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Could the era of manual claims processing be coming to an end? Experian Health's State of Claims 2022 survey revealed that more than half of healthcare providers have embraced advanced automation, freeing up staff from time-consuming and inefficient manual tasks. Automation has dominated as the key strategy used by providers to reduce denials in the previous 12 months. This evident optimism about technology's ability to address challenges in the claims process suggests that automation is here to stay. However, while automation has cracked open the doors to more efficient claims processing, the predictive power of artificial intelligence (AI) in claims processing can unlock exponentially higher rates of reimbursement. Providers may be increasingly aware of the benefits of automation, but many have yet to step into the world of AI. This article considers the advantages to be found in layering AI technology on top of automated claims processing and looks at how two new AI solutions are helping providers reduce denials and expedite payments.  How automation helps with claims processing Healthcare organizations with automated claims processing report improvements in speed, accuracy, financial performance and patient experience. For example: Automated claims management solution ClaimSource® helped Hattiesburg Clinic in Mississippi accelerate cash flow, reduce denials to 6.1%, and expedite claims from secondary and tertiary payers. Summit Medical Group Oregon used Enhanced Claim Status and Claim Scrubber to reduce accounts receivable days by 15% and achieve a first-time pass-through rate of 92%. These tools improve efficiency across the entire claims cycle by automating repetitive tasks, executing effective workflows and generating data-driven insights into root causes of denials so staff can prioritize high-impact tasks and errors are far less likely. Industry reports corroborate these positive results: CAQH reports that the medical industry could save as much as $22.3 billion per year through further automation. Unlocking the untapped potential of AI in claims processing Despite automation's impressive results, claim denials remain a thorn in the side of many revenue cycle leaders. This is where AI can help, thanks to its ability to predict and respond to payer behavior and claims data. But while 51% of survey respondents were using automation, only 11% had introduced AI-based technology to their claims process. For the AI-curious, combining automation and AI could be a good starting point to supercharge claims processing. AI technology can predict potential issues before they even occur by analyzing claims and denials and making suggested corrections or interventions in real-time. It can also assist in identifying fraudulent claims and denials, leading to improved claims processing accuracy and revenue cycle management. By using automation and AI together, healthcare providers can gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. What does that look like in practice? More efficient and accurate claims predictions Automation can relieve staff of manual data handling activities, increasing the speed and accuracy of claim processing, from patient intake through scrubbing, submission and adjudication. AI enables staff to perform remaining tasks with greater confidence and accuracy. They no longer need to wonder, “which claim should I rework first?” – AI has the answer. Without AI, the logical approach would be to rework what appear to be the highest-value denials first. But in many cases, these aren't the ones most likely to result in reimbursement. AI can help staff prioritize by analyzing historical payment data and undocumented payer adjudication rules to flag denials that are most likely to be paid. This is exactly how AI Advantage™ – Predictive Denials works. Experian Health's new AI-based solution checks for any changes to the way payers handle denials and assesses these against previous payment behavior. Providers can set their own threshold for the probability of denial, and if the solution determines that a claim will exceed this threshold, it alerts staff so they can act quickly and decisively before the claim is submitted. Schneck Medical Center was an early adopter of this tool and used it to complement their existing claims workflow (built around ClaimSource®). Within six months, they saw average monthly denials drop by 4.6%. Predictive alerts allowed staff to focus efforts on submitting clean claims the first time, so both the number of denials and hours spent reworking them were drastically reduced. “Learning” from denials data to drive financial performance By definition, automated claims processing systems will repeat the same tasks over and over. This is great for operational efficiency but has limited capacity to handle variation. A major advantage of an AI-based solution is its capacity to “learn” and predict, so each claim can be individually assessed and directed to the most appropriate workflow. AI Advantage™ – Denial Triage uses advanced algorithms to identify and intelligently segment denials so that providers can prioritize accordingly. Just as Predictive Denials uses historical payment data to predict the claims that may be at risk of rejection, Denial Triage learns from payers' past decisions to predict the denials that are most likely to be reimbursed if reworked. Read more about Schneck Medical Center's experience with AI Advantage. How does using AI benefit healthcare staff? The use of AI in claims management can be met with different reactions: some staff are enthusiastic about the prospect of having manual tasks taken off their plate and being able to use their time more effectively. Others may be concerned about the impact of AI on jobs and recruitment. The reality is that many providers face ongoing staffing shortages, and therefore have little option but to augment their existing teams with new technology. Maintaining pre-pandemic headcounts in light of post-pandemic work patterns and budgets may not be possible. Automation and AI can resolve these short-term challenges while generating a positive ROI in the long term, as the volume and complexity of claim denials continue to grow. As noted in the State of Claims 2022 report, technology should no longer be viewed as a threat to jobs, but as a way of making life easier for staff. Automation and AI work hand in hand to execute tasks that many staff find time-consuming and laborious, leaving the more stimulating and high-value tasks for the human workforce. Improving operational performance can therefore have a positive effect on job satisfaction and retention. The integration of AI in claims processing is not about replacing human expertise, but about harnessing the power of AI-powered algorithms to enhance efficiency and minimize denials. The optimal approach lies in combining the strengths of automation, AI and staff. Automation handles repetitive processes, AI expedites decision-making, and human expertise brings contextual understanding and empathy to the process. Learn more about how Experian Health can help organizations utilize AI in healthcare claims processing with AI Advantage.

American consumers may be more optimistic about the state of the economy, but concerns about healthcare costs are always top-of-mind. A survey by Experian Health found that 40% of patients would cancel or postpone care if they were not informed of costs in advance. Planning for medical expenses can be a struggle for families facing rising costs and increasing deductibles. With profit margins under increasing pressure, providers must make constant improvements to patient collections processes to help patients navigate their financial obligations more easily. Finding new ways to maximize patient collections and increase efficiency while reducing friction in the patient experience is more important than ever. Technology and patient collections software offer a way to bridge the gap. This article looks at two case studies that involve leveraging automation and digital technology to create better patient collections processes. Case Study 1: how UCSDH improved patient collections with Collections Optimization Manager Patients are footing more of the bill for healthcare, leaving providers more exposed to each individuals' ability to pay. If patients are unable to pay in full and on time, providers will be left with growing ­– but avoidable – collections costs and an escalating risk of uncompensated care. Given that patients can have different financial circumstances, mailing out uniform statements and hoping they will be paid is a futile effort. Instead, providers should look for opportunities to proactively engage patients with personalized information, delivered earlier in the process. This can help maximize patient collections. One way to determine the most suitable collections strategy for each patient is to use data-driven software like Collections Optimization Manager. This tool helped the University of San Diego California Health (UCSDH) score and segment patients according to their propensity to pay so that each account was dealt with in the most appropriate way. For example, patients with a high likelihood of payment could be sent billing information automatically via inbound call campaigns, and offered self-service options to manage payments. Collections Optimization Manager also enabled UCSDH to automate the presumptive charity process, quickly identify patient accounts eligible for Medicaid or charity support, and direct them to the correct work queue to maximize workforce productivity. As a result, UCSDH increased collections by 250% in a single year, from $6 million to $21 million between 2019-20 and 2020-21. UCSDH also used Coverage Discovery® to track down active commercial and government coverage that patients were unaware of. More than $5 million was found in 2021 that would otherwise have been written off. For UCSDH, being able to provide a compassionate patient collections experience has been central to this success: “We serve our patients well when we can explain their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, System Director of Patient Revenue Cycle, UCSDH Case Study 2: how Kootenai Health streamlined eligibility checks with Patient Financial Clearance Another way to provide early clarity is to make sure patients aren't missing out on Medicaid assistance. However, this can be a time-consuming and labor-intensive exercise when attempted through manual processes. Because Kootenai Health needed a more streamlined workflow to screen patients for financial assistance, they implemented Patient Financial Clearance to assess and assign patients to the right pathways and programs, based on their specific circumstances. Patient Financial Clearance uses credit and non-credit data to identify patients missing out on Medicaid or charity assistance in real-time. It automates screening and document-gathering, reducing the manual burden on staff while improving the patient experience. Verifying Medicaid eligibility early prevents patient accounts from being sent down long and expensive collections pathways that would never result in payment. Kootenai's Financial Counseling manager reported that thanks to Patient Financial Clearance, “One of our patients with a $200,000 bill answered a few questions and was found eligible for Veterans benefits. With our previous vendor, we would have written the account off to charity.” In just 8 weeks, Patient Financial Clearance saved Kootenai 60 hours of staff time by automating the presumptive charity process and eliminating unnecessary applications. It also maintained an 88% accuracy in determining the right financial assistance program for the right patient. As Medicaid continuous enrollment under the COVID-19 public health emergency declaration comes to an end, uncertainty around eligibility is likely to increase. Taking steps to verify patients' status quickly and efficiently will be even more important. Bottom line: Maximize patient collections by making it easy to pay These are just two examples of how providers are using automation and digital technology to improve patient collection processes. In addition to screening and segmentation, providers can further tailor the financial experience by offering patients realistic payment plan options to make bills more manageable. Patients are provided with a range of convenient, self-service payment options to settle their bills according to their preferred method. Tools like Patient Financial Advisor allow patients to receive a text message with a link to a clear breakdown of their bill and the option to make a payment right from their mobile device. Find out more about how Experian Health's patient collections software and payment tools can help providers stop chasing the wrong accounts and deliver a proactive and personalized financial experience for patients.

As healthcare providers strive to deliver the highest quality care, it’s critical to understand the importance of improving the patient experience. Patient experiences can have a huge influence on overall healthcare quality and long-term outcomes. This is good news for patients, who consistently say they value healthcare encounters that surpass expectations. Research by Experian Health and PYMNTS in 2022 uncovered frictions in the patient journey, with patients commonly frustrated by poor communications, confusing and time-consuming administrative processes, and a lack of digital choices. In 2023, patients sent a clear message in response to the State of Patient Access 2023 survey: more than half of those who think patient access falls short of expectations would consider switching providers for a better experience. Creating an outstanding patient experience built on empathy, choice and personalization is therefore key to retaining loyal and happy consumers. Healthcare providers should utilize digital tools to offer timely access to services, clear and comprehensive communications, and a tailored approach to patient engagement to foster patient satisfaction – or risk losing patients to their competitors. Why the patient experience matters The patient experience is a gateway to the healthcare system. It encompasses every step the patient takes while seeking and receiving medical care. This goes beyond the clinical aspects of care and includes all the systems and strategies that determine a patient’s access to care. From the moment they book their appointment through their clinical care and final bill payments, each interaction is an opportunity to make or break a patient’s satisfaction with their provider, so improving the patient experience is crucial. The connection between patient loyalty and a provider's revenue is undeniable. However, it is important to recognize that the patient experience plays a significant role in health outcomes. Inefficient systems can lead to missed appointments, while confusing billing practices can prompt patients to postpone care. Adherence to care plans is far more likely when patients are engaged in positive, streamlined and user-friendly pathways. And when patients are positive about their healthcare experience, there are trickle-down effects for staff too, as patient frustrations are minimized and efficient processes ease workload pressures. What does a quality patient experience look like? Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says that a high-quality patient experience should encompass three things: “Choice, flexibility and convenience are themes that have come through strongly in each of our patient surveys. Patients are more mobile and more digitally active, so they expect services to be available on demand. They have a diverse range of schedules, responsibilities and preferences, and providers need to accommodate these variations so accessing care feels easy and convenient. Providers that leverage digital technology to deliver a patient-centered experience will see higher levels of patient engagement, better health outcomes, and a healthier bottom line.” Key factors affecting patient experience Clinical care: It goes without saying that the quality of clinical interactions is a major determinant of the patient experience. Unfortunately, clinical staffing shortages are putting pressure on providers, particularly in rural and low-income areas and in specialties including primary care, obstetrics, and psychiatry. More than a third of nurses say they plan to leave their jobs. Automation and digitally enabled self-service technology could help make workloads more manageable, as well as improve patient outcomes and close gaps in care. Administrative processes: The convenience of booking appointments, registering for care, and navigating billing systems can greatly impact how patients perceive the quality of their care. Efficient and accessible online scheduling, simple and transparent billing, and a choice of channels through which to access information can all play a role. Staff friendliness and availability can also affect patient perceptions. Logistical factors: If patients can’t actually get to a healthcare location easily, this will have a negative impact on their experience. Opening hours, accessible facilities, cleanliness, parking and transportation are factors to consider. How to improve the patient experience (by opening the digital front door) For healthcare providers, there’s always a new delivery challenge around the corner. But it’s also easier than ever to improve the patient experience, thanks to digital technology. Online self-scheduling allows patients to book appointments 24/7 in a convenient and flexible way. Patients can see real-time appointment availability so they can see their doctor as soon as possible, and receive automated reminders so they don’t miss their appointment. Improving the management of cancellations and rescheduled appointments leads to more efficient use of doctors' time, leading to enhanced clinical experiences for patients, too. Targeted patient outreach solutions complement this, by helping providers schedule more visits with automated text messages and interactive voice response campaigns. Patients can book appointments and make payments right from personalized messages, instead of waiting for call centers to open or having to pay through slower traditional methods. Similarly, automated registration using patient intake software and patient portals allows patients to handle pre-appointment administration more easily. Recent data from Experian Health and PYMNTS found that a third of patients choose to fill out registration forms using digital methods, while almost two-thirds would change providers to one that offers a patient portal. In addition to delivering a consumer-oriented experience, automation relies on robust data, which reduces the risk of errors on patients’ records, in turn preventing delays and confusion. Finally, offering digital price transparency and payment tools is an essential strategy to meet patients’ expectations and help them figure out better ways to pay their bills. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch providers, which again points to the competitive advantage in opening the digital front door. Proactive price estimates, support to find missing coverage, and tailored payment plans make the financial journey far less stressful for patients. Patient Financial Advisor can bring these elements together and give patients the option to make online payments, boosting patient collection rates. To enhance the patient experience, it is crucial to identify the moments when patients can be provided with support and reassurance. However, the impact of this goes far beyond patient satisfaction. By focusing on improving the patient experience, a chain reaction of advantageous outcomes occurs throughout the entire healthcare ecosystem, including improved revenue. Learn more about how Experian Health's digital solutions can help healthcare organizations focus on improving the patient experience.

To improve the patient journey, providers need to think like consumers. Patients are accustomed to convenience and choice in industries such as retail and banking, and expect the same of their healthcare experience. How quickly can they see their doctor? How easy is it to book appointments? Are they going to be handed a stack of paper forms when they arrive? From scheduling appointments to making payments, every touchpoint in the patient journey is an opportunity to meet and exceed expectations. To improve the patient journey, providers will need to utilize digital tools. Providers that put themselves in the patients’ shoes and find ways to make patient access as frictionless as possible will secure a competitive advantage. Learn how digital technology can enhance healthcare providers' ability to deliver flexible, efficient, and supportive care throughout the patient journey. This article draws upon the insights of Experian Health's State of Patient Access 2023 report to explore the benefits of utilizing digital tools and solutions in healthcare. In 2023, Experian Health surveyed more than 1,000 U.S. patients & 200 healthcare providers to learn about the state of patient access. Get exclusive insights: Before the appointment: how easy is it for patients to schedule care? The patient journey should begin with a welcoming “digital front door”. Demand is clear: according to the State of Patient Access 2023 survey, 56% of patients want more digital options to manage their healthcare. Specifically, 76% say they would like to schedule appointments online or via a mobile device. Creating an inviting, convenient and user-friendly online presence will encourage patients to book more appointments. A multi-purpose online portal gives patients the flexibility to take care of appointment bookings anytime, anywhere. Automated patient scheduling also reduces pressure on call center staff, who are then able to offer extra support to individuals who need it. Real-time status updates and automated appointment reminders ensure patients see their doctor as soon as possible and reduce the risk of no-shows. By creating a seamless transition between a provider’s online presence and physical office, tools like Patient Schedule can create an efficient experience for both staff and patients. Arriving for care: is pre-registration simple and streamlined? Patients deserve a seamless and stress-free experience when arriving for their appointment. Unfortunately, traditional paper forms can be tedious and redundant. Incomplete forms can also lead to delays in treatment. Online self-check-in options and virtual waiting rooms allow providers to move registration out of the waiting area and into the patient’s home or mobile device. With a digital front door, patients can complete pre-registration tasks, get accurate price estimates and even pay their bills before their appointment, via text or online portal. Automated tools can prefill identity information to keep errors and gaps at bay, and avoid claim denials and delays further on in the patient journey. A painless, paperless registration experience is easier and quicker for patients and saves time and resources for providers. Planning for bills: are patients getting upfront pricing estimates? Providers have many opportunities to improve the patient financial journey. Experian Health’s survey found that 40% of patients would cancel or postpone care without accurate estimates, yet 65% did not receive them. That price transparency isn’t the norm is surprising, given the legislative push in recent years. Medical bills can be extremely complex, so providing a detailed breakdown of expected costs is a great way to improve the patient experience. Patient Estimates is a web-based tool that allows patients to generate accurate estimates using their current insurance and benefits information, before or at the point of service. Patients can also be offered personalized financial assistance options including payment plans and charity care. For patients that prefer to take care of business via their mobile device, Patient Financial Advisor offers a similar service via secure text message. Patients get a clear cost breakdown and a link to make secure payments. When financial management is easier for patients, providers are more likely to get paid. Paying for care: do patients have a choice of payment methods? In addition to clear and upfront pricing, providers can enhance the financial experience by offering multiple convenient payment options. Digital-first consumers are looking for the same self-service, secure, one-click payment options that they use for other purchases. Providers that enable digital patient payment tools earlier in the process are not only delivering a more satisfying patient experience, but they’re also more likely to be paid sooner. With Experian Health’s Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Leveraging digital technology to improve the patient journey Alex Harwitz, VP, Digital Front Door, at Experian Health, says that patient loyalty is increasingly tied to digital offerings: “Whether we’re talking about scheduling, registration or payments, the message from the State of Patient Access 2023 survey is clear: patients are looking for transparency, convenience and a significant amount of control. They’re more likely to choose providers that offer these benefits and switch away from those that don’t. For example, nearly a quarter have considered looking for a different provider because of a poor payment experience.” The realization that a better patient access experience results in better business outcomes is almost universal among providers. And with advancing patient access technology, providers now have more ways to deliver a consumer-friendly experience that allows patients to focus on their health, and not on the admin of care. Download the State of Patient Access 2023 – the Digital Front Door, to find out more about patient and provider perspectives on how to improve the patient journey.

Has patient access gotten better or worse? According to the State of Patient Access: 2023 report, many healthcare providers believe that patient access has gotten worse, and many patients agree. This report is based on a new survey, fielded in December 2022, that gathered responses from 202 healthcare professionals responsible for patient access and 1,001 patients who engaged in care for themselves or a dependent in 2022. What is the challenge around patient access and how can providers overcome these hurdles? Both healthcare providers and patients want patient access functions that are optimized for efficiency, can accommodate a high capacity of patients, and reduced wait times for non-clinical aspects of care. Across the industry, there is widespread acknowledgment that an improved patient access experience is linked to better business outcomes for providers. Digital front door solutions that can enhance patient registration, scheduling and payment processes are the key to overcoming the challenge of better patient access. In fact, 46% of providers plan to invest in digital capabilities in the next 6 months.* Download the State of Patient Access: 2023 report for the full survey results, or contact us to see how Experian Health helps healthcare organizations improve and streamline patient access with digital front door solutions. *survey fielded in Dec. 2022

Millions of patients and their healthcare providers face challenges as State Medicaid agencies unwind coverage rules enacted as part of the COVID-19 public health emergency (PHE) that ended in April, 2023. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Meanwhile, providers may find themselves in an extended state of flux over the next year as Medicaid members have their eligibility re-evaluated and, in many cases, dropped. Kate Ankumah, Principal Product Manager, oversees  Insurance Eligibility Verification solutions at Experian Health. She shares some of the ways providers are managing new demands as they work to keep themselves—and their patients—up to date on coverage changes while navigating Medicaid redetermination and helping patients explore new financial options. Q1: When does the Medicaid redetermination process begin? “Some states have already started the Medicaid redetermination process,” Ankumah says. “Five started in April [of 2023], another 14 states started in May, and we expect many more to start in June. It's going to be a rolling process. Most states are saying this will be a 12- to 14-month effort.” Q2: What can providers expect from their state Medicaid agencies while the renewal process is happening? “State agencies will be going back through their rosters on a monthly cadence to determine who still qualifies for Medicaid,” Ankumah explains. “State Medicaids will start by using internal information to determine eligibility, whether that's eligibility for SNAP benefits or other government data they have access to. If they can't qualify members automatically, they'll reach out to members for more information. If they determine a person is no longer eligible—or they don't get information back by the deadline they've set—that member will be dropped from Medicaid coverage, possibly without ever knowing that they were supposed to respond to an email or other communication to keep their coverage.” Q3: What impact does Medicaid redetermination have on provider workflows? Ankumah sees three major areas of concern: changes to coverage, communication challenges, and downstream impacts on revenue and collections. “Providers should expect to see the hit rate for finding active Medicaid coverage to dip over the next 12 to 14 months. Normally, when reporting shows a decline in Medicaid eligibility, you might think that the payer was down or that the clearinghouse wasn't making the connection. Right now, we know that these are more likely people who don't have coverage,” Ankumah says. “I think providers can also expect to see a lot of very confused patients,” she continues. “Providers are going to need to make phone calls and have difficult conversations with patients who had no idea that this was happening and are frustrated and flustered by this change. “And then ultimately, there are going to be more self-pay patients. Many of these patients will be people who didn't know that they were at risk of losing their Medicaid coverage and aren't sure how to proceed.” Q4: Are there ways to optimize eligibility to mitigate some of the issues being created as redetermination rolls out? “One thing we're seeing is providers utilizing the batches they run through state Medicaid(s) to get a bit of a heads-up about coverage changes. If the provider's state Medicaid is dropping people from its rosters on the first and the 15th of the month, the provider might send everyone they're seeing for the first half of the month through on the first. If they find out a patient has been dropped, they have time to reach out and talk about coverage before the patient comes in for their appointment.” Dealing with the potential fallout is better with advance notice—for providers and patients. “It's a terrible patient experience to walk in thinking you have coverage and finding out you don't,” says Ankumah. “It's not the provider's fault, but patients can feel blindsided learning they'll have to pay out of pocket for care.” “Some clients are also running more frequent batches to try to get a better idea of when [during the month] their state is dropping members. Are they always dropping on the first of the month? Are they dropping on Mondays? It's a bit of an iterative process trying to understand the timing of it, but clients want to learn as soon as possible when a patient is dropped from the roster so they can reach out and have a plan before they walk in to be seen by a doctor.” Q5: Are states including redetermination dates when they send back eligibility transactions? “Some state Medicaids are indicating redetermination dates, but so far there's no standard for doing this. There's no specific field for redetermination dates in the 271,” says Ankumah. “Some states are picking a field and using it: Often they'll use the certification date, or they'll add a message segment to an open field at the end of the 271.” “As states begin to communicate if and where they are sending the redetermination dates in the 271s—and as we can verify that in our system—we can let our clients know that they can start to leverage this information to let patients know when their coverage is ending." “It may seem strange that we can't point to one field that state agencies are using to communicate redetermination dates,” Ankumah says, “but we're dealing with 50 different agencies, each doing it their own way. We're continuing to look for patterns and to work with clients to puzzle this out.” Q6: What can providers do to support patients that are being dropped from Medicaid? If providers learn that a patient has been dropped from Medicaid, Ankumah suggests directing the patient to their state Medicaid website to try re-enrollment. If their organization has a Medicaid enrollment team, they can be an excellent resource for patients. Additionally, providers may want to leverage tools that help patients navigate their financial responsibility. Finding alternative coverage: “For patients who have lost Medicare, Coverage Discovery can help find coverage that they don't know or aren't sure about,” says Ankumah. “They may have signed up for new coverage but aren't sure of their plan information and details. Or they may be covered under an employer's policy without realizing it. Coverage Discovery lets providers search for coverage with the click of a button.” Exploring coverage and payment options: “Patient Financial Clearance helps sort out which patients may qualify for Medicaid re-enrollment, presumptive charity, or—if needed—payment plans that can help manage self-pay balances." Optimizing collections: “Finally, our Collections suite of products can scan patient balances and score accounts to help providers prioritize accounts that are most likely to pay.” Q7: How is Experian Health helping individual clients deal with Medicaid redetermination? “When we talk about these issues generally, we tend to give a lot of 'it depends' answers,” says Ankumah. “That's because a lot of what's happening is state dependent. We really want to make sure that we offer guidance that gives our clients the most value and fits their individual circumstances. “With that in mind, one of the best things a client can do is to work with their relationship manager. They can offer real insights into how their state Medicaid is addressing redetermination, including dates and timing.” Relationship managers can also help providers navigate workflow changes efficiently. “For example, a provider might think sending through daily batches to see who qualifies for Medicaid is a good idea, but they'll be charged for those transactions and can very quickly go over their budget. Our team is here to help providers develop protocols that keep them up to date without overdoing it. “We also have a team dedicated to monitoring payer updates,” Ankumah notes. “We're following what our clients are hearing from their state Medicaid agencies, but we're also looking closely at updates and querying our databases to leverage information and return it back for the benefit of all our clients.” Find out how Experian Health's Insurance Eligibility Verification solution can help connect providers with more than 890 payers, including state Medicaid agencies nationwide. 

Traditional paper-based registration processes can lead to significant inefficiencies and errors in the healthcare industry. Illegible writing and incomplete information can lead to medical errors and delays in care. Loss or misplacement of forms can lead to critical data being overlooked or confused. What's more, staffing shortages and piles of paperwork slow down the patient intake process, creating a stressful experience for patients and staff. Patient registration software can solve each of these problems. Discover 5 powerful ways patient registration software can help healthcare organizations enhance patient experiences, boost operational efficiencies and optimize staff time. 1. Patient registration software can improve patient accessibility  One compelling reason to opt for digital methods instead of traditional paper forms is the increasing demand from patients themselves. In Experian Health's State of Patient Access 2023 survey, more than 8 in 10 providers say their patients prefer an online registration experience. Patients experiencing pain or discomfort shouldn't be burdened with lengthy, repetitive forms in a bustling waiting area. Medical terminology can be perplexing, and staff members may not be available to assist. Fortunately, digital intake forms completed from the comfort of one's home is a more hassle-free and accessible option. Patient registration software can prefill forms with information from the patient's record, so the whole process is faster and less prone to errors. Patients receive text prompts and can begin the registration process with a single click. From there, they can verify and edit information, confirm appointments and sign forms electronically, all at their own convenience.  2. Digital registration can increase patient engagement  Online self-scheduling and digital patient registration create a convenient and personalized patient access experience, which also boosts patient engagement. Interactive patient portals give patients more control. They can communicate more easily with providers, ask questions and provide additional details if needed. Providers can make relevant resources and information available, so patients can take a more active role in their health. By shifting registration online, it also becomes possible for providers to collect and analyze valuable data that helps them build a more detailed picture of who their patients are and what they need and want. This can inform targeted patient outreach strategies to improve health outcomes. 3. Digital tools can improve operational performance Similarly, data analytics can drive operational improvements, by giving staff insights into the accuracy, speed and potential sticking points in their patient registration workflow. Becky Peters, Executive Director of Patient Access at Banner Health, says Experian Health's digital patient access solutions have helped her organization monitor key metrics linked to financial performance: “[With Power Reporting] we're able to monitor the number of registrations staff are doing, how many errors they're making, how quickly they're resolving them, and tie that to a lagging indicator for initial denials… It also ties in with one of our main KPIs, which is cash collections. We use the estimator to provide 100% estimates for every patient that walks in our door, so we know how much we should be collecting. Then we see how much of that we collected.” 4. Patient intake software can decrease staff workload For almost half of providers who responded in the State of Patient Access 2023 survey, patient access has gotten worse over the last two years. Of this group, almost 9 in 10 said the effect of staffing shortages on service levels was their biggest pain point. Patient registration software eases pressure on staff by eliminating the need to help patients with paper forms or manually enter data into electronic health records. Registration Accelerator is an automated, patient-facing solution that decreases the administrative workload with pre-filled information, and then guides patients through the process so any unnecessary additional work, such as chasing up no-shows, can be avoided. Alex Harwitz, Experian Health's VP, Digital Front Door, says: “Patient access is evolving. Providers need to open their digital front door or risk losing their patients to competitors. That starts with frictionless digital patient registration. Patients keep telling us that they're looking for convenient and easy access to care. And staff are looking for streamlined systems that talk to each other and put data and insights at their fingertips. By facilitating better data management and leveraging automation, patient registration software reduces the manual burden on staff so they can focus on what really matters – delivering patient care.” 5. Online registration software can speed up payments As Becky Peters noted, patient collections are a top KPI for most healthcare organizations. Patient registration software speeds up collections by: Verifying insurance information in real-time to reduce the risk of billing errors and denials Delivering upfront, accurate estimates to patients before they're treated, so they can plan for bills Offering patients payment methods so they can pay their bills easily – even before care is delivered. Each of the benefits mentioned above contributes to a more robust revenue cycle. By increasing accuracy, reducing costs, boosting efficiency and prioritizing patient satisfaction, digital patient registration is just what the doctor ordered. Find out more about how Experian Health's patient registration software can help healthcare organizations streamline patient access.

When it comes to healthcare, patient access is the top priority for most individuals. When patients are surveyed on what they value most, timely access to their doctor rises to the top. Experian Health's State of Patient Access 2023 survey found that patient satisfaction hinges on efficient scheduling. Many believe that patient access has improved in recent times due to the ability to book appointments more quickly. On the contrary, those who think otherwise attribute slow booking systems to the decline in accessibility. However, delivering a high-quality patient intake experience isn't always straightforward. Meeting the needs of an aging population – many of whom are managing multiple chronic conditions – is an increasing challenge in the context of ongoing shortages of clinical and administrative staff. With financial performance dependent on attracting and retaining both patients and staff, balancing supply and demand in patient access is a high-stakes equation for providers. Breaking down the key opportunities and challenges can help providers identify appropriate strategies for optimization. Specifically, what role can digital patient access services play in ensuring patients get the care they need when they need it? What is patient access, and why is it critical to the patient experience? Patient access is the cornerstone of the healthcare system. It encompasses the systems and strategies that make or break a patient's access to care. Can they find a suitable provider in their area? How easy is it to book appointments and register for care? Can they understand and pay their bills without too much difficulty? While logistical elements such as geographic location and transportation certainly factor into how easily a patient can get care, patient access tends to focus on the administrative processes involved in scheduling and registration, verifying insurance coverage, appointment management, patient billing and payments, and patient communications. If these services are clunky, slow and disjointed, healthcare providers will fail to deliver high-quality and timely care to those who need it. Top key performance indicators (KPIs) for patient access services Getting patient access right can improve patient outcomes, increase patient satisfaction and reduce healthcare costs over time. But quality is often subjective. What should providers seek when striving for “high-quality” patient access? Common metrics might include: Wait times for appointments, diagnostic tests and procedures Speed and accuracy of the appointment scheduling process Percentage of patient access-related inquiries resolved on first contact No-show rates, which might indicate communication or scheduling issues Efficiency and accuracy of insurance verification, coding and billing Revenue collected before or at the point of service Staff performance and productivity Tracking these metrics can help providers find new ways to optimize patient access services. How to improve patient access services (and why) Monitoring and improving these KPIs is easier with digital and data-driven systems. But the benefits of digital patient access services go far beyond efficient data reporting. Offering patients online, digital and self-service options for scheduling, pre-registration and payments leads to a better patient experience while improving operational efficiency. Improved patient experience Alex Harwitz, Vice President of Product, Digital Front Door, at Experian Health, explains that “For patients, the digital front door results in more convenience, choice and control over their patient access experience. For example, online self-scheduling streamlines the appointment process, so patients can schedule, reschedule, or cancel appointments whenever it is convenient for them, which is often outside provider office hours. We can make sure they're only shown available appointments with the right specialist, and then send them helpful reminders so they're less likely to miss the appointment.” He says, “Digital systems can simplify the booking process for patients with complex medical needs. By incorporating automated scheduling protocols and business rules, navigating specialist appointments becomes more streamlined.” Similarly, digital pre-registration means patients can complete paperwork from home, where they have access to their medical records and insurance information. Tools like Registration Accelerator can pre-fill much of this data, saving time and preventing errors. Patient portals and secure messaging platforms also allow patients to communicate directly with their providers safely and easily. They can seek advice and clarify doubts, fostering a stronger patient-provider relationship. Increased operational efficiency Many providers have hesitated to turn to automation in lieu of human staffing, but implementing automation yields immediate and significant benefits. This includes reduced manual labor, improved workflows and communication, and increased profitability. Self-service tools like Patient Scheduling Software and Registration Accelerator reduce the administrative overhead, so staff can focus on critical tasks that need a human touch. In Experian Heath's survey, 36% of providers said these types of technological improvements have helped to offset staff shortages. By incorporating accurate data from patients' medical records, there's also less risk of data entry errors, which speeds up downstream services and reimbursement. Digital patient access software can also generate performance reports, to drive further operational improvements against the KPIs listed above. What are the main obstacles in implementing patient access solutions?  Implementing patient access software may seem daunting due to resource limitations, outdated technology, and cost concerns. However, with the increasing demand for remote access to digital services, healthcare providers cannot delay any longer. Fortunately, those who have already taken the initiative are experiencing a significant long-term return on investment that outweighs the initial costs. For more complex challenges, a trusted third-party partner can help guide the way. Lack of standardized policies Patient pricing estimates are an essential piece of the patient access experience. However, insurance and reimbursement policies are constantly changing and vary by payer, so delivering accurate estimates is a tough ask. Many hospitals have struggled to comply with new federal price transparency rules. With Patient Payment Estimates, patients can be given an accurate, personalized breakdown of their financial responsibility, sent directly to their phone. Research by Experian Health and PYMNTS suggests that such tools can boost patient satisfaction by 88% and reduce the risk of missed payments. To help providers comply with broader requirements around price transparency, Experian Health has joined forces with Cleverley + Associates to offer a standardized solution. Interoperability and integration with existing systems The lack of compatibility between electronic health records and hospital management software can result in significant errors in patient information. These inaccuracies can lead to miscommunications with patients and payers, as well as delays in providing care and missed opportunities for reimbursement. To avoid this, providers should choose automated patient access tools that integrate with their existing systems. For example, Experian Health clients that already use eCare Next® can integrate additional patient access solutions, such as Eligibility Verification, through the same interface. There's no need for staff to access multiple systems and patient intake is much faster. Comprehensive data analytics give a better overview of operational performance. Safeguarding privacy and data security are also easier with integrated solutions from a single vendor. The future of patient access solutions in healthcare  Rapid technological advancements, evolving policies, and changing patient expectations can make the future of healthcare hard to predict. However, certain patient access trends look set to continue: Patients will increasingly seek out easy-to-use digital platforms for accessing and paying for care, especially as younger generations age and increase their utilization of healthcare services. Patients will increasingly seek personalized care – extending to tailored patient access experiences that reflect individual needs and communication preferences. The use of data analytics and AI will grow exponentially across healthcare services, helping providers identify patterns and automate workflows. Digital patient access services have become an integral part of the healthcare landscape as providers recognize their role in improving patient outcomes and overall business success. In today's healthcare landscape, these services are essential elements to success. Find out more about how Experian Health's patient access solutions can help providers improve patient satisfaction, increase operational efficiency, and future-proof their revenue cycle for years to come.

According to Experian Health's State of Patient Access 2023 survey, providers think recent efforts to improve the patient financial experience are paying off. But do patients agree? The survey, carried out in December 2022, suggests a disconnect between how patients and providers view the patient collections process. Many providers rate their collections services favorably, having invested in pre-service estimates, flexible payment options and tailored payment plans. However, patients see room for improvement and a chance for providers to improve patient collections. Many say they feel anxious about managing medical expenses, with uncertainty prompting some to consider canceling care or switching providers. Could a more compassionate and personalized approach to healthcare billing help patients navigate their financial obligations more easily? Here are 4 ways providers can improve patient collections and create a patient experience that attracts long-term loyalty. 1. Provide proactive price transparency Patients want to know how much their care will cost before they receive it: almost 90% of patients said receiving a price estimate before care is essential. Providers recognize this, and 67% believe their organization is doing a good job of providing clear, understandable estimates prior to care. Unfortunately, only 29% of patients say they actually received one. Easing Digital Frictions in the Patient Journey, a collaborative survey of 2,333 consumers from Experian Health and PYMNTS, found that 82% of patients living paycheck to paycheck with issues paying their bills consider it “very” or “extremely” important to preview out-of-pocket costs before treatment. Among patients who received surprise bills, 40% spent more on healthcare than they could afford, compared with 18% of patients who did not receive surprise bills. Giving patients early clarity with precise pricing estimates helps them plan so they're less likely to avoid care or struggle with unexpected and unaffordable bills. Payments can also be collected faster and more efficiently. Despite the implementation of price transparency regulations, the incorporation of cost estimates into healthcare billing is not yet standardized, presenting a significant gap in the industry. Healthcare providers who prioritize accurate and easy-to-understand cost estimates are more likely to boost patient satisfaction ratings and increase improve patient collections. 2. Create personalized payment plans Personalized financial pathways are essential in healthcare. Patients have unique financial situations, and a one-size-fits-all approach won't suffice. Some patients may prefer to pay their bill upfront so they know it's taken care of, while others may need to spread out the cost into more manageable installments. Advanced data analytics can help providers create a more positive payment experience by assessing each individual's ability to pay and assigning them to the appropriate financial pathway. For example, Collections Optimization Manager scores and segments patients according to their propensity to pay, and automates the presumptive charity process so accounts are handled sensitively and efficiently. Using automation helped the University of California San Diego Health (UCSDH) deliver better patient experiences, maximize collections and reduce the cost to collect. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. UCSDH's Systems Director explains that automation allowed them to maximize staff resources to support patients to understand their bills, as well as provided valuable insights into each patient's situation: “We serve our patients well when we can spend time explaining their bills, what's been covered by their insurer and what payment options they have, so they feel confident in what is owed and why.” Terri Meier, CHFP, CSMC, CSBI, CRCR, System Director of Patient Revenue Cycle at UC San Diego Health, explains how automation helped their organization optimize patient collections and improve patient satisfaction. 3. Provide support to those in need A topic on many providers' minds is Medicaid redetermination, following the loss of Medicaid coverage for millions of patients. Many may be eligible to re-apply, but in the short term, millions could be left floundering financially. Providers can support patients in this situation to sort through coverage, navigate charity eligibility and offer suitable payment plans to keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, says this is both a challenge and an opportunity for providers: “For providers, this may be a hard situation to navigate. At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offer them help can be powerful.” What can providers do as patients lose Medicaid coverage? The priority should be to identify patients who need charity assistance and connect them to any available support. Using credit data and other demographic data points, Patient Financial Clearance screens patients who may still be eligible for Medicaid and finds self-pay patients who may qualify for charity assistance. It also assigns patients to the appropriate pathways and even auto-enrolls them in financial assistance programs so they feel confident they're on the right path. 4. Offer flexible ways to pay Finally, a compassionate billing experience will involve as little friction as possible when the patient comes to making payments. According to the patients who participated in Experian Health's survey, payment experiences should be convenient, transparent and flexible, with 72% expressing a desire for online and mobile payment options. These features are essential to younger generations, who are less tolerant of inflexible, manual systems. Providers should offer a range of payment options that include in-person, telephone, mobile and online patient portals, so patients can pay in a way that's most convenient for them. This also frees up staff to help those patients who may need a little extra help understanding their statements. Experian Health offers a suite of patient payment solutions that enable consumers to make secure payments at any point in their healthcare journey, through multiple channels. From customizable patient statements to mobile-enabled payment methods, these tools support a compassionate and convenient approach to patient billing, turning what can be a confusing process into one that is more efficient for both parties. Improve patient collections with automated solutions Consumers are the cornerstone of healthcare and providing a consumer-friendly payment experience can make a huge difference. Money is often a sensitive topic for patients, but with a consumer-centric payment experience, financial matters can be handled compassionately. Patients will be more satisfied and more likely to pay in full and on time, and providers can improve cash flow. With the right tools, healthcare billing and collections can become seamless and clear, and patients can pay their balances with ease. See how Collections Optimization Manager and other patient payment solutions can maximize and improve patient collections.