Featured

While the healthcare industry remains hesitant about automation, there's one area where digital tools have already proven their worth: patient intake. According to Experian Health's State of Patient Access survey, almost 90% of patients say they welcome digital patient registration, reflecting the growing demand for efficiency and convenience. Staff frustration with mounting paperwork and poorly coordinated manual systems also points to an urgent need for a better way of working. The case for switching from traditional to digital patient intake systems is pretty compelling, even before factoring in potential cost savings. For providers still taking a “wait-and-see” approach, it may be worth considering how digital patient intake could address some of the most common challenges associated with traditional registration methods, such as the following: 1. Online registration can prevent missed opportunities for patient bookings Patients' number one patient access challenge is seeing their doctor quickly. Too many are stopped in their tracks by slow and inflexible intake processes. Inconvenient booking protocols – often requiring phone calls during limited office hours – deter patents, resulting in sluggish scheduling rates and avoidable gaps in physician calendars. Moreover, traditional systems that treat scheduling and registration as two distinct activities miss the chance to accelerate intake because patients have to fill out the same information multiple times. Digital patient intake streamlines scheduling and registration so patients can book and manage appointments anytime, anywhere. With a mobile-first automated platform, patients can provide essential demographic and insurance information at the point of booking, and fill out remaining registration forms whenever it suits with a single click. When intake is easy, bookings increase. 2. Digital patient access can reduce high no-show rates Quick and convenient intake addresses the related challenge of no-shows, which lead to underutilization of services and delayed patient care. If canceling or rescheduling an appointment is easy, patients are more likely to make that little bit of effort to click the link instead of simply not turning up. With accurate patient data coming in at the start, providers can send automated appointment reminders and tailored messages to coordinate follow-ups, so patients are less likely to forget appointments or misremember referral instructions. 3. Digital patient intake can prevent payment delays and claim denials Inefficient registration means patient information passes through multiple hands, resulting in data entry errors that trickle through the revenue cycle. In a recent Q&A, Barb Terry, Product Manager for Registration Accelerator at Experian Health, talked about the importance of ensuring accurate data from the start: “Waiting until the patient's appointment to collect insurance information doesn’t give providers much time to verify insurance, or to determine the patient’s financial responsibility for copays, deductibles, and out-of-pocket expenses… In previous surveys, 40% of providers have said registration errors are a primary cause of denied claims. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.” With Registration Accelerator, patients receive a text to scan their identity and insurance cards, validating the data in real-time and automatically uploading it into eCare NEXT®. Experian Health's Eligibility Verification and Registration QA tools can then use the same verified data, reducing the risk of manual errors that lead to claim denials. 4. Reduce patient stress caused by unclear costs One of the clearest messages from patients in this year's State of Patient Access survey is the need for upfront, transparent information about costs. A disappointing 64% of patients did not get price estimates before care, and of those that did 14% said their estimates were inaccurate. It's extremely challenging for staff to compile all the data points necessary to calculate patient responsibility using traditional systems. Digital tools that automate patient data capture, insurance eligibility verification, coverage discovery and prior authorizations provide financial clarity quickly and accurately, giving patients peace of mind and reducing the burden on staff. By improving the patient billing and payment experience, providers can reduce financial stress for patients and get paid more promptly. 5. Digital patient intake reduces high operational costs and poor use of staff time Traditional registration systems are full of hidden costs, from the hefty price tags associated with paper forms, storage and printing to the time required of admin staff. These expenses are compounded over time by revenue leakage caused by errors in claim submissions and scheduling delays. Staffing shortages mean many providers simply don't have the human power to handle these challenges using manual systems alone. Again, automation comes out on top. Registration Accelerator eliminates the need to scan, fax and file forms and automatically handles patient check-ins, form returns and demographic updates. It is one of a suite of tools that feed into eCare NEXT®, automating up to 80% of the pre-registration process. Anthony Meyers, Director of Patient Access at West Tennessee Healthcare, explains how his team used Registration Accelerator to manage staffing shortages without compromising the patient experience: “We can't train somebody just for them to leave in three months [...] so we looked for digital solutions to help. It's frustrating for patients not to be able to talk to a real person, so I don't ever want to take the personal touch out of healthcare [...] But if we can use technology to make us work faster, harder, smarter and not do things manually, then we've got to do it. And it doesn't mean staff will lose their jobs: we reposition them to do other things to enhance the patient experience.” A digital helping hand for faster, smarter, more accurate patient intake As patient intake challenges continue to grow, digital patient intake stands out as a practical and proven solution to streamline access to care and stabilize cash flow. With Registration Accelerator, staff can focus on critical tasks that drive revenue and make a positive first impression on patients who are looking for a convenient and compassionate healthcare experience. Find out more about how Registration Accelerator expedites patient intake and solves the operational and financial challenges that come with traditional systems. Learn more Contact us

Healthcare claim denials persist as a significant challenge, impacting the efficiency, affordability and timeliness of healthcare delivery and hospitals' financial well-being. They contribute a substantial portion of the staggering $265 billion annual in waste attributed to administrative complexities. On average, hospitals face a yearly loss of $5 million due to healthcare claim denials, amounting to 5% of their net patient revenue, according to the Journal of AHIMA. Yet it appears that the rise in claim denial rates continues unabated. Experian Health's State of Claims 2022 report revealed that 30% of respondents experience medical claims being denied in 10-15% of cases, and 42% confirm an increasing trend in denial rates from one year to the next. There is no question that the claims denial process is ripe for innovation, and that's where reducing healthcare claim denials with artificial intelligence (AI) comes in. Like many other sectors, healthcare providers are slowly but increasingly turning to automation and AI for more accurate data and better insights. The Experian Health survey shows over one-half of healthcare providers turn to AI-driven healthcare claims management software to reduce claim denials. "Adding AI in claims processing cuts denials significantly," Tom Bonner, Principal Product Manager at Experian Health, explains. AI automation quickly flags errors, allowing claims editing before payer submission. It's not science fiction—AI is the tool hospitals need for better healthcare claims denial prevention and management." The current challenges in claims management High patient volumes and complex payer policies Experian Health's 2022 State of Claims survey revealed that reducing denials was a top priority for almost three-quarters of healthcare leaders. Why? High patient volumes mean there are more claims to process, and changing payer policies and insurance coverage compound an already overwhelming problem. An Sg2 report predicts that patient volume issues will continue over the next decade, with inpatient hospital volumes growing by 2%. This rise in patient numbers will require more data for claims management processing. Hospitals, often short-staffed, will have to allocate more resources to ensure claim approval and increase efforts to address claims denial. In addition to managing increasing patient volumes, keeping track of changing payer coverage and requirements has always been challenging for providers. The inconsistency of these payer rules and communication problems exacerbate the situation. Healthcare providers may need efficient solutions to keep up with these rule changes or allocate more time and resources to addressing and revising claims. Labor shortages and financial pressures According to a data brief from the American Hospital Association, the increasing rate of clinician burnout, the enduring effects of COVID-19, and ongoing strains on the healthcare workforce are compelling hospitals to recognize and tackle chronic labor shortages. Notably, 80% of healthcare leaders acknowledge that chronic staffing shortages present significant risks for their organizations. Increasing denial rates is one way these risks manifest. As the State of Claims 2022 report confirms, 30% of respondents mentioned staffing shortages significantly contribute to healthcare claim denials. Additionally, Experian Health's recent survey, Short Staffed for the Long-Term, which investigated the impact of healthcare staffing shortages, found that 70% of respondents facing staff shortages also experienced increasing denial rates. Labor shortages mean fewer hands on deck to deal with the claims processing workload, while financial pressures on hospitals mean the stakes are higher than ever to solve the problem of claim denials. Limitations and costs of manual claims processes Health payers deny hospital systems about $260 billion worth of inpatient claims annually. According to Experian Health's survey, manual processing and a lack of automation are the primary reasons for these medical claim denials. The State of Claims 2022 report found that 61% of respondents do not automate claims submission and denial prevention processes, leaving them to rely on manually processing claims. However, manual claims management tools simply cannot keep up with the complexities and data-intensive nature of claims processing. When claims processes are handled manually, healthcare workers are burdened with cumbersome tasks that could have been automated, there is a higher risk of errors that lead to claims denial, and there'll be more need to dedicate extra time and effort to appeal denied claims. These intensive steps necessary for manual claims processing drain staff resources and create opportunities for money and time waste that are eventually detrimental to the hospital's financial circumstances. How AI and automation address healthcare claim denials Automation and AI can ease the pressure by processing more claims in less time. They give providers better insights into their claims and denial data so they can make evidence-based operational improvements. AI tools achieve this by using machine learning and natural language processing (NLP) to identify and learn from data patterns and synthesize huge data swathes to predict future outcomes. While AI is ideal for solving problems in a data-rich environment, automation in claims processing can complete rules-based, repetitive tasks with incredible speed and reliability that a person might not achieve. By using automation and AI in claims processing, healthcare providers can gain better insights into their claims and denial data, resulting in improved financial performance and greater efficiency. Tom Bonner says, "AI in healthcare claims processing maximizes the benefits of automation for better claims processing, better customer experiences and a better bottom line for healthcare providers." However, the pace of AI adoption is somewhat slower in healthcare due to legacy data management systems and data silos. As efforts to improve interoperability progress, providers will have more opportunities to deploy AI-based technology. This prediction is already evident in claims management, where executives are keeping an ear to the ground to learn of new use cases for reducing claim denials with AI to help maximize reimbursements. Key benefits of AI in healthcare claims management Healthcare claims management upgraded with the inception of AI-driven healthcare claims management software exponentially benefits claims management through its predictive, accuracy, and error-reduction capabilities. Predictive Analytics and Pattern Recognition: The benefits of AI in healthcare claims processing lie in the ability of AI-driven solutions to predict potential issues before they occur by analyzing claims and providing a probability of denial that allows the end user to intervene and determine the appropriate collection. AI can analyze patterns in historical claims data to predict future volumes and costs, so providers can plan accordingly without simply guessing at what’s to come. Error Reduction and Clean Claim Submissions: AI can also assist in identifying inaccurate claims and improve claims processing accuracy to ensure clean claim submission and efficient revenue cycle management. Case studies and real-world applications AI and automation in claims processing are helping healthcare providers overcome the challenges contributing to increasing claim denial rates. Experian Health's AI-driven and automation solutions, like AI Advantage™, enable clients to benefit from the full potential of AI and automation to minimize claim denials. How Community Medical Centers uses AI Advantage to predict and prevent healthcare claim denials Community Medical Centers (CMC), a non-profit health system in California, uses Experian Health's new solution, AI Advantage, which uses AI to prevent and reduce claim denials. Eric Eckhart, Director of Patient Financial Services, says they became early adopters to help staff keep up with the increasing rate of denials, which could no longer be managed through overtime alone. "We were looking for something technology-based to help us bring down denials and stay ahead of staff expenses. We're very happy with the results we're seeing now." AI Advantage reviews claims before they are submitted and alerts staff to any likely to be denied based on patterns in the organization's historical payment data and previous payer adjudication decisions. CMC finds this particularly useful for addressing two of the most common types of denials: those denied due to lack of prior authorization and those denied because the service is not covered. Billers need up-to-date knowledge of which services will and will not be covered, which is challenging with high staff turnover. AI Advantage eases the pressure by automatically detecting changes in how payers handle claims and flagging those at risk of denial so staff can intervene. This reduces the number of denials while facilitating more efficient use of staff time. Eckhart says that within six months of using AI Advantage, they saw 'missing prior authorization' denials decrease by 22% and 'service not covered' denials decrease by 18% without additional hires. Overall, he estimates that AI Advantage has helped his team save more than 30 hours a month in collector time: "Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in-house and save money. The savings have snowballed. That's really been the biggest financial impact." How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Providence Health is a prominent health system with 56 hospitals and over 1,000 physician clinics, serving an annual patient volume of over 28 million. This magnitude of patient volume created greater issues with slow and manual payer eligibility processes and increased eligibility denials. Furthermore, in response to Epic's growing payer plan table, Providence Health sought an effective solution to merge and organize data on insurance plans, contracts, and reimbursement details and automate eligibility tracking within the system. Their search led them to Experian Health's Insurance Eligibility Verification solution. According to Emily Brown, Director of Operation Excellence, "Our search for a solution that seamlessly integrates with Epic led us to choose Experian as our preferred vendor, given their proven track record of working with Epic." Providence Health implemented Experian's Eligibility solution, including a Bad Plan Code Detection tool to catch coding errors before submission. The solution also allowed them to stay connected to over 900 payers and provide backup connectivity to over 300 additional payers for uninterrupted service. The solution's automated work queues also helped staff work more efficiently. Providence reduced denial rates, saving $18 million in potential denials in 5 months of implementing Experian's Eligibility solution. The tool also helped them find $30 million in coverage annually while reducing staff workload. How Schneck Medical Center prevents and triages denials with AI Advantage™ Schneck Medical Center delivers care to four counties in Indiana, supported by a team of over 1,000 employees, 125 volunteers, and close to 200 physicians. According to Skylar Earley, Director of Patient Financial Services, "The challenge we (Schneck Medical Center) sought to overcome by leveraging AI Advantage at our organization was just gaining more insight into how denials originate and what actions we can take to prevent those from happening." Schneck Medical Center collaborated with Experian Health to implement: AI Advantage™ — Predictive Denials and AI Advantage™ — Denial Triage. They aimed to use these tools to identify claims that were more likely to be denied so that the appropriate personnel could address them and clean them before sending them to payers. They also wanted to be able to identify and prioritize denials with the potential for revenue reimbursement that will impact their bottom lines. AI Advantage™ — Predictive Denials enabled team members to make informed and timely decisions before submitting claims. In the first six months of using the tool, Schneck achieved a 4.6% average monthly decrease in denials. The time spent on denials decreased by 4x, and flagged claims were resolved in 3–5 minutes rather than the previous 12–15 minutes per correction. With AI Advantage — Denial Triage, billers were able to redirect their effort on denials more likely to be reimbursed. This prioritization enables them to avoid wasting time on high-dollar claims that are unlikely to be paid. "We had no insight into whether we were performing value-added work when we followed up and worked denials. Now we see those percentages," says Skylar Earley, Director of Patient Financial Services Steps to implementing AI in claims management AI Advantage works in two stages in claims management, reducing claims denial and addressing denied claims to prioritize those with the best value for reimbursement. Stage One: Predictive Denials Stage one is Predictive Denials, which uses machine learning to look for patterns in payer adjudications and identify undocumented rules that could result in new denials. As demonstrated by CMC and Schneck Medical Center, this helps providers prevent denials before they occur. Stage Two: Denial Triage Stage two is Denial Triage, which comes into play when a claim has been denied. This component uses advanced algorithms to identify and segment denials based on their potential value so staff can focus on reworking the denials that will impact their bottom line. Enhancing revenue cycle management with AI Embracing integrated workflows uncovers novel applications for reducing healthcare claim denials with AI and automation. AI Advantage seamlessly works within ClaimSource®, which means staff can view data from multiple claims management tools in one place. These integrations amplify the benefits of each tool, giving healthcare providers better insights into their claims and denial data. With richer data, organizations will find new ways to leverage AI to increase efficiency, reduce costs and boost revenue. Key differentiators In addition to its AI solutions, Experian Health offers solutions that automate claims processing to facilitate claims management and increase efficiency. ClaimSource® helps providers manage the entire revenue cycle by creating custom work queues and automating reimbursement processing. This intelligent healthcare claims management software ensures clean claims before they're submitted, helping to optimize the revenue cycle. The software generates accurate adjudication reports within 24 to 72 hours to speed up reimbursement. ClaimSource ranked #1 in Best in KLAS 2024, for its success in helping providers submit complete and accurate claims. This tool prevents errors and helps prepare claims for processing. Because the claims are error-free, providers can optimize the reimbursement processes and get their money even faster. Another Experian Health solution, Enhanced Claim Status, improves cash flow by responding early and accurately to denied transactions. This solution gives healthcare providers a leg up on denied, pending, return-to-provider, and zero-pay transactions. The benefits include: Provides information on exactly why the claim was denied Speeds up the denials process Automates manual claims follow-ups Integrates with HIS/PMS or ClaimSource Automation frees up staff to focus on more complex claims Denials Workflow Manager integrates with the Enhanced Claim Status solution to help eliminate manual processes, allowing providers to optimize claims submission and maximize cash flow. Using AI and automated solutions to prevent healthcare claim denials There's no question that healthcare claims denials management is an unwieldy, time-consuming, and ever-changing process. Reimbursement is complex, but human error plays a large part in missed opportunities and lost revenue. The revenue cycle becomes seamless with AI and automation in healthcare claims management. Any healthcare provider seeking faster reimbursement and a better bottom line knows that improving claims management is critical to better cash flow. AI and automation-driven claims management software offers healthcare organizations a way to achieve these goals. Contact Experian Health today to prevent healthcare claim denials and improve your claims management process with AI Advantage and other denial management solutions.

Patients increasingly expect convenience and efficiency in all aspects of their lives, including healthcare. A study by Experian Health shows that 89% want the ability to schedule appointments anytime via online or mobile tools. The same survey showed providers are listening, with 63% offering self-scheduling and another 16% planning to go live with these tools in six months. That's good news for everyone, and not just because patients say they want more digital tools to manage their healthcare. Online scheduling addresses patient expectations by offering a range of benefits that traditional scheduling methods cannot match. However, these benefits aren't just for patients; healthcare providers that deploy online patient scheduling software experience four impressive benefits with a direct impact on their revenue cycle. What is online patient scheduling software? Online patient scheduling software is a digital tool designed to facilitate the appointment booking process for healthcare providers and their patients. This patient access technology replaces traditional over-the-phone scheduling methods with an efficient and user-friendly online system. The key features of patient digital scheduling platforms include: 24/7 appointment booking: Patients can schedule appointments at any time, day or night, providing flexibility and convenience that traditional methods cannot offer. Automated reminders: The software sends automatic reminders via email or SMS to reduce the likelihood of missed appointments. Real-time availability: Patients can view and select available time slots in real-time, ensuring they can find appointments that fit their schedules. Calendar integration: The software integrates with the provider's existing calendar systems to ensure that all appointments are accurately tracked and managed. Customizable scheduling: Healthcare providers can customize the software to reflect their specific scheduling rules, such as appointment types, durations, and provider availability. Manual scheduling frustrates patients and providers. Online patient scheduling allows patients to regain control while increasing their engagement in managing their health. Why do patients prefer online scheduling? Patients want online scheduling software because it aligns with their desire for convenience, efficiency, and control over their healthcare experience. One of the primary reasons to use online scheduling software is its round-the-clock availability. Patients can book appointments without office-hour restrictions. Online scheduling software allows patients to select time slots best suited to their schedules, minimizing the time spent waiting on hold during phone calls or in busy waiting rooms. Patients can easily see and compare availability, making planning their visits easier around personal and professional commitments. It also makes canceling or rescheduling appointments less of a hassle. One common issue patients face is forgetting about their appointments. Online scheduling software often includes automated reminders and confirmations via email or SMS, helping patients remember their upcoming visits. Some patients may also feel uncomfortable discussing their medical issues over the phone or in person at the front desk. Online scheduling offers a more private and discreet way to book appointments, allowing patients to select services without disclosing personal information to multiple people. Bringing digital efficiencies to healthcare scheduling leads to a more positive patient experience. One study showed that 28% of patients say care access has improved over the past year, even as more providers adopt these new technologies. But it's not just patients who benefit from online patient scheduling software. There are plenty of incentives for healthcare providers to adopt these tools. Healthcare providers benefit from online patient scheduling By adopting this technology, healthcare providers can streamline operations, improve patient satisfaction, and ultimately deliver higher-quality care. Experian Health offers online patient scheduling software that meets the needs of patients while benefiting providers. For example, Indiana University Health (IU Health) deployed the software across 16 hospitals and the largest network of physicians in the state. The organization leveraged the solution to increase patient volumes with minimal staff training, improving patient utilization by 114% within the first year. Today, four employees can handle patient scheduling for up to eight service lines. An unexpected benefit was the increase in referral management; the software enabled 600 monthly referral appointments, helping to generate new revenue for the system. These results are typical; most providers find the benefits of online patient scheduling software include: Reduced staff training time Improves the scheduling process for patients and providers Decreases patient no-shows Increases patient volumes and revenue Speeds up staff training One of the most significant challenges in any healthcare setting is training new staff quickly and effectively. Getting new staff up to speed rapidly is essential when severe staffing shortages are the norm. Experian Health's online patient scheduling software simplifies training. Its user-friendly interface and intuitive design reduce the learning curve for new employees to about an hour. The software provides guided workflows and real-time assistance, translating to less time spent on training and more time focused on patient care. Streamlines scheduling time Traditional scheduling methods can be time-consuming and prone to errors; 62% of providers say chronic staffing shortages exacerbate the problem. Online scheduling streamlines the entire process, cutting scheduling time in half over traditional methods. By allowing patients to book appointments online, the software reduces the back-and-forth communication typically required for scheduling. Automated reminders and confirmations ensure efficient appointment management. The calendar integration feature allows real-time updates and availability checks, providing a convenient booking process that enhances the patient experience. Improves patient no-show rates Patient no-shows can be a significant issue for healthcare providers, leading to lost revenue and wasted time. Experian Health's online scheduling software tackles this problem head-on. The software includes automated email or SMS appointment reminders, significantly reducing the likelihood of patients forgetting their appointments. Additionally, the ease of rescheduling allows patients to adjust their appointments without the hassle, further decreasing no-show rates. By keeping patients informed and engaged, the software helps ensure they attend their scheduled appointments, improving the clinic's efficiency and patient satisfaction. Josh Brown, Program Manager for Provider Match at IU Health, stated, “We've seen a reduction in no-shows and an increase in patient engagement. By leveraging technology and data analysis, the guided scheduling platform has helped deliver better care more efficiently and effectively.” Increases patient volumes and revenue Online patient scheduling directly contributes to increased patient volumes by improving scheduling efficiency and reducing no-show rates. More patients can schedule in less time, and the reduction in no-shows means fewer appointment slots go unused. The convenience of online scheduling can attract new patients who prefer digital interactions over traditional phone calls. These benefits lead to higher patient volumes and increased revenue for the healthcare practice. Today's digitally-savvy healthcare consumers require a different approach to scheduling services. Online patient scheduling offers them the convenience of DIY appointment setting and has some surprising benefits for healthcare providers, too, making these solutions a win for everyone. Ready to make the move to online scheduling? Contact Experian Health to get started! Improve patient scheduling Contact us

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

The Price Transparency Rule, effective January 1, 2021, requires hospitals to provide clear and accessible pricing information about their items and services online. Although the rule is simple in theory, hospitals are finding it challenging to implement. Under the rule, hospitals can make their pricing information clear and accessible by publishing it online as a comprehensive machine-readable file (MRF) with all items and services and in a display of shoppable services in a consumer-friendly format for at least 300 shoppable services. The Centers for Medicare & Medicaid Services (CMS) states that the rule aims to "help Americans know the cost of a hospital item or service before receiving it." This rule represents a giant stride towards delivering much-needed and long-awaited benefits associated with price transparency. These include empowering consumers to make informed healthcare purchasing decisions based on the costs and benefits involved, enabling cost predictability and closing the information gap between providers and patients. It is also an eye-opener for consumers, preventing them from falling victim to wide price discrepancies prevalent in an opaque pricing system. As Tricia Ibrahim-Zafari, Director of Product Management at Experian Health, states, "The requirements are meant to help patients become true consumers of healthcare." However, the success of the concept of price transparency hinges on hospitals adhering to and implementing the rule. Unfortunately, reports have found that hospitals have struggled with compliance since the rule was enacted. One of the reports, published in February 2024 by the Patient Rights Advocate, found that three years after the Hospital Price Transparency Rule took effect, only 34.5% (689) of the 2,000 U.S. hospital websites analyzed fully complied with the rule's requirements. One of the barriers to the adherence to and successful implementation of this rule is its constant and frequent evolution, making it challenging for hospitals without efficient price transparency solutions to keep up. Stricter penalties due to low compliance rates, increased public access to pricing and the challenging financial environment prohibiting flexible price changes exacerbate existing pressure on hospitals, Ibrahim-Zafari explained. The good news is that hospitals looking to meet the transparency requirements, including the Price Transparency 2024 updates while delivering high-quality care for all, can explore Experian Health and Cleverley & Associates solutions for Price Transparency compliance. These price transparency tools in healthcare help providers comply with the Price Transparency Rule, improve price defensibility and create financial opportunities, as affirmed by Ibrahim-Zafari. Price Transparency 2024 updates: the latest in the price transparency regulatory environment Jamie Cleverley, President of Cleverley & Associates, emphasized that the earlier language of the Price Transparency rule is grounded in provisions of the Affordable Care Act (ACA) and displays noteworthy similarities. Both require making consumer-relevant information easily accessible for easier comparison shopping and providing insights into negotiated rates between clinicians and insurers in a machine-readable format. However, the Price Transparency rule has evolved ever since. Since its introduction in 2021, the Price Transparency Rule has been continuously updated to better align with its intent, to adapt to the changing healthcare landscape and to encourage compliance. For example, Ibrahim-Zafari noted that in 2022, CMS increased the penalty for non-compliance with price transparency requirements from $110,000 to over $2 million a year. Additionally,  the agency imposed stricter timelines for hospitals to address pricing data issues and streamlined the enforcement process. The Price Transparency 2024 updates required to be implemented by hospitals on January 1, 2024, July 1, 2024 and January 1, 2025, fall under five broad categories: new definitions, good faith estimate and machine-readable file (MRF) attestation, ​​standardization of the MRF format and data elements, improving access to hospital MRFs and enhancing enforcement and compliance. Put simply, CMS established definitions for specific terms in regard to the new definitions category. Let's delve into the remaining categories under the price transparency 2024 updates. Good faith estimate and machine-readable file (MRF) attestation The good faith estimate and MRF update emphasize hospital leadership's obligation to verify the MRF content's comprehensiveness and accuracy. Good faith effort - Starting January 1, 2024, CMS requires every hospital to make a good faith effort to ensure that the standard charge information stored in the MRF is accurate and complete. MRF Attestation - Starting July 1, 2024, hospitals must attest to the completeness and accuracy of the applicable standard charge information in their MRF. Cleverley explains that the good faith effort update does not require hospitals to include any attestation on their website or in their machine-readable file. However, beginning July 1, hospitals will be required to use the CMS template for the MRF, which includes an attestation comment, where they must select true or false. Standardization of the MRF format and data elements CMS also introduced updates that ensure the standardization of the MRF formats and data elements across the board. Starting on July 1, 2024, hospitals must format the contents of the MRF into a specific template. This template can be in either .JSON or .CSV format. According to Cleverley, the .JSON format is digital-friendly, making it the preferred option for hospitals. The .CSV format, on the other hand, is more consumer-friendly. Furthermore, the Price Transparency 2024 updates introduced additional required data elements, including five types of standard charges. Some of the new data elements, including "Estimated Allowed Amount," "Drug Unit of Measurement," "Drug Type of Measurement," and "Modifiers," have been stated to be implemented on January 1, 2025. Improving access to hospital MRFs To make hospital MRFs more accessible, CMS requires that from January 1, 2024, hospital websites must include a .txt file in the root folder containing their MRF and contact information. In addition, hospitals are required to include a "footer" at the bottom of their homepage, linking to the webpage that hosts the MRF. Enhancing enforcement Considering that hospitals have been slow to comply with the price transparency requirements, it's not surprising that CMS is ramping up its enforcement efforts through four measures. Increasing scrutiny of hospital compliance efforts - CMS is increasing scrutiny by authorizing comprehensive compliance reviews. Under the Price Transparency 2024 updates, they can also request hospitals to have an authorized official certify the accuracy and completeness of MRF data and submit additional documentation, including payer contracts, to evaluate compliance. Acknowledging warning notices - Hospitals must confirm receiving warning notices from CMS whenever they receive such notice. Addressing system-wide non-compliance - If CMS finds a hospital part of a health system to be non-compliant, they can notify the health system's leadership to address potential defaults from other hospitals within the health system. Publicizing actions and outcomes - CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. Experian Health and Cleverley + Associates solutions for price transparency compliance Compliance with the Hospital Price Transparency Rule is indispensable to achieving price transparency. To support providers in adhering to these rules in the best and most efficient way possible, Experian Health and Cleverley & Associates solutions to provide solutions that ensure maximum compliance while improving price defensibility and creating revenue opportunities. Experian Health's Patient Payment Estimates help providers compile a consumer-friendly list of shoppable service items. Cleverley & Associates provides fully compliant and comprehensive machine-readable files for the hospital's "items and services." The price transparency tools in healthcare are available in two options to cater to the specific needs of healthcare organizations: Machine-Readable File - Standard: This solution provides machine-readable files only in the standardized payer-specific negotiated charge format. Machine-Readable File - Premium: This package provides a price transparency machine-readable file and includes consulting services to assist with price changes. Navigating price transparency requirements in the ever-changing healthcare landscape can be daunting. However, the task becomes seamless with solutions from Experian Health and Cleverley & Associates for price transparency compliance. Healthcare organizations can now stay up to date with and meet evolving transparency rules while also improving profitability. Watch the on-demand webinar, featuring experts from Experian Health and Cleverley & Associates, to learn more about the new updates and explore the latest developments and strategies to navigate price transparency in 2024.

Claim denials are costly to correct and resubmit. They impede revenue flow, slow down patient care delivery, contribute to poor patient experience and satisfaction, increase administrative workload and take up limited staff time and resources. While they're avoidable, Experian Health's State of Claims 2022 report shows that 30% of respondents say denials are increasing between 10-15% year over year, which costs health systems billions of dollars. Moreover, rebilling payers often proves fruitless. Despite taking up resources and staff time and productivity and slowing down healthcare delivery, reworked and resubmitted claims denials often face repeated rejection. A KFF brief on claims denial noted that even though it's uncommon for consumers to resubmit denied claims, insurers usually stick to their original decision when resubmissions occur. Unsurprisingly, preventing claims denial and streamlining the claims management process has become a pressing need for revenue cycle leaders. The report also revealed that 70% of respondents consider claims management and reducing denials as top priorities. However, the reality of a drop in claim denial rates becomes tangible only when healthcare organizations start to automate claims processes. Claim Scrubber sets the standard as a software solution that effectively reduces denial rates, by ensuring that providers submit clean claims from the start. What is Claim Scrubber? Claim Scrubber is an automated software solution that helps healthcare providers identify errors that may lead to incorrect billing and claims denials and submit clean, thorough and accurate claims every time. It reduces undercharges and denials, ensures timely billing and payments, improves staff time and productivity and increases cash flow and bottom lines. This tool is built to seamlessly complement Experian Health's other claims processing solutions, including ClaimSource® and Denial Workflow Manager. By adopting these solutions, healthcare organizations can enjoy the full range of benefits in their claims processing and management experience while benefiting from timely, uninterrupted cash flow and higher revenue. How does Claim Scrubber work? Claim Scrubber is designed to consistently and reliably help healthcare staff produce clean and accurate claims that are more likely to be approved by payers. Here's how: Claim Scrubber meticulously analyzes each line of every pre-claim to ensure accurate coding and information before submission to the claims clearinghouse. After completing the analysis, Claim Scrubber provides general and payer-relevant edits that pinpoint incorrect code combinations or other issues that could lead to claim denial. These edits are stored within the Claim Scrubber portal and can be conveniently accessed by users from their PMS and HIS. Claim Scrubber details reasons for flagging a claim so users can make appropriate corrections before submission. Claim Scrubber enables users to make edits in alignment with payer policies by using Experian Health's comprehensive database of commercial payer policies and content. Claim Scrubber also identifies when the billed amount is less than the payer-allowed amount, helping health systems catch and correct undercharges. Claim Scrubber cleans claims, making them error-free by working with the latest and most up-to-date data. Claim Scrubber is fully functional in batch mode. Claim Scrubber operates on a secure VPN connectivity feature to ensure secure and rapid responses for real-time integrations. How can Claim Scrubber help improve claims management? Claim Scrubber optimizes claims processing by providing revenue cycle decision-makers and their teams with solutions that identify potential coding and billing errors upfront, ensure error-free claims submission to payers or clearinghouses, prevent undercharges and underpayment, increase first-time pass rates and prevent costly, time-consuming rework and rebilling that may result in a second rejection. Additionally, Claim Scrubber enables healthcare organizations to comply with and meet price transparency rules by staying updated on coding variances. Users can also revise flagged claims, ensuring appropriate and accurate corrections are made with access to Experian Health's extensive commercial payer policies and content database. Claim scrubbing occurs within 2.7–3.0 seconds, ensuring speedy transaction processing that leads to faster reimbursements. Healthcare organizations can also enjoy these benefits without the hassle of needing servers, regular maintenance and downtime with Experian Health's cloud-based application. See how State of Franklin Healthcare Associates used Claim Scrubber to expedite accounts receivable (A/R) by 13% and reduced full-time employee (FTE) requirements even as claims volume grew. Read the case study Healthcare organizations that automate claims management gain advantages that benefit all stakeholders and bottom lines. Claim Scrubber enhances operational efficiency, staff productivity, resource utilization, patient experience and satisfaction and hospital cash flow and financial growth. Contact us today to learn how Experian Health's Claim Scrubber software can help your healthcare organization submit clean, thorough claims and get paid faster and more accurately. Learn more Contact us

According to Experian Health's State of Patient Access Survey 2024, eight in ten healthcare providers plan to invest in patient access improvements soon. As they weigh up the pros and cons of different solutions, many will focus on two key areas: making scheduling and registration easier for patients, and streamlining financial processes to boost their profitability. This blog post examines how automated patient access solutions can help providers meet patient expectations and operational demands. Survey snapshot: what do patients want? Experian Health's annual State of Patient Access surveys are useful pulse checks on patient perceptions. What do patients find challenging about accessing care? Where are they bumping up against unnecessary friction? The 2024 survey offers a promising outlook: 28% of patients report improvements in access in the last year, up from just 17% in 2023. Still, there is room for improvement: patients' biggest challenge – seeing a practitioner quickly – has topped the list for the last four years. Other significant challenges include understanding the cost of care and scheduling appointments. The State of Patient Access 2024 survey examines the perspectives from patients and providers on their perceptions of access to healthcare. Download now One key takeaway from the survey is the role of digital technology. Both patients and providers find complex, repetitive and inefficient processes to be the most problematic aspects of patient access – ideal targets for digital tools. Indeed, patients specifically express a desire for online health management tools, while more than half of providers attribute improvements in patient access to automated processes. There's a solid business case for investing in digital patient access solutions to ensure that patients see their doctors quickly and providers get paid without delay. Patient access solutions can open the digital front door with online scheduling and registration The first area where providers may consider investing in digital tools is in the patient's first interactions with their facility. When patients can schedule appointments quickly and complete registration without boring and repetitive paperwork, they're more likely to report a positive patient experience. Survey data backs this up: 89% of patients say the ability to schedule appointments any time, via online or mobile tools, is important to them 89% of patients say digital or paperless pre-registration is important to them. Online self-scheduling gives patients 24/7 access to book, cancel, and reschedule appointments from any device. Based on scheduling rules, they're shown the earliest suitable appointment, which means they'll see their doctor as soon as possible. Patients can be sent automated reminders of upcoming appointments and health checks, which means show rates and health outcomes will be better. It also drastically reduces call volumes so staff can focus on other priorities. Similarly, digital registration lets patients avoid the most dreaded part of patient intake: filling out lengthy forms in the waiting room. Automated registration also ensures that patients (specifically their data) are correctly entered into the system, preventing downstream delays. With text-to-mobile registration, patients are sent a text message prompting them to scan their identity and insurance cards, which are then uploaded and validated against existing records. Securing correct information from the start lays the groundwork for the patient's healthcare experience and the provider's revenue cycle. Interestingly, despite patient demand, self-scheduling and registration did not make the cut for providers' top three priorities. This suggests an untapped opportunity for providers that choose to invest here. Anthony Myers, Director of Patient Access at West Tennessee Healthcare, shares how their organization worked with Experian Health to accelerate and improve the registration process with Registration Accelerator. Watch now Patient access solutions can streamline insurance, eligibility and estimates A second opportunity lies in automating the patient access processes involved in revenue generation and claims submission. The revenue cycle is full of hidden costs for both patients and providers, often resulting from intake inefficiencies. Patients end up with bills that are higher than expected, while providers fall foul of changing payer requirements around prior authorizations and insurance eligibility verification, resulting in lost revenue. Improving upfront pricing estimates and clarifying insurance coverage ranked among the most urgent priorities for both groups in the survey. A few patient access solutions that can help here include: Patient estimates: When patients know in advance how much their care will cost, they can plan better. Web-based and mobile-enabled price transparency tools generate accurate estimates based on chargemaster data, claims history, patient insurance details and payer contract terms, and even account for payment plans and prompt-pay discounts. This improves the patient experience and increases collection rates while easing the burden on staff. Insurance eligibility verification: Manual processes for verifying active coverage are time-consuming and error-prone, causing staff burnout and patient confusion. Automating insurance verification checks at the time of service gives everyone greater certainty and prevents payment delays and claim denials. Personalized payment plans: By using their own data, along with third-party datasets, providers can leverage automation to offer alternative payment plans to patients who cannot pay the full amount right away. For example, PatientSimple® assesses each patient's propensity to pay and recommends the optimal financial plan that works for the patient's unique circumstances. Patients can check estimates and compare pricing plans on the self-service portal, giving them more control over their bills. These options promote financial sustainability by quickly identifying how much should be paid by which party and establishing processes to collect those amounts with minimal fuss. With ongoing staffing shortages, these time-saving tools are crucial for workforce resilience. Integrate patient access solutions with Patient Access Curator While providers may prioritize one of the above areas, the two are complementary: efficient scheduling and registration lead to better patient flow and accurate data collection, accelerating insurance and eligibility verification. This is more likely with an integrated “tech stack” across the whole patient access workflow. However, integration is a challenge for many providers. Nearly a quarter report that their biggest challenge in patient access is wrangling the multitude of tools needed to run pre-registration checks and gather the information necessary for claim submissions. Experian Health's newest patient access solution addresses this challenge by bringing together multiple insurance-related queries together into a single inquiry. With one click, Patient Access Curator automatically captures all relevant patient insurance data in less than 30 seconds. This includes: Eligibility verification, including billable secondary and tertiary coverage, chaining and primacy Coordination of Benefits, analyzing payer responses in real-time using AI to ensure no active insurance is missed Medicare Beneficiary Identifiers, using AI, automation and analytics to check and correct patient identifiers Patient demographics, using in-memory analytics and proprietary algorithms to ensure contact details are current Coverage and financial status, including automatic checks to find any existing coverage for accounts marked as self-pay or unbillable, and generate a summary of each patient's propensity to pay. With over $1 billion saved in prevented denials by clients using Patient Access Curator, it's clear that investing in digital technology is a cost-effective way to address current challenges in patient access. By increasing capacity and reducing errors and delays, these tools not only enhance financial performance, but give providers a head start when it comes to delivering an outstanding patient experience. Learn more about how Experian Health's patient access solutions accelerate access to care and streamline revenue generation from the start.

Once hesitant, the healthcare industry is slowly embracing artificial intelligence (AI)'s potential. Healthcare stakeholders, particularly those in revenue cycle management, are now interested in exploring AI-driven technology solutions to tackle daunting administrative tasks. According to data highlighted by the Journal of AHIMA, two-thirds of health systems are adopting AI to support revenue cycle processes. AI offers solutions that address the complexities of medical billing, insurance claims, and patient payments and enhance hospitals' financial health. The potential savings from AI adoption in healthcare spending could range from $200 to $360 billion annually, making it a compelling option for revenue cycle leaders looking to save more in far less time and with fewer resources. AI-powered tools show strong promise to reshape how revenue cycle leaders manage the most pressing issues in revenue cycle management, offering an efficient and seamless solution to complex revenue cycle tasks, including automated data entry and real-time insurance verification. Read on to discover more about the role of AI in revenue cycle management and how best to take advantage of robust AI solutions to streamline claims processing. How is AI used in revenue cycle management? The state of the average healthcare revenue cycle today reveals a pressing need for improvement. According to Experian Health's State of Claims 2022 report, reimbursement cycles are getting longer and claim errors and denials are rising. Here are everyday revenue cycle management challenges that AI-powered solutions can efficiently solve. AI can help manage complex billing procedures Accurate medical billing is the first step towards guaranteeing claims approval, yet data indicates that revenue cycle managers are falling short in this critical area. Errors in medical billing cost the U.S. healthcare system approximately $935 million weekly, highlighting the urgent need for improvement in the medical billing processes. Navigating the intricate landscape of insurance plans, billing codes, and patient payments can be overwhelming. Each insurance plan has unique nuances and requirements, adding to the complexity. Moreover, the success of a billing process relies on accuracy, which may be near impossible with manual handling. Adopting AI into every aspect of the billing cycle can streamline and improve the billing process while ensuring accuracy at every stage. AI-powered billing solutions like Patient Access Curator effectively manage critical aspects of the process, including verifying a patient's coverage and eligibility and fixing billing errors. Accurate billing significantly reduces the potential for rejected claims, creating opportunities for more efficient healthcare operations and saving money. AI in RCM can help prevent claim denials  According to The State of Claims 2022 report, 200 health professionals surveyed stated that 5% to 15% of claims are denied. These denials result in hospitals losing billions of dollars, approximately $260 billion per year, forcing them to write off massive amounts of debt, as noted in the Journal of Managed Care & Specialty Pharmacy. Insurance claims denials often result from inadequate data and analytics to identify submission issues, manual claims processing, and insufficient staff training. These denials affect the hospital's revenue and create additional administrative work to rectify the errors. The downstream effect is that patients may receive bills in error and end up paying the out-of-pocket bills if resolution does not occur. AI can make a huge difference, turning the bleak trend of increasing claim denials into a more positive experience for hospitals and patients. Encouragingly, The State of Claims 2022 report reveals that over half of healthcare providers use AI-powered healthcare claims management software to prevent claim denials. Among these AI-powered software solutions, Experian Health's AI Advantage™, when used in conjunction with ClaimSource®, an automated claims management system, stands out as a valuable solution for bolstering denial prevention efforts, improving claims management, and increasing revenue savings. Reduce patient payment delays With the rise in high deductible health plans, patients are putting off or not making payments, affecting the hospital's cash flow. According to medical billing analysts, people with health insurance, who previously accounted for only a fraction of hospital debtors, now constitute the majority of debtors in American hospitals. Hence, patient payment delays are now serious roadblocks to seamless revenue cycle management. On the provider end, there's also the challenge of swiftly verifying a patient's coverage and estimating their medical bill without any margin for error. Billing mistakes, surprise expenses, and complex payment processes can make it challenging for patients to manage their finances and make payments as early as possible. On the other hand, early and accurate estimation of patients' financial responsibility can help patients understand and appropriately plan for medical bills in advance. However, achieving the latter experience for patients involves sifting through constantly growing data, compounding the strain on limited hospital resources. That's where AI-powered revenue cycle management solutions can help. With solutions like Patient Access Curator, healthcare providers can quickly and accurately gather and verify necessary information about a patient's insurance, enabling them to promptly provide patients with a clear picture of what's left for them to pay. How can AI help with claims management? AI-powered software offers tailored solutions to simplify and optimize claims management processes and, in turn, improve revenue cycle management. Here are two critical ways AI can help with claims management. Real-time insurance eligibility verification Accurate eligibility verification is a fundamental part of the claims process. It is crucial for an accurate and faster billing process, increasing claims approval rates, and improving revenue cycle management. Conversely, incorrect verification leads to denied claims, contributing to care delays, wasteful healthcare spending, and a poor patient payment experience. By using Experian Health's Al-powered Patient Access Curator solution, healthcare providers can instantly verify and update patient insurance information, ensuring accurate billing and reducing the potential for claims denial. This real-time verification eliminates any need for guesswork and ensures that billing is done based on the most current insurance information. Patient Access Curator is a valuable tool for hospitals looking to save time, money, and staff resources that would have been spent on a lengthy and denial-prone claims process. With just one click and in 30 seconds, it prevents claims denial problems on the front-end. Since 2020, it has been a game changer for the financial health of clients using the platform, helping them save over $1 billion in denied claims. Predictive claims analysis AI can predict potential claim denials or payment delays, empowering hospitals to take proactive measures. By analyzing historical data and patterns, AI can flag potential issues before they become costly problems. AI Advantage™, another AI-powered solution, aims to help healthcare providers prevent and manage claim denials. This solution has two components:AI Advantage – Predictive Denials: reduce claims denials by spotting errors and identifying claims that don't meet ever-changing payer rules, allowing corrections to be made.AI Advantage – Denial Triage: works after a claim has been denied to identify and group denials most likely to be approved after resubmission, allowing organizations to prioritize resubmissions most likely to benefit their finances. As revenue cycle leaders strive to navigate the ever-evolving landscape of healthcare, it is crucial to embrace AI to stay ahead of the game. With Experian Health's expertise and resources, healthcare providers can fully take advantage of robust AI solutions to streamline their revenue cycle processes and achieve financial success. Find out more about how Experian Health helps healthcare providers leverage AI to solve the most pressing issues in revenue cycle management.

Healthcare price transparency is high stakes for both patients and providers. With the average cost of a hospital stay for patients in the United States amounting to $2,883 a day, a patient's bill can quickly add up. Patients need reliable information about the cost of services as early as possible so they can plan accordingly. For providers, transparent pricing helps deliver a more compassionate patient financial experience and reduces the risk of missed revenue opportunities. However, it's also a compliance issue, especially with the introduction of the Hospital Price Transparency Rule. While the Centers for Medicare & Medicaid Services (CMS) found that 70% of hospitals are in compliance as of February 2023, the goal is to reach 100% compliance. Experian Health and Cleverley + Associates have joined forces to address the challenges providers may be facing. Riley Matthews, Lead Product Manager at Experian Health, and Jamie Cleverley, President of Cleverley + Associates, discuss what hospitals need to do to comply with the Hospital Price Transparency Rule. What is hospital price transparency and what is the Hospital Price Transparency Rule? The introduction of CMS price transparency requirements has brought about substantial shifts in the landscape of price disclosure for hospitals across the United States. Enacted as part of the FY19 IPPS Final Rule, these requirements were established in alignment with provisions outlined in the Affordable Care Act. Hospitals are now mandated to provide a comprehensive list of their current standard charges via the Internet in a machine-readable format, with updates required at least annually or more frequently as deemed necessary. This information can be presented in the form of a chargemaster or any other format chosen by the hospital, as long as it meets the criteria of being machine-readable. What are the new price transparency updates coming on July 1, 2024? As of July 1, 2024, CMS mandates that hospitals affirm the completeness and accuracy of their machine-readable file (MRF). This affirmation includes confirming that all applicable standard charge information, as required by § 180.50, has been included in the MRF. Furthermore, hospitals must assert that the encoded information is true, accurate, and up-to-date as of the specified date indicated in the MRF. Also starting on July 1, 2024, CMS will require hospitals to convert the contents of the MRF into a predefined template. This template is available in either .JSON or .CSV format. Additionally, there are new mandatory data elements, supplementing the previously specified ones (e.g., the five types of standard charges). Some of these new data elements have a delayed implementation date of January 1, 2025. What's the difference between the Hospital Price Transparency Rule and the No Surprises Act? The Hospital Price Transparency Rule aims to give patients clear, upfront information about hospital pricing, so they are empowered to make informed choices about their care. The No Surprises Act offers patients protection from surprise billing when they receive certain emergency and non-emergency services from out-of-network providers at in-network facilities. The two sister mandates work together to improve the patient financial experience and help patients navigate their financial obligations. What are the most common price transparency compliance challenges?  Cleverley says there are two main reasons why hospitals may be struggling to comply. First, there is some confusion about what is required to be disclosed (and how). To bridge this gap, Experian Health and Cleverley + Associates have created a standard methodology that satisfies the rule requirements. Second, some providers are hesitant to disclose pay rates amid concerns over financial viability and potential pressure to lower charges. However, the price transparency rule aims to enable market competitiveness and empower patients. Furthermore, making cost estimates freely available improves patient satisfaction by 88%, according to data from PYMNTS and Experian Health. A patient-centered approach to billing and payments not only supports compliance with price transparency regulations, but leads to faster payments and consumer satisfaction. In addition to Patient Estimates and Patient Financial Advisor, which offer patients accurate, pre-service cost estimates, there are a host of other Patient Payment Solutions that allow patients to choose payment plans, manage bills and make payments. How are Experian Health and Cleverley + Associates helping providers comply with the Hospital Price Transparency Rule?  The Hospital Price Transparency Final Rule requires hospitals to display payer-specific rates as a consumer-friendly list of 300 shoppable service items. Experian Health's Self-Service Patient Estimates solution helps providers compile these lists and deliver accurate estimates to patients in a clear and comprehensive way. This puts consumers in the driving seat when it comes to making informed healthcare choices and supports hospitals in providing clear, accurate and legally compliant pricing information. Providers must also make certain pricing information for items and services available as a machine-readable file displayed on their website. Cleverley + Associates has the necessary capabilities to deliver the machine-readable files quickly and at scale. By working together, both organizations deliver a holistic solution to meet price transparency mandates. Jamie Cleverley says this helps hospitals prepare for the changing environment: “It's more than compliance. It’s having trusted partners that are talking through and consulting with hundreds of hospitals across the country.” What is the best approach for providers to ensure price transparency compliance? Riley Matthews says that the first step for providers is to define a strategy that best fits their individual organization. They should identify best practice workflows based on their existing resources and intellectual property and partner with an organization that can bring solutions to areas where the system is lacking. The key is to execute the business strategy while prioritizing the patient experience. Experian Health and Cleverley + Associates can support hospitals in providing an efficient, consumer-friendly workflow, as well as the more robust backend concepts of the machine-readable file. Cleverley says, “We've created a methodology to display aggregated claim payment levels, simplifying the display of information for both hospitals and patients. Many solutions attempt to display just a list of payment rates, but the combination of those lines is really what's most relevant to patients.” For example, a patient coming in for an outpatient surgery has no idea what additional services, drugs and tests they may need. This solution looks at the statistical utilization of services to calculate the charges for that procedure, and then displays that value. This holistic approach meets “not only the letter of the law, but also the spirit of it.” What's next for price transparency? There has been a significant challenge around non-uniformity of data. Hospitals have been using different structures and file formats for displaying required information, but CMS has implemented a standardized file schema for use beginning July 1, 2024.  Cleverley + Associates has a file structure that conforms to the Medicare standard schema and is available to help hospitals understand the new requirements. As the penalties for non-compliance increase, providers need to be proactive in reducing the financial risks associated with price transparency non-compliance. Riley Matthews says that innovation and partnership helps providers get ahead of compliance rules and allows hospitals to focus on patient care. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations comply with the Hospital Price Transparency Rule and improve the patient financial experience.