Patient Access

As margins tighten, traditional revenue cycle management strategies are on shaky ground. Many healthcare providers are turning to automation and AI to simplify payments, prevent revenue loss and protect profits. This article breaks down some of the most common revenue cycle management (RCM) challenges facing healthcare leaders and offers a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Common challenges in revenue cycle management Revenue cycle management is how healthcare organizations handle the financial side of patient care, from patient billing to claims management. Healthcare providers rely on RCM to ensure they are properly paid, so they can keep the lights on, pay their staff and deliver quality patient care. Are traditional RCM strategies still fit for purpose? Consider some of the current challenges: Patients are responsible for a larger share of costs due to high-deductible health plans. How can providers help them understand their financial obligations and make it easier to pay without hurting their experience? Minimizing claim denials is a daily focus, thanks to constantly changing policies and regulatory updates. How do revenue cycle teams keep up with payers? Staffing shortages remain on the agenda. How can providers ease pressure on staff to maintain productivity and morale? There's also the question of how to turn mountains of data into actionable insights. How do teams interpret it correctly to identify bottlenecks and opportunities for improvement? Automation and AI offer a way through. When implemented thoughtfully, these tools can speed up processes, reduce errors and clear operational roadblocks for a more resilient revenue cycle. The following revenue cycle management checklist includes some of the key questions to consider along the way. Checklist for improving revenue cycle management Automating patient access Can patients book appointments online? Does the online scheduler automate business rules to guide patients to the right provider? Are patient identities verified at registration and point of service? A healthy revenue cycle starts with efficient patient access. According to the State of Patient Access 2024, 60% of patients want more digital options for scheduling appointments, managing bills and communicating with providers. Providers who see improvements in patient access also credit automation, which speeds up intake and improves accuracy. A good first step is to replace paper-based processes with online self-scheduling and self-service registration. These tools make life easier for patients, boosting satisfaction, retention and engagement. Behind the scenes, Experian Health's new AI-powered tool, Patient Access Curator, helps providers get paid faster by verifying and updating patient information with a single click – accelerating registration and paving the way for faster reimbursement. Register now: Exact Sciences and Trinity Health will share how Patient Access Curator is redefining patient access in this upcoming webinar. Optimize patient collections with data and analytics Are patient estimates provided upfront? Are notice of care requirements being addressed? Are patients offered appropriate financial plans and easy ways to pay? With more financial responsibility resting on patients' shoulders, patient collections are under the spotlight. The State of Patient Access report shows that upfront estimates and clarity about coverage are top priorities for patients, because when they know what they owe, they're more likely to pay on time. Implementing tools to promote price transparency and easy payment methods should feature in any RCM checklist. With Coverage Discovery, healthcare organizations can run checks across the entire revenue cycle to find billable commercial and government coverage that may have been forgotten, to maximize the chance of reimbursement. Meanwhile, Patient Payment Estimates offers patients clear, accessible estimates of their financial responsibility before treatment, so that hose who need financial assistance can be directed automatically to payment plans and charity options. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery® Improve claims management to reduce denials Are high-impact accounts prioritized? Are remittances reconciled with payments received? Does claims management software generate real-time insights and reports? With 73% of healthcare leaders agreeing that denial increased in 2024, and 67% saying it takes longer to get reimbursed, claims management is a great use case for automation. ClaimSource®, ranked Best in KLAS in 2024 for claims management, automates the entire claims cycle in a single application. It integrates national and local payer edits with custom provider edits to verify that each claim is properly coded before submission. By focusing on high-priority accounts, providers can target resources in the most effective way to ensure a higher first-pass payment rate. A major advantage for ClaimSource users is access to AI Advantage™. This tool utilizes AI to “learn” from an organization's historical claims data and trends in payer behavior to predict the probability of denial. It also segments denials so staff can prioritize those that are most likely to be reimbursed, reducing the time and cost of manual appeals and rework. Case study: After using AI Advantage for just six months, Schneck Medical Center reduced denials by an average of 4.6% each month, and cut rework time from 12 to 15 minutes per correction to under 5 minutes. Benefits of implementing a revenue cycle management checklist The key to choosing the right RCM tools and technologies is to build the strategy around what patients need most. A clear, transparent and compassionate billing experience is more manageable for patients and helps providers get paid faster. An RCM checklist helps teams stay focused on the tasks that matter. Providers can build on the suggestions above by choosing the key performance indicators (KPIs) that align with their specific goals. Metrics like financial performance, billing efficiency and collections rates can be combined to guide resource allocation, drive improvements and speed up reimbursement. With a well-designed checklist informed by clear KPIs, revenue cycle leaders can keep their teams on track and take their organizations from “surviving” to “thriving.” Learn more about how Experian Health's revenue cycle management tools can help healthcare providers meet current challenges, improve the patient experience and increase cash flow. Learn more Contact us

Prior authorizations continue to challenge healthcare organizations as payer authorization requirements expand and change. Automated prior authorizations can bring new efficiency and consistency to a process that's ripe for evolution, but how will providers make the leap? Alicia Pickett, Senior Product Manager at Experian Health, shares her perspectives on the issues providers are talking about now: How to speed up prior authorizations and deliver a better experience for users, leaders, physicians, and patients. Q: Why are providers increasingly concerned about prior authorizations? “Managing prior authorizations is complex,” Pickett says. “Providers have to deal with different payers, different standards, different service lines—all requiring different pieces of information. Without having all the right pieces in place, it's hard to drive a consistent workflow.  An inconsistent workflow can lead to denials, which can be very costly and affect patient care. “Once denials occur, managing them on the back end through appeals takes more time and additional personnel,” Pickett continues. “Creating a consistent workflow on the front end helps reduce manual work and decreases that denial rate.” Prior authorizations are in constant flux. A 2023 survey by the Medical Group Management Association (MGMA) found that 89% of medical practices find prior authorization requirements to be “very” or “extremely” burdensome. Of those surveyed, 92% hired additional staff and 97% reported patients experiencing delays or denials. The most common complaints were decision delays, obtaining authorization requirements for routine items or services, and inconsistent payer payment policies. Coping with complexity and change puts a strain on manual systems. “Inconsistent workflows leave room for interpretation and error,” Pickett notes. One user may be using sticky notes to record information they learned over the phone, while another coworker gets different information from the payer's website. “These coworkers aren't getting the benefit of each other's knowledge, and their information may not match,” says Pickett. “Given how frequently payers make changes, these inconsistencies can snowball really quickly.” Q: What are providers looking for to deal with prior authorization challenges? “Clients continue to look for more automation,” says Pickett. “They're looking for electronic prior authorization tools that help users work more efficiently and create consistency. For example, they may want tools to help determine which CPT codes require authorization and which ones don't. They may be interested in automated processes for follow-up. “Dynamic work queues, automated auth requirements, and follow-up allow users to spend less time on the phone and more time focusing on complex cases where electronic solutions are not available.” When training is time-intensive and staff is in demand, the benefits of automation go beyond administrative gains. “When users are more efficient, they're not only more effective; they're also happier in their jobs,” says Pickett. Q: How is client feedback shaping Experian Health's Authorizations product—and how is automation changing the way clients manage prior authorizations? “Here's an example. One of Experian Health's clients was able to move from a completely manual process, where they were printing schedules multiple times a day and handling inquiries by phone, to an automated prior authorization process using Experian Health's Authorizations solution. Now, they have automated work queues updated dynamically, in real-time. “The dynamic work queue allows users to know which accounts they're supposed to be working on, [even as] patients are being scheduled and rescheduled,” Pickett continues. “Knowledgebase allows users to spend less time on the phone or checking individual portals to find out whether CPT codes require authorizations.” In addition to creating more efficient workflows, Experian Health's Authorizations solution provides metrics organizations can use to evaluate and plan. “When providers use manual processes, leaders and managers aren't able to gather insights because there's nothing to tie metrics to,” Pickett explains. “This client was able to use insights from their electronic preauthorization processes to create greater consistency across their health system. They increased their throughput and managed the process more efficiently with a centralized team. When they were ready to support a new site, they used metrics to guide their planning conversations.” Q: What are the major drivers of change heading into 2025? “The CMS rule is going to be one of the biggest drivers of change,” says Pickett. The CMS final rule on prior authorizations was adopted in January 2024, with many provisions set to take effect in 2026. “What the rule states is that government payers—Medicare, Medicaid and others—are going to be required to provide information electronically through application programming interfaces, or APIs. Because of the CMS mandate, and because of the options that are available with expanding technology, we expect to see improvement in physician satisfaction and reduction in delays that impact patient care.” Pickett explains. These changes should benefit automation. “More data will be available on what requires an authorization, or on where an authorization stands,” says Pickett. “Automating messages reduces manual work and human error, and should make transactions more efficient.” Meanwhile, several states have created their own mandates. “State regulations provide transparency and require authorizations to turn around more quickly,” Pickett says. “They may help providers know what to expect, so they're not left guessing about when authorizations need to be adjudicated and when they'll be reviewed.” Security and privacy are additional concerns. “Recent security threats and breaches are also driving changes,” says Pickett. “Finding and mandating secure connections a key concern. Everyone wants to protect their patients' data, and rightly so." Q: How will electronic prior authorizations and other advancements impact the future of patient care? “Without question, creating greater consistency and efficiency will have a positive impact on patient care,” Pickett says. “Patients just want to know that they can get the service they need within the timeframe they're expecting without issues related to coverage or unexpected cost. A better authorization process provides patients with a better experience.” Physicians also benefit from improvements to the preauthorization process. “Knowing what to expect allows doctors to make informed decisions on how to proceed,” Pickett says. “When you have transparency, everyone is working together.” Finally, users can deliver a higher level of service when electronic processes are in place. “Expecting users to manage these complex processes on their own is a lot to ask,” says Pickett, noting that, with electronic prior authorizations, users are positioned to deal with heavy workflows and take advantage of new advancements on the horizon. “Automating prior authorizations is a big change, but the results can be transformational,” Pickett concludes. “As we continue to grow, physicians and revenue cycle leaders can focus on keeping their teams informed about what's happening, whether it's new payer connections, new information, or new technology,” Pickett says. “Staying informed helps users feel comfortable with the data that's coming back, so they can trust the process that's being automated.” Learn more about how Experian Health's electronic prior authorization software, Authorizations, uses automation to achieve greater consistency and efficiency for healthcare organizations. 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Self-service patient access is a growing trend that's here to stay. Tech-savvy patients want to see their doctor faster and don't want to jump through complicated hoops to schedule an appointment, complete their registration paperwork or pay their medical bills. Opening the digital front door must be a priority for providers who want to keep pace with evolving patient expectations. That's why 79% of providers plan to invest in patient access improvements soon, according to Experian Health’s 2024 State of Patient Access survey data. This article takes a closer look at what patient self-service means and why it should be a top consideration for today's revenue cycle leaders. What is patient self-service? Patient self-service is a collection of digital tools that offer patients more access at every step of the patient journey. Building on innovations that gained momentum during the pandemic, like telehealth and virtual care, today's tech-driven patient self-service experiences offer a seamless patient engagement experience, from scheduling to collections. Patients use self-service tools to easily connect with providers online and manage administrative tasks 24/7. Common patient self-service tools include patient portals, online scheduling and mobile registration. Self-service solutions also include robust financial tools that help patients check eligibility, complete their insurance information, get accurate estimates, apply for charity care and set up payment plans. Why should providers prioritize patient self-service? Providers that prioritize self-service tools to give patients more access gain a competitive edge in today's challenging healthcare landscape. Clunky manual processes and outdated systems frustrate patients and burden staff, often resulting in scheduling gaps, claims delays, increased denials and other revenue cycle disruptions. In today's fast-moving digital world, patients want it to be as easy to book a medical appointment as it is to order takeout from an app. However, according to Experian Health data, just 28% of patients feel access improved in 2023, while more than half (51%) said patient access remained fairly static since the previous year. The data also shows that 60% of patients are looking for more digital and mobile options, with roughly the same percentage saying they'd consider switching providers to get the access they crave. Providers seeking to boost patient satisfaction and shore up a sustainable revenue cycle must invest in a digital front door that includes the self-service tools patients demand across the patient journey—from patient intake to collections. Healthcare organizations that prioritize implementing these self-service solutions free up overburdened staff from tedious, time-consuming administrative tasks, keep provider schedules full, reduce claim denials and increase revenue. Current challenges in patient access The healthcare industry continues to face ongoing challenges that affect patient access. Some of the top obstacles include: Outdated systems and processes The healthcare landscape is riddled with complex, disconnected and often archaic administrative systems. In fact, around 25% of patients say they delay care due to administrative obstacles, and 85% are tired of filling out paperwork after providing the information elsewhere. Today's patients desire frictionless, digital solutions that make it easy to schedule an appointment, submit personal information, understand the cost of care and make secure medical bill payments. Ongoing staffing shortages According to the American Hospital Association (AMA), staffing shortages aren't expected to let up anytime soon. By 2028, the healthcare industry will face a shortage of around 100,000 critical workers. Ongoing staff shortages put increased pressure on a strained healthcare system to keep up with patient care and administrative tasks. Difficulties keeping up with rising healthcare costs Healthcare affordability continues to decline, with around 50% of Americans reporting that paying medical bills is a struggle. Understanding how much insurance covers is also an obstacle, with more than half of patients reporting they need their provider's help to understand how much insurance pays. Growing patient volumes Short-staffed healthcare organizations are treating more patients than ever before. AMA data reports that providers saw more patients in 2024, compared to 2019. However, this growing demand for healthcare isn't the only issue burdening overtaxed healthcare organizations. Today's patients are also sicker and have more complex care needs than they did five years ago. Benefits of patient self-service solutions Self-service solutions offer many benefits to both patients and providers across the entire revenue cycle. Here's a closer look at three ways patient self-service solutions improve patient access. Boosts patient volume It's clear the demand for digital tools is a trend that's here to stay. Patients want more access and are prepared to switch providers to get it. Providers that adopt self-service technology are more likely to retain existing patients and make positive first impressions with new patients. In today's highly competitive healthcare landscape, frictionless patient engagement experiences for scheduling, registration, estimates and payments are key to patient satisfaction. Patient self-service tools, like mobile registration, let patients complete registration forms at their earliest convenience. Automated patient intake solutions, such as Experian Health's Registration Accelerator, help providers save time and verify important patient details quickly. Patients can begin registration with one click, with a text-to-mobile experience, which improves booking rates and reduces administrative burdens. Conserves valuable staff time When staff are overworked, patient access and care often suffer. Self-service tools empower patients to handle numerous administrative tasks, like scheduling and bill payments, with little to no staff help needed. Patients get the 24/7 access they crave, and staff spend less time on patient communication, training and other manual tasks. Self-service tools like Patient Schedule automate scheduling workflows while integrating seamlessly with provider appointment criteria and calendars. Patients can make, change or cancel appointments online, with no login required. Reminders for appointments are sent to patients automatically via text or interactive voice response (IVR), allowing busy administrative staff to spend less time on the phone. Other tools like Experian Health’s Self-Service Patient Financial Clearance solution allows patients to upload forms and complete eligibility checks on their mobile devices, without having to reach out to their providers. Improves financial transparency and boosts revenue Patients want to know how much care will cost before seeing their provider. Healthcare organizations that offer accurate, real-time estimates are more likely to have patients who are better prepared to cover their medical bills. In fact, 80% of patients say understanding their financial responsibility helps them better prepare to cover the bill, according to Experian Health data. Self-service solutions that allow patients to access transparent pricing and billing options, like Experian Health's Patient Payment Estimates, help patients make a plan to pay. Patients get real-time estimates through an easy-access text link or the web-based app. Digital payment solutions, like PatientSimple®, ease cost concerns by allowing patients to apply for charity, make secure payments, set up flexible payment plans and more. See it in action: improving patient access with digital solutions How IU Health used patient scheduling tools to boost patient satisfaction and improve operational efficiency even as patient volumes increased. How Banner Medical Group uses Patient Estimates to boost patient satisfaction and meet compliance requirements. How West Tennessee Healthcare modernized patient intake with automation. Give patients the control they crave with self-service Digital solutions that put patients in the driver's seat are a win-win for patients and providers. With self-service tools, patients are empowered to manage key aspects of the patient experience across the entire patient journey. They're more likely to get the care they need, show up for appointments, be prepared to cover the cost and even benefit from better patient outcomes, according to data from a 2024 HIMSS study. Providers see reduced no-show rates, spend less time on manual tasks and experience more financial stability. Find out more about how Experian Health's patient engagement solutions help healthcare organizations improve the patient experience at every stage of the patient journey. Learn more Contact us

Nearly 46% of patients say being able to manage their health online is their top priority in accessing care, according to Experian Health's State of Patient Access 2024 survey (SOPA). However, the availability of a “digital front door” in healthcare – with online scheduling, mobile registration, and frictionless payments – is not yet meeting demand. Many patients still face convoluted booking systems and stacks of repetitive paperwork. Meanwhile, consumer-friendly tech and retail giants are edging into healthcare. As disruptors set new standards for simple and convenient care, traditional providers are under pressure to open their digital front door to remain competitive. Many are already investing in AI and automation to simplify workflows, cut costs, and upgrade the patient experience. Could 2025 be the tipping point for healthcare's digital transformation? A digital front door strategy could help more providers boost patient engagement, simplify the patient experience and increase profitability. What is a digital front door? The digital front door is more than a well-designed website. It's a single point of access that gives patients convenience, choice and control at every touchpoint in their healthcare journey. It promises patients faster appointments, fewer headaches and more coordinated care. From their mobile device or computer, they can log in to schedule visits, sign intake forms, update insurance details, see costs upfront and even settle their bills. It's secure, easy to use and lets patients handle tasks on their own time. On the back end, patient-facing digital tools can integrate into the provider's existing systems to improve workflows, reduce manual tasks and generate analytics to simplify care. What are the key benefits of implementing a digital front door? Patient satisfaction: According to SOPA, 60% of patients want more digital and mobile options for communicating with their provider, scheduling appointments and managing payments. Fewer no-shows: Patients are less likely to cancel or no-show when they can schedule and manage appointments that work for their time and needs. Frees up resources: Automating repetitive administrative activities means staff can focus on higher-value activities. Fewer errors: Manual processes are rife with data entry errors that increase the risk of denied medical claims and add time on the back end to resolve. Digital patient intake saves time and money by reducing opportunities for human error. Essential features of an effective digital front door What are some of the digital must-haves to simplify access to care? The checklist might include: Online appointment scheduling, to make it easy to book, reschedule, or cancel appointments Digital tools to complete pre-visit paperwork – even better if these automatically prepopulate patient info to save them time and reduce errors Transparent pricing, with tailored information delivered directly to the patient A choice of payment methods, including familiar digital options so patients can pay quickly Access to a patient portal or central hub for managing appointments, medical records and prescriptions Mobile-friendly interfaces and simple designs, so patients can see key data at a glance, from any device, without needing to be tech-literate Secure and compliant communications to protect patient data and privacy. Where to start with a patient-centric digital front door Three specific tools that would check off the above include the following: 1. Multi-channel patient scheduling What matters most to patients is being able to see their doctor quickly. Online appointment booking gives them the 24/7 self-service scheduling options they expect. It delivers quantifiable gains for providers too. For IU Health, automating patient scheduling has been shown to do the work of two full-time schedulers, with more than 35,000 appointments booked with self-scheduling. Experian Health's patient scheduling software guides patients to the appropriate provider and appointment while keeping the provider in control of their calendar. It integrates with a provider's website, call center, and physical office so patients can book their next appointment, even outside of office hours. On-demand webinar: See how IU Health increased one-call resolutions with Patient Schedule 2. Registration Accelerator 49% of providers say that a primary cause of denied medical claims can be traced back to errors in patient registration, forcing health systems to divert revenue to remediate claims that could have been avoided. An automated, data-driven patient registration process improves accuracy, making costly errors less likely. With Registration Accelerator, patients get a text when it's time to register, instead of completing forms in the waiting room. There's no need to download an app or create a user profile: they scan the data from their identity and insurance cards, and Registration Accelerator takes care of the rest. Anthony Myers, Director of Admitting and Registration at West Tennessee Healthcare, says that replacing clipboards with clicks also makes for a much better patient experience: “With our paper-based systems, it seemed like West Tennessee was stuck in the 1990s. We knew our patients expected a more modern experience. We wanted to meet them where they are, rather than forcing them to come to the registration desk. Our goal was to make pre-service registration easier and smoother for patients and staff.” Case study: How West Tennessee Healthcare simplified registration with Registration Accelerator. 3. Patient Financial Advisor The SOPA report shows that almost seven in ten providers believe their patients postpone care at least occasionally because they don't understand the cost of care. Eight in ten patients agree that accurate estimates help them prepare to pay. While price transparency is improving, too many patients still find themselves with bills that are higher than expected. Patient Financial Advisor delivers a pre-service estimate of the patient's financial responsibility based on real-time benefit information directly to their mobile device. It takes account of current provider pricing, payer contracted rates, and any relevant discounts or payment plans for greater accuracy. A secure payment link allows patients to settle their bills quickly and conveniently, at any time. Read more: How to maximize patient collections with digital technology Choosing the right partner for digital transformation Implementing a successful digital front door strategy comes down to one key factor: keeping it laser-focused on the patient. When choosing a vendor, providers should ask how the platform will make life easier for patients. Will it encourage proactive engagement? Is it easy to navigate and demonstrably secure? And on the back end, will it integrate smoothly with the provider's existing systems and workflows – and even improve them? The right partner will bring specialized expertise for a digital transformation, with the capabilities to meet both patients' and providers' needs. Find out how Experian Health's Patient Access solutions help healthcare providers open their digital front door to simplify patient care across the entire revenue cycle. Learn more Contact us

Patient eligibility verification is a critical part of the healthcare revenue cycle. It can help prevent errors with claim submissions, reduce denials, boost the bottom line, and help patients understand what their insurance will cover. However, checking insurance eligibility isn't always efficient or accurate, thanks to outdated systems and complicated manual processes. Ever-evolving payer requirements and new regulations, like the No Surprises Act, add even more complications during insurance eligibility checks. In 2024, providers also treated more patients than they did five years ago, making it harder to keep up with patient eligibility verification. This growing volume of patients have more complex health issues and may struggle to afford medical bills, putting a more pressing urgency on providers to run accurate eligibility checks before service. Having the right health insurance eligibility verification solution can make or break a provider's revenue cycle and allow staff to stay focused on patient care instead of digging for insurance information and correcting errors. This article takes a closer look at why patient eligibility matters, common challenges providers face and strategies to improve insurance eligibility checks, reduce payment delays and minimize denials. What is patient eligibility verification? Patient eligibility verification is an administrative process providers use to check whether or not patients have active medical insurance. It's typically completed before service occurs to confirm coverage for treatment and care. Sometimes called a health insurance lookup, the eligibility check verifies different aspects of a patient's coverage, including insurance status, coverage details and medical service benefits. During patient eligibility verification, billing information is also confirmed. Why is it critical for healthcare providers? Patient eligibility verification offers providers a first line of defense to protect revenue cycles against revenue leakage. It can help healthcare organizations with accurate billing, reduce claims denials and avoid footing the bill for uncompensated care. When eligibility checks are conducted diligently, providers see improved cash flow, staff efficiency is gained, the risk of bad debt is lower, and patients are empowered with accurate upfront estimates. The importance of patient eligibility verification Claim denial rates are growing and show no signs of slowing down. Experian Health's State of Claims 2024 survey reports that nearly three-quarters of respondents saw a rise in denials, with four in ten saying claims are denied 10% of the time. Eligibility issues, along with missing or inaccurate data, are a top reason for denials, according to 15% of providers surveyed. A reliable eligibility verification process is crucial to minimizing the claim denials, rework and billing errors that arise from inaccurate insurance information. It also lets patients know their financial responsibility upfront so there are no surprises when the bill comes. This trust and transparency fosters positive patient-provider relationships while ensuring patients get the care they need and providers get paid. Common challenges in patient eligibility verification Findings from Experian Health's State of Patient Access and State of Claims surveys point to several common challenges in patient eligibility verification. Evolving payer policies and pre-authorization requirements Insurance provider prior authorization requirements change often, making it hard for providers to keep pace. More than 75% of providers report an increasing amount of payer policy changes, and secondary eligibility checks take time and impact efficiency. When a necessary authorization is missed due to manual verification or rushed eligibility checks, it can result in denial, delayed payment and extra work – especially when care is urgent. Incomplete or outdated insurance information Insurance details in the provider's system don't always match the payer's record. This can happen for a wide range of reasons, including job switches, insurance plan changes or patients not being aware of or forgetting to mention secondary coverage. When these changes aren't caught before service, they can lead to rejected claims, billing delays and extra work for staff.  More than four in ten providers report adding at least 10 minutes of staff time per incomplete eligibility check. Inadequate technology to verify eligibility Staff must often wrangle a wide range of disjointed solutions, processes and logins during eligibility checks. While more than 70% of providers feel their organization runs insurance verification checks efficiently and accurately, nearly 60% of providers still use at least two different tools to gather the necessary patient information for claim submission. This can make navigating patient eligibility verification tedious and error-prone, and leads to staff burnout, denied claims and patient dissatisfaction. Strategies to improve patient eligibility verification In today's changing health insurance landscape, providers need to pay more attention than ever to their patient eligibility verification processes. Accurate and timely insurance verification streamlines the claims process, clarifies how bills will be covered (or not) ahead of time and helps patients prepare to pay their bills. Adopting the following strategies to improve patient eligibility verifications can help providers reduce the risk of denied claims, improve the revenue cycle and create positive patient experiences. Automate eligibility verification processes Verifying coverage early in the billing process increases the chance of submitting clean claims the first time. However, it can be tedious for providers to navigate outdated methods like online portals, file batching, automated systems and stay on top of ever-changing payer policies. Automated eligibility verification software helps providers optimize intricate insurance checks, access verified and comprehensive resources to confirm eligibility (with solutions like the MBI Lookup tool), and improve efficiency. Automatically track changing payer policy requirements With payer requirements undergoing constant updates, providers need to have access to solutions that keep up in real-time. Eligibility Verification, for example, seamlessly connects to more than 900 payers and features advanced patient matching tools. It can also be used with Experian Health's automated prior authorization tool, which tracks national payer requirements and flags providers when mandatory pre-authorization information is missing. Offer upfront, accurate cost estimates Patients want to know their financial responsibility up front. When armed with accurate estimates that help patients understand their coverage, co-pays and deductibles, more than 80% of patients say it helps them prepare financially. Eligibility tools allow providers to create more accurate estimates based on actual insurance coverage. This helps patients know what they're responsible for out-of-pocket and reduces surprise billing. Patient eligibility verification is more critical than ever in ensuring smooth and efficient revenue cycle management. With rising patient volumes, evolving regulations and other challenges impacting revenue cycles, providers need to maintain accurate insurance eligibility checks to reduce costly errors, streamline workflows and improve claims success rates. More importantly, accurate eligibility checks empower healthcare staff to focus on delivering quality care, while helping patients better understand and manage their financial responsibilities. Find out more about how Experian Health's insurance eligibility verification solution helps revenue cycle managers prioritize reimbursements with automated eligibility checks. Learn more Contact us

Medical excellence is a given when it comes to improving the patient experience, but what about the non-clinical side of care? Long waits, confusing processes and financial uncertainty can overshadow even the best medical treatment. As many as one in four patients delay care because of hidden administrative obstacles. As providers look to improve the patient experience in 2025, tackling these frustrations is top of mind. How easy is it for the patient to schedule their appointment? How quickly can they complete registration? Do they understand their insurance coverage, and do they have the right support to manage and pay their bills? Clear and straightforward patient access processes give patients support, convenience and control, and allow providers to focus on delivering care. This article looks at the challenges and opportunities that may affect patient access over the next year and highlights three ways to use digital tools to improve the patient experience. The patient experience in 2025: a rollercoaster of risks and opportunities Over the next year, patients' shifting needs and attitudes will change how they access care. Informed, tech-savvy patients armed with wearables and health-tracking apps want streamlined access and contact with their providers, and expect efficiency and personalization when they do seek care. At the same time, an aging population and increasing numbers of people with multiple chronic conditions drive demand for more complex and ongoing support. On the provider side, challenges like staffing shortages and remote work demands will continue to strain patient access teams. Payers' rapid adoption of artificial intelligence (AI) will continue to widen the denials gap. Rising costs will persist. Amidst this uncertainty, the forthcoming change of government may bring additional regulatory and legislative changes, so providers must be ready to adapt. Opening the digital front door is a way to elevate the patient experience to meet changing consumer expectations, while simplifying and streamlining processes so they can respond to whatever's in store. How can digital tools help improve the patient experience? Digital tools take the patient journey from a series of disjointed encounters to a coordinated and personalized experience. Building on innovations that gained momentum during COVID-19, like telehealth and virtual care, these tools keep patients and providers connected throughout the care process. By tailoring experiences to individual needs in real time, digital tools integrate into daily life and meet the rising demand for convenient, tech-driven options. Three ways to improve the patient experience Experian Health's latest State of Patient Access survey offers some pointers as to what providers should prioritize: 1. Expedite scheduling so patients can see their practitioner quickly Patients measure the patient experience by how quickly they can see their doctor. In the State of Patient Access survey, both those who think patient access has improved and those who think it has worsened give this as their reason. As patients' top priority, efficient scheduling is an obvious focus for providers who want to improve the patient experience. Online scheduling, mobile registration and self-service portals can simplify how patients book and check in for appointments. Patient Schedule lets patients book appointments anytime they like without needing to call. It only offers specific types of appointments with the right provider and makes it easy to cancel and reschedule, so no-shows are less likely. This also increases providers' capacity, giving patients more options so they can see their doctor sooner. Mobile registration complements digital scheduling by allowing patients to complete registration forms anytime, anywhere. Automated registration prefills information held on file to minimize paperwork, which is good news for the 85% of patients who do not want to fill out paperwork if they've already provided the information. Reducing manual errors also reduces delays so that patients can get on with their visit. 2. Help patients understand their insurance coverage and bills Patients and providers both cite financial challenges among their top priorities for improving patient access. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care, while more than half say they need their provider's help to understand what their insurance covers. Providers should consider digital tools that support transparent pricing and billing to improve patients' financial experiences. Experian Health's Patient Payment Estimates generates accurate, upfront estimates of what a patient will owe, incorporating real-time pricing information, benefits and discounts. Estimates and secure payment links can be sent to patients via text or through the web-based app for a convenient and user-friendly payment experience. Additional tools can help patients find missing coverage and identify suitable payment plans, empowering patients and accelerating collections for providers. 3. Explore how automation and AI can support a better patient experience The growing use of AI will continue to reshape all aspects of care. By processing vast amounts of information at an unprecedented rate, AI presents exciting opportunities in patient access: keeping patients informed, generating performance insights and reducing the errors, delays and bottlenecks that come with manual processes. One of the highest-ranking challenges for providers in the State of Patient Access survey was the difficulty of managing multiple solutions to run patient eligibility and coverage checks. Patient Access Curator uses AI to address this with a single-click solution that captures all patient data at registration. It checks and verifies eligibility, Medicare Beneficiary Identifiers, coordination of benefits and demographics, delivering results in just 30 seconds. This prevents denials on the front end and takes the pain out of registration and scheduling for patients. Read the blog: How Patient Access Curator uses real-time, automated discovery to prevent denials and improve patient access Put patients in the driver's seat in 2025 As competition intensifies with new providers and disruptive technologies entering the market, patient satisfaction will no longer be optional — it will define success in 2025. Investing in digital patient access tools gives patients the autonomy, choice and convenience they crave as modern digital consumers. Simplifying and streamlining access will not only help meet and exceed patient expectations, but will help providers future-proof their operations and build a sustainable revenue cycle for the years ahead. Find out more about how Experian Health's patient engagement solutions will help providers improve the patient experience in 2025. Patient Engagement solutions Contact us

The growing shift from inpatient to outpatient care continues. The U.S. ambulatory services market was estimated at USD 289.5 billion in 2023 and is projected to grow at a CAGR of 5.38% from 2024 to 2030. A Deloitte study notes that the gap between inpatient and outpatient revenue has been closing for two decades. But what's driving this boom? Clinical advances, patient demand for lower-risk and lower-cost options and payer pressure all play a role. New technologies, like advances in orthopedics, allow more procedures to be performed at outpatient service centers instead of costly hospital settings. Free-standing ambulatory surgery sites are expected to see a 14% volume boost over the next decade as more service lines, like cardiovascular and neurosciences, begin to shift procedures from inpatient to outpatient facilities. The ongoing growth in outpatient services presents a unique opportunity for revenue cycle leaders to use technology to improve outpatient revenue—and the overall patient experience. Grow outpatient revenue with more digital care Patients want a better experience at every step of the patient journey. They want to see their doctor faster, manage appointments online and understand how much it costs—with as little red tape as possible. A lack of streamlined patient access and transparency often results in no-shows, a rise in claims denials, wasted staff time and patient complaints. However, by opening the digital front door, providers can give patients the self-service tools they crave, improve the care experience, keep outpatient schedules full and increase revenue. Additionally, providers can use technology like artificial intelligence (AI) to lower claim denial rates. Here are five strategies to increase outpatient revenue in 2025. 1. Make patient access simple Patients want to see their doctor faster. In Experian Health's latest State of Patient Access survey, eight in ten patients who reported being unhappy with their provider experience cited waiting for an appointment as a top complaint. When trying to schedule, patients are also frustrated by the friction that comes with complex processes, clunky technology systems and sparse provider communication. Outdated manual workflows, staffing shortages and lack of staff training often result in challenges for both patients and providers. Improved patient access is at the heart of patient-centered healthcare. Technology designed to put the patient in control, like online patient scheduling and digital patient intake tools, offer continuous patient engagement, optimized scheduling, and streamlined administrative processes. By leveraging modern patient access solutions, providers can improve patient experiences and alleviate the impact of staffing shortages. 2. Reduce appointment no-shows Missed appointments cause headaches for patients, providers, and revenue cycle managers. Online scheduling and mobile registration are also top of mind for patients. In Experian Health's State of Patient Access 2024 survey, 89% of patients said they wanted self-service scheduling and 85% reported a dislike for filling out repetitive intake paperwork. Online patient scheduling software puts patients in the driver's seat, providing convenient and secure 24/7 access to book, reschedule, and cancel appointments on their own time. Solutions like Patient Schedule sync seamlessly to an organization's scheduling rules, and patients receive automated appointment reminders by text or IVR. On average, providers that use Experian Health's scheduling solution experience an 89% show rate, a 50% reduction in scheduling time, and a 32% increase in patients per month. Patient intake tools like Registration Accelerator simplify mobile registration with a streamlined text-to-mobile experience. Once registration is complete, automated returns of forms, patient-check-ins and demographic information ease the burden on staff. 3. Help patients prepare for outpatient costs Patients need a clear breakdown of their financial responsibility before receiving care. Without it, they may be unable to prepare for care costs appropriately. While hospitals are now required to share detailed pricing for at least 300 common procedures, confusion around a patient's actual financial responsibility still persists. More than half of patients report turning to their provider for help understanding what insurance covers. Digital solutions that provide accurate, upfront estimates empower patients. More than eight in ten patients say pre-service estimates help them prepare for the cost of care. Patient Payment Estimates provide upfront, real-time estimates of what a patient will owe. Providers can offer convenient and secure payment links, and allow patients to pay their bills online or see customized payment plans. Outpatient providers can further maximize the chance of reimbursement by running health insurance coverage checks across the entire revenue cycle. This can help find billable coverage that may have been forgotten and give patients greater certainty about what they'll owe. 4. Automate healthcare collections Collections are often a major challenge in the outpatient revenue cycle. Outpatient procedures can be costly, even with insurance, leaving patients responsible for potentially large bills. Automating healthcare collections allows for faster, more efficient, and more compassionate collections. Tools like Collections Optimization Manager helped Novant Health achieve an overall recovery rate of 6.5% and increase revenue and cost savings to a rolling average return on investment of 8.5:1. With automated tools like Patient Financial Clearance, providers can assess patients' ability to pay and assign them to an appropriate financial pathway. This allows patients to quickly get the assistance they need while freeing up valuable staff time. 5. Streamline claims to increase outpatient revenue Denied claims continue to be problematic for providers. In Experian Health's State of Claims 2024 report, which surveyed 210 healthcare revenue cycle leaders, nearly three-quarters of providers feel claims denials are increasing, while 67% feel getting paid is taking longer. Claims management software can help end the cycle of denials. However, around half of providers still use a manual claims review process, and only 28% feel confident in their understanding of automation, machine learning and AI. Adopting automated and integrated healthcare claims management solutions can reduce errors, prevent undercharges, and ensure a higher first-pass payment rate. Tools like Experian Health's ClaimsSource® simplify the entire claims process, while Claim Scrubber helps providers submit more accurate claims. Digital solutions can also automate claim status monitoring and eliminate manual denial processes. Implementing AI tools to interpret past claims data and recommend next steps can improve outpatient claim denial statistics. Tools like AI AdvantageTM look at past payer behavior and historical claims data to predict and prevent denials. AI Advantage's two components, Predict Denials and Denial Triage, help providers respond to growing denial challenges by identifying claims with a high likelihood of denial before submission, and focus on remits that have the most impact. See how: Find out more about how Experian Health's revenue cycle management solutions can help healthcare organizations increase outpatient revenue, keep pace with growing patient volumes, improve patient satisfaction and boost their bottom lines. Learn more Contact us

Lines at the desk, phones ringing off the hook and a stack of insurance questions waiting to be resolved — this is the daily reality for many patient access teams. Today's patients find these "front door" bottlenecks in healthcare particularly frustrating, especially since they can envision how much smoother the process could be with the digital apps and tools they rely on in other areas of their lives. Despite improvements in patient access, Experian Health's latest State of Patient Access survey suggests that the digital front door in healthcare is still only partially open. Drawing on these survey findings, this article examines how opening the digital front door in healthcare can address common pain points in patient access, improve operational efficiency and better meet the needs of modern healthcare consumers. What is the digital front door in healthcare? Scheduling a doctor's appointment should be as easy as using a food delivery or ride-sharing app. That's the idea behind the digital front door in healthcare. Giving patients secure digital options to book, register and pay for care puts control in their hands so they can manage their care anywhere, anytime. It's part of a larger digital transformation in healthcare, making it easier for patients to connect with services quickly and conveniently. At the same time, it improves efficiency and profitability for providers. From websites and portals to mobile apps, this approach creates a friendly, accessible entry point that focuses on what patients need: simplicity, convenience, and transparency in their healthcare journey. Top pain points in the healthcare digital experience While previous State of Patient Access reports exposed frustrations with patient access, the 2024 survey shows a glimmer of hope. Self-scheduling options are on the rise and telehealth is reducing friction. Patients and providers agree that access is getting better and credit digital tools for many of the improvements. That said, challenges remain. Top 3 pain points for patients Seeing their doctor quickly (27%) Understanding how much their care will cost (17%) Trying to schedule appointments (14%) Top 3 pain points for providers Maintaining staffing levels (45% vs. 55% in 2022) Efficient and timely management of prior authorizations (39%) Improving speed and accuracy of resolving patient information prior to claims submission (31%) When it comes to future priorities, patients and providers agree that accurate pre-service price estimates and clarity around insurance coverage are the top two. Providers believe they're getting better at providing accurate estimates, and while 74% of patients say they did receive accurate estimates, this is down from 78% the previous year. It's a good reminder that the digital front door isn't just about online scheduling: using digital tools to help patients understand and prepare for their bills is a key component. Patients and doctors want more — not fewer digital services The 2024 report reaffirms previous findings that patients want more digital options for managing their healthcare: six in ten say this is important. And among providers, it's clear that digital front door technology is seen as a critical driver of improvement in patient access. Here are just a few ways providers say they're using digital tools to reduce friction: Expanding telehealth services Introducing digital/mobile patient communications Launching patient portal services Enabling online and mobile payment tools Implementing digital self-service registration and online/mobile self-scheduling Mitigating staffing shortages is a major benefit. Staffing issues have lessened since the peak of the pandemic, but remain an obstacle to effective scheduling and registration for 72% of providers. Automation and self-service patient access tools help alleviate these pressures. How digital solutions improve patient access and satisfaction “These digital tools make healthcare more accessible by eliminating barriers and simplifying patient-provider interactions,” says Alex Harwitz, VP, Digital Front Door, at Experian Health. “Automation can take care of repetitive tasks that take up staff time, so staff can focus on helping patients directly. Real-time scheduling, accurate cost estimates and streamlined mobile options meet patients where they are and give them the control and flexibility they want.” Bottlenecks, wait times and costly errors go down, while patient satisfaction is higher. 3 solutions to improve the digital front door Harwitz suggests three ways to use the digital front door to eliminate friction in the patient journey: 1. Simplify patient scheduling Patients' litmus test for patient access is how quickly they can see their doctor. To help patients quickly find and book the earliest available appointment, healthcare organizations turn to Experian Health's Patient Schedule software. This 24/7 digital scheduling platform guides patients to the right appointment and provider in line with scheduling and business rules. Patients can easily cancel and reschedule if necessary, and no log-in is required, so new patients can get started instantly. Automation optimizes scheduling capacity, so no appointment slots are wasted, improving call center efficiency. There's also the option to incorporate automated text, interactive voice response and email reminders so patients don't forget their appointments, which will increase completion rates and reduce gaps in care. 2. Speed up registration times Patients don't want to sit in waiting rooms and fill out manual paperwork, and healthcare staff have limited bandwidth to handle high patient volumes. Tools like Registration Accelerator can streamline the registration process, by reducing manual efforts and paperwork for patients and staff. This patient intake solution sends an automated link that allows patients to register anywhere, and at any time. Patient Access Curator uses AI-powered data capture technology to collect and verify patient information at registration, reducing the need for manual input. In a single click, the tool runs simultaneous inquiries to capture: Eligibility verification Coordination of benefits Medicare Beneficiary Identifiers Coverage discovery and patient financial status Patient demographics Not only does this accelerate the registration process for patients, but it also gathers clean, accurate data for downstream claim submissions. This technology has prevented over $1 billion in denials since 2020. Watch the webinar: How Patient Access Curator is transforming claims management from the front end of the revenue cycle. 3. Provide more accurate estimates With 96% of patients looking to their provider to help them understand their insurance coverage, the demand for better financial communications is clear. More than 80% of patients say accurate upfront estimates help them plan for costs. If they feel they can't afford to pay, 43% say they would consider postponing or canceling care. Lack of clarity is a health risk as much as a financial one. Experian Health created Patient Financial Advisor and Patient Estimates to help providers improve price transparency. Healthcare providers can use these tools to generate precise cost estimates based on real-time pricing information and offer convenient online payment options to expedite collections. Patients can get a personal estimate, customized payment plan and submit a payment in a few clicks. This addresses patient concerns about affordability and transparency, while ensuring providers remain compliant. See it in action: the digital front door in the real world How IU Health used guided scheduling to boost patient satisfaction and improve operational efficiency even as patient volumes increased. How Banner Medical Group uses Patient Estimates to boost patient satisfaction and meet compliance requirements. How West Tennessee Healthcare modernized patient intake with automation. The evolving digital front door in healthcare The digital front door in healthcare isn't just a single entry point — it's a constantly evolving way to connect with patients, bridging digital and real-life interactions. By tackling common challenges like outdated booking systems, unclear financial statements, lengthy waits and limited payment options, healthcare organizations can create a smooth, patient-friendly experience that boosts satisfaction, builds trust and improves results for everyone involved. Learn more about how Experian Health's digital front door solutions tackle the most common pain points in patient access and deliver convenience, clarity and control. Learn more Contact us

According to Experian Health's State of Claims 2024 survey, missing coverage is the top reason for healthcare claim denials for almost a fifth of providers. However, the issue isn't just about whether a patient is insured — four in ten providers worry about insurance companies paying out even where patients have active coverage. Constantly changing payer policies can result in altered or expired benefits, leaving providers scrambling to secure alternative sources of payment. That's why many providers are turning to automated health insurance discovery to find missing coverage and catch outdated policies early. This article looks at how coverage discovery software helps healthcare organizations address some of the most stubborn pain points in the revenue cycle. What is health insurance discovery? When a patient comes in for care, one of the first jobs is to figure out exactly what insurance they have — if any — and what it covers. Health insurance discovery is the process of checking whether the patient has active insurance and confirming details of that coverage, such as payer name and plan type, to ensure the cost of care is billed to the correct payer. If a patient has multiple active plans, the provider must also determine how much should be billed to each payer and in what order. How does it work? Ideally, coverage discovery occurs pre-service, but it can occur later if a claim is denied, and alternative coverage sources must be found. The main steps in the process include: Collecting insurance details when patients schedule or check in Checking with insurance companies to confirm that coverage is active and will cover planned services Cross-checking payer databases to ensure no coverage is missed Considering a patient's eligibility for Medicaid or other charity support Coordinating benefits for accurate billing Benefits of automated health insurance discovery for providers While respondents to the State of Claims survey are reasonably confident about their coverage discovery processes, the actual outcomes are less robust. Eligibility checks are taking longer and errors are on the rise. Only 54% of providers believe their claims technology can meet current revenue cycle demands. Automation offers a reliable and adaptable solution to bridge the gap between front-end checks and back-end claims management. Here are a few ways automated health insurance discovery sets the stage for smoother claims submissions and revenue cycle performance: 1. Maximize reimbursement by finding missing coverage quickly Challenge: Patients don't always provide complete insurance information, which can cause providers to miss out on opportunities for reimbursement. How automation helps: Automated health insurance discovery digs deeper than manual processes to find any coverage that may have been missed or forgotten. Experian Health's Coverage Discovery® solution combs through multiple proprietary databases, including employer information, historical search information, registration history and demographic validation to proactively identify billable Medicare, Medicaid, and commercial coverage. With minimal patient details, it finds additional sources of primary, secondary and tertiary insurance instantly. In 2023, Coverage Discovery tracked down previously unknown billable coverage in a third of patient accounts, resulting in more than $25 million in found coverage. 2. Reduce the manual workload Challenge: Staff spend too much time calling payers, logging into portals and manually entering patient data. This is time-consuming and error-prone, especially when one in four resubmissions are worked on by a different person than the one who originally processed it. How automation helps: Automation eases the admin burden by handling repetitive aspects of insurance verification behind the scenes, freeing staff to focus on more complex tasks. Coverage Discovery saves staff time by continuing to check for health insurance throughout the patient journey, and not just at registration. This final post-service check is vital to detect discrepancies that could lead to denied claims. Staff can also automate the self-pay scrubbing process to further reduce the risk of errors. As providers continue to feel the squeeze from staffing shortages and rising operating expenses, any move to reduce costs while bringing in more revenue is to be welcomed. 3. Prevent eligibility issues Challenge: Providers often only discover that active benefits have changed after the claim has been submitted. That's too late. For 43% of providers, it takes at least 10 more minutes to check eligibility when initial checks are incomplete. How automation helps: With automation, providers can run real-time eligibility checks, ensuring that changes to the patient's benefits are caught early so claims aren't denied due to outdated information. Experian Health's new Patient Access Curator uses artificial intelligence-based data capture technology to return accurate information from multiple sources with a single click. It automatically interrogates data from more than 270 payer responses, including active and billable coverage, plan level detail, chaining and primacy, so providers can verify eligibility and more in an instant. 4. Reduce claim denials and rejections Challenge: Incorrect or incomplete insurance information results in errors on claims forms or claims sent to the wrong payer, which causes denials, delays and rework. How automation helps: Automated discovery ensures that the correct payer and coverage information is attached to claims, reducing the likelihood of denial. This solves one of the most frustrating parts of coverage discovery, making the process faster, more accurate and less reliant on manual effort. Read more: How to leverage AI and automation to minimize healthcare claim denials 5. Improves the patient experience Challenge: Patients are often confused about their coverage status and worried about whether their healthcare costs will be met by their insurance provider. Medicare beneficiaries, in particular, report difficulty understanding and comparing plan options, leading to potential gaps in coverage. When healthcare providers fail to catch errors or gaps in their information, this erodes trust and negatively impacts how they feel about their experience. How automation helps: By correctly identifying coverage and verifying benefits eligibility, automation allows providers to give their patients early certainty about how their healthcare costs will be covered. Patients are less likely to receive unexpected or incorrect bills, which prevents delays and disputes. Automated tools can go a step further to improve the patient experience by guiding patients toward additional support and payment plans. For example, Patient Financial Clearance identifies patients who may be eligible for Medicaid or charity assistance, and identifies appropriate payment plans for anyone with an unmanageable self-pay balance. Case studies: See health insurance discovery in practice How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month Learn more about how automated health insurance discovery helps providers reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us