Patient Access

Staffing shortages continue to plague the healthcare industry, creating challenges for both healthcare providers and patients. In a 2022 CVS Health-Harris Poll National Health Project survey, 51% of 2,023 U.S. adults surveyed said they had been directly affected by healthcare staffing shortages. Among this group, 45% had trouble scheduling appointments, more than a third said their doctor was operating on reduced hours, and a quarter had treatments or surgeries delayed. Digital self-scheduling solutions help patients access care even when appointments are in limited supply. It allows patients to schedule care whenever they decide they need it—during the work day, in the evening, or overnight when a child wakes up coughing—without having to rely on front desk or call center availability. Coupled with digital registration and patient outreach, self-scheduling helps to uncomplicate early steps in the patient journey, making it easier for patients to access care, prepare for their visits, and keep their appointments without canceling. Getting provider scheduling right is a critical step With staff and inventory in short supply, healthcare organizations are under increasing pressure to optimize scheduling. “Some doctors may only be available a few days a week,” explains Sanju Pratap, Vice President of Product Management at Experian Health. “They may prefer to see new patients only on certain days or reserve a certain number of next-day or same-day appointments for patients with urgent needs. Scheduling has to account for these details, while effectively connecting patients with the care they need, and ensuring that next-day or same-day appointments are available to book when appropriate.” At the same time, overbooking and scheduling glitches can contribute to burnout, a growing problem that contributes to the industry staffing shortage. “It’s absolutely critical to get scheduling right,” Pratap says. Digital solutions help keep complex schedules in order, while also making inventory available via a variety of channels. “We’ve been able to offer appointments across multiple access points: hospital websites, practice websites, our contact centers, and in our texting and referral outreach programs,” says John Mercer, Executive Director of Online Scheduling at HCA Healthcare. “Experian Health's Patient Schedule has been well-received by our provider population, both employed and affiliated,” Mercer says. “It affords providers the opportunity to receive new patients from a digital domain even when the office is closed. We can also specify certain appointment types and dedicated inventory for patients with acute needs." Listen in as John Mercer, Executive Director of Online Scheduling at HCA Healthcare, discusses how they utilize Experian Health's Patient Schedule solution to improve the patient experience: In a digital world, patients would rather do it themselves Meanwhile, 90% of patients want easier access to care in the form of digital self-scheduling tools, according to a 2021 Salesforce survey. This isn’t surprising in a world where consumers use digital self-service to accomplish logistically complicated tasks every day. Summoning a late-night ride in a strange city or finding replacement parts for a 1970s-era light fixture used to seem difficult. Now, the integration of digital self-service into daily life means a majority of consumers feel willing and able to handle scheduling themselves. It may be a happy accident: At a moment when scheduling and staffing have become key challenges for healthcare providers, patients want to take scheduling into their own hands. And interest in digital self-service doesn’t end with scheduling: Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Opening the digital front door with patient self-scheduling, pre-appointment registration, and patient outreach solutions not only reduces the need for staff time, but also meets patients where they live. Digital scheduling works for patients in part because they manage their own calendars digitally. Receiving appointment reminders by text is helpful because texting is the channel patients already use to communicate with friends, family, and coworkers. Remote registration continues to meet the patient where they are. Using digital scheduling solutions to combat healthcare staffing challenges Patient self-scheduling and other digital front door solutions offer providers the opportunity to serve patients effectively while improving their own efficiency. Digital solutions can alleviate the burden on call center or front-desk staff and reduce the potential for human error when collecting patient identification and insurance information. Capturing this information accurately has downstream benefits when it’s time to process claims and manage billing. “Digital scheduling also plays a role when providers are bringing in new patients,” Pratap says. “Patient Schedule asks a series of questions that helps patients choose the right provider and the right type of appointment for their needs, even across specialties like orthopedics and cardiology, and subspecialties within these areas. Digital scheduling that is capable of complex decisioning makes it less likely that staff will need to follow up and reschedule. Having access to this level of self-service is invaluable for new patients who find providers on third-party sites: As they learn about each provider, they can see their availability and book an appointment on the spot. Positive experiences with scheduling can set the tone for a patient’s interactions with a provider.” The need for automation and digital solutions is intensifying as patients continue to gravitate toward digital self-service and providers continue to grapple with healthcare staffing challenges. Providers and their partners will need to evolve. “As we’ve grown from website scheduling and contact center scheduling to new forms of patient outreach, Experian has been able to provide us with those solutions and work with us to develop new ones as well,” Mercer says. The time to incorporate patient self-scheduling solutions is now. Learn more about how Experian Health can help address healthcare staffing challenges and close gaps in care by allowing patients to schedule appointments on their preferred device, anytime.

Hospitals continue to face a capacity crisis as COVID-19, flu and respiratory syncytial virus (RSV) converge. Staffing shortages in both clinical and administrative teams further constrain the delivery of optimal care, with consequences for patient satisfaction and provider cash flow. With this challenge still ongoing, providers must find ways to maximize operational efficiencies and maintain patient flow. Accelerating patient intake with automated patient registration is a good place to start. Too often, registration requires patients to spend hours in a waiting room, filling out forms on a clipboard and conjuring up insurance information and medical history details from memory. These clunky processes cause delays, errors and stress for both patients and staff. In the current climate, healthcare providers should leverage digital tools that allow patients to complete registration easily and efficiently before they come in. Pitfalls of paper-based patient intake During registration, patient access teams must put considerable effort into collecting and checking patient information, documenting medical history and medications, verifying insurance eligibility and making sure the patient knows the details of their appointment or referral. Often, these checks are completed manually, with patients filling out paperwork in person when they arrive. It’s a slow and tedious process for patients and staff, made worse when there aren’t enough staff available. Unfortunately, manual processes also open the door to errors, creating additional work for staff members. If a patient’s address is inputted incorrectly, they may not receive important communications about appointments or billing, causing delays and confusion further down the line. In The Digital Healthcare Gap, a report by Experian Health and PYMNTS, Experian Health President Tom Cox says the “waiting room experience” is a common pain point for patients: “Having to schedule appointments at exactly 8 a.m. when the office opens isn’t convenient or efficient. Filling out paperwork that one has completed several times as a prerequisite to seeing a care provider aggravates just about everyone. And finding out how much the doctor visit and treatment costs long after the visit is complete is an experience unique to healthcare.” It's not an ideal first impression for patients, and it only compounds the pressure on short-staffed teams. Accelerate patient intake with advanced registration In The Digital Healthcare Gap, one-third of patients surveyed said they filled out registration forms from home. Enabling patients to complete registration in advance can greatly speed up patient intake. Patients can fill out forms in their own homes, with all their medical details at hand. It’s a more comfortable experience for patients and saves staff time by reducing the risk of errors. Shifting registration out of the waiting room can also help protect patients and staff from infection. But these survey results suggest that many patients are still completing registration in person. Providers should consider offering faster alternative options to those that want them, especially as waiting rooms fill up. With Experian Health’s Registration Accelerator, patients can complete intake forms from their mobile devices, anywhere and anytime. Details can be pre-filled automatically to save time and reduce errors, resulting in an easier intake experience with fewer issues for staff to resolve. By reducing administrative overhead, self-service tools can help providers manage unpredictable patient numbers and avoid bottlenecks during busy times. Automated patient registration for a more streamlined patient experience The current crisis magnifies the need for automated patient intake solutions, but patient access is already evolving. More than 8 in 10 providers say their patients prefer an online registration experience, according to Experian Health’s State of Patient Access 2.0 survey. In another report, 6 in 10 patients said they’d switch providers to one that offers a patient portal. Providers must open their digital front door or risk losing patients to competitors. A seamless patient intake experience that integrates scheduling, registration and payment systems will make patients feel taken care of. With user-friendly interfaces, automated appointment reminders and pre-filled insurance information, Registration Accelerator offers patients the speed and convenience that today’s consumers have come to expect. Patients can initiate registration with one click, then upload photos of their driver’s license and insurance card. Optical character recognition technology captures the necessary identity and insurance details, so patients and staff don’t have to fill it out manually. Patients can check their details and confirm appointments before completing authorization and consent forms. They don’t have to spend a minute more on registration than necessary and are less likely to miss appointments, leading to faster care. Maximize operational efficiency with automated patient registration solutions Registration Accelerator integrates with other automated patient-facing intake tools, such as Patient Scheduling and Patient Financial Advisor, to create a frictionless experience. Giving patients more control is not only more satisfying and convenient for them, but it also helps drive efficiency – which is increasingly important as hospitals reach capacity. Using digital systems instead of manual processes also enables easier integration with other data management systems, such as electronic medical records, hospital information systems and eCare NEXT®. Data need only be added once, which reduces the burden on staff and helps to avoid errors arising from ineligible handwriting. In addition to having greater confidence in the integrity of their data, providers can also use patient intake software to generate performance reports, revealing further opportunities to improve efficiency. Providers can allocate staff to high-priority tasks and use customizable workflows to maintain operational standards. The impact on the bottom line can be significant. Automated registration solutions reduce administrative costs. But perhaps more importantly, they prevent delays in reimbursement by avoiding time-consuming errors and inefficiencies. In this way, faster registration leads to earlier care, with better outcomes for both patients and providers. Find out more about how Registration Accelerator can ease the pressure on providers by speeding up patient intake during the busy winter period.

With 2023 just around the corner, healthcare executives are teasing out their strategic priorities for the next 12 months. Where should they be focusing their attention? Here are the top 3 healthcare predictions to watch in 2023 and the actions needed to help providers prepare. Prediction 1: AI and automation will continue to gain traction “The time is now for providers to get ready, prepare and implement these technologies.” - ­Jason Considine, Chief Commercial Officer at Experian Health Automation came to the forefront during the pandemic, enabling essential access to care and filling in gaps created by staffing shortages. By now, the use of remote and digital tools is pretty well-established. Automation is the norm, but there’s room to leverage these solutions for an even greater ROI. As Jason Considine says, investing in technology that makes it easier for providers to get paid will be a particularly effective use of digital tools. One such example is in the digitalization of healthcare claims. Healthcare claims management processes have typically relied on manual systems. These can be slow and error-prone, creating avoidable extra work for staff and friction for patients. In the State of Claims 2022, 78% of executives said their organization would be likely to replace their existing claims management solution if convinced something else can deliver better ROI. Eliminating inefficiencies and optimizing reimbursement would certainly check that box. Tools like Denials Workflow Manager, Enhanced Claim Status and ClaimSource® use automation and detailed analytics to improve claims management performance. More claims can be processed more accurately, resulting in fewer denials and faster reimbursement. With denials increasing by 10–15%, claims automation is likely to be a top priority for many providers in 2023. Prediction 2: Patients will increasingly choose providers that offer a user-friendly financial experience  “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” - Victoria Dames, Vice President of Product Management at Experian Health The economic downturn has put pressure on providers and patients, which we can expect to last into 2023. Patients are concerned about healthcare costs, but they’ve also come to expect a more transparent and compassionate financial experience. Experian Health's top healthcare predictions finds that reliable pricing estimates, support to find the right payment plan, and convenient and flexible payment options will be table stakes in 2023. For providers, implementing digital payment options to meet these needs may be challenging, but it’s an investment that will yield positive long-term results. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch healthcare providers for a better experience in future, placing transparent medical billing at the core of attraction and retention strategies. The medical billing software outsourcing market is already experiencing historic growth as providers respond to patient demand for a digital financial experience: the market’s value is expected to grow over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032. Experian Health leads the way when it comes to creating a patient-friendly billing and payment experience, with solutions such as Patient Financial Advisor and Patient Estimates. Giving patients greater control over their financial journey with upfront estimates and tailored payment plans makes it easier for them to prepare for payments. Prediction 3: Providers that fail to create a welcoming digital front door could be closing off revenue opportunities  “Deliver convenience. People are consumers before they are patients.” - Tom Cox, President at Experian Health Automation offers opportunities for optimization throughout the revenue cycle, but one of the most crucial points is in patient access. Making patient access easier is on the list of top healthcare predictions, and for good reason - a frictionless first impression can have a powerful lasting effect. What should this look like? Cox advises that providers should “anticipate the needs of digital-first customers.” Patients expect the same personalized service they are accustomed to in other sectors, with convenience, choice and control at the center. Administrative “relics” such as the traditional waiting room clipboards and repetitive forms must be minimized where possible. A report from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods. 61% of patients even said they’d consider changing healthcare providers to one that offers a patient portal. Online scheduling software and self-service registration makes it easy for patients to complete these tasks in advance. Providers can then round out a user-friendly patient experience with Patient Payment Solutions. This gives patients a choice of payment methods, leading to faster payments. Providers have realized that many patient access functions can be achieved more efficiently and cost-effectively using self-service and remote digital tools. By streamlining intake operations, organizations can make better use of staff time, reduce errors and increase productivity, while improving the patient experience simultaneously. As revenue cycle technology continues to develop in 2023 and beyond, providers need to ensure they are capitalizing on the latest software to improve their bottom line, deliver on patients’ service expectations, and keep pace with healthcare predictions. Learn more about Experian Health's revenue cycle management solutions and contact us to find out how these solutions can help healthcare organizations open their digital front door and prepare for 2023.

Respiratory syncytial virus (RSV) is surging throughout the United States. RSV typically peaks during the fall and winter, when cold and flu season are in full swing, but the U.S. is seeing unprecedented numbers right now. With RSV spreading — on top of flu and COVID-19 cases — healthcare providers are under more pressure than ever. They need to efficiently manage the spike in patients without compromising the quality of care. This includes utilizing the digital front door and finding new ways for patients to manage their own health journey. That’s where patient appointment scheduling software comes in. Challenges for healthcare providers Increased risk of worker burnout: The healthcare industry is already under major strain, especially with flu season and COVID-19 cases. At the end of 2021, over half of healthcare professionals were experiencing burnout, according to the American Medical Association. The RSV surge has now been added to the mix. Patient frustration: When patient volumes are high, delivery of outstanding care is difficult. Patients may experience longer wait times, become annoyed by call-center scheduling, or have a hard time getting an appointment at all. How digital solutions and patient appointment scheduling software can help Technology and patient engagement solutions are critical to alleviating the strain on healthcare staff. These solutions offer patients the flexibility and convenience to self-schedule appointments online on any device, 24/7. “Self-service tools provide patients with convenience, information, reminders, and a seamless process,” said Liz Serie, Senior Director, Product Management at Experian Health. “This helps reduce the patient’s wait time and gives them peace of mind so they can focus on getting better.” Having an easy-to-use patient portal is a big part of the solution. A recent report commissioned by Experian and PYMNTS found that 2 out of 3 consumers use patient portals. The remaining third say they’d use digital platforms too if they had access to them. Another interesting finding: urgent care patients are among those most likely to schedule appointments via digital channels. The rise of patient appointment scheduling software Patient appointment scheduling software eliminates the inconvenience of traditional call-center booking. These types of remote, touchless scheduling systems took off out of necessity during the COVID-19 pandemic. The result has been a digital healthcare experience that mirrors the way consumers shop online. People want simple, self-service options from any device – this includes around-the-clock appointment scheduling. Online scheduling platforms let patients book, reschedule and cancel appointments — all with just a few clicks. Automated reminders that come with these scheduling platforms also reduce no-shows and increase the number of patients physicians are able to accommodate. Self-scheduling has other benefits, such as: Empowering patients to book appointments on their schedule Taking pressure off healthcare staff, many of whom are overworked amid the current labor shortage Giving healthcare providers a leg up over competitors who are still using traditional call center scheduling Giving providers a powerful tool to keep up with patient surges, especially with the rise in RSV cases Using digital patient intake to streamline administrative tasks Patient engagement solutions make it easier for healthcare professionals to provide the best care possible. From the very beginning of an appointment, they can focus on patient needs — instead of asking them to fill out paperwork, provide ID and insurance cards, or reschedule missed appointments. With the right digital solutions, patients can do these things on their own. Healthcare providers understand that scheduling, registration, cost estimating, and paperwork are often confusing and frustrating for patients. This can translate to missed appointments, as well as late or delinquent payments. Experian Health’s Registration Accelerator makes many of these issues more manageable and increases the accuracy of patient intake. As RSV, flu and COVID-19 roll through the United States, healthcare providers can offer digital patient intake to streamline key administrative tasks. It also eliminates hurdles for patients, especially parents trying to schedule urgent appointments for sick children. They can easily find open dates and times through an online patient portal, versus waiting on the phone for a response. Experian Health’s Patient Scheduling software is helping to make the journey easier for both patients and providers. It allows for self-service options and equips call-center agents with an efficient platform to schedule patients right then and there. When patient volumes spike, it can be a game-changer. Learn how Experian Health can help streamline patient scheduling and registration processes.

Up to 15 million Americans may find themselves without healthcare insurance when the COVID-19 public health emergency (PHE) ends. The PHE has been renewed until January 11, 2023, and while further extensions haven’t been ruled out, the Centers for Medicare and Medicaid Services (CMS) has advised healthcare providers to prepare for a return to pre-pandemic rules. Looming uncertainty over coverage has consequences for both providers and patients. This article looks at what providers may expect as the PHE comes to an end, and specifically, how to proactively verify insurance eligibility to maintain cash flow and help patients navigate the changes. How will insurance coverage change when the PHE ends? Emergency legislation has required Medicaid and the Children’s Health Insurance Program to maintain continuous enrollment for the duration of the PHE. When the previous rules resume, states will have 14 months to process eligibility checks for Medicaid and CHIP enrollees. The US Department of Health and Human Services (HHS) estimates that around 8.2 million Medicaid enrollees will no longer be eligible for coverage. Another 6.8 million eligible individuals may lose coverage through “administrative churn.” Churn occurs when patients fail to provide annual confirmation of Medicaid eligibility. This can occur because of short-term changes in circumstances or because they don’t reply to or understand requests for information. Some patients will qualify for Marketplace tax credits under the Affordable Care Act and others may seek employer-sponsored coverage. But a large proportion may fall into the “coverage gap,” earning too much to be eligible for Medicaid, but too little to qualify for Marketplace credits. The Inflation Reduction Act of 2022 extends access to enhanced Marketplace provisions until 2025, which may bridge the gap for some. HHS lists a number of additional actions that may be taken at the state level to mitigate potential coverage loss. This includes the adoption of Medicaid expansion, outreach and engagement campaigns. It also includes investments in end-of-PHE preparedness, staffing capacity and in eligibility and renewal systems. What do these changes mean for providers? Providers must be proactive in managing the disruption that could occur when millions of patients lose or change coverage. If more patients are without coverage and unable to pay for services, this could lead to an increase in uncompensated care, which costs providers millions in lost revenue. The process of verifying insurance for those with coverage is likely to be more complex, which could also affect providers’ bottom lines. Changes can increase the risk of errors, which could lead to more claim denials. Longer verification checks may cause delays in patient registration and higher call volumes, creating extra work and stress for staff and a poor experience for patients. The end of the PHE may also affect access to vaccines and food benefits, both of which were expanded under the emergency legislation. These changes could lead to an influx in calls and queries which could compound pressure on staff. These staff pressures are a particular concern given ongoing hospital staff shortages. A possible surge in COVID-19 and flu hospitalizations over winter could ramp up the challenge even more. How can providers verify insurance eligibility? The process of verifying insurance eligibility and benefits involves confirming that: the patient’s insurance information is valid and current they’re eligible to have the services in question covered under their existing plan. A patient insurance ID card is useful, but it’s not enough to prove eligibility. Patient access staff will often check payer websites or call payers directly to verify coverage. This can be a time-consuming and laborious process. Some providers use clearinghouses to run these checks in batches. This can be more efficient than verifying each account in-house but usually takes time to receive confirmation. Another option is to deploy insurance verification software. Experian Health’s Insurance Eligibility Verification solution allows providers to confirm patient eligibility in real-time. The tool connects with over 890 payers to access up-to-date eligibility and benefits data. Responses from multiple payers are modified so registrars can view patient information in a consistent format. Staff gets notifications when edits or follow-ups are needed. The tool also checks self-pay patients against Medicaid databases, which will be invaluable when the PHE ends. Why are automated, real-time insurance checks so important? No one wants patient care to be delayed. By validating a patient’s coverage before the patient arrives, Insurance Eligibility Verification helps fast-track registration. Automated checks also ease the manual burden on staff and handle higher patient volumes more efficiently. This improves operational efficiency, increases cleaner claim submissions and accelerates reimbursement, creating a more satisfying patient experience. Patients will have a clearer idea of what they’ll owe at the time of service, leading to fewer payment delays. What else can providers do to close the gaps in health insurance coverage and verify insurance eligibility? Providers can streamline coverage checks by incorporating automated searches for any missing or forgotten active coverage. Coverage Discovery runs multiple checks throughout the patient journey, using proprietary data repositories, advanced search heuristics and matching algorithms to comb through government and commercial payers to find previously unknown insurance coverage. Fewer accounts end up going to bad debt or written off as charity. This maximizes reimbursement for providers, while reassuring patients who may have believed they were uninsured. A further step to ease the financial burden on patients and increase the likelihood of reimbursement is to combine these solutions with tools that give patients greater clarity about their healthcare bills. For example, Patient Payment Estimates offer patients clear and accurate estimates of their financial responsibility before they come in for care. Patient Financial Advisor provides personalized payment plans so patients can spread out payments in a way that works for them, together with easy payment methods. Find out more about how Insurance Eligibility Verification helps providers verify insurance eligibility, speed up eligibility checks, maximize reimbursements and ease pressure on patients and staff as the continuous enrollment provision unwinds.

As the flu season collides with COVID-19—and an unexpected surge in respiratory syncytial virus (RSV) strains hospital capacity—healthcare providers need digital tools that give patients simple, easy access to appointment scheduling and self-registration, while helping staff meet increased demand. Digital appointment scheduling software, together with online registration solutions and automated patient outreach, help providers create a better patient experience, achieve greater operational efficiency, and ultimately improve access to care. 24/7 self-scheduling opens the digital front door A surge in seasonal viruses presents numerous challenges for healthcare providers. The sheer volume of patient calls can be overwhelming for staff. Meanwhile, patients need immediate help, often 24/7. “Patients who are feeling sick, or who have a sick child, are in a vulnerable position,” says Sanju Pratap, Vice President, Product Management at Experian Health. “They need care, but they may also need help figuring out where they should receive that care and how urgent their situation is. Can they wait until the next available appointment, or should they go to the emergency room now?” With patient scheduling software, providers can configure the online self-scheduling process to include key questions about the patient’s symptoms that help determine what the next steps should be. Patients who need immediate medical treatment receive a recommendation to seek emergency care; patients with less urgent needs can schedule appointments online or may be directed to telemedicine visits or urgent care. Digital appointment scheduling tools provide patients with the kind of around-the-clock access they enjoy every day. They already use online portals and mobile apps to book flights, make dinner reservations, and even schedule their COVID-19 vaccinations. They expect scheduling healthcare to be equally convenient. “Patient scheduling software changes the way patients feel about the availability of care. When patients have to wait for the office to open or negotiate with a call-center representative to make an appointment, scheduling feels like a hassle,” Pratap says. “For patients who are accustomed to online scheduling in other areas of their lives, this lack of access could be a reason to look elsewhere for care. Meanwhile, our experience is that providing online self-scheduling can add as many as eight new patients per provider per month. Self-scheduling opens the digital front door.” Making the waiting room a safer space As the flu, COVID, and RSV cause the number of patients needing appointments to surge, online self-scheduling can relieve front desk and call center staff by offloading a large volume of calls—both from patients needing immediate care for viral illnesses and from patients needing to cancel unrelated appointments due to illness. From there, digital tools also improve efficiency and make the waiting room a safer space once patients come in for care. “Patient scheduling software that integrates with patient self-registration and targeted patient outreach can further ease the workload for over-burdened staff,” says Pratap. “After patients schedule online, they receive automated reminders and the opportunity to complete registration forms before they come in for their appointments.” Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Pre-appointment registration keeps sick and contagious patients out of the waiting room, which reduces exposure to other patients and staff, and makes everyone more comfortable. Automated patient outreach can send appointment reminders and follow-up emails to patients who miss their appointments and may need to reschedule. Preparing for a busy season—and beyond Getting ready for a busy virus season is just one reason providers are adding digital tools to improve the patient experience and lighten the burden on staff. Expanded access to appointments, automated outreach, and online registration gives patients the digital engagement they expect from their healthcare providers. Digitalization also improves efficiency. Experian’s Patient Scheduling Software can also provide insights into patient demand and capacity and allows providers to better optimize appointment capacity and the patient scheduling experience. Integrated digital tools make scheduling, intake, verification, billing, and collections more efficient while reducing the need for human input. The result is not only greater capacity for providers, but also greater resilience. The fall and winter virus season may be annual, but it takes on a different magnitude each year. Meanwhile, no one can predict whether a new or recurring virus (think RSV or Monkeypox) will trigger a surge in care needs. Adding digital solutions that can flex with changing patient volume takes some of the strain off staff members who may be stretched thin—and may require care or downtime after catching a seasonal virus themselves. “The challenge for providers lies in identifying and implementing the digital solutions they need to move their operations to a new level, keeping in mind patients’ needs as digital consumers. Patients expect and demand constant and real-time connections. These solutions can help providers grow and thrive even as they experience continued staffing shortages and pressure to find new operational efficiencies and timely access to care,” Pratap says. Learn more about how Experian Health can help organizations implement digital appointment scheduling software, registration solutions, and increase patient outreach.

More than 4 in 10 working-age adults do not have adequate healthcare insurance in 2022, according to a recent survey by The Commonwealth Fund. Half of those surveyed said they’d be unable to pay an unexpected medical bill of $1000 within 30 days, and 46% said they’d postponed care because of concerns about cost. Recent data from Experian Health and PYMNTS showed very similar findings. This means providers must take proactive steps to find missing health insurance for their patients or risk negative impacts on their bottom line. Aside from causing distress to patients and hindering access to prompt, effective care, inadequate insurance coverage also raises the risk of uncompensated care for providers. The American Hospital Association reports that hospitals have provided almost $745 billion in uncompensated care since 2000. What makes this even more frustrating is that in many cases, patients do have additional coverage that could help close the gaps, but they’ve either forgotten about it or are unaware of their eligibility. Hunting down this missing health insurance is a daunting challenge for healthcare providers, but is essential if they are to avoid giving away care. Unfortunately, the problem is likely to worsen as patient volumes increase, and pressure mounts on collections teams that are already stretched. Finding undisclosed active coverage should be a priority for providers who want to avoid more revenue slipping through the cracks. Watch the video to see how Coverage Discovery helps healthcare providers find previously unidentified coverage – while saving time and money. Why is tracking down active coverage so challenging? While the benefits of finding missing coverage are clear, doing so is less straightforward. In most cases, coverage has been forgotten because a patient has moved to a new house and/or state, changed employers, or experienced financial difficulties – all challenges that have been exacerbated by the COVID-19 pandemic. Patients may be misclassified as self-pay or as having only one form of insurance. In recent years, it has become more common for a patient to access care from multiple healthcare facilities, which adds layers of complexity to the reimbursement process and introduces more opportunities for data errors. Providers must also contend with regulatory changes, particularly regarding Medicaid and Medicare coverage. For example, Medicaid enrollment grew by 25% between February 2020 and May 2022. Now, up to 14 million people are set to lose that coverage as the continuous enrollment requirement winds down with the end of the COVID-19 public health emergency nearing. Some will seek coverage outside the marketplace; others may be eligible to re-enroll; others will go without, seeking charity assistance. Verifying active coverage in this context can be extremely resource-intensive and time-consuming for providers and their staff. How can providers find missing health insurance quickly and accurately? Providers can turn to automated digital solutions to ease some of these pressures. Coverage Discovery is the only comprehensive coverage identification solution that works across the entire revenue cycle. It searches government and commercial payers to find previously unknown insurance coverage in advance of scheduled appointments, at the point of service, and even after appointments have taken place. Using multiple proprietary data sources, advanced search heuristics and machine learning, it reliably identifies accounts that may be submitted for immediate payment under primary, secondary or tertiary coverage. Running repeated checks at various points in the revenue cycle means the value of Coverage Discovery builds over time. The Director of Patient Access at Essentia Health says: “We found 67% of coverage for accounts that were at self-pay or uninsured accounts at the time of pre-service and 33% at the time of post-service. We have found a total of 16,990 accounts since we went live on Coverage Discovery.” In 2021 Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts representing more than $66 billion in corresponding charges. The business case is clear: collections and cash flow go up, while A/R balances, self-pay write-offs and charity care misclassifications go down. What else can providers do to help patients manage the cost of care? Clearly, patients benefit from collections processes that have the potential to reduce their financial responsibility. Reducing friction at the point of service and providing cost information upfront increases the likelihood of correct and timely payments, as well as helps consumers manage their financial obligations. Patients today want to play an active role in their healthcare journey, and that includes making financial decisions in addition to care choices. Tools such as Patient Financial Advisor, Patient Financial Clearance and PatientSimple work alongside Coverage Discovery to empower patients and streamline complex payment processes. By providing an efficient, user-friendly suite of digital tools and solutions, health services can ensure a compassionate patient financial experience, get paid faster and increase profits. The search for insurance coverage does not have to be complicated. Contact Experian Health to find out how Coverage Discovery makes finding missing health insurance easier.

Does a patient’s age influence their experiences with rising healthcare costs? A recent report from Experian Health and PYMNTS points to a generational gap when it comes to the impact of and responses to medical bills. The study takes a deep dive into how Gen Z, millennials, Gen X and seniors are reacting to the growing cost of care. From canceling appointments to being surprised by out-of-pocket expenses, this article looks at the key differences in generations and healthcare costs, and the tools and solutions providers can implement to support their patients. Millennials are most likely to cancel appointments due to high-cost estimates A worrying proportion of patients are choosing to delay or forego care because of concerns about cost. This seems to be felt most acutely among younger patients. According to the new data, 74% of millennials and 56% of Gen Z patients have canceled a healthcare appointment after receiving a cost estimate that was higher than they could afford, compared to 13% of baby boomers and seniors. Gen X patients fell in the middle, with just over half canceling appointments after receiving high estimates. That said, healthcare costs affect all generations. While older patients seem less likely to cancel appointments due to cost, the “Medicare Effect” suggests that many hold off seeking care in the first place, until their costs are covered at age 65. Many households, regardless of demographic, are walking a financial tightrope as inflation continues to climb and patients bear responsibility for a greater portion of healthcare costs. Providers can help minimize the number of patients forgoing essential care by helping to track down any available coverage, so patients aren’t inadvertently billed for care that could have been covered by a forgotten health plan. Coverage Discovery continuously scans commercial and government coverage using multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms. Finding missing coverage means upfront estimates will be more accurate, and patients will be likely to see a lower co-pay amount. In 2021, Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts and found more than $66 billion in corresponding charges, removing a huge burden for patients and providers alike. Gen Z patients are most surprised by out-of-pocket expenses Overall, 19% of patients found they spent more on healthcare than they could afford in the last 12 months. As would be expected, those who received inaccurate estimates (43%) experienced more financial distress than those who received accurate estimates (26%). Among those who paid out-of-pocket expenses for their most recent healthcare visit, Gen Z patients were the least aware that they would be required to make a payment, with 32% not knowing that they’d need to make co-payments. Only 20% of Gen X and 10% of baby boomers and senior patients were unaware. One way to alleviate the strain of unexpected bills is to issue cost estimates automatically, before the patient’s visit. Only 34% of surveyed patients received estimates automatically before their visit, so it’s no surprise that many are caught unaware when the final bill arrives. With Patient Estimates, patients get a breakdown of their expected costs based on real-time provider and payer data. The estimates are delivered automatically to the patient’s mobile device (along with links to convenient payment methods. An earlier report by Experian Health and PYMNTS found that patient satisfaction rose by 10% when billing estimates were provided, underscoring their value. Millennials pay the highest out-of-pocket expenses Millennials appear to have been hardest hit by out-of-pocket bills. The average across all respondents was $363, but millennials paid an average of $619. This could explain why millennials were more likely to cancel appointments. Providers can help patients manage balance bills by providing tools that make it easier to plan and pay their bills. For example, Patient Financial Clearance screens and segments patients so providers can help guide them to the most suitable financial pathway. PatientSimple and Patient Financial Advisor help patients access cost estimates, identify best-fit payment plans, apply for financial assistance and make payments, via their patient portal or mobile device. Baby boomers and seniors are most satisfied with the healthcare payment process Most patients were generally satisfied with the payment process for their medical bills. Older patients appeared to be slightly more content, with 77% of baby boomers and seniors saying they were satisfied, compared to just under 70% of Gen X and millennial patients. Gen Z was the least satisfied, at 60%. With 22% of unsatisfied patients saying they’d consider switching providers, getting the payment experience right is high stakes for providers. So, how can providers improve the payment experience for those who are less than completely satisfied? Accurate estimates, tailored payment plans, clear communication and convenient payment methods will all be in the mix. For most healthcare organizations, this will mean embracing digital tools and automation. Experian Health’s State of Patient Access 2.0 survey revealed that while younger patients may be especially receptive to a digital patient payment experience, it crosses generational lines. Members of “Gen C” – digitally-connected consumers of all ages – are looking for a streamlined payment experience. When patient loyalty and decisions about when to receive care are so heavily influenced by the financial journey, it makes sense to offer digital estimates, billing and payments where possible. The good news for providers is that prioritizing patient satisfaction doesn’t mean sacrificing efficiency. Automation and digitalization can facilitate greater choice and convenience for patients, without requiring additional staff input. In fact, it’s likely to yield productivity gains and free up staff to focus on delivering an even better patient experience, and support patients to get the care they need. Find out more about how Experian Health’s suite of patient payment solutions can help providers deliver a financial experience that satisfies patients of all generations and healthcare costs.

On July 28, the US House of Representatives voted in favor of extending Medicare telehealth flexibilities after the COVID-19 public health emergency ends. If enacted, the Advancing Telehealth Beyond COVID-19 Act will allow beneficiaries to continue to access telehealth services at any site, including their home, until December 31, 2024. Coverage for a wider list of telehealth practitioners, delivery at specific clinics, audio-only telehealth, and remote behavioral health and hospice care would also continue. After a quick implementation period at the start of the pandemic, providers spent the last two years refining telehealth delivery. However, a question mark remained about telehealth’s post-pandemic prospects. The new legislation offers welcome certainty around reimbursement, at least until December 2024. More significantly, it’s further confirmation that telehealth is likely to become a permanent fixture in modern healthcare delivery. What does that mean for providers? Telehealth is here to stay Throughout the pandemic, remote and virtual care proved an effective way for providers to maintain relatively stable service delivery and limit gaps in care. It even helped to tackle inequitable access to care by making it easier for rural and underserved communities to speak to their doctor. Now, patients and providers alike are familiar with the benefits of telehealth. It’s an expected component of the overall healthcare experience. For the American Telehealth Association, the vote is “a significant step forward in providing much-needed stability in access to care for millions of Americans… We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent.” As telehealth is gradually stitched into the fabric of the US healthcare system, providers should consider the following three actions to maximize the opportunities that come with delivering virtual and remote care: 1) Review the digital patient journey and increase telehealth access Telehealth is more than just a video visit – a truly virtual patient care experience starts from the moment the patient books their appointment all the way through to patient billing. Recent data from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods, while 61% of patients said they’d consider changing healthcare providers to one that offers a patient portal. Prioritizing the use of digital channels could therefore boost patient attraction and retention, as well as efficiency and productivity. Integrating telehealth platforms with online scheduling software means patients can choose how and when to book their appointment, and appointment options are synced with physician calendars for maximum efficiency. Similarly, providers can ease friction when patients are registering for a telehealth visit by offering digital, automated and mobile-friendly registration. 2) Prioritize personalized patient outreach and engagement While many patients are now familiar with telehealth services, many may not be aware that it’s an option or may be unsure of how it works. Patient engagement strategies are essential in communicating to patients that telehealth services are available. By providing clear information about how the visit will work, how to use the technology and how to prepare, providers can help patients understand the process more clearly so they get the most out of their visit. This is especially important for patients who may be unable to attend in-person visits (e.g., due to location, disability, or lack of transportation or childcare). Telemedicine helps these patients take a more active role in their health and healthcare journey, in turn closing gaps in care. It also creates opportunities for remote patients to access experts that they’d otherwise be unable to see. Consumer data helps providers build patient engagement and outreach strategies based on reliable demographic, behavioral, psychographic and financial information. As telehealth services grow, a tool like ConsumerView enables providers to segment, identify and communicate with different audiences so that patients receive the most relevant message at the most useful time. 3) Explore automation for efficient telehealth billing Keeping track of telehealth reimbursement regulations has been one of the key challenges for providers as telehealth services have expanded. Flexibility reduced some of the barriers to scaling telehealth services, but did leave the door open to variation in payer requirements, coding changes and geographical coverage. The new legislation would maintain the status quo for a while longer. But looking ahead, any further changes to telehealth reimbursement rules, combined with greater telehealth utilization, could leave providers with an administrative mess to clear up if they don’t have robust processes in place. Those that utilize claims management and billing tools now will be best placed to manage what may follow. Automation can ease the burden in several ways. For example, with Coverage Discovery and eligibility verification solutions, providers and patients can confirm coverage eligibility early, which will speed up collections further down the line. Another option is to use automated healthcare claims management software to ensure every telehealth claim is submitted correctly the first time. With Experian Health’s customization function, telehealth alerts can be automatically checked so providers know whether the patient is covered for virtual care. As telehealth services gain a permanent place in the healthcare ecosystem, providers should act now to optimize patient-facing services and back-end processes. Failure to do so could cause patients to look elsewhere for the healthcare experience they desire and lead to lost revenue opportunities. Contact Experian Health today to discover how data-driven insights and automation can help providers bolster their telehealth offerings to maximize reimbursements.