Patient Access

If there's one topic that's sure to elicit groans from claims and billing teams, it's prior authorizations. Despite promising improvements overall, Experian Health's most recent State of Patient Access survey suggests that the efficient and timely management of prior authorizations remains a headache for providers, with 89% citing this as one of their top three improvement priorities in patient access. Obtaining pre-authorizations is time-consuming, often relying on antiquated manual systems that drag staff away from patient care. Ever-changing payer guidelines make an already frustrating process even more difficult. In this context, automating prior authorizations is an obvious choice for the 79% of providers who plan to invest in improving patient access in the near future. Why are prior authorizations required? Prior authorizations are when payers and providers determine in advance if the patient's insurance plan will cover a particular drug, medical item or service. Providers submit information about the patient's medical history and the rationale for the proposed treatment. The insurer evaluates this information and approves or denies the request. If a provider goes ahead without obtaining authorization, they are unlikely to be reimbursed for the cost of that care. The intention is to ensure that tests and procedures are safe, effective and high-quality. It's also a cost-control strategy, ensuring that expensive services are offered only to patients who really need them. Why do prior authorizations get denied? Insurers only approve prior authorization requests for treatment and services deemed medically necessary and aligned with their coverage policies. Authorization may be denied for several reasons: the treatment isn't covered by the patient's plan, the proposed treatment isn't considered medically necessary, or alternative, less expensive treatments are available. Denials often result from simple paperwork errors, such as incomplete clinical documentation or missed deadlines. Automating prior authorizations: an untapped opportunity The prior authorization workflow involves some of the most time-consuming and expensive manual processes in the revenue cycle, making it an ideal use case for automation. Yet, according to the Council for Affordable Quality Healthcare (CAQH), only 31% of providers use electronic prior authorizations. This contrasts with much higher adoption rates for other transactions: 94% use automation for eligibility checks, 98% for claims submissions and 90% for coordination of benefits tasks. With the amount spent on prior authorizations jumping by 30% between 2022 and 2023, switching to automated processes could save the industry hundreds of millions of dollars and many hours of staff time, among other benefits described below. Here are 5 benefits of automating prior authorizations: 1. Prevent costly claim denials and rework Without prior authorization, providers do not get paid. Failure to secure authorization was among the top three reasons for denied claims for almost half of the State of Claims 2022 survey respondents. Often, this is because the authorization does not cover all elements of a patient's treatment, or the information included in the claim submission does not match the original documentation that was authorized. With automation, it's much easier to ensure that all codes, documentation and records are accurate and complete, reducing the risk of claim denials. Automation also gives payers and providers a shared view of account information, minimizing the need for prolonged discussions about the status of authorization and rework requests. 2. Access a central payer database that automatically syncs with changing payer rules Revenue cycle management teams often struggle to keep track of changing payer requirements. Experian Health's prior authorization knowledge base solves this by collating real-time updates to payer requirements. Staff can check what's needed without needing to visit multiple payer websites and cross-check data by hand. Users also benefit from a guided, exception-based workflow, which notes whether submissions are pending, denied or authorized, and flags where manual intervention is required. 3. Improve operational efficiency Almost four in ten providers find timely and efficient management of prior authorizations challenging. Automating prior authorizations reduces the manual burden on staff, so resources and time aren't wasted on low-value activities. Providers can augment efficiencies by combining prior authorization software with other revenue cycle tools to create more coordinated and cost-effective processes. On a webinar about how AI and automation reduce claim denials, Skylar Earley from Schneck Medical Center commented specifically on how AI Advantage was facilitating more efficient prior authorizations: “[With AI AdvantageTM], we've seen the number of authorized outpatient visits increase by about 2.5%. For anyone that deals with prior authorizations and denials relating to prior authorizations, that's incredibly promising. Billers feel like they've got another tool in their belt. For people who spend hours on the phone with insurance companies, fighting for dollars and claims we believe should be paid, any leg-up is a big deal.” 4. Prevent dangerous delays to care with faster prior authorizations A 2022 survey by the American Medical Association showed that the authorization process leads to delayed and abandoned care and even severe adverse events, as patients and doctors wait to hear if paperwork is in order before proceeding with treatment. Automating prior authorizations helps ensure patients don't miss out on essential care because of administrative obstacles. Staff can shave an average of 11 minutes from each transaction, allowing them to initiate more authorizations in less time, and protect patients from the clinical consequences of rescheduling. 5. Deliver a better patient experience Aside from these obvious and significant health effects, the prior authorization workflow also influences patient perceptions overall: in the State of Patient Access 2024, just over a quarter of patients said authorizations were the main reason they considered patient access to be better or worse than last year. Automated prior authorizations free up staff to create a smoother clinical and financial experience for patients. Patients see their accounts processed quickly, with fewer errors and delays. When patients are certain that their insurer will cover their care, they can concentrate on their treatment rather than worrying about how and when it will be financed. Find out how Experian Health's automated prior authorizations help healthcare organizations get on the right path to reimbursement and make these benefits a reality in 2024.

Could patient text reminders play a key role in making healthcare more convenient and accessible for patients? Experian Health's latest State of Patient Access 2024 survey found that six in ten patients want more digital tools to manage their healthcare. Overall, it indicates a greater demand for more transparent, simpler processes. Patient text reminders make this a reality by reducing the cognitive load of scheduling and paying for care. With 98% open rates and an average response time of 90 seconds, text messaging is a simple but powerful engagement tool for providers. For the eight in ten providers gearing up to invest in digital patient access tools in the near future, sending patient text messaging reminders could be a smart choice. Here are three use cases to consider. Use case 1: Patient text reminders can boost patient collections For providers with squeezed margins, every cent counts. While healthcare affordability poses the biggest challenge for patient collections, outdated billing and payment processes hinder patient revenue overall. SMS (text message) reminders prevent unnecessary delays by gently prompting patients to settle their bills. They're direct, convenient and discreet, so they're more likely to be acted upon, as opposed to emails or phone calls that are easily ignored. Texting also supports a tailored experience. For example, Experian Health's PatientText solution integrates with Collections Optimization Manager to segment patients based on their needs and preferences. The Text-to-Pay feature sends patients personalized messages with secure links to payment options, so they can pay their bills when convenient without having to remember a username and password. Case study: See how St Luke's used Collections Optimization Manager and targeted patient outreach to increase average monthly collections by $1.7 million. Use case 2: Reduce no-shows with patient appointment reminders Almost 90% of patients say they want to be able to schedule appointments at any time via online or mobile tools. Automated text reminders ramp up the return on investment in online scheduling and mobile registration tools by reducing no-shows, optimizing patient flow, and ensuring patients get the care they need. Messages can include preparation instructions, so patients know exactly where to go and when, and if they need to fast beforehand or bring anything. It's much easier for patients to click a link in a text to confirm, reschedule, or cancel appointments, than to check their email or wait to speak to a call center agent. That's good news for call centers too – when more patients opt for self-service options, providers can scale targeted outreach while keeping call volumes manageable. Case study: See how IU Health transformed patient scheduling with self-service automation Use case 3: Patient text reminders increase patient satisfaction and care plan adherence with handy alerts Patients actively engaged in their health are more likely to follow through with treatments and care plans, leading to better health outcomes. Text messages can remind patients about post-appointment care, check-ups and medication refills to help them stay on track and reduce the risk of missed doses or appointments. Closing gaps in care and preventing avoidable complications is not just good from a medical perspective – it also reduces the risk of more expensive care being needed further down the line. However, one of the most significant advantages of using patient text reminders is creating a more organized and patient-friendly experience with little effort, benefiting patients and staff. Automated, timely messages through patients' preferred channels ensure they feel cared for and informed, without staff needing constant, high-touch follow-up. Staff members are free to focus on patient support and other revenue-generating tasks, instead of wading through endless admin. Read more: 5 benefits of automated patient outreach PatientText in practice: How one provider used targeted outreach to boost collections by nearly $2M One of Experian Health's clients offers a snapshot of what they've achieved in the year since implementing SMS-based patient outreach: $1.89M in patient collections via Text-to-Pay $168 collected per transaction on average 11K+ transactions via text These results show that offering patients the flexibility to engage with payment processes at their convenience leads to higher transaction amounts and more dollars collected overall. Take advantage of smartphone culture with patient text reminders Many patients have their smartphone with them 24/7, which gives providers a fantastic opportunity to improve patient engagement through automated text reminders. Whether the drive is to increase collections, improve patient flow, or create convenient patient experiences, it's clear that this relatively simple technology punches above its weight. Schedule a demo to see how Experian Health's patient text reminders solution, PatientText, can help your organization improve patient engagement and optimize collections.

In healthcare revenue cycle management (RCM), the mantra is clear: maximize revenue and minimize costs. It's more complex in practice, requiring RCM leaders to anticipate and adapt to whatever's around the corner. Following the latest revenue cycle management trends is vital, as economic turbulence and labor shortages demand flexibility and resilience. Competition from new players and changing consumer expectations call for constant updates to the latest technology. And currently, as electoral news cycles heat up ahead of the general election, attention is turning to potential policy changes and their implications for revenue cycle management. Keeping an eye on how the industry evolves will help RCM managers hold the course for financial stability and growth. Here are 12 revenue cycle management trends to watch: 1. Investment in managed RCM services Investment in managed RCM services has become an increasingly attractive option for RCM managers grappling with persistent workforce challenges and navigating the intricate landscape of payer policies. Outsourcing has become a strategic solution to address staffing shortages and limited resources. By partnering with vendors like Experian Health, healthcare organizations can get access to specialist expertise, datasets and automated technologies they'd be hard-pressed to develop in-house. For example, Collections Optimization Manager allows users to retain control and oversight of their collections processes but comes with real-time support from a dedicated Collections Optimization Consultant for a bespoke collections strategy built on data insights and industry knowledge. 2. Staff shortages and reimbursement model changes Staffing shortages are particularly problematic when they bump up against changing reimbursement models. Unfortunately, staffing shortages are still common in the future of revenue cycle management. In Experian Health's latest staffing survey, 69% of respondents believe that staffing will continue to be a problem in the future. More providers are moving to value-based care models, which have implications for claims submission processes and provider-payer relationships. High staff turnover leaves providers without the knowledge and expertise to handle more complex claims and billing processes. A tool like Contract Manager and Contract Analysis, recently awarded Best in KLAS for Contract Management, helps monitor and manage payer contracts to stay on top of terms and conditions, mitigate risk and maintain financial stability. 3. Workflow inefficiencies Another way to ease staffing pressures is to improve workflow efficiency. A recent Bain report found that 40% of clinicians reported a lack of effective workflows, while up to 70% had never tried automated workflow management. There's a missed opportunity here, as manual processes and communication bottlenecks seriously disrupt revenue cycle functions. Organizations that leverage more efficient ways of working will secure a competitive advantage as new demands and pressures arise. Reviewing key performance indicators is a good starting point for determining where to focus improvement efforts. 4. Technological advancements in RCM The ongoing evolution of artificial intelligence (AI) has profoundly impacted various sectors, and the realm of revenue cycle management is no exception. AI-based tools will continue to shape the future of revenue cycle management, and providers will have to implement these tools in order to keep up with the competition. Machine learning algorithms increase RCM efficiency and accuracy by automating routine tasks, while advanced tools like AI AdvantageTM analyze vast datasets to identify patterns and predict outcomes. AI Advantage transforms claims management by predicting claims that are most likely to be denied, and then triaging denials so staff can focus on those with the highest likelihood of reimbursement. Eric Eckhart, Director of Patient Financial Services at Community Medical Centers, says, “We were looking for something technology-based to help us reduce denials and stay ahead of staff expenses. We're very happy with the results we're seeing with AI Advantage.” 5. Technology integration The amount of data being collected, generated, processed and shared within healthcare organizations is skyrocketing. More data means greater capacity for personalized services, fewer gaps in care, and more streamlined RCM processes—but only if data systems talk to one another. Opting for a single integrated solution avoids the pitfalls of shoe-horning new tools into legacy systems. For example, Experian Health's acquisition of Wave HDC means organizations can now access a single tool to check multiple data sources at registration. Patient Access Curator uses AI to perform eligibility verification, coordination of benefits, coverage discovery and more, to help healthcare organizations accelerate registration and reduce claim denials. 6. Medical billing errors Whether a coding mistake or an accidental typo, billing errors cost providers dearly in lost revenue and time. Unfortunately, they're a growing risk as more patients show up with coverage from multiple payers and high deductibles. On the upside, organizations should see improvements with relatively little effort—assuming they deploy the right tools and strategies. Patient Access Curator, mentioned above, uses AI and robotic process automation to collect and verify the information needed to compile error-free claims with just a single click. Watch the webinar to find out more about how Patient Access Curator helps providers eliminate errors and reduce claim denials from the front end. 7. Patient-centric approaches A McKinsey report published in April 2024 highlighted a continuing trend in healthcare consumers' keenness to use digital products and services when accessing care. Experian Health's series of patient access surveys show a consistent desire for personalization, convenience, choice and compassion in patient access. These principles underpin Experian Health's approach to helping providers open their digital front door. Online self-scheduling, digital registration, and tailored patient outreach all improve patient satisfaction and engagement, subsequently bolstering revenue generation. 8. Financial clearance and diverse payment options One specific opportunity relating to the above point lies in offering a patient-centered financial experience. Financial clearance tools and flexible payment plans have gained prominence by making it easier for patients to understand and manage their financial obligations. Tools like Patient Financial Clearance automate presumptive charity screening to see if patients qualify for financial assistance programs, provide scripts to help staff deliver compassionate financial counseling, and calculate affordable monthly payments based on individual circumstances. Case study: Discover How UCHealth wrote off $26 million in charity care with Patient Financial Clearance. 9. Financial engagement and omnichannel platforms Patient collections are a growing challenge for providers. Patients similarly complain of unnecessary friction in the payment process: The State of Patient Access 2024 survey found that 72% of patients want more digital payment options digital methods. By providing a unified experience across online portals, mobile apps and point-of-service payments, providers can increase patient engagement with financial processes and accelerate collections. 10. Challenges specific to each revenue cycle segment Organizations are shifting away from uniform solutions for the entire revenue cycle and instead embracing tailored strategies that accommodate the unique requirements of various departments, services, and workflows. By harnessing advanced analytics and automation, providers gain insight into the nuanced challenges within revenue cycle management, enabling them to adopt the best tools. This approach ranges from customizing intake and billing processes on a departmental basis to automating claims processing tailored to different payers' specifications. 11. Customizable RCM solutions Just as patients want tailored solutions, so too do providers. Data analytics and AI advancements enable providers to develop claims management solutions that fit their unique mix of payers and patients. On a recent webinar, representatives of Eskenazi Health discussed their use of Patient Financial Advisor, and how Experian Health consultants helped their organization customize their setup and workflow. 12. The role of strategic partnerships Partnering with a vendor like Experian Health can be a transformative step for healthcare organizations seeking to optimize their operations and enhance patient care. With Experian Health's expertise in healthcare technology and data management, organizations gain access to a comprehensive suite of automated solutions tailored to their specific needs. This also ties in with the first item in this list: implementing new ways of working isn't always easy, but with a trusted vendor, providers can manage and accommodate revenue cycle management trends more confidently, efficiently, and cost-effectively. By partnering with Experian Health: Providence Health found $30million in coverage and reduced denial rates IU Health processed $632 million in claims transmissions West Tennessee Healthcare automated and modernized patient intake The pace of change may be relentless, but with the right tools and support, RCM managers can stay one strategic step ahead and future-proof their revenue cycle for whatever surprises lie in store. Learn more about how Experian Health's revenue cycle management solutions can help providers keep up with revenue cycle management trends while maximizing revenue and minimizing costs.

The State of Patient Access 2024 marks the fourth installment of a series of surveys initiated in 2020, comparing patient experiences and providers' perceptions of those experiences. Experian Health's latest infographic highlights findings from the latest survey, conducted in February 2024, involving 200 healthcare revenue cycle decision-makers and over 1,000 patients. The study reveals an overall improvement in perceptions of access to care, indicating a positive trend in providers' efforts. However, there are still significant challenges ahead. Providers continue to believe access is better than what patients actually experience, a consistent finding across surveys. Check out the highlights in the infographic: Despite progress, there's a clear need to bridge the gap between patient experience and provider perception. How can providers turn their perceptions into reality for patients? Download The State of Patient Access 2024 report to gain deeper insights into patients' and providers' perspectives on access to healthcare.

“We are really happy with Experian. It takes away duplication of efforts and allows us to see the bigger picture. The eligibility solution works well for our team and patients.” —Emily Brown, Director of Operation Excellence at Providence Health  Challenge Providence Health is a leading health system comprising of 56 hospitals and over 1,000 physician clinics. With an annual patient volume of over 28 million, Providence strives to prioritize the well-being of their patients by providing convenient, accessible, and affordable medical services.   Because of high patient volumes, they faced issues with slow payer eligibility processes and increased eligibility denials, which meant their staff spent a lot of valuable time verifying eligibility manually.   Additionally, as Epic's payer plan table expanded, Providence Health needed an efficient way to consolidate and align the data pertaining to insurance plans, contracts, and reimbursement details. In order to streamline the process and keep their staff within the system, Providence Health sought to automate eligibility tracking.  Solution Providence Health implemented Eligibility Verification and leveraged the Bad Plan Code Detection tool, which identifies coding errors before they're submitted to payers. With this solution, the system immediately alerts users when an incorrect plan code is flagged, allowing users to fix any issues quickly and avoid costly claim rework. Additionally, integration with Epic facilitated seamless 1:1 plan mapping, and automated the creation of new coverage records in Epic based on responses received. This streamlined the process, eliminating guesswork for staff and ensuring accurate plan selection. Emily Brown, Director of Operation Excellence says, “Our search for a solution that seamlessly integrates with Epic led us to choose Experian Health as our preferred vendor, given their proven track record of working with Epic.” By working with Experian Health, Providence has uninterrupted service and connections to over 900 payers, with backup connectivity to 300 additional payers. Providence staff can utilize automated work queues fueled by response data and custom alerts, which allows them to work more efficiently.   Outcome Thanks to Eligibility Verification, Providence Health achieved the following results:  Found an average of $30 million in coverage annually   Saved $18 million due to decreased denial rates within five months  By automating eligibility checks for high patient volumes, Providence Health boosted patient satisfaction while significantly reducing staff workload. Partnering with Experian Health allowed them to identify an increased amount of active eligibility, ensuring accurate reimbursement and avoiding claim denials. Automation also eliminated time-consuming tasks, allowing staff to focus on providing better patient care.   “Checking if my insurance was accepted was a fast and friendly process. The staff even helped clarify which insurance was the right one for me since I had multiple cards.”   - Providence Health Patient  Learn more about how Eligibility Verification helps healthcare organizations access real-time insurance coverage data, improve reimbursement rates and avoid claim denials.  

What do patients and providers really think about patient access services in 2024? Drawing insights from more than 1000 patients and 200 healthcare executives, Experian Health's fourth State of Patient Access survey pulls back the curtain. Previous surveys revealed a persistent gap between patient and provider perspectives on patient access, but could the gap finally be closing? The State of Patient Access 2024 report suggests that while discrepancies remain, the two groups appear closer than ever. This article provides a summary of the State of Patient Access 2024 report, and gives a run-down of patient and provider perspectives on patient access, what they see as top challenges, where opinions diverge and the steps providers can take to continue building a positive patient access experience in the year ahead. How do patients feel about patient access? 1. More patients think access has improved compared to last year 28% of patients believe patient access has improved over the last year, which is up from just 17% in 2023. As in previous years, patients' perception of whether access has improved hinges on how quickly they can see their doctor. Anything providers can do to accelerate scheduling and registration will be a winner. 2. Patients welcome the efficiency and accuracy of digital tools Patients have noticed improvements in scheduling and registration processes. They welcome the ability to book appointments anytime and avoid unnecessary paperwork using digital technology. That said, financial considerations trump convenience: the ability to look up insurance coverage and obtain accurate price estimates before care have risen to the top of the list of what patients consider the most important aspects to improve. 3. Cost of care remains a concern Unfortunately, patient sentiment around healthcare payments has remained relatively flat since 2022. Slightly more patients are receiving upfront cost estimates compared to previous years, but accuracy appears to have dropped, with 74% of patients reporting accurate estimates compared to 78% in 2023. Patients must have faith in their estimates if they are to plan for upcoming bills with confidence, and providers should be able to provide transparent and accurate payment estimates. What do providers think about patient access? 1. Providers are again more optimistic about improvements than patients Like patients, providers are generally positive about the state of patient access, though they may be a little too optimistic about the effect of improvement efforts. Around twice as many providers think access is better than the previous year compared to patients (55% compared to 28%). For providers, perceptions of improvements in patient access are closely tied to the impact of staffing levels. 2. Self-scheduling is back in favor Providers are aligned with patients on the need for digital scheduling and registration options. Interestingly, after the urgency to implement contactless scheduling during the pandemic began to wane in 2022, the latest survey suggests that self-scheduling is back in fashion, with 63% offering self-scheduling compared to 40% in 2022. 3. “Dirty data” remains a stubborn challenge Data collection at patient intake is a persistent headache for providers. Almost half (49%) say that inaccurate patient information contributes to claim denials. Improving the speed and accuracy of resolving patient information prior to claims submission were frequently listed in providers' top three challenges. See how healthcare organizations are using AI AdvantageTM to improve data accuracy and reduce claim denials. Digital technology bridges the gap between patient and provider perspectives on patient access When asked for their top three priorities for improvement, both groups ranked accurate price estimates and efficient insurance verification among their top two. While they diverge on the third – access to online health management tools for patients, and automated pre-authorizations for providers – it's interesting to note that these both reflect a desire to use digital solutions for greater efficiency and convenience. The survey highlights several opportunities to use digital technology to address upcoming challenges and continue to close the gap. Key challenges in patient access in the year ahead 1. Improving accuracy of upfront price estimates The survey showed 79% of providers plan to invest in patient access improvements soon. Given shared concerns about patients' ability to cover the cost of care, and worrying hints that some may postpone care due to cost concerns, prioritizing and providing accurate patient estimates would be a smart choice. While patients and providers are in closer agreement that estimates are accurate most or all of the time (74% and 85% respectively), there's clearly room for improvement. 2. Accelerating insurance verification and claims submission processes Several of the providers' top challenges speak to how difficult it can be to collate accurate information prior to claims submission. The need for better insurance reviews, more efficient management of prior authorizations, and more accurate patient information all contribute to the overarching goal of getting properly reimbursed. Almost a fifth say that managing multiple tools to determine eligibility, coordination of benefits (COB), and other pre-service checks is a top challenge. Could a single solution be the answer? Experian Health's new Patient Access Curator solution checks eligibility, COB, Medicare and commercial coverage, demographics and financial status in less than 30 seconds. Staff can check off several of these tedious tasks with just a single click. 3. Bolstering workforce capacity with technology A final challenge in the year ahead is the ongoing impact of staffing shortages. For the of providers who feel that staffing levels are disrupting delivery of scheduling and registration services, technology may offer a way through. Automation and artificial intelligence not only reduce the burden on staff by eliminating time-consuming manual tasks, but also allow staff to work smarter and faster on remaining tasks by improving data accuracy and insights. Most importantly, digital technology can improve scheduling, registration and payment processes for patients – and bring the patient experience in line with what both groups aspire to see. Download the full report: State of Patient Access 2024, or contact Experian Health to learn how technology can help streamline patient access.

Many healthcare providers believe pairing “revenue cycle” with a qualifier like “predictable” is an oxymoron. From healthcare staffing shortages that slow down reimbursement tasks to increasing payer denials, financial regularity can seem like an unattainable goal for these organizations.  The American Hospital Association (AHA) reports over one-half of U.S. hospitals had financial losses in 2022. Another AHA survey shows that 84% of these organizations say the cost of complying with complicated payer policies is climbing. Providers throw an excessive amount of time and staff at chasing revenue, but reimbursement complexities make for anything but smooth financial sailing. How can healthcare providers even out the ebbs and flows of the revenue cycle? Experian Health's suite of revenue cycle management (RCM) solutions can help. Revenue cycle predictability during the life of a claim When it comes to finances, U.S. healthcare providers rarely have an easy go of it. Today, the average life of a claim is anything but average. From registration to collections, hospitals established a new normal over the past decade: Widening gaps between service delivery and reimbursement. How can providers tackle this untenable situation? The answer is two-fold: with technology and at each stage of the life of a claim. Here are three ways healthcare providers can use technology to create reimbursement predictability at each stage of a claim's life. 1. Establish payment accountability at patient registration with price transparency Reimbursement problems begin at patient registration. Healthcare price transparency demands patients understand the cost of care. According to Experian Health's State of Patient Access survey, 81% of patients agreed that an accurate estimate helps them better prepare to pay for their care costs. However, only 31% of patients received a cost estimate before care. There are three significant impacts of this troubling trend: Nearly 40% of patients say they put off needed care due to cost. The number rises to 61% if the patient is uninsured. Patients can't afford to pay for needed care. Currently, 41% of U.S. adults have medical debt. An Experian Health study showed four in 10 patients spend more than they can afford on healthcare treatment. Uncompensated care causes a significant drop in healthcare provider income, which has amounted to almost $745 billion, according to the AHA. Experian Health offers several data-driven solutions to improve price transparency. These tools make it easier for patients to handle their financial responsibilities while helping providers find solutions to help ease their burdens.Patient Financial Advisor creates more accurate service estimates for patients before their procedure. The mobile-first platform offers patients a detailed cost breakdown on their preferred digital device. Patient Estimates is a web-based platform offering real-time service estimates. Blessing Health System uses the tool to provide patient estimates that are up to 90% accurate. The provider increased collections by 58% and credits the software with a 1,200% return on their investment. Patient Access Curator automatically initiates communication with payers to improve coordination of benefits and maximize return. It also automatically identifies missing or incorrect Medicare Beneficiary Identifier (MBI) numbers or errors in patient contact details. This solution also helps providers understand the patient's ability and propensity to pay, allowing these organizations to predict revenue streams after service delivery. Behind the scenes, Experian Health also automates insurance eligibility verification to unlock hidden reimbursements. This software roadmaps the correct coverage, connects to more than 900 payers and verifies insurance coverage at the time of service to improve cash flow and ease patient payment burdens. 2. Reduce claim denials by decreasing manual paperwork errors Claim denials are one of the biggest impediments to revenue cycle predictability. Providers are stuck in an endless cycle of inaccurate payer submissions, rejected claims, and rebilling, creating a chaotic chase for payment long after the service. Today, 35% of healthcare organizations report $50 million or higher in lost revenue due to claims denials. Even worse, Experian Health's State of Claims 2022 report showed that 30% of providers say denials are increasing by up to 15%. According to that data, the top three reasons for claim denials are: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Coding inaccuracies. Experian Health's Claim Scrubber software levels out provider cash flow, creating predictability amidst the chaos. The solution reviews complete claims for errors, generating actionable edits before submission. Claim Scrubber also reviews approved reimbursement rates to prevent undercharging. Transactions process within three seconds and providers reduce the need to rework claims. Experian Health's AI Advantage solution uses the power of artificial intelligence (AI) to evaluate every claim for its propensity to turn into a denial. Instead of submitting claims and hoping the payer will accept them, this solution takes the guesswork out of reimbursement for a more rational, predictable process. The software automatically scans for payer updates to reimbursement requirements that significantly contribute to claims denials. Hospitals like Schneck Medical Center use this tool to streamline the revenue cycle by preventing denials. After just six months, the provider’s denied claims reduced by an average of 4.6% each month. Claim corrections that took up to 15 minutes manually are now processed in less than five. 3. Increase collections efficiency with automation Patients trust their healthcare providers to take care of them. Providers also rely on patients to pay their bills. It's a mutually beneficial arrangement. However, it's also a problem forcing providers to walk a delicate tightrope between caring for a sick patient while still chasing payment for their services. Unfortunately, the increasing cost of healthcare leaves patients on the hook for more than $88 billion in debt. The volume of healthcare payments in arrears is staggering, causing a substantial drain on provider cash on hand. However, technology offers healthcare providers a way to improve the patient collections process. For example, Coverage Discovery impacts the revenue cycle at every stage of the claim: Before providing care, the software scans patient data to determine reimbursement coverage options from Medicaid, Medicare, and commercial insurance. It scans for active insurance 30, 60, and 90 days after care delivery. The tool scans patient data before determining whether the account moves to bad debt collections. A more robust understanding of patient payment options at every stage of claims management allows healthcare providers to forecast reimbursements more accurately, increasing the predictability of the revenue cycle. Collections Optimization Manager provides organizations with actionable insights, so that providers can segment and prioritize accounts by proprensity to pay. This solution increases patient collections by leveraging Experian's data driven segmentation models, and helps providers screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility ahead of time. Experian Health's AI Advantage – Denial Triage prioritizes rejected claims based on their yield potential, automating workflows for claims managers so they focus first on the patients more likely to pay. This tool segments denials based on their potential value to help even out the revenue cycle with a faster rate of financial return. Denial Triage expedites A/R by increasing revenue collection per person per hour. Revenue cycles can be more predictable, but the complexities of reimbursement require technology to achieve this goal. Experian Health offers a comprehensive line of revenue cycle management solutions to help healthcare providers maximize collections and improve RCM. Find out why Experian Health ranks Best in KLAS for 2024 in the categories of Claims Management & Clearinghouse and Revenue Cycle: Contract Management, or contact us for a more predictable revenue cycle, better cash flow, and a healthier organization.

Improving the patient pre-registration process continues to present a challenge on both sides of the front desk. For patients, dealing with paperwork, struggling to provide the right information, and worrying about payment and insurance coverage make in-person registration feel fraught. Meanwhile, providers are searching for digital solutions to make the patient registration process simpler, more accurate, and more efficient. How are providers tackling these patient registration challenges? Barb Terry, Product Manager at Experian Health, who oversees Registration Accelerator, a digital pre-registration solution, shares her perspective on the state of the industry and insights from Experian Health's State of Patient Access 2024, a survey of 200 healthcare executives and more than 1,000 consumers conducted in February, 2024. Q1: Why is patient registration still so challenging for providers? “It continues to present challenges for both providers and patients,” says Terry. Despite the growing availability of patient registration software, many providers and their patients still contend with outmoded manual processes and confusion over insurance and the cost of care. For providers still coping with staffing shortages, manual registration can be time-consuming and error prone. According to the State of Patient Access 2024 survey, 82% of providers who say access is a challenge cite staffing as a reason. Meanwhile, Terry estimates a typical registration process consumes 15 minutes of staff time and 10 minutes for patients: “It's time that neither the provider nor the patient has,” she points out. “The manual registration process for most offices requires printing, scanning, faxing, calling the patient a few times, and then manual data entry into the office systems,” Terry explains. “The provider is also under pressure to obtain financial clearance before the appointment. In many cases the provider team is working with reduced or new staff, managing repetitive and manual tasks for registration, all while striving to maintain a positive patient experience.” Q2: Why is creating a positive registration experience important for patients? “Patients are evolving into consumers of healthcare, meaning they're more active in their healthcare decisions,” says Terry. “They have growing expectations of their healthcare experience and expect the same convenience and modernization they find with other industries like retail and financial services.” To keep up, healthcare providers need to meet patients where they're used to completing tasks and communicating---namely, on their smartphones. “Patients use their smartphones to complete many everyday tasks at their convenience. Many prefer to be contacted via text rather than with a phone call, since text allows them to answer when they have time.” Terry says. Helping patients complete registration on their time increasingly means providing mobile solutions. As an example, Registration Accelerator sends patients a pre-registration link they can use to scan in their identity and insurance cards. Patients can locate their cards and scan them in wherever and whenever they prefer. Data is captured accurately and sent automatically to the eCare NEXT platform, where it can be verified and used for billing. “Compare this process to time-consuming phone calls that must be made and re-made until contact happens,” Terry says, “or trying to collect information at the time of the appointment. Simply put, patients do not want to spend time in a waiting room completing paper forms that could have been completed digitally.” Q3: How is patient pre-registration important to the revenue cycle? “The traditional registration process isn't very efficient,” says Terry. “Manual processes can easily lead to inaccurate patient information. If the registration process does not include real-time insurance verification, there will likely be more denials and a slower revenue cycle process." “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,” Terry continues. “At the same time, patients don't have time to prepare for their out-of-pocket costs. In the 2024 survey, 94% of providers said they felt a sense of urgency to implement a faster, more comprehensive review of insurance coverage." “We know from past surveys that 40% of providers say registration errors are a primary cause of denied claims,” Terry concludes. “When the provider has patient information early, they can start facilitating an estimate and confirm insurance coverage before the appointment. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.” Q4: Greater efficiency is better for providers, but how does it help patients? “The State of Patient Access 2024 survey found that patients expect efficiency as well as convenience,” Terry says. “Here's an example: 85% of the patients surveyed think they shouldn't have to fill out paperwork if their information hasn't changed.” Digital pre-registration solutions that allow providers to re-use valid patient information on file simplify registration all around. “For the patient, spending less time filling out paperwork in the waiting room contributes to a positive experience and improves their overall satisfaction with their provider, in turn leading to increased consumer loyalty,” says Terry. “Instead of managing forms at the appointment, the staff can focus on addressing any questions or discrepancies, and getting the patient settled in for their appointment. For many reasons, going to the doctor can be stressful for patients. Minimizing the forms they need to complete in the waiting room can alleviate some of that pressure.” Q5: How are providers improving the patient pre-registration process? “Providers are presenting additional registration options to their patients, including a modernized and digital process,” says Terry. “In the 2024 survey, 65% of providers agreed that patients prefer digital and self-service pre-registration,” so patient-facing mobile solutions like Registration Accelerator are a clear option for providers to explore. “Patients expect an easy digital experience,” Terry continues, “and, in response, providers should make registration as simple and straightforward as possible.” Yet, the same tools that make pre-registration better for patients can improve the process for providers as well. “Optical character recognition (OCR) is a great example of a feature that creates mutual benefits,” says Terry. “OCR can be leveraged to read insurance cards and pull out relevant and correct information. Staff members are under less pressure to avoid manual errors, and so are patients, who are relieved of the pressure of having to decipher their own insurance cards. “A registration solution should streamline the workflow, reuse patient information, keep data private and secure, and reduce manual entry,” Terry concludes. “By putting the registration process in the patient's hands, the provider is gathering information directly from the source while reducing their operational costs. Once registration data is obtained, it should flow into the front-end revenue cycle processes, so that eligibility is validated and errors are highlighted. This helps the provider ensure they have up-to-date insurance information for billing, leading to faster claims processing and reimbursement.” Q6: What does the future of pre-registration look like? “As patient expectations and provider demands grow, providers will increasingly turn to digital solutions,” says Terry. “Our survey found that 42% of providers have already expanded digital/mobile patient communications to reduce intake friction, and that trend is likely to continue.” “Digital solutions like Registration Accelerator give patients the ability to complete the registration process at their convenience and give providers more consistency in gathering information, less manual data entry errors, and opportunities to integrate with other patient access processes. All these benefits provide much-appreciated efficiencies for providers, and can lead to a better healthcare experience for the patient, so they can focus on their appointment and time with their provider.” Learn more about Registration Accelerator, a patient-facing mobile solution that lets patients scan in their own insurance and identity cards, captures data accurately, and uploads it automatically into Experian Health's eCare NEXT® platform, simplifying registration for patients and providers.

The State of Patient Access 2024 is the fourth in a series of patient and provider surveys that began in 2020. This year's report compares how patients experience access to care and providers' perceptions of those experiences. This blog post highlights findings from the survey, which was conducted in February 2024 and is based on 200 healthcare revenue cycle decision-makers and more than 1,000 patients. The study finds that perceptions of access to care are improving. It's a positive sign that providers are moving in the right direction—but there are still have mountains to climb. What remains the same from prior surveys is that providers believe access to care is much better than what their patients are truly experiencing. The survey showed 55% of healthcare providers believe patient access has improved. It's a big jump from 2022, when just 27% of doctors felt access increased. What's striking, however, is that patients don't completely agree. Only 28% say patient access improved in 2023, an 11% increase from the prior year. Over half (51%) of patients and 26% of providers say patient access has remained fairly static. While the findings show access is improving, there is still a gap between patient experience and provider perception. How can providers improve care access and make their perceptions a reality for their patients? Download The State of Patient Access 2024 report to get the perspectives from patients and providers on their perceptions of access to healthcare. Myths vs. realities of patient access The good news from the survey is that most providers and patients agree access to care isn't worsening. Despite increasing patient volumes and chronic staff shortages, patient access is better than before the pandemic. The findings are a sharp reversal from last year's report, where almost one-half of providers and one-fifth of patients reported care access had grown more challenging. Patient access is: Better Patients: 28% Providers: 55% The same Patients: 51% Providers: 26% Worse Patients: 22% Providers: 20% Consistently, across these annual surveys, providers believe access to care delivery is better than what their patients experience. The survey highlights opportunities to bridge this gap by using digital technologies to align the patient experience and provider assumptions. Opportunity 1: Provide accurate upfront financial estimates 96% of patients want an accurate upfront estimate of treatment costs. 88% of providers agree an accurate upfront estimate contributes to successful patient payments. The survey showed upfront cost estimates are central to a better patient experience. A high percentage of patients (96%) said an accurate estimate of treatment costs is essential before service—so crucial that 43% said they would cancel their procedure without it. Yet 64% of patients did not receive a cost estimate before care, despite increasing state and federal regulations that require this transparency. Perhaps even more troubling, the accuracy for those estimates is questionable. Of the 31% of patients who received a pre-procedure cost estimate, 14% reported the final cost was much higher than anticipated. At the same time, 85% of providers say their estimates are accurate most or all the time. The gap in provider perception and patient reality come together at the point of understanding the need for accurate cost estimates. Understanding what is covered by insurance helps patients manage their healthcare costs. Providers are invested in getting estimates correct because they are a key part of getting paid on time, in full. Patient payment estimates software can automatically create a more accurate picture of costs, reducing the burden on healthcare staff and eliminating unwelcome patient surprises. Consolidating service pricing estimate data from multiple sources empowers patient accountability and decision-making. One health system used these digital tools to increase point-of-service patient collections by nearly 60%, producing estimates that were 80 to 90% accurate. Opportunity 2: Improve data collection at patient intake 85% of patients dislike repetitive paperwork during the intake process. Almost half (49%) of providers say patient information errors are a primary cause of denied claims. The survey showed patients and providers are frustrated with the data collections process during registration. More than eight of 10 providers say automation could improve this process. Yet, in practice, intake remains primarily manual. Patients complain they shouldn't have to complete the same paperwork at each visit. Providers know these manual tasks lead to errors that cause big headaches for claims departments later. However, only 31% consider improving the speed and accuracy of collecting patient information a priority. The top reasons for claim denials are paperwork inaccuracies and missing or incomplete claim information. Human errors cause challenges when it's time for providers to get paid. Up to 50% of claims denials stem from a paperwork processing error at patient intake. As a result, in 2022 alone, healthcare providers spent nearly $20 billion pursuing reimbursement denials. Everyone agrees that providers must do all they can to prevent errors. Providers understand claims denials are a significant roadblock to cash flow. Patients grow frustrated when account balances remain in limbo long after their procedure is complete. Digital technology can streamline patient access and transform the healthcare revenue cycle. Experian Health's Patient Access Curator solution can check eligibility, COB, MBI, demographics, insurance coverage, and financial status in less than 30 seconds, in one click, speeding up the laborious human intake process that creates anxiety—and errors—for patients and providers. Opportunity 3: Give patients online self-service options 89% of patients said the ability to schedule appointments anytime via online or mobile tools is important. 63% of providers have or plan to implement self-scheduling options. According to this year's survey, self-scheduling is hot; waiting on hold with a call center is not. Digital and paperless pre-registration is increasingly important to patients and there is evidence that providers are finally starting to listen. For example, 84% of the providers strongly agreed that digital and mobile access is important to patients. However, self-scheduling did not make the list of the top three provider priorities for improving patient access to care. But the data tells us patients hold out hope for a mobile-first online scheduling process that puts them in the driver's seat to control their access to care. Convenient online scheduling software gives patients control over booking, canceling, and rescheduling appointments. It's a digital front door that's easy to use across any device. Automated notifications can remind patients of annual health exams, replacing the need for staff calls and closing any gaps in preventative care. These tools can reduce time spent scheduling patients by 50% and significantly decrease appointment no-shows. More importantly, they give patients the digital experience they demand. Digital technology brings together patient experience and provider perceptions The State of Patient Access 2024 survey illustrates a narrowing gap between what providers perceive and patients experience. That's good news because a lack of access to healthcare is a contributing factor to a sicker population, which costs much more in the long run. According to Deloitte, barriers to accessing healthcare in this country will grow to a $1 trillion problem by 2040. Patients will continue to experience care access issues in the coming years, from staffing shortages and a lack of rural providers, higher co-pays and more. Can we bridge these future gaps? The answer is a resounding yes. While there's still work to do, the survey showed that 79% of providers plan to invest in patient access improvements soon. Download The State of Patient Access 2024 to get the full survey results, or contact us to see how Experian Health can help your organization improve patient access.