and potentially life-threatening care. Common ways it occurs include database breaches, improper disposal of records, phishing scams, insider theft by healthcare professionals, and theft by family members.  Data breaches in healthcare have reached alarming levels, with the Office of Civil Rights reporting 725 notifications of breaches in 2023, where more than 133 million records were exposed or impermissibly disclosed. Social engineering poses a threat to individual Medicare beneficiaries, but healthcare providers also face risks from ransomware attacks, hacking, and employee errors. Hacking constitutes the dominant threat, accounting for 75% of reportable breaches.  Regardless of how health data is exposed, be it through individual identity theft, hacking attacks, or unintended sharing, any disclosure of payment information increases the risk of healthcare fraud.  Protecting patients and improving their experience  To prevent medical fraud and ensure eligibility integrity, here are some steps healthcare organizations can take:   Implement robust verification processes: Develop and enforce strict protocols to verify patient eligibility and review supporting documents. This includes verifying insurance coverage, confirming the patient's identity, and validating their relationship to the covered individual (e.g., spouse, dependent). Stay updated with legal and regulatory requirements: Stay informed about the latest laws, regulations, and industry guidelines related to medical eligibility and fraud prevention. This could include understanding requirements for reporting changes in eligibility status and keeping up with best practices recommended by regulatory authorities. Train staff on fraud prevention: Provide comprehensive training to all staff members regarding medical fraud prevention, eligibility verification procedures, and red flags to look out for. Staff should be educated on relevant laws and regulations, as well as proper documentation practices. Conduct regular internal audits: Regularly review patient records, claims, and billing processes to identify any inconsistencies or irregularities. Internal audits can help detect potential fraud and ensure compliance with eligibility requirements. Utilize technology and automation: Implement healthcare management systems or software that incorporate automated eligibility verification processes. This can help streamline and improve accuracy in eligibility determinations, reducing the risk of fraudulent benefits being provided. Encourage patient engagement: Educate patients about their responsibilities in maintaining accurate eligibility information. Promptly notify patients about the importance of reporting changes in their circumstances (e.g., marital status, employment status) that may affect their eligibility for medical benefits. Report suspicious activity: Train staff to recognize and report any suspicious activity or potential fraud. Establish clear reporting channels within your practice and encourage a culture of transparency and accountability. Stay vigilant: Stay alert for emerging trends, schemes, and new types of medical fraud. Regularly review industry updates, attend relevant workshops or seminars, and participate in fraud prevention initiatives to stay informed about evolving threats and prevention strategies. By implementing these measures, healthcare organizations can help safeguard their medical practices against medical fraud and preserve the integrity of eligibility determinations.   Finding the right partner  Healthcare fraud is a serious crime that affects everyone and should concern everyone—government officials and taxpayers, insurers and premium-payers, healthcare providers and patients—and it is a costly reality that can't be overlooked. By taking steps to find the right partner along the way, providers are helping to protect the integrity of the nation's healthcare system. Experian Health works across the healthcare journey to improve the patient experience, make providers more effective and efficient, and enhance and simplify the overall healthcare ecosystem.   Learn more or contact us to see how Experian Health's patient identity solutions can help healthcare organizations prevent medical ID theft. 

Prospects for US hospitals that closed out 2022 at a financial loss looked brighter by the end of 2023, prompting cautious optimism heading into 2024. An industry analysis published in October 2023 found that most hospitals were back in the black from March 2023 onward, while the economy more generally ended the year with a strong finish. That said, healthcare margins remain slim, and expenses continue to grow. Finding efficiency savings across all operations remains a top priority. That's where revenue cycle automation comes in. With revenue cycle automation, providers can eliminate many of the persistent pain points in traditional revenue cycle management (RCM). Staff no longer lose time to tedious manual tasks, patients get their queries answered faster, and managers get the meaningful data they need to drive improvements. And the biggest win? It's easier for providers to get reimbursed for the services they provide – faster and in full. What is revenue cycle automation and how does it work? Healthcare revenue cycle management knits together the financial and clinical components of care to ensure providers are properly reimbursed. As staff and patients know all too well, this can be a complex and time-consuming process, involving repetitive tasks and lengthy forms to ensure the right parties get the right information at the right time. This requires data pulled from multiple databases and systems for accurate claims and billing, and is a perfect use case for automation. Revenue cycle automation refers to the application of robotic process automation (RPA) to these repetitive, rules-based processes. In practice, this might include: Automatically generating and issuing invoices, bills and financial statements Streamlining patient data management and exchanging information quickly and reliably Processing digital payments Collating and analyzing performance data to draw out useful insights. Common RCM challenges Automation is already making headway in tackling some of the most pervasive challenges, such as: Stemming the rise in claim denials: Experian Health's State of Claims 2022 survey found that a third of providers had around 10-15% of their claims denied. These often result from errors made earlier in the revenue cycle such as incorrect patient information or overlooked pre-authorizations. RCM automation reduces the propensity for errors significantly. Streamlining patient access: Without a welcoming digital front door, the revenue cycle gets off on the wrong foot. Automation can be deployed in patient scheduling and registration to ensure patient information is collected and stored quickly and accurately. Improving collections rates: Self-pay patients (who are increasing in number) want clear, upfront information about what their care is likely to cost. Providers can find themselves playing catch-up if patients are unsure about what they owe. Automated tools that generate accurate estimates and support pre-service payment can build a more resilient cash flow. Expanding access to data insights: One of the biggest ironies in revenue cycle management is that more data is collected than ever, but managers are struggling to digest it and uncover actionable insights. RCM automation helps identify patterns in claims and collections. Six ways revenue cycle automation accelerates reimbursements Let's break down these opportunities into six specific actions providers can take to improve their organization's financial health: 1. Capture accurate information quickly during patient access Victoria Dames, Vice President of Product Management at Experian Health, says, “Patient access is the first step in simplifying healthcare and revenue cycle processes. Replacing manual processes and disjointed systems with integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle.” Patient Estimates automatically compiles an accurate breakdown of what a patient is likely to owe before or at the point of service. It builds in prompt-pay discounts, financial assistance advice and instant payment links, so patients are more likely to pay sooner. 2. Simplify collections and focus on the right accounts Healthcare collections are a drag on resources. Automating the repetitive elements in the collections process helps reduce the burden on staff. Collections Optimization Manager leverages automation to analyze patients' payment histories and other financial information to route their accounts to the right collections pathway. Scoring and segmenting accounts means no time is wasted chasing the wrong accounts. Patients that can pay promptly are able do so without unnecessary friction. As a result, providers get paid faster. 3. Reduce manual work and staff burnout Chronic staffing shortages continue to plague healthcare providers. In Experian Health's recent staffing survey, 96% of respondents said this was affecting payer reimbursements and patient collections. While automation cannot replace much-needed expert staff, it can ease pressure on busy teams by relieving them of repetitive tasks, reducing error rates and speeding up workflows. Hear Jonathan Menard, VP of Analytics at Experian Health talk to Andrew Brosnan of Omdia about how AI and automation are addressing staff burnout and improving revenue cycle efficiency. 4. Maintain regulatory compliance with minimal effort While regulatory compliance may not directly influence how quickly providers get paid, it does play a crucial role in preventing the delays, denials and financial penalties that impede the overall revenue cycle. Constant changes in regulations and payer reimbursement policies can be difficult to track. Automation helps teams continuously monitor and adapt to these changes for a smoother revenue cycle – often with parallel benefits such as improving the patient experience. One example is Experian Health's price transparency solutions, which help providers demonstrate compliance with surprise billing legislation while boosting patient loyalty via a more compassionate financial experience. 5. Improve the end-to-end claims process Perhaps the most obvious way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claim scrubbing, real-time eligibility verification, more reliable coding, and easier status tracking all improve the chances of a provider being reimbursed promptly and fully. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI AdvantageTM uses machine learning to find patterns in payer behavior and identify undocumented rules that could lead to a claim being denied, alerting staff so they can act quickly and avert issues. Then, it uses algorithmic logic to help staff segment and rework denials in the most efficient way. Providers get paid sooner while minimizing downstream revenue loss. 6. Get better visibility into improvement opportunities Finally, automation helps providers analyze and act on revenue cycle data by identifying bottlenecks, trends and improvement opportunities. Automated analyses bring together relevant data from multiple sources in an instant to validate decisions. Machine learning draws on historical information to make predictions about future outcomes, so providers can understand the root cause of delays and take steps to resolve issues. A healthcare revenue cycle dashboard is not just a presentation tool; it facilitates real-time monitoring of the organization's financial health, so staff can optimize workflows and speed up reimbursement. Revenue cycle automation is the solution Just like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Together, these six revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth. Learn more about Experian Health's revenue cycle management technology and see where automation could have the biggest impact on your organization's financial health.

Racing against the clock to troubleshoot billing issues, claims bottlenecks and staffing shortfalls are just part of an average day for healthcare revenue cycle managers. It's hard enough to maintain the status quo, never mind driving improvements in denial rates and net revenue. With integrated artificial intelligence (AI) and automation, many of these challenges in revenue cycle management (RCM) can be alleviated – and with just a single click. Real-time coverage discovery and coordination of benefits software reduces errors and accelerates accurate claim submissions. This eases pressure on busy RCM leaders, so they have the time to focus on improving the numbers that matter most. Top challenges in revenue cycle management Efficiency is the currency of revenue cycle management. Maximizing resources is not just about keeping dollars coming in the door but about making the best use of each team member's time and expertise. The ever-present call to “do more with less” is probably the biggest challenge. Breaking that down, some specific concerns that consume more time and resources than RCM managers would like, are: Complex billing procedures: With hundreds of health payers operating in the US, each offering different plans with different requirements, providers have their work cut out to ensure claims are coded and billed correctly. Any errors in verifying a patient's coverage, eligibility, benefits, and prior authorization requirements can lead to delays and lost revenue. More claim denials: Inaccurate patient information and billing codes guarantee a denial. Beyond the rework and revenue loss, denied claims leave patients with bills that should not be their responsibility to pay, causing confusion, frustration, and higher levels of bad debt. Garbage in, garbage out. Patient payment delays: A few years back, patients with health insurance represented about a tenth of bills marked as bad debt. Now, this group holds the majority of patient debt, according to analysts. The rise in high-deductible health plans combined with squeezed household budgets means patients are more likely to delay or default on payments. Providers must be on the lookout for ways to help patients find active coverage and plan for their bills to minimize the impact of these changes. How can AI-powered revenue cycle management solutions help? The Council for Affordable Quality Healthcare (CAQH) annual index report demonstrates how much time can be saved using software-based RCM technology. Case in point: switching from manual to automated eligibility and benefits verification could save 14 minutes per transaction. This adds up quickly when daily, monthly, and yearly transactions are factored in. Predictive analytics can be used to pre-emptively identify and resolve issues and support better decision-making, giving providers a head start on those elusive efficiency gains. Three specific examples of how automation, AI and machine learning can streamline the front-end and solve challenges in revenue cycle management are as follows: 1. Upfront insurance discovery to find and fill coverage gaps Confirming active coverage across multiple payers gives patients and providers clarity about how care will be financed. But this can be a resource-heavy process when undertaken manually. Coverage Discovery uses automation to find missing and forgotten coverage with minimal resource requirements. By unearthing previously unidentified coverage earlier in the revenue cycle, claims can be submitted more quickly for faster reimbursement and fewer write-offs.With Experian Health's recent acquisition of Wave HDC, clients now have access to faster, more comprehensive insurance verification software solution. The technology works autonomously to identify existing insurance records for patients with self-pay, unbillable, or unspecified payer status and correct any gaps in the patient's coverage information. The patient's details are updated automatically so that a claim can be submitted to the correct payer. 2. Real-time eligibility verification and coordination of benefits As it gets harder to figure out each patient's specific coverage details, it also makes sense to prioritize automated eligibility verification. Eligibility Verification uses real-time eligibility and benefits data to confirm the patient's insurance status on the spot.Similarly, Wave's Coordination of Benefits solution, now available to Experian Health clients through Patient Access Curator, integrates directly into registration and scheduling workflows to boost clean claim rates. It automatically analyzes payer responses and triggers inquiries to verify active coverage and curate a comprehensive insurance profile. This means no insurance is missed, and the benefits under each plan can be coordinated seamlessly for more accurate billing. 3. Predictive denials management to prevent back-end revenue loss Adding AI and machine learning-based solutions to the claims and denials management workflow means providers can resolve more issues pre-claim to minimize the risk of back-end denials. Use cases for AI in claims management might include: Automating claims processing to alleviate staffing shortages Reviewing documentation to reduce coding errors Using predictive analytics to increase operational efficiency Improving patient and payer communications with AI-driven bots All of these contribute to a front-loaded denials management strategy. While prevention is often better than a cure, AI can be equally effective later in the process: AI AdvantageTM arms staff with the information they need to prevent denials before they occur and work them more efficiently when they do.Whatever new challenges may pop up on the RCM horizon, AI and automation are already proving their effectiveness in helping providers save time and money. But more than that, they're giving busy RCM leaders the necessary tools to start future-proofing their systems for persistent and emerging RCM challenges. Learn more or contact us to find out how healthcare organizations can use AI and automation to manage current revenue cycle management challenges with a single click.

Healthcare is a challenging profession. Providers understand that their mission of care delivery is fueled by the revenues they capture; after all, it is the business of healthcare. However, capturing revenues through the claims management process is burdensome and complex. Denials are all too common, hampered by inefficient workflows and manual tasks. As a result, it slows down reimbursement and impacts revenue. Moving toward reliable claim acceptance requires the strategic use of automation and technology to reduce denials. These initiatives accelerate the cycle of payments, improve cash flow, and ease strains on existing staff. This article takes a deep dive into the challenges of healthcare claims processing and strategies to help providers transform the claims management process. Challenges of healthcare claims processing The healthcare claims management process desperately needs modernization and optimization. Last year, an Experian Health survey showed that three out of four providers say reducing claims denials is their top priority. What's making it so difficult for providers to get paid? The healthcare reimbursement journey Let's start with the typical claims management process. Step 1: Prior authorization The first issue is that most generally accepted standard practices in healthcare claims processing create a long journey for provider reimbursements. This journey starts even before patient care, at eligibility and preauthorization. The American Medical Association (AMA) states, “Prior authorization is a huge administrative burden for physician practices that often delays patient care.” While prior authorization may help insurance companies reduce the cost of “unnecessary” treatments, the data shows it's having the opposite effect on the providers themselves. An AMA physician survey shows that 86% of prior authorizations lead to higher overall utilization of services. The practice doesn't appear to help patients, either; the AMA says 94% of doctors report care delays related to prior authorization, and 82% say patients abandon their treatment plans due to prior authorization struggles. Step 2: Data capture The second part of healthcare claims processing begins after the patient encounter. It involves many manual tasks, often leading to errors and claim denials. Intake and billing specialists must gather data from multiple sources for coding claims, including electronic health records (EHRs), physician notes, diagnosis codes, paper files, and the patients themselves. These workflows require significant manual data entry and review, which is impacted further when codes or insurance reimbursement requirements are out-of-date in provider systems. A recent survey shows that 42% of providers report code inaccuracies, and 33% say missing or inaccurate claims data as the top reasons for rejected claims. Step 3: Processing claims denials Post-submittal, there's more work when claims bounce back. It's part of the claims management process with the most inefficiencies and friction, costing the average provider millions annually. Healthcare providers experience Experian Health survey—but that number is rising. Responses from Experian Health's State of Claims 2022 report revealed that 30% of respondents experience denials increases of 10 to 15% annually. In June 2022, Experian Health surveyed 200 revenue cycle decision-makers to understand the current state of claims management. Watch the video to see the results: These challenges illustrate the need for modern and optimized healthcare claims processing. With this lens in place, healthcare providers can apply more effective claims management strategies to increase claims accuracy and reimbursement and reduce denials. Innovating your claims management strategy Healthcare professionals and organizations can proactively address challenges in the claims acceptance process by implementing effective strategies to optimize revenue cycle management. This effort should include the following: A cohesive and comprehensive claims management processNew approaches to outdated claims management workflows will address gaps, inefficiencies, and errors. Upgrading to a turnkey insurance claims manager can reduce denials and speed up claims processing. Address data quality and consolidationThe sheer volume of data required for healthcare claims processing increases the risk of errors. If the data isn't accurate at the front end, it's a fast track to denial. But claims go through multiple touch points in disparate systems without a single source of control and oversight. Organizations can employ standards for data intake to reduce inaccurate or incomplete patient information and duplicates and leverage technology to aggregate data from the multiple sources needed for claims processing. Implement best practices for denial workflowsClaim denial management on the backend of healthcare claims processing is even more challenging than capturing patient data at the front end of the encounter. Managing claims denials is time-consuming, and delays reimbursements, but denial workflow technology can streamline all follow-up activities. With this support, billers have less administrative work and can stretch farther, alleviating the burden of staffing shortages. Deploy tools for analysis and prioritizationA claims management platform can automatically analyze the components of each claim. With this information, the technology can prioritize denials workloads so high-impact accounts get the most attention. Upgrade claims technology automation with artificial intelligence (AI)Providers can transform claims management with a technology update. According to the State of Claims report, almost half of organizations replaced legacy healthcare claims processing technology in the past year. A vital component of this upgrade includes expanded automation capabilities that stretch the workforce further. Solutions like AI Advantage™ can help speed up the claims management process by predicting and preventing denials. Add prior authorization softwareAnalysis suggests that healthcare could automate up to 33% of manual tasks. Research on the benefits of automation showcases its potential for decreasing errors and other reimbursement obstacles. With prior authorization software, task assignment is seamless, and AI adds even more functionality with predictive capabilities. Accelerate claim follow upMonitoring claim status is another aspect of the payment ecosystem that heavily impacts provider cash flow. Technology automates much of this workflow. Organizations can adopt functionality that eliminates manual follow-up tasks to accelerate an unwieldy process. These solutions enable providers to respond quickly to issues, enhancing productivity beyond basic ANSI 277 claims status responses. Technology is the unifying thread behind a cohesive claims management strategy for any healthcare provider struggling with a high rate of denials. While 61% of providers lack automation in the claims/denials process, increasing evidence shows these tools drive revenue cycle efficiencies that transform claims denials management. Forward-thinking organizations like Summit Medical Group Oregon—Bend Memorial Clinic (BMC) leverage Enhanced Claim Status and Claim Scrubber to achieve a 92% primary clean claims rate. Schneck Medical Center uses AI Advantage to denials by an average of 4.6% each month. Implementing effective claims management strategies Strategies rooted in reliable, practical technology transform the claims management process. Healthcare organizations benefit from AI-driven automation solutions as part of an overarching claims management strategy that streamlines workflows, reduces denials, and boosts cash flow. Experian Health offers a portfolio of provider claims management tools to help organizations realize effective claims management process improvements to get paid faster. Learn more about the No. 1 Best in KLAS 2023 Claims Management and Clearinghouse tools or contact us to see how Experian Health can help improve your claims management processes.

More than 13 million Americans have lost Medicaid coverage since continuous enrollment came to an end in April 2023. Unwinding the emergency provisions requires states to determine which individuals remain eligible for Medicaid, leading to widespread disenrollment. The Medicaid redetermination process created a major admin burden for agencies and providers, and now, the impact of that burden on patients has become clear: more than 7 million of those who lost coverage were disenrolled because of administrative processes, and not due to ineligibility. While some will find coverage elsewhere, many will be left without insurance. These coverage gaps disrupt health services with adverse effects for patients and providers. In a recent webinar, Kate Ankumah and Mindy Pankoke, Product Managers at Experian Health, reflect on the Medicaid redetermination process and discuss how providers can mitigate the effects of redetermination heading into 2024. Recap: Medicaid continuous enrollment provision timeline How does the Medicaid redetermination process work? The redetermination process, led by state agencies, involves reviewing Medicaid rosters and automatically renewing coverage for individuals that still qualify, based on benefits or other government data. When coverage cannot be confirmed automatically, states need to reach out to patients to fill in the gaps. If the individual is no longer eligible (or does not provide the necessary data), they will be removed from coverage lists. Many patients are confused about the process and may not even realize they're no longer covered, leading to delays and distress when they try to access care. This blog post breaks down the 5 things providers can do if a patient loses Medicaid coverage. 1. Tighten up insurance eligibility verification processes During the webinar discussion, Kate Ankumah explains that implementing a reliable eligibility verification tool is essential to reduce financial risk, increase revenue and streamline staff workflows: “With our Eligibility product, we connect to more than 900 payers with search optimization. Providers don't need to send the same information over and over – we'll run through the search options ourselves and find the information as quickly as possible. Then we standardize the data so front desk staff can read all the responses in the same way. We also build in alerts. A couple of clients have alerts set up for Medicaid redetermination dates that pop up if a patient is due for redetermination so the front desk staff know to have a conversation with them about it.” Eligibility also includes an optional Medicare beneficiary identifier (MBI) lookup service, to check if any patients who may have been disenrolled from Medicaid are now eligible for Medicare. 2. Find missing coverage with Coverage Discovery Providers may also want to automate the search for any active coverage that may have been overlooked. Coverage Discovery searches for possible billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient's status changes, their bill won't be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 3. Quickly identify patients who may be eligible for Medicaid and financial assistance The lack of clarity around enrollment and eligibility is disruptive for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Denial rates are already a top concern for providers, and staff cannot afford to waste time seeking Medicaid reimbursement for disenrolled patients. Patient collections also take a hit when accounts are wrongly designated as self-pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient's ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps secure reimbursement and means patients are less likely to be chased for bills they can't pay. 4. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, but particularly now that federal support has ended. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. Drawing on Experian's consumer credit data, Collections Optimization Manager's segmentation models are powered by robust and proprietary algorithms. These models screen out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Case study: See how University of California San Diego Health (UCSDH) increased collections from around $6 million to over $21 million in just two years using Collections Optimization Manager. 5. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they'd struggle to pay an unexpected medical bill of $500, providers should make it easier for patients to gauge their upcoming bills. Patient Financial Advisor and PatientSimple® can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage Medicaid changes efficiently and offer extra support to patients who may be facing disenrollment. Watch the webinar to see the full discussion on how Medicaid redetermination is affecting providers and find out how Experian Health's digital solutions can help healthcare organizations quickly and easily verify insurance coverage.

For many Americans, access to healthcare is increasingly a question of affordability. There's no room for error when it comes to determining a patient's medical bill. Helping patients understand and plan for medical bills starts with calculating patient responsibility quickly and accurately. Incorrect charges, unexpected costs and confusing payment processes create poor financial experiences for patients. According to research by Experian Health and PYMNTS, patients are increasingly worried about their healthcare costs. 46% of those surveyed had canceled care after receiving a high-cost estimate, while 60% of those with out-of-pocket expenses said inaccurate estimates or an unexpected bill would prompt them to consider switching providers. As the stakes get higher, providers must reexamine how to calculate patient responsibility in medical billing so all parties are clear about who will pay for what. Providing that clarity will improve the patient experience, streamline patient collections and protect the organization from bad debt. What is patient responsibility? Responsibility for paying medical bills is apportioned between the patient who receives care, their insurance provider (if they have one), and government payers like Medicare and Medicaid (if the patient is eligible). “Patient responsibility” refers to the portion of the bill that should be paid by the patient themselves. Getting these calculations right is critical to the provider's revenue cycle. Determining patient responsibility starts during patient registration. Here, providers have their first opportunity to check that insurance details are up to date and ensure that the patient has not overlooked any active coverage. If the patient does not have coverage, they'll be liable for the whole bill (or will have to find charity assistance). If they do have insurance, the provider will liaise with their payer to check that the proposed care is covered under the patient's plan and establish any prior authorization requirements. Then, the provider can estimate how much of the cost of care should be reimbursed by the payer, and how much will fall to the patient. The amount paid by patients includes the following categories: Co-payment – this is a fixed, flat fee the patient pays toward their medical care at the time of service. If providers do not have accurate co-pay information available at the time of the visit, they may need to bill or refund the difference later. Not all health plans include co-payments, and those that do often specify exceptions. Deductible – this the total amount the patient must pay toward medical care each year before the payer contributes. For example, if a patient has a $1000 deductible, they must pay the first $1000 of medical bills that year, and any eligible costs on top of that will be covered by their payer or shared between the patient and payer. High-deductible health plans are attractive to patients who don't think they're likely to need care, as these plans often come with lower monthly premiums. However, if the patient does need care, they'll be left footing a greater portion of the bill. Coinsurance – this is the patient's share of remaining medical costs after paying their deductible. Out-of-pocket maximum – some health plans set an annual limit to the amount a patient needs to pay toward care, including co-payments, deductibles and coinsurance. Once that limit is reached, the payer will cover the remaining eligible expenses for the remainder of the period. Clearly, this is a complicated formula. To bill correctly, providers need to know whether the proposed treatment is covered by the patient's plan, how much the payer has agreed to pay for specific services, and whether individual service providers involved in the patient's care are in-network or not. Claims will only be reimbursed if all necessary coding and payer policy requirements have been met. Revenue cycle management tools to calculate patient responsibility Traditionally, providers have relied on teams of hard-working coders and billers to manually compile and review each claim. But with so many moving parts – not to mention frequent payer policy changes and staffing shortages – manual processes are no longer viable. When determining how to calculate patient responsibility in medical billing, providers should turn to automation and digital tools. This can help them augment their staff's capacity to calculate patient responsibility more efficiently and accurately and optimize patient collections. Here are a few examples of how they might do that: Automate insurance eligibility verification - Without understanding exactly what the patient's active coverage includes, providers will remain one step behind in the medical billing and claims management process. Payers are already using automation and artificial intelligence to fulfil their side of the equation, and providers cannot risk being left behind. Automating the verification process allows providers to capture up-to-date eligibility and benefits data, including the patient's co-pay and deductible amounts, to calculate the patient's responsibility pre-services. Find missing and forgotten coverage - As more patients switch health plans, more payers join the Affordable Care Act marketplace, and employer-based insurance changes, it's increasingly likely that the patient may not be 100% sure of their active coverage. With Coverage Discovery, providers can run quick, automated and repeated checks to see if any active coverage has been overlooked. This could drastically reduce the patient's responsibility, leaving them with a more affordable bill. Automate prior authorization - Many health plans require specific services to be authorized by the payer before being administered. Providers must check these requirements pre-service, or face a denied claim which could affect the patient's bill. Obtaining authorization from health plans before administering services can be slow and expensive, and often delays care. The Council for Affordable Quality Healthcare (CAQH) states that automating prior authorizations could save the medical industry $449 million per year (or 11 minutes per transaction). Automated prior authorization software gives providers real-time insights into payer requirements, so they can speed up reimbursement and give patients clarity over what they'll owe. Why use a patient cost estimator? With the necessary insurance information at their digital fingertips, providers can then use a patient responsibility pricer to calculate the patient's co-pays, deductibles and other out-of-pocket expenses. For example, Patient Payment Estimates is a web-based price transparency tool that generates personalized estimates for patients before and at the point of service. Patients get a comprehensive breakdown of what they'll owe, so they can plan for upcoming bills or even pay upfront. Patient liability estimator tools give patients more financial clarity, saving staff time and encouraging prompter payments. They're also an important compliance tool, and are specifically recommended in CMS advice on compliance with the Hospital Price Transparency Final Rule. Accelerate and streamline patient collections Early financial clarity encourages patients to pay sooner. This means it's more likely that those bills are paid in full, instead of lingering on the aged receivables list. In addition to upfront estimates, providers should make the payment process itself as easy as possible. This might include directing patients to payment plans or charity assistance, and connecting patients to convenient payment tools at any point in their healthcare journey. Inevitably, there will be some patients who simply cannot pay their bills. Collections Optimization Manager shows staff which accounts, so they don't waste time chasing the wrong accounts. By scoring and segmenting patient accounts based on the likelihood of payment, and adjusting as the patient's situation changes, Collections Optimization Manager helps providers manage resources more efficiently, while supporting a more compassionate patient financial experience. It also enables more effective use of collections agencies to minimize the cost to collect, and incorporates reporting and benchmarking tools to identify improvement opportunities. Find out how Experian Health's revenue cycle management tools can help providers calculate patient responsibility in medical billing, for a more compassionate patient experience and streamlined collections process.

What's weighing on providers' minds as we head into 2024? According to a 2023 Medical Group Management Association (MGMA) survey, an overwhelming percentage of providers are wondering how to speed up prior authorizations. The answer: automation and electronic prior authorizations. The 2023 MGMA Annual Regulatory Burden Report surveyed executives representing more than 350 group practices about the impact of federal policies and regulations. The MGMA is the nation's largest association focused on the business of medical practice management. Respondents cited a growing volume of pre-authorizations as a key challenge, along with complex coding requirements, lengthy response times, and delays in treatment. Survey results showed that prior authorizations are a pervasive issue: 89% of respondents called pre-authorizations either “very” or “extremely” burdensome. 90% said the regulatory burden has grown in the past 12 months. 92% had hired additional staff to deal with prior authorizations. 97% said patients had experienced delays or denials due to pre-authorization requirements. 97% said a reduced regulatory burden would allow resources to be reallocated toward patient care. Neeraj Joshi, Director of Product Management at Experian Health, sees the issue as complex but solvable: “Providers have to get ahead of the constant changes in regulations and payer rules, while also overcoming the operational limitations inherent in manual processes and the industry's ongoing staffing shortages,” he says. Joshi shared his perspective on the state of pre-authorizations going into 2024—and what may be ahead as providers consider automation and new technologies surrounding electronic prior authorizations. Here's where he sees the industry heading in the year to come. Q1: What feedback have you received from providers about the challenges they face, and how is this feedback shaping the development of Experian Health's solutions? “The feedback from providers is clear: They highlight the challenges of managing an increasing volume of pre-authorizations, the complexity of payer rules, and the burdens of manual data entry,” says Joshi. “This feedback has been crucial in shaping Experian Health's solutions, leading to the development of tools that automate the pre-authorization process and keep providers up-to-date with payer rules.” Technology plays a key role in helping providers take on these challenges. Case in point: Experian Health's online authorizations solution includes access to a complete payer database that stores and dynamically updates payer prior authorization requirements. Experian Health's pre-authorization Knowledgebase works together with Authorizations software to reduce the manual workload. Automated inquiries work behind the scenes without intervention to maintain a high level of accuracy that improves efficiency, drives revenue, and protects profits. “Features like the Knowledgebase and tools such as Medical Necessity, which automatically checks patient orders against payer rules, and Claims Scrubber, an automated solution that reviews and edits claims pre-submission, reduce the time and effort required to manage pre-authorizations and minimize the risk of errors,” says Joshi. “These tools address providers' specific challenges around maintaining operational efficiency and optimizing the revenue cycle as they navigate a complicated pre-authorization landscape.” Q2: Why are providers increasingly concerned about pre-authorizations now? “A number of factors are contributing,” says Joshi. “Providers' concerns about pre-authorizations have intensified due to the pandemic's impact on healthcare operations, leading to rescheduled care and uncertainties around existing authorizations. Additionally, evolving and diverse payer rules, coupled with manual, labor-intensive processes, have exacerbated these challenges.” Each of these concerns is significant by itself. Together, they create an even greater challenge to operational efficiency. “Providers are grappling with the need to adapt to these changes, often with reduced staff,” says Joshi. “This has increased the administrative burden and complexity of managing pre-authorizations. State-specific regulations, such as New York's temporary suspension of prior authorizations, have added another layer of complexity, creating a landscape where providers must continuously adapt to both national and regional policy changes.” Q3: How do regulatory changes impact the pre-authorization landscape, and how is Experian Health adapting to these changes? “Regulatory changes, including state-specific mandates and evolving payer policies, significantly impact pre-authorizations by introducing new requirements and exceptions,” Joshi explains. As of late 2023, 40 states have enacted prior authorization regulations, with the possibility of additional and amended regulations constantly looming. Additionally, the 2024 Medicare Advantage and Part D Final Rule will change pre-authorization requirements nationwide for patients with Medicare Advantage plans. Payer rules shift constantly—both in response to regulation and independent of it—creating a massive operational challenge for providers. “These constant changes necessitate a dynamic response from healthcare providers,” says Joshi. Outdated manual processes simply aren't up to the task, least of all when staffing is limited. “Experian Health helps providers adapt by continuously updating its platforms and solutions to align with the latest regulations and payer policies. This includes integrating real-time updates and automating the process of keeping track of changing requirements, thus ensuring that providers using Experian Health's solutions are always working with the most current information.” Q4: What other ways can electronic prior authorization tools help providers address current pre-authorizations challenges? “Leveraging technology to streamline and automate the pre-authorization process is the core advantage,” Joshi says. Electronic prior authorization tools, powered by AI, represent a giant leap forward.  “Adopting solutions that reduce manual workloads, such as Experian Health's Knowledgebase, and dynamic work queues that help operational teams work the exceptions and discrepancies, rather than spending their time handling every authorization transaction, can make complex processes manageable. Emphasizing back-end automation and keeping abreast of the latest payer policies are key strategies to manage increasing patient volumes effectively. “Providers can also focus on implementing patient-facing digital tools to facilitate self-service,” Joshi continues. “A greater emphasis on self-service can reduce administrative burdens without sacrificing the patient experience.” Q5: How do you see the future of patient care being impacted by electronic prior authorizations and other advancements? “The future of patient care is poised to be significantly impacted by these advancements,” Joshi says. “Streamlined and automated pre-authorizations can lead to reduced wait times for patients and more timely access to necessary treatments.” Automating the pre-authorization process and introducing new technologies to deal with an ever-evolving, ever-expanding workflow may also help providers break a difficult cycle of overwork and understaffing. “As the administrative burden on healthcare providers decreases, more resources can be allocated to direct patient care,” Joshi maintains. “This shift will not only improve the efficiency of healthcare delivery but also enhance the overall patient experience, leading to better health outcomes and higher patient satisfaction.” Learn more about how Experian Health can help your organization improve operational efficiency and drive revenue with electronic prior authorizations.

Today, U.S. healthcare providers struggle with three significant challenges affecting care delivery—each resulting from chronic healthcare workforce shortages. Ultimately, these challenges threaten the fiscal health of the country's most critical care safety nets. Over 80% of the healthcare C-suite say the chronic staffing shortage creates significant risk for their organizations. The effects of healthcare staffing shortages are severe - Experian Health's recent survey of revenue cycle leaders found these executives unanimously agreed that staffing shortages impact cash flow, patient engagement, and the work environment of their current staff. Experian Health’s new survey, Short Staffed for the Long-Term, polled 200 revenue cycle employees to determine the effects of healthcare staffing shortages on patients, the workforce, and their facilities. What did these teams say about the healthcare workforce shortage and the state of care delivery? Find out by downloading the full report. Healthcare providers experience a vicious cycle, and the effects of healthcare staffing shortages can be seen in many different areas. For example, it makes it harder for existing team members to register patients on the front end of the encounter. On the back end, revenue cycle staff face higher workloads and stress leading to preventable reimbursement claims errors and missed collections opportunities. Ultimately, that stress leads to staff turnover, exacerbating the healthcare workforce shortage. This article dives into three effects of healthcare staffing shortages and how providers can combat them. Result 1: Short-staffed providers struggle with reimbursement and cash flow. 70% of respondents who say staff shortages affect payer reimbursement also report escalating denial rates. 83% report it's harder to follow up on late payments or help patients struggling to pay their bills. Costs are up, and cash flow is down. Claims denials are increasing by 15% annually. Reimbursement rates continue to decline even as denials rise and patient debt increases. These are the revenue cycle challenges healthcare providers face on top of the chronic healthcare staffing shortage. Healthcare organizations must look for new ways to improve reimbursements while engaging patients and staff to benefit everyone involved. Experian Health's Short Staffed for the Long-Term report noted two of the most significant revenue channels for healthcare providers, claims reimbursement and collections, are experiencing significant challenges. Reimbursement denials tie up cash flow in an endless cat-and-mouse game of revenue collection. HealthLeaders termed 2023 as, “the year of reducing denials for revenue cycle.” Their statistics further reinforce Experian Health data correlating increasing denial rates with the healthcare staffing shortage. Simultaneously, healthcare providers find it harder to collect from patients. High self-pay costs lead to lower patient collection rates. One study showed patient collections declining from 76% in 2020 to 55% in 2021. Providers desperately need a more patient-centered collections process that helps these customers understand their cost obligations and payment options. Integrating automated collections solutions can also help providers do more with less. Healthcare stakeholders must collaborate to devise innovative solutions that prioritize workforce augmentation and streamline financial workflows. Technology can solve these problems by automating manual revenue cycle processes that lead to delayed reimbursements. New solutions that use artificial intelligence (AI) software can help in other areas (like claims denials) to save staff time and reduce workloads. Result 2: A lack of staff directly impacts successful patient engagement. Surveyed staff say 55% of patients experience engagement issues at scheduling and intake. 40% say patient estimates suffer, leading to potential miscommunications in credit and collections. Experian Health's The State of Patient Access, 2023: The Digital Front Door reported patients and providers believe healthcare access is worsening. 87% of providers in the survey blamed the effects of healthcare staffing shortages. Earlier data from ECRI shows patients wait longer for care, and nearly 50% of providers say access is worse. Over 100 academic studies in the past two decades confirm the correlation between poor patient health outcomes and industry staff shortages. Existing staff members may take on heavier workloads to cover gaps in patient care. The resulting fatigue can impact the quality of care delivery. When healthcare organizations are short-staffed, each team member may spend less time with patients, resulting in rushed assessments and potentially missed diagnoses. Staff shortages can impact every phase of the patient journey, beginning with patient scheduling and potentially delayed essential medical services. On the backend, patients suffer when the pressure staff members feel to work faster causes preventable errors leading to healthcare claim denials. Collections suffer, as frustrations mount, and healthcare staff waste time on patients who are simply unable to pay. The adverse effects of staffing shortages in healthcare weaken with technology to improve the patient experience at every stage of their encounter. Better technology lessens the burden of care for staff by automating mundane administrative tasks so every provider can focus on serving patients—not filling out forms. Improving patient engagement starts at the beginning of the healthcare encounter. For example, patient scheduling software can create a seamless online experience that halves appointment booking time. More than 70% of patients say they prefer the control these self-scheduling portals offer, putting access to care back in their hands. Patient payment estimation software creates much-needed healthcare price transparency, improving satisfaction by eliminating financial surprises after treatment. These solutions, combined with automated revenue cycle management software, can streamline healthcare processes and improve patient experiences. Result 3: Overwork is the norm as staff work environments decline and turnover increases. 37% of survey respondents report issues with staff burnout. 29% list the departure of experienced staff as one of their top challenges. Whether in frontend care delivery or backend revenue cycle, overworked and stressed healthcare professionals are more susceptible to making mistakes, diminishing the overall quality of the patient experience. The attention to detail, a critical component in a complex, high-stakes business, may be compromised due to the strain on the existing staff. When a healthcare organization is short-staffed, it increases the stress on the existing employees. In turn, this contributes to higher turnover rates. Job dissatisfaction and increased stress levels create a challenging work environment, perpetuating the cycle of staffing shortages. Recruiting and training new staff to fill these gaps further exacerbate the strain on existing teams. One area that is critically impacted by staffing shortages is seen in claims management, as claim denials continue to increase, which cost American healthcare providers an estimated 2.5% of their gross revenues annually. Billions of reimbursement dollars logjam in the endless cycle of claims submissions, rejections, and manual mitigations. In 2022, the cost of denials management increased by 67%. Revenue cycle staff, stretched to their limits by staffing shortages, will likely continue to make preventable mistakes during patient intake and claims submission. However, automating claims management with a solution like ClaimSource® can help lower denial rates and ease this burden.  This solution delivers increased operational efficiencies and effectiveness by prioritizing claims, payments and denials so that users can work the highest impact accounts first. Other solutions, like Claim Scrubber, can improve claim accuracy before submission, by submitting clean and accurate claims every time. These technologies enable healthcare providers to reduce claims denials while relieving some of the terrible pressure felt by their financial teams to work harder and faster. By automating clean claims submissions, healthcare organizations free up their teams to focus on taking better care of patients—and themselves. Healthcare staffing shortages + manual revenue cycle = Unsustainability What happens to a process that heavily relies on human labor—when there aren’t enough people to go around? In the case of the healthcare revenue cycle, it means staffing shortages heavily impact a hospital's ability to collect revenue. Medical Economics reports that 78% of providers still conduct patient collections with traditional paper statements or other manual processes. In an era of talent shortages, these manual processes bog down the entire organization with no relief in sight. Overwork leads to burnout, a significant problem in the industry that also contributes to staff turnover. But this is exactly how digital technology can solve the healthcare staffing shortage. While AI and automation can’t help providers find the staff they need, it can eliminate manual tasks and reduce errors that lead to more work, staff burnout, and patient care disruption. McKinsey says automation can eliminate approximately half of the activities employees now perform. It could considerably improve the work environments for revenue cycle staff, allowing them to focus on high-value tasks, and engage patients in more caring and personalized experiences. Experian Health offers providers proven technologies to increase revenue, improve patient care, and lessen the strain on existing staff, to combat the effects of healthcare staffing shortages. Contact Experian Health today to get started.

Between November 2022 and September 2023, St. Luke's University Health Network (SLUHN) saw a 22% uplift in self-pay collections, amounting to an additional $1.2 million in average monthly collections. What makes this particularly noteworthy is that they achieved this during ongoing staffing shortages. It's an encouraging result for providers facing similar challenges, so how did they do it? On a recent webinar with Experian Health, Cindy Samuels, Senior Manager of Patient Revenue Services at St. Luke's, and Rich Wade, Strategic Product Consulting Director at Experian Health (and the Patient Revenue Services team's designated consultant), share how Collections Optimization Manager and PatientDial allowed St. Luke's to automate and optimize their collections efforts. How staffing shortages wreak havoc on the collections process Revenue cycle managers are all too familiar with the downward trend in collections recoveries over the last few years, which is exacerbated by labor shortages and rising self-pay balances. In Experian Health's August 2023 survey, Short-Staffed for the Long Term, 100% of respondents said that staffing shortages had affected revenue cycle management. Many reported that resource shortages in patient collections made it harder to follow up on late payments or help patients who were struggling to pay. With six vacancies in their own Patient Revenue Services team, St. Luke's needed a way to improve efficiency. Cindy Samuels says, “more and more dollars were falling to the patient. I had a team of folks making outbound phone calls to collect outstanding dollars, but staff were leaving messages all day long and our cash wasn't increasing. Outsourcing wasn't an option that we wanted to pursue, so we looked at technology automation.” Since St. Luke's were already using Experian products in other parts of the revenue cycle, replacing their outdated call center platform with an Experian Health solution made sense. Developing a successful strategy for collecting self-pay balances To handle increasing self-pay balances with limited staff resources, St. Luke's used Collections Optimization Manager to generate a daily accounts receivable (AR) file and then screen, segment and monitor accounts so they could be managed in the most efficient way. Samuels explains: “Every active self-pay account goes through [Experian's] scrubbing system, so they're finding medical assistance, presumptive charity, deceased bankruptcy, and other types of insurance. So, we know to set those accounts aside. The rest are segmented into five segments [based on propensity to pay] so I know where to put my resources when it comes to reaching out to patients.” With the help of an Experian Health consultant, Collections Optimization Manager users can then implement specific collections strategies that are tailored to each segment. For St. Luke's, this included automating patient calls using PatientDial, a cloud-based call system that facilitates inbound, outbound and blended call environments to help collect patient balances. The combination of segmentation and automation allows St. Luke's to have multiple call campaigns running at once, so more patients can be contacted and in a way that is more likely to lead to payment. Maximizing collections by shifting focus from “high dollar” to “ability to pay” Typically, collections teams focus on aged accounts with the highest dollar amounts. Unfortunately, this can result in staff chasing accounts that are unlikely to be paid. Collections Optimization Manager's segmentation strategy means accounts are sorted according to likelihood of payment, and treated in a way that is more likely to yield results without wasting staff time. With Collections Optimization Manager and Patient Dial, patients that are more likely to pay can be allocated to an unassisted call campaign and given an automated reminder about their balance at the appropriate time. It may not make sense to have staff spend time calling patients at the other end of the spectrum who are unable to pay or even engage with the process. An automated message with information about financial assistance may be a more appropriate approach. St. Luke's focused their resources on the segments in the middle, who are likely to be engaged but may have specific issues to resolve, such as needing details of payment plans or updating a credit card. This approach has helped the team reach more patients than ever and maintain an abandon rate of below 1.2%. Samuels says, “not only have we been able to collect more cash, but we've also been able to resolve more accounts, because with segmentation we've been able to clean up the AR that don't belong in the collections world. We can also help patients go down the financial assistance road if that's what they need. So maybe not every call results in cash, but at least we've been able to speak to patients and help them resolve any questions or concerns.” Boosting staff efficiency through automation Around 90% of St. Luke's Patient Services Team work remotely. This adds a new challenge for managers, who need to be sure that staff have the information they need to work confidently and effectively, while being able to monitor workloads and maintain productivity levels. While the increase in call volumes and collections speaks to the boost in productivity, PatientDial's reporting function has made it possible to generate a scorecard for each representative to measure performance. This allowed Samuels to identify potential training needs and foster knowledge exchange, especially when remote working means staff can't simply ask the person next to them for help. Samuels says her staff have welcomed the ability to handle more calls, more efficiently, without having to redial patients several times. PatientDial provides user-friendly dashboards, so call center agents have all the necessary details at their fingertips. Staff have said they find it motivating to be able to help more patients, which is reflected in high employee satisfaction scores in St. Luke's annual employee engagement survey. A snapshot of success In addition to increasing average monthly collections by $1.7 million in a little under a year, St. Luke's has seen the following results:     “We have increased our outbound call volume by 274% since last November, so we're reaching more patients. If we're not reaching them, we're leaving more messages. The dialer has also saved 740 hours monthly because staff are no longer dialing numbers and getting nothing. And we’re using an interactive voice response (IVR) campaign for payments, so we've saved around 253 hours each month, because patients make their payment electronically over the phone with no need to speak with a representative. It was a very positive thing for us.” Cindy Samuels provides more details of their approach on the webinar, plus her tips for others who may be considering implementing Collections Optimization Manager and PatientDial in future. Watch the webinar for full details on how St. Luke's increased collections despite staffing shortages, or contact us to learn how Experian Health can help optimize your collections efforts.