Tag: collections
Today, U.S. healthcare providers struggle with three significant challenges affecting care delivery—each resulting from chronic healthcare workforce shortages. Ultimately, these challenges threaten the fiscal health of the country's most critical care safety nets. Over 80% of the healthcare C-suite say the chronic staffing shortage creates significant risk for their organizations. The effects of healthcare staffing shortages are severe - Experian Health's recent survey of revenue cycle leaders found these executives unanimously agreed that staffing shortages impact cash flow, patient engagement, and the work environment of their current staff. Experian Health’s new survey, Short Staffed for the Long-Term, polled 200 revenue cycle employees to determine the effects of healthcare staffing shortages on patients, the workforce, and their facilities. What did these teams say about the healthcare workforce shortage and the state of care delivery? Find out by downloading the full report. Healthcare providers experience a vicious cycle, and the effects of healthcare staffing shortages can be seen in many different areas. For example, it makes it harder for existing team members to register patients on the front end of the encounter. On the back end, revenue cycle staff face higher workloads and stress leading to preventable reimbursement claims errors and missed collections opportunities. Ultimately, that stress leads to staff turnover, exacerbating the healthcare workforce shortage. This article dives into three effects of healthcare staffing shortages and how providers can combat them. Result 1: Short-staffed providers struggle with reimbursement and cash flow. 70% of respondents who say staff shortages affect payer reimbursement also report escalating denial rates. 83% report it's harder to follow up on late payments or help patients struggling to pay their bills. Costs are up, and cash flow is down. Claims denials are increasing by 15% annually. Reimbursement rates continue to decline even as denials rise and patient debt increases. These are the revenue cycle challenges healthcare providers face on top of the chronic healthcare staffing shortage. Healthcare organizations must look for new ways to improve reimbursements while engaging patients and staff to benefit everyone involved. Experian Health's Short Staffed for the Long-Term report noted two of the most significant revenue channels for healthcare providers, claims reimbursement and collections, are experiencing significant challenges. Reimbursement denials tie up cash flow in an endless cat-and-mouse game of revenue collection. HealthLeaders termed 2023 as, “the year of reducing denials for revenue cycle.” Their statistics further reinforce Experian Health data correlating increasing denial rates with the healthcare staffing shortage. Simultaneously, healthcare providers find it harder to collect from patients. High self-pay costs lead to lower patient collection rates. One study showed patient collections declining from 76% in 2020 to 55% in 2021. Providers desperately need a more patient-centered collections process that helps these customers understand their cost obligations and payment options. Integrating automated collections solutions can also help providers do more with less. Healthcare stakeholders must collaborate to devise innovative solutions that prioritize workforce augmentation and streamline financial workflows. Technology can solve these problems by automating manual revenue cycle processes that lead to delayed reimbursements. New solutions that use artificial intelligence (AI) software can help in other areas (like claims denials) to save staff time and reduce workloads. Result 2: A lack of staff directly impacts successful patient engagement. Surveyed staff say 55% of patients experience engagement issues at scheduling and intake. 40% say patient estimates suffer, leading to potential miscommunications in credit and collections. Experian Health's The State of Patient Access, 2023: The Digital Front Door reported patients and providers believe healthcare access is worsening. 87% of providers in the survey blamed the effects of healthcare staffing shortages. Earlier data from ECRI shows patients wait longer for care, and nearly 50% of providers say access is worse. Over 100 academic studies in the past two decades confirm the correlation between poor patient health outcomes and industry staff shortages. Existing staff members may take on heavier workloads to cover gaps in patient care. The resulting fatigue can impact the quality of care delivery. When healthcare organizations are short-staffed, each team member may spend less time with patients, resulting in rushed assessments and potentially missed diagnoses. Staff shortages can impact every phase of the patient journey, beginning with patient scheduling and potentially delayed essential medical services. On the backend, patients suffer when the pressure staff members feel to work faster causes preventable errors leading to healthcare claim denials. Collections suffer, as frustrations mount, and healthcare staff waste time on patients who are simply unable to pay. The adverse effects of staffing shortages in healthcare weaken with technology to improve the patient experience at every stage of their encounter. Better technology lessens the burden of care for staff by automating mundane administrative tasks so every provider can focus on serving patients—not filling out forms. Improving patient engagement starts at the beginning of the healthcare encounter. For example, patient scheduling software can create a seamless online experience that halves appointment booking time. More than 70% of patients say they prefer the control these self-scheduling portals offer, putting access to care back in their hands. Patient payment estimation software creates much-needed healthcare price transparency, improving satisfaction by eliminating financial surprises after treatment. These solutions, combined with automated revenue cycle management software, can streamline healthcare processes and improve patient experiences. Result 3: Overwork is the norm as staff work environments decline and turnover increases. 37% of survey respondents report issues with staff burnout. 29% list the departure of experienced staff as one of their top challenges. Whether in frontend care delivery or backend revenue cycle, overworked and stressed healthcare professionals are more susceptible to making mistakes, diminishing the overall quality of the patient experience. The attention to detail, a critical component in a complex, high-stakes business, may be compromised due to the strain on the existing staff. When a healthcare organization is short-staffed, it increases the stress on the existing employees. In turn, this contributes to higher turnover rates. Job dissatisfaction and increased stress levels create a challenging work environment, perpetuating the cycle of staffing shortages. Recruiting and training new staff to fill these gaps further exacerbate the strain on existing teams. One area that is critically impacted by staffing shortages is seen in claims management, as claim denials continue to increase, which cost American healthcare providers an estimated 2.5% of their gross revenues annually. Billions of reimbursement dollars logjam in the endless cycle of claims submissions, rejections, and manual mitigations. In 2022, the cost of denials management increased by 67%. Revenue cycle staff, stretched to their limits by staffing shortages, will likely continue to make preventable mistakes during patient intake and claims submission. However, automating claims management with a solution like ClaimSource® can help lower denial rates and ease this burden. This solution delivers increased operational efficiencies and effectiveness by prioritizing claims, payments and denials so that users can work the highest impact accounts first. Other solutions, like Claim Scrubber, can improve claim accuracy before submission, by submitting clean and accurate claims every time. These technologies enable healthcare providers to reduce claims denials while relieving some of the terrible pressure felt by their financial teams to work harder and faster. By automating clean claims submissions, healthcare organizations free up their teams to focus on taking better care of patients—and themselves. Healthcare staffing shortages + manual revenue cycle = Unsustainability What happens to a process that heavily relies on human labor—when there aren’t enough people to go around? In the case of the healthcare revenue cycle, it means staffing shortages heavily impact a hospital's ability to collect revenue. Medical Economics reports that 78% of providers still conduct patient collections with traditional paper statements or other manual processes. In an era of talent shortages, these manual processes bog down the entire organization with no relief in sight. Overwork leads to burnout, a significant problem in the industry that also contributes to staff turnover. But this is exactly how digital technology can solve the healthcare staffing shortage. While AI and automation can’t help providers find the staff they need, it can eliminate manual tasks and reduce errors that lead to more work, staff burnout, and patient care disruption. McKinsey says automation can eliminate approximately half of the activities employees now perform. It could considerably improve the work environments for revenue cycle staff, allowing them to focus on high-value tasks, and engage patients in more caring and personalized experiences. Experian Health offers providers proven technologies to increase revenue, improve patient care, and lessen the strain on existing staff, to combat the effects of healthcare staffing shortages. Contact Experian Health today to get started.
“We wanted the right technology that could look for insurance coverage for self-pay patients without the need for us to increase our manpower. The cost savings were a big win for the department.” — Brent Rikhoff, Director of Pre-Access, UCHealth Challenge UCHealth is an integrated health system with a network of 12 hospitals and more than 30,000 employees. At the height of the COVID-19 pandemic, UCHealth maintained its commitment to an excellent patient experience by giving all patients access to tests and vaccinations. Costs for uninsured and self-pay patients could be recovered under the Health Resources and Services Administration's (HRSA) COVID-19 Uninsured Program (UIP), but only after confirming that the patient had no relevant active coverage. If they missed this step, UCHealth would be landed with bad debt, increasing collection costs and unwanted audits: they needed a reliable way to track and verify insurance coverage accurately and in real-time. Solution UCHealth chose to use Coverage Discovery® after experiencing positive results with Experian Health's Eligibility solution. Coverage Discovery allowed them to scan the entire revenue cycle for billable commercial and government coverage that patients may have been unaware of or forgotten about. The tool gave UCHealth access to Experian's proprietary databases, including employer group mapping and patient search history, so they could track and verify potential coverage in multiple locations. This made it much easier to find insurance information for plans without a self-pay search feature. After seeing positive results, UCHealth expanded their use of Coverage Discovery to self-pay and emergency department patients. This helped them root out discrepancies in patient accounts and prevent accounts from being misclassified as bad debt or charity. Uncovering additional active coverage was also a major benefit for patients. Discover the top 4 strategies to optimize patient collections while delivering a more compassionate financial experience for patients. Outcome Thanks to Coverage Discovery, UCHealth achieved the following results: Over $62 million in insurance payments in 2022, a 25% increase from 2021, includes payments from their top three payers $45 million in coverage found between May 2022 and May 2023 Over $3.5 million in collection costs savings in 2022 Overall, Coverage Discovery has helped UCHealth create a more streamlined approach to verification and billing. The batching feature made it easy for staff to process the backlog of patient accounts awaiting insurance verification, while access to large, current datasets facilitated more accurate billing. Director of Pre-Access at UCHealth, Brent Rikhoff, said the ability to integrate Coverage Discovery with Epic® enabled the team to achieve proper reimbursement for services rendered. Expanding the solution to include Medicaid coverage identification would be an obvious next step for UCHealth, following this impressive return on investment. Learn more about how Coverage Discovery identifies missing and forgotten billable coverage, so healthcare providers can get fully reimbursed while maintaining an outstanding patient experience.
Could common revenue cycle management (RCM) myths be preventing healthcare organizations from getting paid in full? Does what constituted best practice a few years back still apply to revenue cycle operations today? Many providers are embracing new technology to strengthen their RCM processes, using automations and software to create more accurate and efficient billing and claims management workflows. But if these processes are built on shaky assumptions, the results will be sub-optimal. As year-end financial reviews get under way, there is a prime opportunity to re-evaluate some long-standing beliefs about billing, collections and payments that, if not set straight, could limit financial performance in the year ahead. This article examines four of the most common revenue cycle myths and considers what providers can do to make financial growth a reality in 2024. Revenue Cycle Myth 1: All patients are equally likely to pay Reality: No two patients are alike – whether in their medical needs or financial circumstances. Providers know this, yet many rely on revenue cycle management solutions that lean toward a one-size-fits-all approach to patient payments. Instead, providers should consider RCM tools that use data and analytics to segment patients according to their individual financial situation, to create a more personalized and proactive approach to collections. This should take account of both the patient's ability to pay (i.e., whether they can afford their bills), and their likelihood to pay promptly, which may be enhanced by offering payment options that are convenient and aligned to their personal preferences. Collections Optimization Manager analyzes patients' individual payment history and demographic information so their accounts can be routed to the most appropriate collections pathway from the start. Patients that are likely to pay quickly can be sent billing information automatically and presented with self-service payment options. Alongside this, Patient Financial Clearance pulls together credit and non-credit data to help providers identify patients who may need a little more guidance and connect them to suitable payment plans. It catches any individuals who may be eligible for Medicaid or charity support. Staff get accurate, at-a-glance data to help them have sensitive financial conversations with patients, and can avoid losing time chasing collections from patients who would never have been able to pay. Case study: See how Stanford Health Care improved collections with a tailored, patient-focused approach to healthcare collections. Myth 2: It's hard to have meaningful pre-service financial conversations with patients Reality: Contrary to popular belief, most patients are receptive, and even eager, to have financial discussions with their provider as soon as possible. Doing so need not be challenging. In the past, providers may have worried that broaching the money question could deter patients from seeking necessary care, or simply not prioritized such discussions. Billing and insurance can also be highly complex, which may lead staff to assume that patients would find conversations about these issues to be confusing or overwhelming. But it is for these exact reasons that providers should have financial discussions with patients as early as possible. Experian Health's 2023 State of Patient Access survey found that almost 90% of patients wanted upfront pricing estimates so they could plan ahead for their financial obligations – yet less than a third received one. Tools like Patient Payment Estimates and Patient Financial Advisor can calculate cost estimates, taking account of the patient's claim history, deductibles and other insurance information, and automatically send these to patients before treatment so they know what to expect. These can also be combined with quick payment links so bills can be cleared before care. Giving patients consistent information through whichever digital channel they prefer means they will be better positioned to make informed decisions and discuss their situation with patient access staff if necessary. When patients are better informed and supported, they're also less likely to end up postponing care due to cost concerns. And with the same accurate data at their fingertips, patient access staff can serve as financial concierges, helping patients to understand coverage and copayments and check eligibility for relevant financial assistance programs. In addition to user-friendly data tools, providers should consider whether staff would benefit from additional training to bolster their confidence in leading compassionate financial conversations. Myth 3: It's impossible to know what patients owe across a system with a single look-up Reality: Thanks to data analytics and digital payment technology, it is now pretty straightforward to consolidate a patient's outstanding balance information from across an entire health system, and debunks common revenue cycle myths. Patient access staff can view a comprehensive summary of a patient's insurance status, estimated liability and open balances from multiple providers, enabling them to have meaningful financial conversations with patients. Even if these discussions do not lead to immediate payment, they can still act as a reminder to nudge the patient to act soon, thus accelerating the payment process. Selecting RCM tools from a single vendor makes it easier to integrate data from multiple workflows and generate a unified view of what a patient owes. When systems talk to each other, it's possible for a single tool to leverage the data and create a better experience for patients and staff. For example, PaymentSafe® automatically brings together data gathered throughout the revenue cycle to streamline what was previously a disjointed and time-consuming process. With point-to-point encryption, it accepts secure payments at any point in the patient's journey, using cash, check, card payments and recurring billing, through a single web-based application. Myth 4: Revenue cycle management is “set-and-forget” Reality: Revenue cycle managers may dream of setting up a system once and then forgetting about it, but the reality is that managing billing, claims and collections is an ongoing and evolving process that needs constant attention. Healthcare organizations must regularly review and adjust their RCM strategies to prevent missed revenue opportunities, manage compliance risks and promote operational efficiencies. That said, data analytics and automated revenue cycle management tools do make it far easier for providers to stay on top of RCM demands. These tools help providers with everything from monitoring payer policy changes and identifying billing errors to personalizing patient communications and generating monitoring reports. Artificial intelligence takes it a step further, for example, by preventing and predicting claim denials. In this way, these tools reduce the need for extensive staff input, so staff can spend more time focusing on the issues that need more human attention. With up-to-the-minute reports covering multiple RCM processes, staff also have the information they need to optimize performance and find opportunities to boost reimbursement that may have been previously overlooked. So, while RCM is not quite a “set-and-forget” process, automations and analytics can simplify it significantly, so it's less labor-intensive for staff and more efficient overall. Debunk revenue cycle myths and proactively challenge assumptions to increase profitability Debunking these revenue cycle myths is simple and achievable with tools that integrate a patient's clinical and financial data for a fuller picture of what that patient needs. This is crucial as changing consumer expectations, economic drivers, and new technology reshape how patients, providers and payers interact with one another. Checking underlying assumptions in any RCM process is essential to root out potential misunderstandings and outdated thinking. Not doing so leaves providers vulnerable to inaccurate financial projections, mismatched strategies and poor patient experiences. See how Experian Health's industry-leading Revenue Cycle Management Solutions make streamlined billing and collections a reality.
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.
Patient collections go to the heart of the debate about mission versus margin. As healthcare providers navigate the delicate balance between their mission to heal and the need to run a successful business, optimizing patient collections becomes a critical challenge. The weight of asking patients for payment is not lost on providers, especially considering the financial burden many patients already face due to medical expenses. It doesn't help that healthcare providers understand patients' struggles with medical debt. A 2023 Consumer Financial Protection Bureau report stated, “Many people experience unexpected health shocks that affect their financial well-being as much as, or even more than, their physical health.” As of June 2021, the United States recorded $88 billion in consumer debt to hospitals; 58% of all consumer debt is healthcare-related. One recent Experian Health and PYMNTS report shows that one-fifth of patients experienced financial distress by spending more on healthcare than they could afford. With healthcare costs rising, patients and healthcare providers feel a great deal of pain around budget balancing. Rising co-pays affect consumers in tandem with healthcare providers experiencing declining reimbursement. It's an untenable situation, but healthcare providers are increasingly turning to four critical strategies driven by technology solutions to ease these collections conundrums. Four alternative strategies to optimize patient collections In this blog, we explore four key strategies fueled by technology solutions that help healthcare organizations optimize patient collections while upholding compassionate care. 1. Do ongoing reviews of patient finances with the possibility of charity eligibility in mind While the unemployment rate is currently low compared to pandemic numbers, providers need to remember that just a few years ago, four in 10 Americans were without work for 27-weeks or longer. Americans are still playing catch up, and the data tells us nearly half of patients who reschedule their healthcare appointment do so related to cash flow concerns. Healthcare providers can help by working presumptive charity screenings into their collection workflows throughout the patient journey. Experian Health's Patient Financial Clearance software uses advanced analytics and data to analyze individual patient accounts and determines their ability to pay. This technology allows front desk personnel to quickly choose the most appropriate financial pathway for each patient. Patient Financial Clearance brings healthcare personalization to the most delicate part of the provider/consumer relationship, allowing staff to adjust their approach to suit each patient's financial abilities. 2. Using automation to find patient payment coverage Manual processes for patient financial arrangements slow down registration and ultimately miss potential payment resources. Unidentified coverage opportunities leave hospitals with over $745 billion in uncompensated care costs annually. The solution lies within Experian Health's Coverage Discovery software. This tool automatically scans the patient's account throughout their healthcare journey, searching for alternative payment methods to help patients improve their financial burden. Luminis Health leveraged Coverage Discovery and found more than $240k in active coverage on average per month in 2021. 3. Implementing compassionate billing methods to improve the collections experience Streamlining the registration process while discovering payment resources are two critical ways to create a more compassionate billing process and improved patient experience. Nearly one-quarter of patients face an unexpected medical bill after care delivery. Creating transparency between provider billing and the patient requires better technology to build personalized payment plans. Collections Optimization Manager makes payment collections easier by creating data-driven payment plans and individualized communications for each patient. This software can fully integrate with commonly used provider systems to connect with the patient from start to finish. It's a smarter and faster way to collect patient payments. 4. Using data for better collections In healthcare, software applications are only as good as the data behind them. While healthcare organizations have relied on behavioral and demographic datasets, adding a layer of credit data informs the revenue cycle in a way that adds enormous financial value to these organizations. With tools like Collections Optimization Manager, unpaid accounts are monitored for changes in a patient’s contact information or ability to pay. When a patient becomes employed, pays off delinquent accounts, or shops for credit, the in-house staff or the collection agency working the account is notified. These combined datasets lay the groundwork to inform the payment collections process. Case study: Using technology for better healthcare collections Healthcare organizations like Stanford Health Care leverage technology as part of their strategies to optimize patient collections—and improve the patient experience with their system. The provider handles over two million patients annually and uses Experian Health's Collections Optimization Manager software to improve their bottom line. The software analyzes individual patient data at the point of service, segmenting patient accounts on their ability to pay. The software recovered significant revenue for the system while creating a more personalized approach to patient payment requirements. Missing coverage at the front desk resulted in significant revenue losses for the system, unnecessarily shifting payment burdens to patients. With Coverage Discovery, the system uncovered patient reimbursement resources, eliminating the need to write off or send these accounts to collections. Together, these tools achieved stunning results: More than $4m in average monthly payments More than $1 million in efficiency gains Savings of nearly 700 hours monthly by automating customer account screening Nearly 30% of all Coverage Discovery reviews found patient payment resources Experian Health: providing strategies and compassionate, personalized software to optimize patient collections With millions of Americans struggling with medical debt, healthcare providers must proactively address the challenges surrounding patient collections. By embracing innovative strategies powered by technology, providers can strike a balance between compassionate care and financial sustainability. Optimize patient collections with Experian Health's coordinated ecosystem of intelligent technologies, designed to simplify healthcare, promote customer-centricity, drive data-driven decision-making, and generate sustainable revenue.
Compared to other industries, healthcare tends to be more resilient to economic turbulence. But the weight of the pandemic, labor shortages, rising costs and increasingly complex reimbursement structures are squeezing hospital margins. A Kaufman Hall National Hospital Flash Report in July 2023 found that many hospitals underperformed, and the gap between high-performing hospitals and those struggling continues to widen. Providers must find new and effective ways to improve revenue cycle management, should any new uncertainties emerge. With pressure mounting to increase efficiency and reduce expenses, more providers are turning to automation and artificial intelligence (AI) to eliminate unnecessary manual work and optimize revenue cycle management processes. For example, Stanford Health Care leveraged automation to reduce their cost to collect. Banner Health improved patient collections with transparent price estimates. Schneck Medical Center zeroed in on claims management and incorporated AI to reduce denials. In the face of a cashflow crunch, healthcare providers increasingly turn to data-driven revenue cycle management (RCM) strategies that span the entire patient journey. This article lists six of the most effective income-generating digital RCM strategies that providers are using to maximize profits. Building blocks of a healthy revenue cycle At its core, revenue cycle management is about ensuring providers are fully reimbursed for the care they provide. The true ROI is much broader – efficient financial and administrative processes for patient billing, claims management and collections contribute to better care, satisfied patients, high-performing staff and good financial health. Realizing these benefits calls for revenue cycle processes built on three principles: Efficiency – streamlining processes to reduce resource utilization across the entire billing cycle Accuracy – ensuring all patient and claims data is correct and complete to avoid denials and delays Transparency – giving patients, providers and payers relevant and timely information, so they can act with confidence in each financial transaction. To achieve this, providers are moving away from slow, costly manual systems. Digital RCM tools are becoming non-negotiable. 6 data-driven strategies for effective revenue cycle management 1. Increase efficiency in patient access Revenue cycle management starts when the patient books their appointment and ends when the final bills are settled. Claim denials and delayed payments often arise from data errors and miscommunications in the early stages of the patient journey, which means patient scheduling and registration processes are critical to streamline RCM. With automated, data-driven patient access tools, providers can simplify tasks across the patient journey, so patients can move from one stage to the next with as little friction as possible. Fewer errors mean delays and disappointment are more easily avoided. Automated registration and online self-scheduling can also lead to savings through more efficient use of staff time and reducing the number of appointment no-shows. Experian Health clients find that online tools allow them to make relatively minor adjustments to their workflows, with a major impact on productivity. 2. Deliver accurate and timely patient billing Patients want the payment process to be as painless as possible. In multiple surveys, Experian Health has found that patients are worried about the cost of care, while 63% of providers believe patients frequently postpone care because of cost concerns. Clear, comprehensive estimates, billing and collections practices can make it easier for patients to navigate their financial journey. And with the end of continuous Medicaid enrollment, it's likely that more patients will find themselves unsure of their coverage situation, and in need of greater support to manage the financial process. For Stanford Health, the key to improving revenue cycle management centered around patient billing and collections. To achieve the dual goals of improving the patient experience and increasing collections, they used data-driven insights and automation to remove uncollectible accounts, prioritize accounts with a high propensity to pay, find missing coverage and reduce the manual workload. Collections Optimization Manager helped Stanford Health identify the best possible collections strategy, by scoring and segmenting patient accounts with the highest propensity to pay. Coverage Discovery® supplemented this strategy by checking for any unidentified primary, secondary or tertiary coverages that can potentially reduce self-pay amounts and avoidable charity designations. As a result, Stanford Health achieved a $4.1m increase in average monthly payments and efficiency gains of $109k per month. 3. Provide transparent price estimates Experian Health's State of Patient Access 2023 report suggests that fewer than three in ten patients know how much their care will cost in advance, while nine in ten consider it important. Delivering accurate pre-care estimates to help patients plan for bills could therefore be an easy win to improve the patient experience and recoup more revenue. Banner Health used Patient Estimates as part of a wider strategy to improve patient collections. This solution generates detailed estimates of the patient's financial responsibility along with recommendations for payment plans and financial assistance, if appropriate. Listen in as Becky Peters, Executive Director of Patient Access at Banner Health, talks about streamlining the patient registration process and improving patient access with pre-care estimates. 4. Effective claims management Perhaps the biggest opportunity to improve revenue cycle performance lies in claims and denial management, which accounts for a major proportion of wasted healthcare dollars. Summit Medical Group Oregon–BMC paired Enhanced Claim Status with Claim Scrubber to submit cleaner claims the first time and avoid lost revenue. These tools help providers submit accurate claims and monitor claim status to prevent denials and resolve issues quickly. For Summit Medical Group, this led to a 92% primary clean claims rate, and a reduction in accounts receivable days and volume by 15%. Experian Health also offers a new solution that leverages machine learning and artificial intelligence for predictive reimbursement. AI Advantage™ uses AI to predict and prevent claim denials based on historical claims data. In the first six months, this solution helped Schneck achieve a 4.6% average monthly decrease in denials and decreased time spent on denials by 4x. 5. Easy ways to pay (plus clear pricing and payment policies) How easy is it for patients to pay? This simple but important question points to another vital element of effective revenue cycle management. A compassionate and convenient patient payment experience that matches consumer experience in other industries can encourage earlier payments. Easy digital options are especially important for millennial and younger patients: research by Experian Health and PYMNTS found that 60% of younger patients are looking for digital services. Experian Health's patient-friendly payment tools are designed to help patients navigate their financial responsibilities with confidence and ease. For example, PaymentSafe® allows providers to securely collect payments anytime, anywhere, including mobile payments and patient portals. 6. Operational efficiency with automation, data and analytics RCM processes generate vast amounts of data, providing valuable insights into the organization's operational performance, revenue trends and areas for improvement. Being able to parse and translate this data into actionable insights is essential to determine the right strategies to pursue to optimize financial performance. But this in itself can be a major lift. Revenue Cycle Analytics is a web-based tool that breaks down data into actionable insights across billing, reimbursement and payer performance, presenting KPI data via comprehensive dashboards. Effective revenue cycle management strategies from start to end From labor shortages to rising costs, healthcare providers are finding creative ways to manage cash flow. While each healthcare organization’s needs and goals are different, understanding these six key strategies of successful revenue cycle management can help hospitals manage their revenue cycles more effectively and efficiently, while responding to new uncertainties. Find out more about how Experian Health helps healthcare organizations leverage automation and AI to streamline processes and boost revenue cycle performance.
The healthcare staffing crisis was one of the biggest challenges facing healthcare providers pre-pandemic, only to be exacerbated by the pressures of dealing with the COVID-19 crisis. Almost a fifth of healthcare workers resigned between February 2020 and September 2021. Unfortunately, the problem isn't in the rearview mirror yet – a new study from McKinsey reveals that worker shortages persist, with 31% of nurses declaring their intent to leave their jobs in the next year. These shortages put pressure on remaining staff, compromise hiring efforts and make high-quality services difficult to maintain. Without a thriving, vibrant workforce, how can healthcare providers meet the needs of their patients? Can automation help address the healthcare staffing crisis? Stubborn staff turnover levels aren't unique to healthcare, but addressing them is even more critical, given the detrimental effect on patients. As the staffing crisis shows no signs of letting up, providers should consider how technologies that leverage automation and AI can help. Tom Cox, President at Experian Health, says, “Automation has transformed many aspects of healthcare, from driving down appeals and denials to improving the digital front door. We're now seeing AI starting to make waves, too. These technologies are the future and are changing healthcare for the better.” Opening healthcare's digital front door is a good place to start. By eliminating repetitive and time-consuming tasks like data entry, manual patient registration and prior authorizations, staff will be freed up to focus on what matters most: delivering high-quality patient care. Here, we look at three areas where automation can simultaneously alleviate the burden of staff shortages and create a better patient experience. Use case 1: automate patient access to manage the growing demand for services Manual and repetitive processes eat up valuable time and create greater workloads that contribute to staff burnout. This is especially true in patient access, which is a typically admin-heavy process. Allowing patients to complete more of their registration and scheduling tasks themselves can reduce the workload in understaffed teams. Many patients prefer not to book appointments through call centers, and high call volumes are a major pressure point for staff. Similarly, manual patient registration is labor-intensive and error-prone, eating up staff time and creating bottlenecks for patients. Automated registration and self-scheduling solutions help patients access care without waiting in phone queues. Patients can book, cancel and reschedule appointments through their mobile devices. On the back end, data can be leveraged to predict and manage demand, while digitized scheduling means agents can spend less time checking referrals against scheduling rules. Automated prior authorizations mean staff no longer need to spend hours poring over payer policies and checking individual payer websites to check for changes – the software updates automatically in real-time. Simplifying these processes with automation not only minimizes operational strain but also reduces friction for patients who want to see the right specialist in the least amount of time. Use case 2: automate personalized patient outreach to reduce call volumes Another way to reduce the administrative burden is with automated patient outreach. Reducing no-shows is an important strategy to promote better health outcomes and boost financial performance. Instead of burying staff with a list of patients to follow up with, providers should utilize automated patient reminders. Automated patient outreach solutions allow providers to segment patients according to their individual needs and preferences, so patients get relevant information through the most appropriate channel. This allows patients to proactively and conveniently manage their own healthcare journey. Automated messages can also be sent to remind patients of outstanding bills and link them to payment options. This means patient collections teams can spend less time on calls and focus instead on meaningful conversations with patients who need extra guidance or support. Use case 3: automate patient collections for faster payments and a better patient experience With fewer staff, patient collections teams must figure out which accounts to prioritize, while navigating increasingly complex payer policies. Advanced data analytics and automation can be used to make these processes more efficient. Similarly, automated patient collections software can screen and segment patient accounts to allow staff to quickly prioritize those with the highest probability of being paid. Collections Optimization Manager offers convenience and clarity to staff with an easy-to-use interface, while targeted collections strategies facilitate conversations with patients based on accurate information and fewer calls and emails. Speed and accessibility create a better experience all around for both patients and staff. Using automated solutions to reduce the pressure of the healthcare staffing crisis Cox says, “Over the last few years, Experian Health has focused on helping providers and payers solve the immediate challenges associated with a remote workforce and staffing constraints while scaling services in response to surging demand. Integrating automation with self-service tools is just the beginning. Our vision is to continue driving innovative and automated solutions that will improve care outcomes and transform our clients' healthcare operations.” These are just a few examples of how automation can create new opportunities for healthcare providers. Digital processes that were once considered merely “nice to have” are now critical components to alleviate the healthcare staffing crisis and deliver positive patient experiences. Contact us to find out more about how Experian Health can help your organization use automation to alleviate the healthcare staffing crisis.
In today's digital world, it's easy to access information with just a click. But despite being constantly connected, many patients find themselves lacking the vital information they need to navigate their medical journey successfully. Waiting weeks or months for appointments and dealing with confusing medical jargon on forms can create additional stress. Additionally, limited office hours make it difficult for busy patients to receive important information. Closing the patient engagement gap is just as crucial for providers: delays and misunderstandings lead to scheduling gaps, poor productivity, missed reimbursement opportunities and costly no-shows. Automated patient outreach has the potential to eliminate these challenges. By implementing the right strategy, providers can establish better communication with patients, anticipate their needs, optimize care plans, and provide improved patient experiences. This approach allows staff resources to be utilized more efficiently and effectively, resulting in better health outcomes and financial performance. It's a win-win situation for both patients and providers. What is patient outreach? Patient outreach refers to proactive efforts by a healthcare organization to educate, inform and engage patients in their healthcare journey. Effective patient outreach strategies may include sending patients prompts for health checks, appointment reminders, test results, and information about billing and payment. Ideally, communication will be initiated through whichever channel the patient finds most convenient, whether it's a phone call, text message, email or patient portal. If patients are supported to stay engaged in their care, they will be more likely to adhere to care plans and take the necessary next steps. Leveraging the benefits of automated patient outreach While online self-scheduling, digital patient registration and contactless payment methods deliver the convenience and choice patients desire, automated patient outreach goes a step further to improve patient access and close more gaps in care. Interactive voice response (IVR) and text messaging (SMS) campaigns are helping providers reach out proactively and efficiently to scale scheduling efforts without pulling in additional staff resources. Here are just a few benefits that providers see as a result: 1. Extended outreach capabilities Automated patient outreach surpasses traditional call centers in its ability to effectively reach multiple patients with timely and accurate information. This advanced technology allows for thousands of automated calls per day, eliminating the need for manual facilitation by agents. For instance, SMS and IVR campaigns empower patients to self-schedule appointments without requiring a phone call. Call center agents can easily identify patients who have not booked appointments and follow up accordingly. For those who prefer booking by phone, automated outreach provides a queue callback feature, ensuring that patients are promptly connected to an available agent instead of waiting on hold. This allows agents to efficiently work through the queue. 2. Increased appointment bookings Reaching more patients means more booked appointments, and in turn, fewer gaps in care. Experian Health's patient outreach technology automates the entire scheduling process, from guiding patients to best-fit appointments to issuing reminders to reduce no-shows. Real-time scheduling information ensures that canceled slots are offered to other patients, so those patients can see their doctor sooner, and the doctor's time doesn't go to waste. Convenient self-scheduling options can also increase patient satisfaction and loyalty, which can benefit both patients and providers - by ensuring timely access to care and better use of healthcare resources. 3. Better adherence to treatment plans and fewer unplanned admissions Strategic communication can also help patients stick to medication schedules, book follow-up appointments and make lifestyle changes that will reduce the risk of complications and improve their health overall. This is particularly helpful for chronic disease management and post-operative care, where post-discharge engagement allows providers to monitor and catch any issues before symptoms get worse. A 2022 evaluation of automated text message outreach found that this technology can reduce the risk of 30-day hospital readmission by 41%. 4. Improved patient engagement and satisfaction In today's world, phone calls dominate healthcare communications. But is that always convenient for patients? What if they are at work when their provider calls? In such cases, would they prefer a text message or an email? With reliable consumer data, providers can select the channel that patients will be most likely to engage with. Experian Health's State of Patient Access survey 2.0 found that patients appreciate proactive outreach, though many say this doesn't always happen. Providers that can leverage consumer data, combined with automated outreach, will be better placed to keep pace with evolving consumer expectations. 5. Improved collection rates A final important benefit of patient outreach software is evident on provider balance sheets. Inbound and outbound calling with secure, cloud-based dialing software can generate and issue bill reminders and self-pay options to patients. Experian Health's PatientDial solution provides IVR, bill reminders and self-pay options, which reduce the need for agent interaction. If it's quick and easy to pay, then patients will be more likely to clear their bills in a timely manner. For providers, that means higher in-house collection rates and fewer accounts receivable days eating into the bottom line. In 2021, Experian Health's PatientDial solution helped clients collect over $50 million in patient collections, through more than 250,000 IVR transactions. The automated dialer featured helped our clients save 900,000 labor hours, which would have been otherwise spent in manual dialing. Key considerations when implementing automated patient outreach Building a successful patient outreach strategy can be challenging. It's crucial for providers to deliver timely and pertinent information without overwhelming patients already susceptible to information overload. It is crucial that communications are secure and compliant with privacy regulations such as HIPAA, and consistent with the provider's brand to avoid being mistaken for spam. Additionally, any new systems or technology implemented should be easy for both staff and patients to navigate. By choosing a patient outreach solution that offers a user-friendly interface and ongoing support, providers can ensure that staff hit the ground running. Find out more about how Experian Health's automated patient outreach solutions can help providers improve patient engagement and close more gaps in care.
How do patients rate their “patient access” experience? For most, the rating comes down to how quickly they can see their doctor – and many don't feel like their expectations are met. In December 2022, Experian Health surveyed more than 1000 adults who'd accessed care in the previous 12 months to gauge perceptions of patient access. Most think the experience remains unchanged or has gotten worse in the last two years, despite advancements and providers' heavy investments in technology. Almost 8 in 10 of those patients say “seeing a doctor/practitioner quickly” is their biggest pain point. Other major factors include the level of friction involved in scheduling and registering for care and obtaining accurate pricing estimates before services are rendered. Patient access tools can help ensure that patients receive the care they need in a timely, efficient manner. Breaking down barriers for friction-free patient access What hinders patients' ability to see their doctor quickly? For some, the obstacles are logistical: patients may live far from facilities or lack reliable transportation to get to appointments. Others may have financial concerns, where a lack of insurance coverage or fear of mounting bills prevents them from seeking care. Language and cultural barriers can make it difficult to engage with healthcare services. But for many, it comes down to friction in the “patient access” process itself. This includes long wait times for appointments, disjointed scheduling systems, manual registration processes, and limited payment options. These processes are not only critical to patient satisfaction but also have real consequences for the patient's health and the provider's bottom line. One effective approach to improve access to care is to continue leveraging patient access tools, which has been proven successful in several use cases. Use case 1: Reduce wait times with online self-scheduling Among patients who think access has worsened over the last two years, 49% say their main challenge is finding appointments that fit their schedule, while 40% blame the scheduling process itself. Online self-scheduling solves both, making it easier to book and reducing wait times. With online self-scheduling, patients can log on to book appointments any time they like. There's no need to wait until the phone lines open and speak to customer support representatives. A self-scheduling tool like Patient Schedule can incorporate each provider's business rules and scheduling protocols, so patients get real-time access to the earliest available appointments. By allowing patients to easily cancel or reschedule appointments, same-day slots can be opened up to other patients, so they can see their doctor sooner. Use case 2: Increase operational efficiency with digital patient registration Staffing shortages are an ongoing stressor for providers, so making the best use of available staff time is crucial. Patient intake software can automate many of the manual activities associated with patient registration, such as helping patients fill out forms or manually entering information into electronic health records. In addition, more than 8 in 10 providers say their patients prefer an online registration experience. This corroborates earlier findings from a study by Experian Health and PYMNTS, which found that a third of patients prefer to fill out registration forms at home. Experian Health's Patient Intake Solutions allow patients to complete registration from their mobile. Data can be automatically pre-filled and checked against existing records to save time and avoid errors. Not only is this more appealing to patients than filling out forms in a stuffy waiting room, but it also helps drive down the risk of costly and time-consuming denials. Use case 3: Boost patient engagement with targeted patient outreach Another way to leverage patient access technology is through targeted, automated outreach. With automated text message (SMS) and interactive voice response (IVR) campaigns, patients can receive a personalized link to schedule their appointment directly. Alerts can be sent when earlier appointments become available, which both reduces wait lists and makes it more likely that patients will book. Patients can be sent bill reminders and payment options in the same way. Automated outreach solutions that incorporate reliable consumer data make sure patients get the details they need in a format and timeframe that helps them take action. Use case 4: Speed up collections with accurate estimates and payment plans As rising staffing and supply costs put a squeeze on healthcare profit margins, expediting collections is crucial. This begins with patient access: if patients can pay for care right at the start of their healthcare journey, this eases pressure on both parties to make sure bills are paid in a timely manner. Upgrading payment technology to include upfront pricing estimates, payment plan recommendations and convenient payment methods can all help patients better manage their financial responsibility. Unfortunately, it's still common for patients to go into procedures without knowing how much they'll owe. In Experian Health's survey, 65% of patients said they did not receive an estimate prior to care, and 40% said they were likely to cancel care without advance notice of costs. Leveraging tools such as Patient Financial Advisor and Patient Payment Estimates can automatically arm patients with the information they need to plan and manage their bills. Utilizing patient access tools to meet patients' expectations It is evident from the results of the State of Patient Access 2023 survey that patient access remains an issue. To ensure patients receive the care they need in a timely and efficient manner, providers must make a concerted effort to leverage digital technology. Although healthcare providers have made great strides in providing more efficient patient access solutions, clearly there is still much progress to be made. The success of any patient-focused initiative relies heavily on being able to meet patients' expectations with timely, effective tools and resources. As healthcare evolves and continues to put a priority on improving outcomes, it's important to take proactive steps toward ensuring the best possible experience for patients when accessing their care. Find out more about how Experian Health's patient access tools can improve patient access and increase profitability for healthcare providers.