Tag: patient access

Racing against the clock to troubleshoot billing issues, claims bottlenecks and staffing shortfalls are just part of an average day for healthcare revenue cycle managers. It's hard enough to maintain the status quo, never mind driving improvements in denial rates and net revenue. With integrated artificial intelligence (AI) and automation, many of these challenges in revenue cycle management (RCM) can be alleviated – and with just a single click. Real-time coverage discovery and coordination of benefits software reduces errors and accelerates accurate claim submissions. This eases pressure on busy RCM leaders, so they have the time to focus on improving the numbers that matter most. Top challenges in revenue cycle management Efficiency is the currency of revenue cycle management. Maximizing resources is not just about keeping dollars coming in the door but about making the best use of each team member's time and expertise. The ever-present call to “do more with less” is probably the biggest challenge. Breaking that down, some specific concerns that consume more time and resources than RCM managers would like, are: Complex billing procedures: With hundreds of health payers operating in the US, each offering different plans with different requirements, providers have their work cut out to ensure claims are coded and billed correctly. Any errors in verifying a patient's coverage, eligibility, benefits, and prior authorization requirements can lead to delays and lost revenue. More claim denials: Inaccurate patient information and billing codes guarantee a denial. Beyond the rework and revenue loss, denied claims leave patients with bills that should not be their responsibility to pay, causing confusion, frustration, and higher levels of bad debt. Garbage in, garbage out. Patient payment delays: A few years back, patients with health insurance represented about a tenth of bills marked as bad debt. Now, this group holds the majority of patient debt, according to analysts. The rise in high-deductible health plans combined with squeezed household budgets means patients are more likely to delay or default on payments. Providers must be on the lookout for ways to help patients find active coverage and plan for their bills to minimize the impact of these changes. How can AI-powered revenue cycle management solutions help? The Council for Affordable Quality Healthcare (CAQH) annual index report demonstrates how much time can be saved using software-based RCM technology. Case in point: switching from manual to automated eligibility and benefits verification could save 14 minutes per transaction. This adds up quickly when daily, monthly, and yearly transactions are factored in. Predictive analytics can be used to pre-emptively identify and resolve issues and support better decision-making, giving providers a head start on those elusive efficiency gains. Three specific examples of how automation, AI and machine learning can streamline the front-end and solve challenges in revenue cycle management are as follows: 1. Upfront insurance discovery to find and fill coverage gaps Confirming active coverage across multiple payers gives patients and providers clarity about how care will be financed. But this can be a resource-heavy process when undertaken manually. Coverage Discovery uses automation to find missing and forgotten coverage with minimal resource requirements. By unearthing previously unidentified coverage earlier in the revenue cycle, claims can be submitted more quickly for faster reimbursement and fewer write-offs.With Experian Health's recent acquisition of Wave HDC, clients now have access to faster, more comprehensive insurance verification software solution. The technology works autonomously to identify existing insurance records for patients with self-pay, unbillable, or unspecified payer status and correct any gaps in the patient's coverage information. The patient's details are updated automatically so that a claim can be submitted to the correct payer. 2. Real-time eligibility verification and coordination of benefits As it gets harder to figure out each patient's specific coverage details, it also makes sense to prioritize automated eligibility verification. Eligibility Verification uses real-time eligibility and benefits data to confirm the patient's insurance status on the spot.Similarly, Wave's Coordination of Benefits solution, now available to Experian Health clients through Patient Access Curator, integrates directly into registration and scheduling workflows to boost clean claim rates. It automatically analyzes payer responses and triggers inquiries to verify active coverage and curate a comprehensive insurance profile. This means no insurance is missed, and the benefits under each plan can be coordinated seamlessly for more accurate billing. 3. Predictive denials management to prevent back-end revenue loss Adding AI and machine learning-based solutions to the claims and denials management workflow means providers can resolve more issues pre-claim to minimize the risk of back-end denials. Use cases for AI in claims management might include: Automating claims processing to alleviate staffing shortages Reviewing documentation to reduce coding errors Using predictive analytics to increase operational efficiency Improving patient and payer communications with AI-driven bots All of these contribute to a front-loaded denials management strategy. While prevention is often better than a cure, AI can be equally effective later in the process: AI AdvantageTM arms staff with the information they need to prevent denials before they occur and work them more efficiently when they do.Whatever new challenges may pop up on the RCM horizon, AI and automation are already proving their effectiveness in helping providers save time and money. But more than that, they're giving busy RCM leaders the necessary tools to start future-proofing their systems for persistent and emerging RCM challenges. Learn more or contact us to find out how healthcare organizations can use AI and automation to manage current revenue cycle management challenges with a single click.

As 2023 draws to a close, revenue cycle leaders are in planning mode, reviewing financial performance, and gearing up for resource allocation negotiations in the new year. What should they be prioritizing? Three of Experian Health's senior executives share their healthcare predictions for 2024 based on the latest healthcare trends, and the steps providers can take to maximize reimbursements in the year ahead. Healthcare prediction #1: “Staffing shortages will persist, driving demand for technology-based solutions over traditional HR tactics” According to Jason Considine, Chief Commercial Officer, the healthcare staffing shortage is unlikely to let up any time soon: “In our recent survey, we found that 100% of respondents are seeing ongoing shortages affect revenue cycle management and patient engagement. There's an urgent need to address the problem, but too many providers are relying on traditional recruitment approaches that won't give them the longer-term resilience they need. Heading into 2024, providers should leverage technology and data to alleviate the burdens on front and back-end operations, and drastically improve efficiencies. This will better protect providers from the talent pipeline fluctuations that cause major disruptions.” This healthcare prediction for 2024 is based on Experian Health's staffing survey that was relased in 2023. Participants in the survey agreed that the staffing crisis would continue, expressing concerns about its impact on revenue and patient engagement. For many, the culprit is high turnover rates. More than four in ten said turnover in their administrative teams exceeds 25%. Given the difficulties in finding skilled candidates and addressing staff burnout, it seems clear that traditional HR-based strategies will fall short. Despite this, salary increases, cross-training and incentives remain go-to responses. Responding to the survey findings, Considine says, “It's time to look at the many areas where automation – and even artificial intelligence – can stabilize, improve and optimize understaffed functions.” One use case for artificial intelligence is in claims management. Experian Health's AI Advantage™ solution uses historical and real-time claims data to identify claims that may be at risk of being denied. This allows staff to zero in on those claims and ensure all information is correct and complete before submission. It integrates seamlessly with ClaimSource® to augment the claims workflow, so staff can focus on claims and denials with the highest likelihood of payment. As well as alleviating pressure on staff, it reduces costs and maximizes reimbursements, helping providers to protect margins during uncertain times. See how AI Advantage helps healthcare organizations reduce and prevent claims denials. Prediction 2: “Patients' changing digital expectations will prompt more providers to adapt (and those that don't will risk losing market share)” Clarissa Riggins, Chief Product Officer, says that patients are increasingly likely to expect a better “digital front door” experience, and will start to look elsewhere care if they encounter too much friction: “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. We're seeing a continuing trend in the number of patients who say they'd switch providers if the digital front door isn't open.” That healthcare trend was evident in Experian Health's State of Patient Access 2023 survey, which showed that 56% of patients who had seen a deterioration in the patient access experience would switch providers because of it. Demand for more digital options can be tracked back to the “Amazon effect” and the rise of online retail environments that give consumers convenience and choice at the tap of a button. Indeed, healthcare providers stepped up during the pandemic to deliver flexible, contactless care, so patients have seen that it's possible. With digital transactions now well-established, patients will find it surprising to be asked to fill out paper forms at the registration desk or have limited online payment options in 2024. Riggins says providers must update their technology or risk being left behind. “Clients who are making the switch to digital patient access offerings tell us they don't want to look stuck in the 90s. They want a more contemporary patient experience that's smoother and more efficient for both patients and staff.” To open the digital front door and kepe up with healthcare predictions in 2024, Riggins recommends prioritizing self-service and digital options for patient registration, scheduling and billing inquiries. Prediction #3: “More patients are struggling financially, so providers will need to do more – and sooner – to help them manage bills” Victoria Dames, Vice President of Product Management, says that with household finances under pressure, patients will remain anxious about the cost of care: “The earlier providers can give patients clarity, the better for all involved. Creating a convenient and transparent patient collections experience should begin during patient onboarding, so patients can start to plan. With integrated patient access software, providers can deliver a more compassionate and efficient collections process, which supports patients while accelerating the revenue cycle. They don't have to choose between prioritizing revenue and patient experience – patient access technology delivers on both.” Recent Experian data suggests that many Americans are not confident in their financial literacy. This does not bode well for their ability to navigate the increasingly complex processes involved in healthcare billing. The troubling health consequences are already evident: a 2023 Gallup poll revealed that record numbers of patients were putting off medical care because they were worried about the cost. Anything providers can do to simplify the payment process is going to improve access to care and minimize bad debt, as noted in Dames' healthcare predictions for 2024. Dames says the collections effort should be viewed as an ongoing interaction with patients, beginning in patient access: “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, with compassionate and frictionless patient interactions, can facilitate payment and collections downstream.” A better financial experience in 2024 should include self-service and digital tools that guide patients through each step of their financial journey. For example, PatientSimple® gives patients a user-friendly, comprehensive way to generate price estimates, apply for charity care, set up payments plans and even make payments, all through a single web-based portal. Patient Payment Estimates deliver accurate pre-service cost estimates through the patient's preferred channels and point them toward any appropriate financial assistance. And of course, offering a wide range of convenient and flexible payment options will promote timely payments and maximize collections. Learn more about our revenue cycle management solutions or contact Experian Health today to discuss how we can support your strategies, based on our healthcare predictions for 2024.

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. 

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.

After a brief hiatus, the COVID-19 virus is reemerging, just in time for cold and flu season. According to the Centers for Disease Control and Prevention (CDC) July numbers show COVID-related hospitalizations are ticking upward. A spokesperson from the agency said this is the first notable acceleration of the illness in 2023. In these challenging times, healthcare providers prepare for the next COVID-19 surge. While the American healthcare system struggled just three years ago to cope with COVID-19 as a black swan event, these organizations now have the perspective that comes from hard-earned experience. They also have the potential benefit of time. It makes sense to take the lessons learned from the 2020 crisis and apply best practices to prepare for a COVID-19 resurgence. A new survey shows healthcare teams still struggling with burnout from the last COVID uptick. By leveraging technology and implementing best practices, providers can streamline processes, improve patient access, and alleviate burdens on healthcare staff. Let's explore how digital solutions such as online self-service scheduling, mobile-first registration, and patient portals can help healthcare organizations prepare for the next wave of COVID-19. COVID lesson #1: Online self-service scheduling offers key benefits for patients and staff During the previous COVID-19 outbreak, online self-service scheduling proved to be crucial in mitigating the spread of the virus. Not only did it improve the experience for patients and healthcare staff, but it also reduced the volume of visitors to emergency rooms and prevented sick individuals from congregating in waiting rooms. While self-service patient registration isn't just for a pandemic, COVID-19 clearly illustrated the critical need for digital patient intake solutions. A recent Experian Health survey showed seven of ten patients prefer self-service appointment scheduling. Forbes says, “Scheduling options are now a must-have feature for hospital and health systems…Health systems that do not offer online patient scheduling will not only be left behind but will be left out.” With the potential for an additional COVID upsurge in the future, health providers must also consider the benefits for staff of offering online patient scheduling options. They include: Fewer manual tasks associated with patient registration Real-time scheduling information that streamlines workflows Reduced patient no-shows Improves team communication and closes care gaps Automates unnecessary administrative functions COVID lesson #2: Mobile-first registration increases patient access and satisfaction The Experian Health State of Patient Access 2023 shows increasing the convenience of patient access is the quickest way to improve customer satisfaction scores. The survey showed access to provider care is challenging post-pandemic; four in ten say access has worsened because of scheduling. These challenges are always more daunting during high utilization—such as during the COVID-19 pandemic. As healthcare providers prepare for a COVID surge during flu season, adopting a mobile-centric registration accelerator solution can empower patients and streamline the registration process. Patients can complete registration safely and conveniently in their homes without spending time in a waiting room. Providers benefit from this online solution with reduced paperwork, automation of manual tasks such as appointment reminders, and a lightened workload. Implementing mobile-first registration not only improves patient satisfaction but also eases the burden on healthcare staff. Patients that use these solutions reduce practice call volumes by 50%. COVID lesson #3: Patient portals streamline communication and engage patients Harnessing technology to streamline processes and alleviate burdensome tasks is crucial. Patient portals are revolutionizing healthcare by empowering patients and lightening the load on the system. The pandemic accelerated the use of patient portals. In 2020, the National Institute of Health (NIH) found less than half of insured adults used these tools. Today, the usage of online patient portals such as PatientSimple is much higher—and on the rise. A recent national survey shows even seniors are getting into online patient portals to access healthcare information; 78% of people aged 50 to 80 now use at least one of these online hubs. Five years ago, researchers say just 51% of this population used these tools. Leveraging a patient portal now before cold and flu season makes sense. Patients can use patient portals to manage common tasks such as: Pay balances up front with an on-file credit card Set up payment plans View test results Generate price estimates View statements and test results online Apply for charity care Communicate with providers The latest research from Experian Health and PYMNTS says two out of three consumers use patient portals to “streamline the medical journey,” while the remainder say they'd use these tools if their provider offered them. Online patient portals increase access and convenience for healthcare customers. However, there are just as many arguments in favor of providers investing in patient portals to benefit their staff.As COVID-19 cases rise, patient portals serve as critical information hubs, streamlining communication between providers and the patients they serve. Self-service portals ease pressure on overburdened care teams and upfront administrative staff. They also integrate with electronic health records (EHRs), streamlining the flow of personal health information (PHI) between providers and patients. It's a more engaging and effective experience for patients that lightens providers' workloads. As we move toward increasing COVID cases this fall, patient portals will be vitally important for everyone involved in the patient journey—including the patients themselves. Learn how Experian Health is helping care providers streamline their efficiencies with digital software and prepare for the next COVID surge.

Could patient access software be the 'most valuable player' in healthcare? Experian Health's annual State of Patient Access surveys show an upward trend in the use of digital tools and software to help minimize the hoops patients must jump through to access care. In the most recent, 46% of providers said they expected to increase their digital investment over the next six months. The business advantages around increased capacity, reduced cancellations, improved data accuracy and higher patient satisfaction make a strong case for investing in patient access software. This article looks at how patient access tools can solve for some of the most stubborn problems in patient scheduling, registration and payments. Finding the formula for frictionless patient access Revenue cycle management comes down to minimizing service utilization while maximizing revenue potential. This starts with patient access. Efficient scheduling, intake and financial processes means more patients get better care, sooner – and providers get paid for their services without delay. Patient access software includes a range of digital and self-service tools that allow patients to complete administrative patient intake tasks with ease. Appointment management, patient registration, patient outreach, and patient estimates and billing are common use cases for patient access software. These solutions use in-depth data and automation to pre-fill patient information, check data for accuracy and completeness, tailor patient communications and accelerate workflows. Advances in AI and machine learning are creating new opportunities to remove obstacles in patient access and boost patient satisfaction. 5 problems that can be solved with patient access software 1. Painfully slow scheduling operations  Problem: Too often, patient access processes are complex and time-consuming. Over time, small frustrations from errors, delays, and repetitive manual tasks can cause a significant decline in the patient experience. It's unsurprising that 56% of patients want digital options to manage care and speed things up. Solution: Patient access software makes it easier for patients to see their doctor without delay. For example, rather than being forced to call the provider's office and wait for an agent to check for an available slot, patients can use online scheduling software to book, reschedule and cancel appointments whenever suits them best. This also alleviates call center volumes, easing pressure on staff. 2. Error-prone registration processes Problem: Manual intake and registration systems are vulnerable to quality issues, resulting in denied claims, increased admin costs and delayed access to care. Illegible writing, incomplete insurance information and missing forms mean patients and staff must spend more time going back and forth to find and fix mistakes. And at the extreme end of the spectrum, data errors can lead to medical errors, with life-or-death consequences. Solution: Automated patient registration can pull patient data from reliable sources and fill out basic details ahead of time, reducing the need for manual data entry. Preventing avoidable errors in this way improves communication, workflows and profitability. For example, Registration Accelerator is a text-to-mobile patient intake solution that allows patients to complete appointment registration from the comfort of home. The patient takes a photo of their insurance card and driver's license, and then optical character recognition (OCR) technology automatically enters the correct information for insurance verification. The patient can review and sign authorization and consent forms, and confirm their appointments all at once, with just a few clicks. 3. Excessive (and growing) admin burdens and staffing shortages Problem: Patient access is admin heavy. This wastes valuable staff time and resources and diverts attention from patient care. With healthcare staffing shortages reaching emergency levels and patient volumes on the rise, providers must find ways to manage workloads while maintaining output. Solution: By automating administrative tasks and expanding self-service options, patient access software takes the pressure off busy teams. In Experian Health's survey, 36% of respondents reported that technological improvements offset staff shortages, by making better use of staff time and lowering operational costs. Automated prior authorizations are a good example of how digital tools can help tame the admin burden. This software generates real-time updates for multiple health plans, so staff no longer need to cross-reference individual payer policies and websites. It uses exception-based workflows and guided work queues to help staff prioritize their activities. Patient access tools can also issue performance reports, so staff can continue to find ways to work more efficiently. Cutting-edge technology also offers a less obvious but equally important competitive advantage – helping providers attract and retain high quality staff. 4. A patient experience that falls short of expectations Problem: Unnecessary administrative obstacles, unclear communication, and slow processes result in subpar patient experiences. More than 6 in 10 patients don't think their experiences have improved much in the last few years, despite the wider availability of digital patient access tools. Providers need a solution urgently, given that 56% of patients would switch providers for a better patient experience. Solution: With automation and self-service digital tools, providers can finally put patients in the driver's seat and deliver the patient-centered experience that has been promised for years. Patients say they want access and payment experiences to be convenient and transparent, with specific examples including: Accurate pre-care estimates Payment plans Digital payment options A multi-purpose portal Mobile access for scheduling, registration, communications and care Alex Harwitz, VP, Digital Front Door at Experian Health, says that while this list may seem daunting, providers have reason to be optimistic about delivering a better patient experience: “Patients want a lot from the digital front door, especially younger and digitally savvy consumers. Speed, convenience and compassion are through-lines in our patient surveys. As expectations increase, so does the pressure on providers to deliver. But the good news is that technology is advancing too. There's a wealth of patient access software ready to help optimize the patient experience. And you don't have to implement them all at once: Experian Health's patient access tools are specifically designed to work independently or in combination, for hassle-free implementation.” 5. Missed revenue opportunities Problem: Missed appointments, billing mistakes and operational inefficiencies lead to avoidable revenue leakage. A significant portion of denied claims occur earlier in the revenue cycle, so improving patient access processes should be top of the list when it comes to optimizing revenue. Solution: Revenue loss in patient access comes down to data errors, poor analytics and workflow inefficiencies. By leveraging the right software, front- and back-office teams can collaborate to resolve issues and enhance decision-making. Digital tools can also improve the patient billing and payment experience, so providers get paid promptly. Upfront price estimates, payment plan recommendations and one-click payment options can make it easier for patients to understand and pay their bills. Implementing transparent and empathetic billing procedures not only enhances patient satisfaction but also accelerates the collection process. With Experian Health's Patient Payment Solutions, providers can collect payments 24/7 via mobile, web and patient portals. Maximizing revenue opportunities while meeting the changing needs and expectations of healthcare consumers calls for smart patient access strategies. Find out more about how Experian Health's patient access software helps healthcare organizations lay the foundations for a solid revenue cycle and a positive patient experience.

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.