As retail and technology companies make moves in healthcare, existing providers must find new ways to attract and retain patients. Offering personalized patient payment plans is one way to meet evolving consumer demands and hold on to the competitive edge. The best part of this strategy? Providers can use data they already hold to deliver convenient and compassionate collections. Digital disruptors are driving a consumer-centric approach to healthcare payments Having transformed consumer expectations over the last decade, digital technology giants – along with a new generation of start-ups – are now actively pursuing a share of the multi-billion-dollar US healthcare market. Concierge medicine, on-demand virtual health and other personalized services are solidifying consumer expectations of flexibility, convenience and control. While consumers have more choice, they're also paying more for healthcare. Inflation-weary consumers are apprehensive about rising costs, and many report frustrations with healthcare billing and payment processes. According to a 2022 Gallup poll, nearly four in ten patients postponed medical care because of cost concerns. This tension between demand for choice and concerns about affordability leaves the sector vulnerable to disruption by players that offer alternative payment models that make healthcare more affordable for consumers, while making it easier to pay for care. Creating a more consumer-friendly approach to patient collections is essential for profitability. 1 in 10 patients use payment plans to manage the cost of care Research by Experian Health and PYMNTs shows that patients welcome payment plans to spread out the cost of care. One in ten patients had used a payment plan to pay for their most recent doctor's visit. Nearly three in ten older patients used a payment plan after receiving an unexpected bill. Unsurprisingly, those on lower incomes were most likely to need payment plans. Experian Health's State of Patient Access survey 2023 emphasized patients' desire for more flexible and transparent payment options, including pre-service estimates, payment plans and digital payment methods. Providers see the benefits too: around two-thirds of providers said their organization understands patients' unique financial situations and offers payment plans and financial assistance where appropriate. Using data to tailor patient payment plans For payment plans to work effectively, personalization is non-negotiable. Too often, payment plans apply a generic “one size fits all” formula to patient accounts, regardless of payment history, financial situation or other key indicators of the patient's ability to pay. This runs the risk of delivering a poor consumer experience while doing little to reduce patient bad debt. With a data-driven approach, healthcare organizations can identify the optimal plan for each patient. For example, PatientSimple® uses Experian Health's proprietary data and analytics to assess each patient's propensity to pay and guide them to the most appropriate financial pathway. A self-service portal gives patients a convenient way to generate estimates and consider different pricing plans, so they can make a more informed and confident decision about how to pay their bills. It also supports staff to have more compassionate financial conversations with patients. Similarly, Patient Financial Advisor and Patient Estimates give patients upfront, accurate estimates of what they're likely to owe, drawing on current chargemaster lists, payer contracts and the patient's insurance data. Together with payment plans, these estimates help patients avoid unexpected bills, so they have a more positive payment experience and are less likely to miss payments. A third tactic is to make it as easy as possible for patients to pay. Self-service and contactless payment options remove friction from the payment process, so patients are more inclined to pay promptly where they can. The patient's account data can be securely auto-populated into payment tools so they can pay and go with minimal fuss. Stay ahead of competitors by creating patient-friendly experiences As healthcare evolves, healthcare organizations need to develop strategies to remain competitive while still delivering compassionate care. Personalized patient payment plans are one way to strike that balance. Not only do they give patients the flexibility and convenience they’re looking for, but providers can also use existing data to tailor plans that benefit both company and customers alike. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, says these tools can help providers stay competitive as patients are exposed to a growing range of consumer-friendly healthcare services: “The move towards more patient friendly online experiences is a catalyst for improved price transparency. The challenge for providers is to adapt to shifting consumer needs while managing their resources wisely. But there's a major opportunity for providers to use data they already hold to help patients figure out the best financial pathway. Putting patients first is a sure-fire strategy to see patient satisfaction and patient collections rise in parallel.” Find out how healthcare organizations can remain profitable in an increasingly competitive market with personalized patient payment plans and patient payment solutions.

With artificial intelligence (AI) continuing to dominate conversations among healthcare's strategic thinkers, it's clear that recent innovations in this field could herald a step-change in healthcare delivery. AI's ability to mimic human intelligence and machine learning (ML)'s capacity to learn from vast amounts of data means these technologies are fast becoming indispensable tools for healthcare leaders who want to optimize operations. Understanding how they work – and where to apply them for maximum impact – will be crucial to stay ahead of the competition as the revenue cycle landscape evolves. This article breaks down the what, why and how of AI technology in healthcare, and includes a look at Experian Health's new AI-based claims denial solution, AI Advantage™. Understanding machine learning and AI in healthcare The terms “machine learning” and “artificial intelligence” are often used indiscriminately, but what do they mean in a healthcare context? Generally speaking, AI is a machine's ability to perform cognitive functions that would normally be associated with humans, such as interacting with an environment, perceiving information, and solving problems. It can spot patterns, learn from experience and choose the right course of action to achieve a desired outcome. This includes natural language processing, robotics and machine learning. In healthcare, AI might be used to transform diagnosis through the analysis of medical images, expedite drug discovery by monitoring side effects, improve the safety and efficiency of surgery through robotics, and support patients to take ownership of their own health through health monitoring and wearables. Machine learning is a broad term that covers the processes used to extract meaning from (usually large) datasets to create and train a predictive model. It will look for historical patterns in input and output that a human eye might miss, and generate recommendations based on outcome parameters defined by the user. For example, it can look at patients' electronic health records to identify those who may be at risk of specific medical conditions so they can be offered appropriate advice. Another useful application is in predicting service demand, for more efficient appointment scheduling and resource allocation. Further subsets of machine learning include supervised learning, where training data is labelled with the desired outcomes that the algorithm should aim to detect, and unsupervised learning, which has no predefined targets and is useful for discovering patterns, insights and anomalies. Unlocking the AI Advantage™: how AI can reduce claim denials and improve financial performance The transformative potential of ML and AI technology in healthcare isn't limited to clinical decision-making and patient engagement: optimizing revenue cycle operations is a particularly attractive place to leverage the technology. It can be used to identify and reduce billing errors, enhance coding accuracy, and predict revenue leakage. This results in faster payments, better use of staff time and fewer claim denials. However, Experian Health's State of Claims 2022 survey revealed that while 51% of providers were using automation, only 11% of providers had integrated AI technology into their claims processes. Experian Health's new AI-based claims solution is specifically designed for those looking to take the next step to leverage AI to predict and prevent denials. AI Advantage takes a two-pronged approach to reduce the risk of denials and expedite any rework that may be needed. AI Advantage – Predictive Denials examines claims before they are submitted and calculates the probability of denial, based on thresholds set by the provider. It incorporates historical payment data and undocumented payer claim processing behavior to evaluate individual claims in real-time, with a level of speed and accuracy that would be unachievable using manual processes alone. High-risk claims can be edited before submission to reduce the risk of denial. AI Advantage – Denial Triage evaluates and segments denials based the likelihood of reimbursement following resubmission and prioritizes the work queue based on financial impact. It learns from payers' past decisions to formulate recommendations with increasing accuracy. This means staff can eliminate guesswork and focus their attention on the denials that will be most likely to yield results. See how Experian Health's AI-powered solution works to reduce and prevent denials. Challenges to watch out for when implementing AI While the benefits are clear, the rise of AI in healthcare applications also brings some challenges. Here are some key questions to consider for smooth implementation: How reliable is the data underpinning AI technology? AI tools are only as good as the data they're analyzing. Without high-quality, structured data, they will be unable to make accurate predictions. Providers need to ensure that data is available in a usable format and free from errors. Partnering with a reliable third-party vendor can help ensure all the relevant boxes are ticked. Does the technology integrate easily with existing workflows and software systems? Integrating new tools with the existing RCM infrastructure can be complex. Organizations often have legacy systems that may trigger interoperability issues, limiting effective data exchange and requiring staff to log in to multiple interfaces. A single vendor solution can mitigate for this. For example, AI Advantage fits together seamlessly with the industry-leading claims processing tool, ClaimSource®. Experian Health's consultancy team are also on hand to ensure smooth implementation. Does the software protect data privacy and security? Healthcare data is subject to multiple privacy and security regulations, such as HIPAA. Any new technology that processes data must comply with regulations and industry best practice. Being able to reassure patients that their data is safe is also an important driver of patient loyalty. What does the future hold for AI technology in healthcare? Looking ahead, the role of ML and AI in both patient-facing healthcare processes and revenue cycle operations is only going to grow. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursement, while minimizing the burden on the workforce. Emerging technologies such as robotic process automation and natural language processing will offer more sophisticated and comprehensive workflow solutions, while AI's ability to continually learn and improve means providers that leverage AI will be better placed to make full use of their data and adapt to evolving trends and challenges. Discover how AI Advantage™ is helping Experian Health's clients transform their healthcare operations.

Staffing shortages are the new normal in healthcare. Most news headlines focus on gaps between the supply of providers and the growing demand for care. However, a recent survey by Experian Health, released in November 2023. shows the massive impact staffing shortages have on back office revenue cycle where these functions intersect with front-of-house patient engagement. Strikingly, the healthcare staffing shortage statistics in the survey show revenue cycle executives are 100% in agreement—staffing shortages significantly affect reimbursement workflows to the detriment of patients and healthcare employees. Experian Health's report, Short-staffed for the long term, surveyed 200 healthcare executives responsible for revenue cycle functions. The goal was to gauge the impact of worker shortages on revenue cycle management and patient engagement. While the pandemic brought these shortages into the public purview, this new data shows most providers believe healthcare staffing gaps are chronic and here to stay. These results reinforce The State of Patient Access 2023 survey, where 87% of providers blamed staffing shortages for declining access to care. As the healthcare industry continues to struggle with an ever-increasing staffing shortage, it has become increasingly evident that if left unresolved, this situation can wreak havoc on revenue cycle management (RCM). The latest survey illustrates the need for new strategies to alleviate healthcare worker shortfalls. This article explores the most recent healthcare staffing shortage statistics and some key findings from the study to help determine how healthcare providers can turn these challenges into opportunities. Experian Health surveyed 200 revenue cycle executives to determine the impact of staffing shortages on reimbursement and patient engagement. Download the report to get the full results. Finding 1: Most revenue cycle leaders believe staffing shortfalls negatively affect payer reimbursements and collections. 96% of survey respondents indicated a lack of qualified workers has a detrimental impact on organizational revenue channels. 80% say turnover in their department ranges from 11 to 40%, much higher than the national average of 3.8%. When healthcare organizations lack revenue cycle talent, they risk missing performance goals. High turnover and the departure of experienced staff create information deserts within healthcare organizations. It forces new team members to train faster, handle bigger caseloads before they're ready, and potentially burnout from stress. The pressure to do more faster creates a higher volume of preventable claims errors that lead to denials. The survey showed all these factors at play, and their negative impact on reimbursement, collections, and the patient experience. While the traditional way to alleviate staffing shortages is to increase recruiting and retention efforts, these approaches no longer work when there simply isn't enough available staff to hire and train. Healthcare organizations must consider new partnerships with technology providers who offer automation tools to streamline human workflows. Revenue cycle management software eliminates repetitive tasks and lessens errors that lead to rejected claims. Digital technology can help solve labor shortages by reducing staff workloads and improving operational performance. Automation can streamline collections by prioritizing the accounts most likely to pay. These tools help existing revenue cycle teams work more efficiently while enhancing patient encounters. Finding 2: Healthcare staffing shortages roadblock a positive patient experience. 8 of 10 survey respondents say patient experience suffers due to gaps in staffing coverage. 55% report the patient experience is most heavily affected at intake, and 50% say at appointment scheduling. Staffing shortages and turnover cause an undue burden on the healthcare workers left behind. The survey asked respondents to indicate the top pain points experienced by revenue cycle professionals, and one of the major challenges was staff burnout. Stress has a detrimental effect on patient interactions throughout the revenue cycle. The survey shows staffing shortages impede patient satisfaction in critical areas within revenue cycle functions, including: Scheduling appointments Patient registration Prior authorization Insurance coverage confirmation Patient estimates Revenue cycle interactions can be delicate, requiring extreme patience and clear communication. Healthcare organizations must provide the support their revenue cycle teams need to handle these crucial conversations appropriately. To improve the patient experience, organizations must first improve the workflows and workloads of these critical back-office teams. When healthcare organizations have the right tools to eliminate manual tasks that bog down revenue cycle staff, these professionals can spend more time on the compassionate handling of patients and their accounts. Providers have the opportunity to solve these challenges with digital patient engagement solutions that improve workflow efficiencies at every level of the revenue cycle. Patient scheduling software creates a self-service environment that 73% of healthcare customers prefer. Patient intake improves with online software that automates the tedious paperwork that tie up staff. Better technology can create price transparency without manual effort, ensuring patients understand their responsibilities up front instead of facing surprises during or after care delivery. Finally, a frictionless online payment platform allows patients to handle their obligations seamlessly without staff intervention. Finding 3: Errors arise when healthcare providers are short staffed, leading to claims denials. 70% of survey respondents say staff shortages exacerbate denial rates. 92% of survey respondents said new staff members make errors that negatively impact claims processing. Some of the most common reasons for healthcare claim denials include: Incomplete collection of claims data Coding errors Billing errors Eligibility verification errors Missed insurance verification Healthcare operations and revenue cycles are full of manual processes. RevCycleIntelligence reports one-third of prior authorizations are completed manually, and two-thirds of hospitals haven't automated any part of their denials management processes. Yet technology has made significant strides toward reducing these error-prone manual tasks. Leveraging artificial intelligence (AI), with solutions like AI Advantage™, within the complexities of claims processing could cut provider spending by up to 10% annually. Eliminating repetitive tasks with automated claims management solutions improves the lives of staff, cuts manual errors that tie up cash flow in reimbursement wrangling, and creates a better, less stressful environment for customers. Reducing the impact of healthcare staffing shortages with revenue cycle automation and technology Sometimes, 100% agreement isn't the desired outcome. In this case, the healthcare staffing shortage statistics found in the survey shows healthcare providers agree unanimously that chronic staffing shortages create a problematic environment for employees that costs revenue and patient engagement. While technology exists that can maximize revenue staff workflows to extend the reach of overburdened employees; survey participants suggest that healthcare organizations continue to approach solving these issues by adding staff.  But healthcare's staffing challenges are not new. While organizations have historically invested revenue in higher salaries and sign-on bonuses to attract staff, technology offers a new opportunity for history to avoid repeating itself. It's time for healthcare organizations to support their teams with automation. These tools alleviate mundane, error-prone tasks that tie up staff. Experian Health offers these organizations a way to improve the lives of everyone within the revenue cycle by allowing back and front-office teams to focus on patient care, rather than filling in forms. It's a more humane way to handle a very human staffing crisis. Download the survey or connect with an Experian Health expert today to learn how we can help your healthcare organization combat staffing shortages.

Hospital admissions for COVID-19 increased by almost 92% between the last week in July 2023 and the last week in August 2023, according to figures published by the Centers for Disease Control and Prevention (CDC). It is worth noting that this time last year, the numbers were double what they are now. However, it is important to acknowledge that the virus is still evolving. Demand for services may be unpredictable over the coming months, so providers will need to position their teams to adapt to changing patient volumes and staff absences. Additionally, seasonal flu vaccination programs are underway, putting extra pressure on patient access. Now is the perfect opportunity for healthcare providers to reassess and streamline patient intake processses. This article looks specifically at how online scheduling for patients can help providers prepare for the unexpected this fall. Rethinking patient intake Online scheduling helps providers create a more efficient patient access experience by allowing patients to schedule appointments from home, instead of by phone or in person. It's more convenient for patients, limits exposure to infection and reduces the administrative burden on front office staff. Understandably, some providers without online scheduling software in place may worry about implementing new tools during the busiest time of year. They may see it as a “nice to have” to deploy when demand is more stable. But this is a false economy: any time saved by postponing the switch to online scheduling will be lost to costly inefficiencies over the hectic winter period. It's crucial to start the process now, before the stress hits. In a 2022 evaluation of self-scheduling processes at the Mayo Clinic, the authors describe themselves as “fortunate to have the self-triage and self-schedule process in place during the unanticipated surge of COVID variant omicron in the winter of 2021-2022.” The organization saw utilization of self-scheduling for COVID-19 tests increase from 4% of appointments booked in December 2020 to 44% in January 2022, saving thousands of hours of staff time, reducing no-shows and streamlining the patient experience. Get more benefits from online scheduling with a tailored approach Switching to online scheduling doesn't have to be complicated. To simplify implementation, providers should focus on how online scheduling can support their organization's specific operational challenges and goals. Choosing a solution that integrates with existing practice management and hospital information systems will also ensure implementation is as frictionless as possible. Here are a few examples of ways to maximize the benefits of online scheduling for their organization: 1. Create screening questionnaires to manage demand Screening questionnaires can be given to patients as soon as the log in to book appointments for specific services. Their answers can then be used to determine the appropriate appointment type and guide patients to their next step quickly and efficiently. Clinical needs, billing requirements, and patient preferences (such as the need for an accessible location or interpreter), can all be managed automatically.It's an effective strategy to manage demand for high throughput and routine services that are less likely to need staff assessment, such as COVID-19 testing or flu vaccinations. In the Mayo Clinic example, self-scheduling took just 3.1 minutes for asymptomatic patients, increasing to just 5.8 minutes for symptomatic patients who self-triaged with a screening questionnaire. 2. Use guided search to direct patients to virtual services Online scheduling can also guide patients to appropriate and convenient services they may not otherwise have considered, such as virtual care. Virtual care proved its value at the height of the pandemic, and while utilization has levelled off, providers should not see this as a lack of appetite for digitally-enabled care among patients. In Experian Health's State of Patient Access survey 2023, 56% of patients said they wanted more digital options for managing healthcare. Respondents (particularly younger patients) listed mobile scheduling for telehealth appointments among their expectations of the digital front door.The recent explosion in digital health companies offering at-home care solutions also speaks to patient demand for virtual services. Established providers should look to expand and promote their digital offerings, or risk losing their competitive edge. Leveraging the incumbent advantage is a move to make now, while new players are still finding their feet. One effective method to achieve this is by directing patients to existing virtual services through an online scheduling platform. 3. Eliminate walk-in traffic at urgent care centers Urgent care centers are the 'doctor of choice' for many patients, with patient volumes increasing by 60% since 2019, according to the Urgent Care Association. If COVID-19 and seasonal flu cases collide over the winter, urgent care centers may become overwhelmed by patients with both infections. Urgent care center managers may want to consider switching to an appointment-only system, where appointments must be scheduled online or by phone. This helps reduce the number of in-person visits and walk-in traffic, which will not only help prevent spread of infection, but also contribute to a better patient experience.Online self-scheduling also eases pressure on urgent care centers in another important way. Allowing patients to book their own appointments reduces the risk of cancellations and no-shows. This proactive approach prevents delays in care, effectively bridging gaps that can potentially escalate into costlier and riskier emergency situations. 4. Extend staffing capacity with real-time resource allocation Experian Health's data shows that between June 2022 and June 2023, providers that used Patient Schedule saw an average of 40% of patients book appointments after hours, saving hours of administrative time. Efficiencies on this scale will be invaluable, should COVID-19 or seasonal flu cases trigger a rise in patient volumes and staff absences.Patient Schedule automatically optimizes patient and provider capacity in real-time. Scheduling rules based on providers' calendars, appointment types and business needs are built into the platform, so that patients only see the available appointments based on those rules. The tool gathers calendar inventory from across multiple providers for a comprehensive view of network capacity, to make even better use of available staff time. The calendar inventory can cover an entire care team, such as a physician, physician assistant and nurse practitioners. This frees up staff to focus on other administrative tasks and assist patients with additional needs. Get ahead of winter pressure points with online self-scheduling These are just a few examples of how providers can use online patient scheduling to zero in on their own operational priorities, make life easier for schedulers and patients, and ease pressure on services over the coming months. Contact Experian Health today to explore self-scheduling options and immediately boost your service capacity.

The phrase “it's complicated” resonates well in the realm of prior authorizations in healthcare. Initially devised as a cost control strategy by insurance payers, the concept of prior authorization holds merit. However, the reality unfolds as a different tale, with 94% of doctors attributing care delays and diminished clinical outcomes to prior authorization hurdles. Furthermore, one in three doctors  connect these authorizations to escalated healthcare resource utilization, manifested through patient hospitalizations and life-threatening clinical events. There is a shimmer of hope as some insurers are retracting prior authorization prerequisites for certain conditions and procedures. However, this move might produce more complexities, given the distinct protocols of each payer. The traditional manual handling of prior authorizations by most providers leaves ample room for errors amidst these changes. A viable solution lies in leveraging technology. Experian Health's electronic prior authorization software can expedite and streamline pre-certification workflows, keeping providers updated with the ever-evolving payer requirements. What are prior authorizations?  Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. This process can be time-consuming, burdensome, and can lead to delays in patient care. Kaiser Family Foundation (KFF) says, “Prior authorization, or pre-certification, emerged decades ago to deter physicians from prescribing costly tests or procedures unjustifiably, aiming at delivering cost-effective care.” Initially, the focus was on high-cost care like chronic condition treatments. However, the spectrum has broadened, encompassing mundane clinical encounters like basic imaging or medication refills. Since 2020, a whopping 80% of providers have witnessed a surge in prior authorization volumes, stirring discussions on their necessity. The American Medical Association (AMA) critiques the overuse of prior authorization, emphasizing the administrative and clinical issues it spawns. The lack of uniform documentation requirements across payers often culminates in unwarranted care denials and treatment delays. The administrative overhead is hefty; an average doctor processes 45 pre-authorizations weekly, a task primarily manual, time-consuming, and error prone. Some insurers lifting prior authorization requirements  The scrutiny over the years has prompted some payers to relax prior authorization mandates:  UnitedHealth is reducing nearly 20% of their prior authorization requisites for a variety of treatments from spine surgery and breast reconstruction to outpatient therapies and durable medical equipment Humana has eliminated prior authorizations for cataract surgery for Georgia Medicare Advantage beneficiaries.  Following suit, Aetna has waived pre-certification for certain cataract surgeries, albeit excluding Medicare Advantage beneficiaries in Georgia and Florida. They have also ceased prior authorization for physical therapy in five states. Currently, 30 state bills aiming to rectify the prior authorization problem are in the pipeline. Washington is on the verge of introducing new mandates for both private and public payers. However, the diverse new rules from payers and legislative attempts to address the issue might create new challenges.  How to keep track of prior authorization changes  The traditional reliance on manual paperwork for prior authorizations remains predominant. Over half of the providers find the process daunting to organize and maintain. Experian Health's electronic prior authorization solution stands to help automate this process, enhancing operational efficiency and curbing costly denials. The solution auto-updates with the latest payer rules, offering real-time tracking of authorization status and allowing manual look-up by CPT code or service description. This significantly reduces the time spent hunting for updated information. Furthermore, the software can add actionable alerts, creating flags when payers change their requirements. For example, the Prior Authorization Knowledgebase, a proprietary repository for more than 160 national payers and their pre-certification rules, allows quick check functionality to see if a procedure requires appropriate use criteria adherence. Users can create service work queues when CMS requires adherence to Appropriate Use Criteria (AUC). Two supporting tools to aid these processes include the Medical Necessity tool, which validates clinical orders against CMS and private payer rules for fewer denials, and Claims Scrubber, which helps healthcare organizations prevent denials by improving claims accuracy.  Neeraj Joshi, Director of Product Management, at Experian Health, says, “Technology has the potential to significantly reduce the need for pre-authorization in healthcare by improving efficiency, streamlining processes, and enhancing decision-making. Automating prior authorizations eliminates the burden of tracking these constantly changing requirements. Following these changes by hand, scrolling back and forth between websites, then manually adding them to a rules list leaves room for error that no one can afford.”   Using technology to streamline prior authorizations Today, a mere 21% of providers have adopted electronic prior authorization software. The Council for Affordable Quality Healthcare (CAQH) projects that automation of service preapproval could slash healthcare's administrative encumbrances by $437 million annually. More crucially, it would expedite patient decision timelines and care delivery. The impact on patient outcomes could be significantly positive over time. The utilization of electronic prior authorization software promises to alleviate the anxiety doctors and patients endure while awaiting treatment approval. The AMA reports that 8 in 10 doctors acknowledge patient experience unwarranted care delays, sometimes leading to treatment abandonment due to prolonged prior authorization procedures. The technology to expedite prior authorizations is at our disposal, and progressively, healthcare organizations are transitioning towards it, mending the broken pieces of care delivery and reimbursement. Joshi says, “While technology can reduce the need for pre-authorization in healthcare, it's essential to strike a balance between ensuring the appropriate use of medical services and avoiding unnecessary delays in patient care. Healthcare providers can use technology to design more efficient workflows that minimize administrative burdens. For example, automating data entry and documentation can free up healthcare staff to focus on patient care. We have the tools available that can speed up these processes.”   Today, better health requires reducing the complexities of the healthcare paradigm. Experian Health offers provider organizations improved options for delivering care with robust technological solutions that improve the lives of clinicians, staff, and patients. We specialize in offering digital tools to improve every stage of the patient journey. Contact Experian Health today to improve your pre-approval processes with electronic prior authorization software. 

AI and automation could cut US healthcare spending by up to 10% – a promising figure for hospitals operating on razor-thin margins. Despite the potential for cost savings and revenue growth, investing in AI can seem risky while the technology feels relatively new. But as denial rates increase, staff shortages persist, and payers race ahead with their own AI-led efficiencies, investing in AI and automation could help healthcare providers increase efficiency and reduce manual workloads, while improving the patient experience. In a recent podcast interview, Johnathan Menard, VP of Analytics at Experian Health, talked to Andrew Brosnan of Omdia about how providers can use AI and automation in healthcare to reduce admin costs and tackle staff burnout, while maximizing the ROI on new technology. This article sums up the key takeaways. “AI and automation are gaining momentum in the healthcare revenue cycle, but there remains untapped potential” For healthcare leaders, maintaining the financial health of their organization is critical to serving their communities. Menard sees untapped potential to use AI to improve financial prospects by automating and eliminating administrative tasks within the revenue cycle: “There are many repetitive, tedious tasks involving large amounts of data that's already collected, and mostly structured and standardized. That can be organized and analyzed with AI to help improve efficiency and accuracy.” Automation is a well-established route to lowering manual workloads, increasing efficiencies and generating data for better decision-making. AI takes this a step further. For example, Experian Health's flagship AI platform, AI Advantage™, can parse an organization's data to identify and predict patterns in payer behavior. It translates this data into insights that help providers boost profitability and improve the staff and patient experience. Menard explains why claims management is a prime use case for AI: “Last year, the average denial rate was already above 11%. That's 1 in 10 patients potentially having to deal with uncertainty about who will pay the bill, when they should be focusing wellness. That's where we see Experian Health being able to lean in and drive value and change in the healthcare industry with AI.” “Cost is the biggest barrier to AI and automation adoption in healthcare – but can be offset with the right data” Despite the potential upside, healthcare still lags other industries when it comes to implementing AI. Menard says that workforce costs are the biggest barrier to adoption: “In healthcare, it's not just a matter of implementing the technology or solution, but also maintaining it on a yearly basis with talent. Organizations are going to have to recruit an AI-competent workforce.” He says that providers may struggle to offer competitive salaries to attract staff with this skillset, but there are other ways to offset cost concerns. One example is working with a trusted third-party vendor to choose the best-fit AI solution for their organization. These vendors can leverage economy of scale, data and lessons learned in other markets to help providers deliver new models of care: “At Experian Health, we have health data spanning eligibility and benefits, address, identity, claims remittance payments. We have insights on 300+ million consumers and 126 million households. We're able to offer providers one of the most holistic views of today's health care consumer. It gets really exciting when you think about partnering with providers to augment their capacity to deliver a different style of care.” “Providers need to make sure staff see the benefits of AI and automation” Menard notes that successful implementation of AI needs staff buy-in: “Providers need to make sure staff see the benefits of what this technology can bring. They must also make sure they give them the proper training on how to embrace these capabilities. They do not replace your job; they augment you to do more, or they allow you to focus on doing the right thing, not the right thing that needs their specific level of expertise.” AI Advantage is a prime example, reducing the admin burden for staff, who can then focus on higher priority tasks. The solution takes a two-pronged approach to help staff reduce claim denials and maximize reimbursement: AI Advantage – Predictive Denials synthesizes historical and real-time claims data and payer decisions to flag claims that are likely to be denied. This allows staff to intervene and make necessary amendments prior to submission. AI Advantage – Denial Triage performs a similar function for claims that do end up being denied. It helps staff eliminate time spent on low-value denials by guiding them resubmissions that are most likely to be reimbursed. Schneck Medical Center and Community Regional Medical Center (Fresno) are seeing the benefits of AI Advantage. Watch the on-demand webinar to hear about their results. Moving beyond proof of concept Menard acknowledges that providers need to feel confident in a tool's ability to deliver before they make an investment, especially if they are operating on single-digit margins: “You can't do that without the proof of concept. There are too many competing priorities, especially in the revenue cycle, and healthcare leaders need to be laser-focused and very confident in their decision-making.” In part, this is what Experian Health is looking to do with AI Advantage. By demonstrating the power of AI to reduce costs and alleviate staff pressures within claims management, it can act as a springboard for smarter automation across other revenue cycle operations. Menard believes that as AI adoption expands, it will become faster, easier and cheaper to develop solutions at scale: “That's why we built the AI Advantage platform – to launch other products in the future and solve other issues throughout the healthcare journey. We talked about automation, adoption and healthcare. To me, the best way to automate a process is to eliminate the need for it in the first place.” Find out more about how AI and automation in healthcare can reduce costs, prevent staff burnout and help providers prepare for future challenges.

In July this year, the Centers for Medicare & Medicaid Services (CMS) reported that a data breach in a contractor's network may have compromised the data of more than 600,000 current Medicare beneficiaries. The breach, which occurred in May 2023, involved a vulnerability in file transfer software that enabled an unauthorized party to access beneficiaries' personally identifiable information (PII) and protected health information (PHI). Some patients were issued with new Medicare Beneficiary Identifiers (MBIs) following the incident. The contractor also offered two years of Experian credit monitoring at no cost to those affected. However, providers may see an increase in patients who are confused or concerned about using their MBI card. Experian Health's MBI Lookup service can help providers ensure that Medicare eligibility verification remains as efficient as possible. Thousands of beneficiaries issued new MBI numbers In response to the breach, CMS announced that 47,000 individuals would be mailed new MBI cards with new MBI numbers. However, as 612,000 patients were affected by the breach, there may be a significant number of people whose MBIs may change without notice. Since these individuals will not be able to use their old MBIs when trying to find Medicare coverage and benefits, there could be confusion among patients and providers who rely on MBIs to confirm a patient's eligibility for Medicare coverage. It could also affect billing processes and claim status inquiries. Experian Health reached out to CMS for clarification and received the following guidance: If a Medicare beneficiary's MBI number has changed, then their old (now inactive) MBI will return an AAA72 error when attempts are made to confirm coverage using the HIPAA Eligibility Transaction System (HETS). The HETS 270/271 platform will accept historical 270 requests that use the patient's new MBI. Old MBI numbers will only be accepted if that number was active during the Date(s) of Service noted on the request. Providers should note that some patients may inadvertently use invalid MBI numbers and review processes for verifying Medicare eligibility accordingly. Verifying Medicare eligibility with Experian Health's MBI Lookup tool Verifying active coverage can be a painstaking process, but it's a vital step to confirm that planned services will be covered by the patient's insurance provider. If a patient is unaware or cannot demonstrate eligibility for Medicare, then the provider cannot make a claim for reimbursement, and the patient may be left to pay a bill they cannot afford. Finding active coverage helps providers reduce the risk of bad debt. Experian Health's Insurance Eligibility Verification speeds up this process by accurately confirming coverage at the time of service. The process comes with an optional MBI Lookup feature, which checks transactions against MBI databases to see if the patient may be eligible for Medicare. If the patient has forgotten their MBI card, the tool will check to see if they're included in the database, using their name, date of birth, and Social Security Number (SSN) or Health Insurance Claim Number (HICN). The MBI Lookup service triggers on 270/271 transactions in the following cases: Where the transaction fails because the subscriber is not found or their MBI number or other identification is missing or invalid (a “Traditional Medicare Failure”) Where a commercial 270 inquiry returns a “Medicare Advantage Plan” or “Managed Care Plan” indication on the “Other Payer” or “Other Coverage” section of the 271 response Where a commercial 270 transaction returns a failed response and the patient is aged 65 or older. If the provider's system attempts to use a patient's old number, and the patient does not realize that they have a new number or card, MBI Lookup will find and verify their new MBI. When the tool is triggered, it finds active and verified MBI numbers in 60% of cases on average. Find coverage faster with automated discovery tools Kate Ankumah, Principal Product Manager of Eligibility Verification and Alerts at Experian Health, says the automated MBI Lookup service has proven especially useful during times of change: “Providers relied on this service to verify Medicare coverage quickly when the pandemic hit, just as the industry was adjusting to the use of MBIs instead of their legacy HICN. Now, MBI Lookup can help providers smooth out the impact of data breaches involving Medicare beneficiaries with minimal fuss. It's a reliable way to give patients clarity without placing any undue burden on staff.” Insurance Eligibility Verification can be used alongside other automated coverage identification tools, such as Coverage Discovery®. Coverage Discovery scans government and commercial payer databases throughout the patient journey to find any previously unknown or forgotten coverage, eliminating the need for manual inquiries. Using multiple sources of data and tried-and-tested algorithms, these tools work together to locate coverage for patients, giving patients peace of mind and helping providers avoid uncompensated care. Both tools can be accessed via the eCareNext® platform, so staff can view eligibility responses and manage work queues through a single interface. And of course, this recent breach is a stark reminder of the need to protect patient data. Using a single vendor with integrated software and data solutions can help reduce the risk of data getting into the wrong hands. Find out more about how Experian Health's Eligibility Verification solution and MBI Lookup tool can help providers verify active coverage and give patients peace of mind following a data breach.

Humans increasingly benefit from the convenience of a self-service world. Thanks to the internet and companies like Amazon, online digital interactions yield an almost immediate result. It's a standard consumers have adapted to and unconsciously expect from every service provider, whether it's same-day grocery delivery or scheduling the next doctor's appointment. Today's gold standard for most services is a few clicks with a favorite handheld digital device. But when it comes to healthcare, sometimes expectations don't meet reality. Healthcare providers must accommodate patient expectations by opening a digital front door. Despite the complexities inherent in American healthcare, patients increasingly demand a frictionless online experience where they manage their care at their leisure. Clarissa Riggins, Chief Product Officer at Experian Health, says, “Patients have increasingly high expectations for easy and efficient tech-enabled solutions when it comes to accessing healthcare services. They seek convenient self-scheduling options, accurate cost estimates, and the ability to pre-register through their smartphones.” Understanding the need for a digital front door in healthcare Healthcare's digital front door is a set of online tools that enable patients to manage their care. These tools began growing in popularity during COVID, when the necessity of limiting physical interactions drove many patients to online healthcare alternatives. These digital encounters further increased patient expectations of a seamless healthcare experience from scheduling to service delivery to payment. Meeting patient demand for digital services Increasingly, the level of control that stems from online scheduling is what healthcare customers demand. Digital tools used to book appointments, register for care, and make payments are becoming a norm across the healthcare continuum. Survey results from the State of Patient Access 2023 found that some of the most important digital services for patients that drive a positive experience include being able to schedule appointments online or via a mobile device (76%), having an online/mobile option for payments (72%), and more digital options for managing healthcare (56%). Clarissa Riggins points out the gap between these expectations and the reality of most patient experiences, stating, “In general, findings seem to show progress has stalled when it comes to making patient access functions like scheduling, registration, coverage verification, and cost estimates more efficient.” Yet providers seem aware of their patient's interest in seeing more, not fewer, digital front door tools in healthcare delivery. The State of Patient Access 2023 report shows 86% of healthcare providers want their organizations to improve by adopting digital front door software. Riggins says, “But provider's motivation is not necessarily generating action.” Patients are growing frustrated; nearly half say they can't find appointments to fit their schedule, and 40% complain that even trying to schedule with a doctor is challenging. Today, 87% of patients perceive the across-the-board accessibility of their healthcare practitioners as a problem. Digital front door software is healthcare's solution to provider shortages, decreasing access, and our patient's on-demand scheduling requirements. Patients and doctors want digital front door software to increase access to care Patients are turning to providers who use automated solutions. 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, and 61% of patients said they'd consider changing healthcare providers to one that offers a patient portal. A prior study showed 44% of patients say they prefer to receive test results via a secure online hub. While staffing shortages certainly impact the ability to schedule care, Riggins points out, “Since patients associate 'access' with their ability to see a provider quickly, it makes sense that, without technology in place, staffing shortages will negatively impact the consumer experience.” It's a good point; nearly 40% of healthcare providers say technology solutions like digital front door software offset staffing shortages. Healthcare patients demand digital front door access and their doctors agree. But healthcare organizations are lagging in implementing these tools. Where is the disconnect? Eliminating the tedious human tasks that accompany manual patient registration, automating accurate price estimates, or offering patients one-click, convenient payment options, will free up staff to focus on key initiatives. Not to mention that these digital innovations will give patients and providers what they want. Perhaps the lag in implementing healthcare digital front doors occurs because these organizations find digital transformation daunting. But healthcare providers can work with a third-party trusted advisor with the right expertise to make the transition to digital front door software. Utilize mobile and self-service scheduling Experian Health specializes in opening healthcare's digital front door, beginning at the front door of any practice. Automated patient scheduling gives patients 24/7 control over when they visit doctors. Easy one-click functionality in a comfortable user interface allows patients to reach the right doctor at the best time for everyone. For providers, this kind of digital front door software alleviates the pressure on overburdened scheduling staff by moving these processes to a self-service online environment. Provide a better registration experience Experian Health's registration software also takes the next step, inviting patients through the digital front door by simplifying and streamlining intake. Healthcare organizations can create a better registration experience and increase patient booking with text-to-mobile registration. Two-way automated communications with patients decrease no-shows and engage patients at every step of their journey. For new and existing patients, automated cost estimates with easy payment options let them know their obligations to a healthcare practice, increasing co-pay collections while lessening burdens on providers and staff. Communicate costs upfront Communicating the costs associated with healthcare delivery is a critically important step toward improving patient experience. Experian Health's State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. That's why Experian Health expanded their digital front door software to include tools like Patient Estimates and Patient Financial Advisor. These tools creates true price transparency between healthcare providers and their patients. Providing a patient with an on-demand, clear, accurate cost estimate for healthcare should be a standard part of the care delivery paradigm. These solutions automate this process so that every customer understands the costs associated with receiving care. The bottom line There is evidence now that patients want a digital front door to improve access to care. They want to retake control of their health and do it from their preferred digital device. Experian Health has a set of digital front door tools that brings healthcare consumers exactly what they want while lowering provider staffing costs. Adopting innovative digital solutions is no longer an “if” proposition; healthcare customers have shown they will seek out new providers if their scheduling, registration, and payment processes are not seamless. This shift in the consumerism of our healthcare services means that healthcare organizations face a strategic imperative to open the digital front door—or lose patients to the competition.  Contact Experian Health to learn we help organizations open their digital front door with automated patient access solutions.

Is streamlining patient access with technology the key to improving revenue cycle management? Technology is already making intake, insurance verification, patient estimates, and other elements of patient access simpler. The same technology can also speed up and smooth out the healthcare revenue cycle: a goal many providers can get behind. Victoria Dames, Vice President of Product Management at Experian Health, says, "Patient access is the first step in simplifying healthcare and revenue cycle processes. Trading in manual processes and disjointed systems for integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle. For providers trying to choose between prioritizing revenue and patient experience, patient access technology can deliver on both.” The digital transformation journey starts with patient access technology Starting at the beginning with patient access makes perfect sense for providers who want to embark on their digital transformation journey. The early touchpoints in the patient experience, like patient intake and scheduling, not only set the tone but also lay the foundation for successful claims and collections in the future. Patient access technology can help streamline patient access processes, making it easier for patients to receive accurate cost estimates, understand insurance eligibility and coverage, and work out payment strategies. Integrated patient access solutions—including automated registration and financial clearance with eCareNext®, and accurate patient estimates and mobile payment options with Patient Financial Advisor —deliver convenience to the patient while requiring less manual work and reducing data errors that can cause problems with billing and collections. Dames says, "Patient access is where providers begin collecting data, confirming insurance eligibility, and providing accurate patient estimates. Completing these actions successfully at the beginning of the patient journey can facilitate payment and collections downstream. As providers continue their digital transformation journeys, improvements made in patient access enable further improvements in later stages of the revenue cycle: collections, claims management, and payer contracts.” Streamlining patient access affects revenue cycle management Efficiency in patient access has a direct impact on revenue cycle management. Here are three key areas where streamlining patient access can bring real improvements: Efficient revenue management begins with good data Up to 50% of denied claims originate in patient access. Manual intake processes are time-consuming for staff and carry the risk of human error. Staffing shortages put increased demands on workers, leading to an even larger potential for problems. To add to the mix, patients may be increasingly likely to have incorrect information. Medicaid redetermination following the end of the COVID-19 pandemic is ending coverage—and creating confusion—for millions of patients. Job and coverage changes can translate to confusion over coverage and eligibility. “Automation virtually eliminates human error, so providers get accurate patient information and standardized data they can use throughout an integrated revenue cycle,” says Dames. Nearly 90% of patients want an accurate estimate; only 29% get one Experian Health's 2023 State of Patient Access survey found that nearly 90% of patients want an accurate pre-treatment estimate, but less than a third receive one. Although estimates are a requirement under price transparency laws, delivering an accurate estimate is difficult without the help of automated systems. Dames says, “Patients are anxious about the cost of care, and they can't estimate their own out-of-pocket costs. Accurate, transparent pre-treatment estimates are an important tool for building trust with patients. When providers offer real-time insurance verification and coverage information, they proactively help patients understand their own financial obligations. From there, providers can collect copays at the point of service and suggest options like payment plans or charity care, if appropriate.” Automated processes and tools like Patient Estimates improve staff productivity and speed up collections. As staffing shortages continue, streamlining back-office tasks improves efficiency and reduces frustration. Valuable staff members have more time to do the complex human work of talking with patients and solving problems. Real-world success story: Blessing Health Systems oversees two hospitals, a college of nursing, and a charitable foundation with nearly 3,000 total employees. Like many healthcare providers, Blessing faced challenges, including registration errors, inaccurate patient estimates, and collection difficulties. Blessing implemented an integrated suite of solutions including eCareNext®, Patient Estimates, Patient Self Service, Patient Statements, Payer Alerts, PaymentSafe®, Registration QA, and several financial clearance products. The results: Point of service collections increased by more than 80%. Clean claim rate increased from 63% to 90%. Denials decreased by 27%. Gross A/R decreased by an average of 28 days. “[Blessing now has the tools needed] to be successful in one, user friendly application,” says Jill Stroot, Director of Patient Access at Blessing. An integrated patient access solution allows Blessing to capture and verify important insurance information and catch registration errors in real time, resulting in less manual work, less rework, and a faster, better revenue management process overall. Best practices for implementing patient access technology Most providers are looking to improve and accelerate the revenue cycle. Many, too, are looking toward digital transformation as a long-term goal. But that means many are balancing the need for system-wide transformation against current realities. Incremental change allows providers to advance the ball now while preparing for further opportunities in the future. While providers weigh their options, here are a few best practices to help guide their thinking. Prioritize If doing everything at once isn't possible, providers can start with the processes that will have the greatest impact. Identify areas of greatest need. Look for the greatest ROI. Find quick wins that can be implemented with little change or investment. Choose solutions that integrate now Blessing Health Systems chose Experian Health solutions in part for their easy integration with Cerner. Finding solutions that integrate with existing systems is critical. Ultimately, solutions should also integrate throughout the healthcare revenue cycle. Choose a partner for the long haul Finding a technology partner that offers a full range of revenue cycle solutions—extending beyond patient access—helps ensure providers can continue their digital transformation journeys. Technology isn't the only factor to consider: Support and consultation along the way can help providers make the right decisions and maximize the value of new solutions as they're added. How to improve the healthcare revenue cycle Recent years have brought many new challenges to the healthcare space, but also new technology that can smooth out kinks in the revenue cycle. Providers that leverage patient access technology to deliver convenience and transparency to patients, and greater efficiency and cost savings internally, can look forward to better revenue cycle management while laying the groundwork for continued evolution. Learn more about how Experian Health's integrated suite of solutions can help with streamlining patient access.