Tag: patient access curator

As margins tighten, traditional revenue cycle management strategies are on shaky ground. Many healthcare providers are turning to automation and AI to simplify payments, prevent revenue loss and protect profits. This article breaks down some of the most common revenue cycle management (RCM) challenges facing healthcare leaders and offers a practical checklist to optimize patient access, collections and claims management, while building a resilient and patient-centered revenue cycle. Common challenges in revenue cycle management Revenue cycle management is how healthcare organizations handle the financial side of patient care, from patient billing to claims management. Healthcare providers rely on RCM to ensure they are properly paid, so they can keep the lights on, pay their staff and deliver quality patient care. Are traditional RCM strategies still fit for purpose? Consider some of the current challenges: Patients are responsible for a larger share of costs due to high-deductible health plans. How can providers help them understand their financial obligations and make it easier to pay without hurting their experience? Minimizing claim denials is a daily focus, thanks to constantly changing policies and regulatory updates. How do revenue cycle teams keep up with payers? Staffing shortages remain on the agenda. How can providers ease pressure on staff to maintain productivity and morale? There's also the question of how to turn mountains of data into actionable insights. How do teams interpret it correctly to identify bottlenecks and opportunities for improvement? Automation and AI offer a way through. When implemented thoughtfully, these tools can speed up processes, reduce errors and clear operational roadblocks for a more resilient revenue cycle. The following revenue cycle management checklist includes some of the key questions to consider along the way. Checklist for improving revenue cycle management Automating patient access Can patients book appointments online? Does the online scheduler automate business rules to guide patients to the right provider? Are patient identities verified at registration and point of service? A healthy revenue cycle starts with efficient patient access. According to the State of Patient Access 2024, 60% of patients want more digital options for scheduling appointments, managing bills and communicating with providers. Providers who see improvements in patient access also credit automation, which speeds up intake and improves accuracy. A good first step is to replace paper-based processes with online self-scheduling and self-service registration. These tools make life easier for patients, boosting satisfaction, retention and engagement. Behind the scenes, Experian Health's new AI-powered tool, Patient Access Curator, helps providers get paid faster by verifying and updating patient information with a single click – accelerating registration and paving the way for faster reimbursement. Register now: Exact Sciences and Trinity Health will share how Patient Access Curator is redefining patient access in this upcoming webinar. Optimize patient collections with data and analytics Are patient estimates provided upfront? Are notice of care requirements being addressed? Are patients offered appropriate financial plans and easy ways to pay? With more financial responsibility resting on patients' shoulders, patient collections are under the spotlight. The State of Patient Access report shows that upfront estimates and clarity about coverage are top priorities for patients, because when they know what they owe, they're more likely to pay on time. Implementing tools to promote price transparency and easy payment methods should feature in any RCM checklist. With Coverage Discovery, healthcare organizations can run checks across the entire revenue cycle to find billable commercial and government coverage that may have been forgotten, to maximize the chance of reimbursement. Meanwhile, Patient Payment Estimates offers patients clear, accessible estimates of their financial responsibility before treatment, so that hose who need financial assistance can be directed automatically to payment plans and charity options. Case study: How UCHealth secured $62M+ in insurance payments with Coverage Discovery® Improve claims management to reduce denials Are high-impact accounts prioritized? Are remittances reconciled with payments received? Does claims management software generate real-time insights and reports? With 73% of healthcare leaders agreeing that denial increased in 2024, and 67% saying it takes longer to get reimbursed, claims management is a great use case for automation. ClaimSource®, ranked Best in KLAS in 2024 for claims management, automates the entire claims cycle in a single application. It integrates national and local payer edits with custom provider edits to verify that each claim is properly coded before submission. By focusing on high-priority accounts, providers can target resources in the most effective way to ensure a higher first-pass payment rate. A major advantage for ClaimSource users is access to AI Advantage™. This tool utilizes AI to “learn” from an organization's historical claims data and trends in payer behavior to predict the probability of denial. It also segments denials so staff can prioritize those that are most likely to be reimbursed, reducing the time and cost of manual appeals and rework. Case study: After using AI Advantage for just six months, Schneck Medical Center reduced denials by an average of 4.6% each month, and cut rework time from 12 to 15 minutes per correction to under 5 minutes. Benefits of implementing a revenue cycle management checklist The key to choosing the right RCM tools and technologies is to build the strategy around what patients need most. A clear, transparent and compassionate billing experience is more manageable for patients and helps providers get paid faster. An RCM checklist helps teams stay focused on the tasks that matter. Providers can build on the suggestions above by choosing the key performance indicators (KPIs) that align with their specific goals. Metrics like financial performance, billing efficiency and collections rates can be combined to guide resource allocation, drive improvements and speed up reimbursement. With a well-designed checklist informed by clear KPIs, revenue cycle leaders can keep their teams on track and take their organizations from “surviving” to “thriving.” Learn more about how Experian Health's revenue cycle management tools can help healthcare providers meet current challenges, improve the patient experience and increase cash flow. Learn more Contact us

Medical excellence is a given when it comes to improving the patient experience, but what about the non-clinical side of care? Long waits, confusing processes and financial uncertainty can overshadow even the best medical treatment. As many as one in four patients delay care because of hidden administrative obstacles. As providers look to improve the patient experience in 2025, tackling these frustrations is top of mind. How easy is it for the patient to schedule their appointment? How quickly can they complete registration? Do they understand their insurance coverage, and do they have the right support to manage and pay their bills? Clear and straightforward patient access processes give patients support, convenience and control, and allow providers to focus on delivering care. This article looks at the challenges and opportunities that may affect patient access over the next year and highlights three ways to use digital tools to improve the patient experience. The patient experience in 2025: a rollercoaster of risks and opportunities Over the next year, patients' shifting needs and attitudes will change how they access care. Informed, tech-savvy patients armed with wearables and health-tracking apps want streamlined access and contact with their providers, and expect efficiency and personalization when they do seek care. At the same time, an aging population and increasing numbers of people with multiple chronic conditions drive demand for more complex and ongoing support. On the provider side, challenges like staffing shortages and remote work demands will continue to strain patient access teams. Payers' rapid adoption of artificial intelligence (AI) will continue to widen the denials gap. Rising costs will persist. Amidst this uncertainty, the forthcoming change of government may bring additional regulatory and legislative changes, so providers must be ready to adapt. Opening the digital front door is a way to elevate the patient experience to meet changing consumer expectations, while simplifying and streamlining processes so they can respond to whatever's in store. How can digital tools help improve the patient experience? Digital tools take the patient journey from a series of disjointed encounters to a coordinated and personalized experience. Building on innovations that gained momentum during COVID-19, like telehealth and virtual care, these tools keep patients and providers connected throughout the care process. By tailoring experiences to individual needs in real time, digital tools integrate into daily life and meet the rising demand for convenient, tech-driven options. Three ways to improve the patient experience Experian Health's latest State of Patient Access survey offers some pointers as to what providers should prioritize: 1. Expedite scheduling so patients can see their practitioner quickly Patients measure the patient experience by how quickly they can see their doctor. In the State of Patient Access survey, both those who think patient access has improved and those who think it has worsened give this as their reason. As patients' top priority, efficient scheduling is an obvious focus for providers who want to improve the patient experience. Online scheduling, mobile registration and self-service portals can simplify how patients book and check in for appointments. Patient Schedule lets patients book appointments anytime they like without needing to call. It only offers specific types of appointments with the right provider and makes it easy to cancel and reschedule, so no-shows are less likely. This also increases providers' capacity, giving patients more options so they can see their doctor sooner. Mobile registration complements digital scheduling by allowing patients to complete registration forms anytime, anywhere. Automated registration prefills information held on file to minimize paperwork, which is good news for the 85% of patients who do not want to fill out paperwork if they've already provided the information. Reducing manual errors also reduces delays so that patients can get on with their visit. 2. Help patients understand their insurance coverage and bills Patients and providers both cite financial challenges among their top priorities for improving patient access. More than eight in ten patients say pre-service price estimates help them prepare for the cost of care, while more than half say they need their provider's help to understand what their insurance covers. Providers should consider digital tools that support transparent pricing and billing to improve patients' financial experiences. Experian Health's Patient Payment Estimates generates accurate, upfront estimates of what a patient will owe, incorporating real-time pricing information, benefits and discounts. Estimates and secure payment links can be sent to patients via text or through the web-based app for a convenient and user-friendly payment experience. Additional tools can help patients find missing coverage and identify suitable payment plans, empowering patients and accelerating collections for providers. 3. Explore how automation and AI can support a better patient experience The growing use of AI will continue to reshape all aspects of care. By processing vast amounts of information at an unprecedented rate, AI presents exciting opportunities in patient access: keeping patients informed, generating performance insights and reducing the errors, delays and bottlenecks that come with manual processes. One of the highest-ranking challenges for providers in the State of Patient Access survey was the difficulty of managing multiple solutions to run patient eligibility and coverage checks. Patient Access Curator uses AI to address this with a single-click solution that captures all patient data at registration. It checks and verifies eligibility, Medicare Beneficiary Identifiers, coordination of benefits and demographics, delivering results in just 30 seconds. This prevents denials on the front end and takes the pain out of registration and scheduling for patients. Read the blog: How Patient Access Curator uses real-time, automated discovery to prevent denials and improve patient access Put patients in the driver's seat in 2025 As competition intensifies with new providers and disruptive technologies entering the market, patient satisfaction will no longer be optional — it will define success in 2025. Investing in digital patient access tools gives patients the autonomy, choice and convenience they crave as modern digital consumers. Simplifying and streamlining access will not only help meet and exceed patient expectations, but will help providers future-proof their operations and build a sustainable revenue cycle for the years ahead. Find out more about how Experian Health's patient engagement solutions will help providers improve the patient experience in 2025. Patient Engagement solutions Contact us

According to Experian Health's State of Claims 2024 survey, missing coverage is the top reason for healthcare claim denials for almost a fifth of providers. However, the issue isn't just about whether a patient is insured — four in ten providers worry about insurance companies paying out even where patients have active coverage. Constantly changing payer policies can result in altered or expired benefits, leaving providers scrambling to secure alternative sources of payment. That's why many providers are turning to automated health insurance discovery to find missing coverage and catch outdated policies early. This article looks at how coverage discovery software helps healthcare organizations address some of the most stubborn pain points in the revenue cycle. What is health insurance discovery? When a patient comes in for care, one of the first jobs is to figure out exactly what insurance they have — if any — and what it covers. Health insurance discovery is the process of checking whether the patient has active insurance and confirming details of that coverage, such as payer name and plan type, to ensure the cost of care is billed to the correct payer. If a patient has multiple active plans, the provider must also determine how much should be billed to each payer and in what order. How does it work? Ideally, coverage discovery occurs pre-service, but it can occur later if a claim is denied, and alternative coverage sources must be found. The main steps in the process include: Collecting insurance details when patients schedule or check in Checking with insurance companies to confirm that coverage is active and will cover planned services Cross-checking payer databases to ensure no coverage is missed Considering a patient's eligibility for Medicaid or other charity support Coordinating benefits for accurate billing Benefits of automated health insurance discovery for providers While respondents to the State of Claims survey are reasonably confident about their coverage discovery processes, the actual outcomes are less robust. Eligibility checks are taking longer and errors are on the rise. Only 54% of providers believe their claims technology can meet current revenue cycle demands. Automation offers a reliable and adaptable solution to bridge the gap between front-end checks and back-end claims management. Here are a few ways automated health insurance discovery sets the stage for smoother claims submissions and revenue cycle performance: 1. Maximize reimbursement by finding missing coverage quickly Challenge: Patients don't always provide complete insurance information, which can cause providers to miss out on opportunities for reimbursement. How automation helps: Automated health insurance discovery digs deeper than manual processes to find any coverage that may have been missed or forgotten. Experian Health's Coverage Discovery® solution combs through multiple proprietary databases, including employer information, historical search information, registration history and demographic validation to proactively identify billable Medicare, Medicaid, and commercial coverage. With minimal patient details, it finds additional sources of primary, secondary and tertiary insurance instantly. In 2023, Coverage Discovery tracked down previously unknown billable coverage in a third of patient accounts, resulting in more than $25 million in found coverage. 2. Reduce the manual workload Challenge: Staff spend too much time calling payers, logging into portals and manually entering patient data. This is time-consuming and error-prone, especially when one in four resubmissions are worked on by a different person than the one who originally processed it. How automation helps: Automation eases the admin burden by handling repetitive aspects of insurance verification behind the scenes, freeing staff to focus on more complex tasks. Coverage Discovery saves staff time by continuing to check for health insurance throughout the patient journey, and not just at registration. This final post-service check is vital to detect discrepancies that could lead to denied claims. Staff can also automate the self-pay scrubbing process to further reduce the risk of errors. As providers continue to feel the squeeze from staffing shortages and rising operating expenses, any move to reduce costs while bringing in more revenue is to be welcomed. 3. Prevent eligibility issues Challenge: Providers often only discover that active benefits have changed after the claim has been submitted. That's too late. For 43% of providers, it takes at least 10 more minutes to check eligibility when initial checks are incomplete. How automation helps: With automation, providers can run real-time eligibility checks, ensuring that changes to the patient's benefits are caught early so claims aren't denied due to outdated information. Experian Health's new Patient Access Curator uses artificial intelligence-based data capture technology to return accurate information from multiple sources with a single click. It automatically interrogates data from more than 270 payer responses, including active and billable coverage, plan level detail, chaining and primacy, so providers can verify eligibility and more in an instant. 4. Reduce claim denials and rejections Challenge: Incorrect or incomplete insurance information results in errors on claims forms or claims sent to the wrong payer, which causes denials, delays and rework. How automation helps: Automated discovery ensures that the correct payer and coverage information is attached to claims, reducing the likelihood of denial. This solves one of the most frustrating parts of coverage discovery, making the process faster, more accurate and less reliant on manual effort. Read more: How to leverage AI and automation to minimize healthcare claim denials 5. Improves the patient experience Challenge: Patients are often confused about their coverage status and worried about whether their healthcare costs will be met by their insurance provider. Medicare beneficiaries, in particular, report difficulty understanding and comparing plan options, leading to potential gaps in coverage. When healthcare providers fail to catch errors or gaps in their information, this erodes trust and negatively impacts how they feel about their experience. How automation helps: By correctly identifying coverage and verifying benefits eligibility, automation allows providers to give their patients early certainty about how their healthcare costs will be covered. Patients are less likely to receive unexpected or incorrect bills, which prevents delays and disputes. Automated tools can go a step further to improve the patient experience by guiding patients toward additional support and payment plans. For example, Patient Financial Clearance identifies patients who may be eligible for Medicaid or charity assistance, and identifies appropriate payment plans for anyone with an unmanageable self-pay balance. Case studies: See health insurance discovery in practice How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks How UCHealth secured $62M+ in insurance payments and saved $3.5M+ in 2022 with Coverage Discovery How Luminis Health used Coverage Discovery to find $240K in billable coverage each month Learn more about how automated health insurance discovery helps providers reduce claim denials, improve cash flow and deliver better patient experiences. Learn more Contact us

Experian Health's State of Claims 2024 report reveals a worrying trend in healthcare claim denials, with nearly three-quarters of survey respondents reporting a rise. Around four in ten say claims are denied 10% of the time, with one in ten seeing denial rates above 15%. Denials at this scale, driven by various claim denial reasons, represent billions of dollars in lost or delayed reimbursements, so it's no wonder that reducing health insurance claim denials tops healthcare providers' “must-fix” list. However, despite being highly motivated to resolve the challenge, many organizations need more support to overcome operational roadblocks. Prior authorizations are taking longer to come through. Payer policy changes are more frequent. Patient information is increasingly inaccurate. For 65% of respondents, submitting clean claims is more complex than before the pandemic. With some wrangling more than three technological solutions and others lacking confidence about using automation and AI, providers seem to be struggling to find the sweet spot when tackling denials. This article looks at the reasons for increased claim denials, as well as how automation and artificial intelligence (AI) can help healthcare providers overcome these obstacles to increase operational efficiency and improve cash flow. Major operational challenges leading to increased claim denials Clarissa Riggins, Chief Product Officer at Experian Health, says that many providers are increasingly concerned that payers won't reimburse costs as denial rates increase, when discussing the State of Claims 2024 report. These concerns reflect operational challenges, including difficulty keeping track of pre-authorization requirements, inability to keep up with rapidly changing payer policies and inadequate front-end data collection. While staffing shortages are not among the top three claim denial reasons as they were last year, they are a continuing drag on efficiency for 43% of providers. Burdened by limited resources, these revenue cycle teams are more likely to make avoidable errors during claim submission—a problem that is affecting the four in ten providers who say they have limited resources to cross-check claims for errors. Riggins suggests that healthcare organizations look to technology to close the claims gap: “We had hoped to see a decrease in claim denials from our previous survey, but it's clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes. This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology to navigate this volatility.” Top reasons for healthcare claim denials Here are the top three claim denial reasons and how automation and AI can solve them: 1. Missing or inaccurate claims data Missing or inaccurate claims data is the number one operational challenge responsible for the increase in medical billing claim denials – among the top three challenges for 46% of respondents in the State of Claims 2024 survey. Submitting clean claims relies on getting data right the first time. It calls for speed and efficiency, which is impossible with slow, error-prone manual systems. Yet almost half of the respondents say their organizations are reviewing claims manually. While 54% of respondents believe their technology is sufficient to meet claims management demands, increasing errors and rising denials tell a different story. Revenue cycle leaders who embrace automation in their claims submission and denial prevention strategy set themselves up for smoother operations and a boost to the bottom line. Without the right automation to increase the speed and accuracy of claim submissions, valuable staff time and effort are wasted on manually processing error-prone claims, increasing the likelihood of denial. The lack of automation also places unnecessary strain on staff, diverting their attention from more complex claims issues. 2. Prior authorizations Claim denials often stem from poor communication between payer and provider systems, with the prior authorization process as a prime example. The process requires providers to seek agreement from the payer to cover a service or item before it is administered to the patient. Failure to do so results in the claim for that treatment being denied. Unfortunately, obtaining prior authorizations is not always straightforward; sometimes, the patient's treatment must begin before the authorization process is concluded. Other times, the authorization only covers certain aspects of the treatment. Not only is the prior authorization process complex, but it is also costly, laborious, and time-consuming to navigate successfully. According to the 2023 AMA Prior Authorization Physician Survey, physicians and their staff spend 12 hours per week completing prior authorizations, with almost all reporting physician burnout as a result. Providers must stay on top of frequent changes to payer policies, and staff must use multiple payer portals to track authorization requests. Unsurprisingly, authorizations are among the top three claim denial reasons for 36% of respondents in the State of Claims survey. As with any challenge involving digital systems “talking” to one another, authorizations are a great use case for automation. Automation can be used to check payer policy changes, alert staff when prior authorization is needed, gather relevant documentation, and review authorization requests for accuracy. This significantly reduces the burden on staff and minimizes the risk of claims being submitted without the necessary authorizations in place. Experian Health's Prior Authorizations technology automates authorization inquiries and checks requirements in real time. It uses AI to help users find and access the appropriate payer portal to speed up the authorization workflow. Users will have confidence that they're looking at the same account information and policy details as the payer, which means lengthy negotiations can be avoided. Staff also get accurate status updates on pending and denied submissions so they can take appropriate action and maximize reimbursement. 3. Inaccurate or incomplete patient data Even the slightest mistake or mismatch in a patient's name, address or insurance details can result in a denial, leading to payment delays and extra work for the staff. These denials are particularly frustrating because they should be avoidable. Automation can be used to pre-fill the patient's information before they arrive to avoid the errors that occur with manual input. This has the added benefit of accelerating registration. These solutions can also check for duplicate charges, missing fields and coding inaccuracies. For example, Claim Scrubber helps providers prepare error-free claims for processing by reviewing each line of the claim before it's submitted. ClaimSource® helps providers manage the entire claims cycle by creating custom work queues and automating claims processing to ensure that claims are clean the first time. Implementing technology to prevent claim denials The report details some of the strategies providers are using to try to reduce denials. These include upgrading existing claims process technology, automating or expanding patient portal claims reviews, and automating tracking of payer policy changes. More than half are motivated to adopt new technology to reduce manual input. This is exactly what Denial Workflow Manager is designed to do. It enables providers to track claim status and appeals and quickly identify those that need to be followed up on. It eliminates the need for manual review, while analysis and reporting give staff insights into the root causes of denials to optimize performance. This solution can be integrated with tools like Enhanced Claim Status, which sends automatic status requests based on the type of claim and specific payer timeframes. It generates accurate adjudication reports within 24-72 hours to accelerate the revenue cycle. The output is viewable in ClaimSource to streamline workflows and manage the claims process in a single online application. Automation and digital technology are also valuable counterweights to the shortage of qualified staff. While staffing shortages aren't as high on the list of concerns as in previous years, they remain a stubborn problem. By reducing the need for manual input, claims management can be accelerated while freeing staff to focus their attention where it matters most. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more AI solutions for reducing claim denials Healthcare organizations can get more bang for their buck from automation by integrating these solutions alongside AI. Interestingly, the survey suggests that providers have mixed feelings towards AI: 35% of providers say they want solutions that leverage more AI and machine learning, yet only 8% are actually using them. Current ClaimSource users might consider AI Advantage™, which uses AI and automation to generate real-time insights for a proactive approach to denial management. It helps providers combat claim denials from two angles: AI Advantage – Predictive Denials uses AI to identify undocumented payer adjudication rules that result in new denials. It identifies claims with a high likelihood of denial based on an organization's historical payment data and allows them to intervene before claim submission. AI Advantage – Denial Triage comes into play if a claim has been denied. This component uses advanced algorithms to identify and intelligently segment denials based on potential value so that organizations can focus on resubmissions that most impact their bottom line. Doing so removes the guesswork, alleviates staff burdens, and eliminates time spent on low-value denials. This solution complements existing claims management workflows to help providers expedite claims processing, reduce denials, and maximize revenue. Another AI-powered solution helps prevent denials on the front end: Patient Access Curator allows patient access teams to capture multiple data points in seconds. This solution solves the “bad data” problem, using AI and robotic process automation to run checks for eligibility, coordination of benefits, Medicare Beneficiary Identifier, demographics and coverage discovery with a single click. The financial impact of denials and the ROI of technology Another paradoxical finding in the report is that while 47% of respondents see having AI technology as a competitive advantage, less than half say they'd be up for fully replacing their existing claims processing technology, even if presented with compelling ROI projections. Automation and AI can meaningfully impact the claims metrics that keep revenue cycle leaders awake at night – denial rates and clean claim rates being the top two. Patients also want to see improved performance when it comes to reducing denials. If healthcare organizations cannot offer a reliable, error-free system, they risk losing patients' trust and loyalty. Providers who demonstrate a well-managed claims system with swift and accurate results will inspire confidence and improve patient engagement. It's essential to assess how existing solutions perform against these metrics and implement upgraded solutions to deliver a more substantial ROI. AI and automation in practice How are Experian Health's clients using AI and automation to reduce claim denials? Here are a few examples: In only six months of adopting AI Advantage for claims processing and reducing claims denial, Schneck Medical Center saw denials fall by an average of 4.6% each month. In addition, the time needed to correct claims dropped from 15 to less than five minutes. The ambulatory clinic Summit Medical Group Oregon implemented Experian Health's claims management solutions, including Enhanced Claim Status and Claim Scrubber, to improve its registration and coding processes. These two solutions helped the team submit cleaner claims, resulting in a decrease in denials. As a result, the company now maintains a 92% primary clean claims rate. Another compelling example of the positive impact of technology on healthcare claims management is IU Health's experience with the all-in-one claim cycle management platform ClaimSource. With ClaimSource, IU Health managed the transmission of $632 million in claims in five days and processed $1.1 billion of claims backlog. Clients who have implemented Experian Health's Patient Access Curator have saved over $1 billion in denied claims, significantly boosting their bottom lines. Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system – for the second consecutive year.  Learn more Enhancing revenue cycles by addressing claim denial reasons By pinpointing the most common health insurance claim denial reasons and adopting automation and AI-driven solutions, providers can increase the first-pass clean claim rate, ramp up the likelihood of reimbursement, and reduce the overhead of reworking and resubmitting claims. Inevitably, hospitals will witness a surge in their financial performance. Contact us today to learn how data-driven claims management technology can help your organization reduce denied claims in healthcare and increase ROI. Improve claims management Contact us

The denial challenge is getting tougher. In Experian Health's latest State of Claims 2024 survey, almost three-quarters of healthcare administrators agree that claim denials are increasing. The majority also agree that difficulties with claims—like reimbursement times, errors, and payer policy changes—are becoming more common. It's no surprise that denial prevention is a priority for 84% of respondents. However, many organizations still focus on reactive strategies, like working harder with denial management teams or appealing claims once the denial comes through. These efforts have their place, but they only address the problem after it occurs. It's a time-consuming, costly and ultimately inefficient way to face the denial challenge overall. A better approach is to figure out how to prevent claim denials in the first place. This article looks at how to build a proactive denial prevention strategy using automation and artificial intelligence (AI), to streamline claims processing and nip denials in the bud. Understanding denial prevention in healthcare Preventing denials starts with understanding the “ins and outs” of the claims process, particularly payer requirements. Denials occur when a payer refuses to reimburse a provider for services rendered, often due to avoidable coding errors, missing documentation or procedural mistakes. When that happens, providers are left to rework the submission or look elsewhere – most likely to the patient – to fill the funding gap. Many are simply written off to bad debt. To avoid receiving an 835 file with the dreaded claim denial notice, providers must focus on the root causes of denials and get ahead of the pitfalls. The importance of claim denial prevention With denial rates exceeding pre-pandemic levels, 42% of survey respondents say the economy and declining consumer confidence make payer reimbursements more urgent. While financial stability is the obvious driver for getting claims right the first time, denial prevention also improves operational efficiency and reduces the billing and coding staff workload. Denials are frustrating for patients and staff. When claims are processed correctly the first time, providers avoid delays and billing complications and reduce patient stress over unexpected costs. Preventing denials is critical for maintaining trust and ensuring patients feel secure about their financial obligations. How to prevent claim denials Denial prevention strategies should start with addressing the underlying causes of denials. Here are five denial prevention strategies to consider: 1. Improve data accuracy from the start Garbage in, garbage out. If patient information, insurance eligibility, prior authorizations and billing codes are input incorrectly or missing altogether, providers will continue to submit error-filled claims that have no hope of being paid. Tools like Registration Accelerator and Patient Access Curator can verify relevant data for accuracy before claim submission and reduce the risk of denial. 2. Use AI and automation for efficiency If there was ever a case for using automation and artificial intelligence, it's in claim denial prevention. However, around half of providers are still using manual processes, leaving them playing catch-up to the payers who are already using AI to work at scale. Only 10% have automated the process, using AI to correct and resubmit claims. Tools like ClaimSource® can automate eligibility verification and coding, perform error checks before submissions and ensure claims meet payer requirements instantly. This cuts the time and effort wasted on manual processes, releasing staff to focus on activities that need human attention. 3. Automate pre-claim scrubbing to catch errors A great use case for automation is in providing an extra pair of eyes to pore over claims and catch common errors like missing data and wrong codes before submission. Experian Health's Claim Scrubber analyzes claims line by line to ensure that claims are submitted to payers and clearinghouses without errors, increase first-time pass rates and prevent rebilling. 4. Track performance for ongoing improvement Every denial prevention strategy should include monitoring and reporting. Tools that offer real-time tracking of key performance indicators such as denial rates, clean claim percentages, resubmission times, and the reasons for denials can help staff identify patterns. With these insights, they'll have complete visibility into any recurring problems clogging up their claims processes. 5. Outsource to a trusted vendor for extra support and expertise Finally, providers might consider outsourcing denial prevention to a specialist vendor who can help them develop the right strategy and toolkit to streamline billing, improve data integrity and manage claims to ease pressure on internal resources. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more Proactively reducing claim denials These strategies raise an important question: can existing revenue cycle technology handle the increasing volume of denials? Healthcare administrators aren't convinced: only 54% of survey respondents feel their organization's technology is sufficient to meet demand, down 23 percentage points since 2022. To implement these denial prevention strategies effectively, providers may need to consider upgrading their toolkit rather than relying on traditional systems. Experian Health offers two AI-powered solutions that help providers better predict and prevent denials: Prevent denials with Patient Access Curator  Too many denials originate in patient access, so prevention must start here. Patient Access Curator uses AI-driven data capture technology to verify patient details quickly and accurately. With a single click, PAC can automatically check eligibility verification, coordination of benefits, Medicare Beneficiary Identifiers, coverage discovery and financial status. Running multiple manual queries is a thing of the past, saving staff hours and propagating clean data throughout the entire revenue cycle. Watch the webinar to learn more about how Patient Access Curator helps prevent denials with accurate data from the start. Predict denials with AI AdvantageTM Clean data sets the stage for denial prevention, but AI adds an extra layer of protection by forecasting potential issues before it's too late. AI AdvantageTM does this in two ways. First, the Predictive Denials component analyzes claims using the provider's own ClaimSource® data and alerts staff to high-risk claims so errors, inconsistencies or missing documentation can be corrected before submission. Next, the Denial Triage component prevents missed revenue opportunities by segmenting denials and guiding staff to those worth reworking. See how AI Advantage works: If providers can't prevent denials, they can't protect their bottom line. With the right data analytics, automation and AI, providers can take control and spot issues before they become problems instead of spinning their wheels in endless rework. With more advanced tech on their side, it's possible to close the gap with payers and prevent denials, but it also gives staff the headspace to focus on patient care and support. Find out more about how Experian Health's Claims Management solutions help providers build effective denial prevention strategies and reduce lost revenue. Learn more Contact us

Millions of healthcare claims are denied annually, costing providers billions in lost revenue and expensive appeals. A 2024 survey shows that around 15% of all claims submitted to private payers, Medicare Advantage and Medicaid managed care plans are initially denied. Since most involve charges of $14,000 and above, the stakes are worryingly high. Frustratingly, more than half of these denials are eventually overturned, but not before providers have spent an average of $43.84 reworking each claim. With hospitals and health systems spending almost $20 billion on denial management in 2022 alone, this administrative tug-of-war with payers brings a substantial toll. While some denied claims are valid, there's no doubt that many are avoidable, as evidenced by the number that are successful on the second try. This is where effective claim denial management strategies and solutions come into play. Understanding the root cause of denials in healthcare and implementing the right systems ensures that claims are right the first time. This article looks at the importance of denial management, strategies for improvement, and why more providers are shifting from defense to offense by putting automation and artificial intelligence (AI) at the heart of their claims management processes. The importance of denial management in healthcare A traditional denial management definition in healthcare might focus on the steps needed to resolve denials after they occur. The reality is much broader. Providers need a proactive strategy that addresses why claims are denied in the first place to prevent them from occurring in the future. Claims may be denied because the insurer doesn't consider the treatment medically necessary, believes there's a cheaper alternative available or doesn't cover it because the patient's insurance doesn't cover it. Sometimes, the culprit is an erroneous billing code or typo. Providers avoid costly and time-consuming rework by ensuring that claims are accurate, compliant, and complete at the start. As denials become more common and costly, streamlining denial management is increasingly urgent. The provider-payer relationship One of the major challenges for providers is the shifting relationship with payers. According to a survey by the American Hospital Association (AHA), 78% of hospitals say interactions with commercial payers are getting worse, with 84% noting the rising costs of complying with insurer policies. Providers report spending more time on prior authorizations, yet the growing pile of denials includes pre-authorized services. The pattern of claims being denied and then granted on appeal drains financial resources, delays patient care and contributes to staff burnout. Moreover, payers have been much faster in adopting AI-based technology, allowing them to process and deny claims at an unprecedented rate. Providers that rely on traditional denial management methods are starting to fall behind. The denial management process: how it works Healthcare denial management involves four key steps: Track all claims from submission through final adjudication and identify denials as quickly as possible. Denials should be categorized by type, payer and service to identify trends and understand underlying issues that need addressing. Investigate the cause of each denied claim, such as coding errors, missing documentation or non-adherence to payer guidelines. This stage often involves collaboration among billing teams, coders and clinicians to pinpoint what went wrong. Rework the claim by gathering missing data or documents and correcting errors before resubmitting the claim to the payer for reconsideration. This will also include monitoring the outcome to see if the appeal is successful. Prevent future denials through improvement measures such as staff training, updates to billing software, and ongoing payer policy reviews. A preventive approach ensures claims are managed without a hitch and keeps revenue flowing. Strategies for effective healthcare denial management Prevent denials upstream with accurate patient access Because so many denials originate early in the revenue cycle, patient access should be the first target in any denial reduction strategy. Experian Health's Patient Access Curator solution uses AI-powered data capture technology to collect and verify patient information in seconds. A single click checks eligibility verification, coordination of benefits (COB), Medicare Beneficiary Identifiers (MBI), coverage discovery and financial information to determine the patient's propensity to pay quickly and accurately. Staff no longer need to run multiple queries and can have confidence that their claims are built on the correct data. Watch the webinar to learn how Patient Access Curator shifts denial management upstream and propagates clean data throughout the revenue cycle. Process denials more efficiently with workflow automation A second strategy is to automate the denials workflow to alleviate the administrative burden on staff and expedite the appeals process. Denial Workflow Manager automatically identifies denials, holds, suspends, zero pays and appeal status so staff can follow up quickly, without the need for manual reviews. They'll have the time and intel to rework the denials that are most likely to be overturned, resulting in maximum cash flow. When used alongside ClaimSource®, they can do all this using standardized protocols with claim and denial information on the same screen. Denial Workflow Manager provides American National Standards Institute (ANSI) reason and payer codes and descriptions so staff know precisely why a claim was denied. Reports and responses can be forwarded to Health Information and Practice Management Systems to facilitate better coordination. The tool also provides advanced analytics to identify trends and inform tactics for further improvement. This significantly reduces the overall time and cost associated with managing denials. The future of denial management in healthcare While automation has lifted healthcare denial management out of inefficient manual processes, AI takes predicting and preventing denials a step further. AI AdvantageTM enhances the denial management toolkit with two new offerings: Predictive Denials uses the provider's own claims data from within ClaimSource to identify claims that are most likely to be denied, so staff can step in to take corrective action before submitting the claim. Denial Triage analyses and segments denials that do occur so staff can focus on reworking claims with the highest potential for reimbursement. With these tools, providers can eliminate guesswork, reduce denials and minimize financial losses. But it's not just about finding more innovative ways of working: payers have already made huge strides in using AI to deny claims at speed and scale. The future of denial management in healthcare will hinge on technology, and providers will need to adapt to keep up with the fierce competition. Find out more about Experian Health's Denial Management Solutions and see why they're top-rated by clients in the 2024 Black BookTM RCM User Survey. Denial Management Solutions Contact us

Maintaining a healthy cash flow is the only way to deliver quality patient care, invest in state-of-the-art technologies and keep daily operations running smoothly. But that's easier said than done: data errors, delayed payments, denials and staffing disruptions leave providers vulnerable to escalating admin costs and revenue leakage, with little left over to reinvest. By adopting a few key revenue cycle management (RCM) strategies, providers can sidestep these challenges and bring in more dollars. This guide summarizes five revenue cycle management best practices healthcare leaders should follow to optimize RCM workflows and promote financial stability. Key challenges in revenue cycle management Common issues that can get in the way of a healthy revenue flow include: Inaccurate patient data leading to coding errors, claim denials and billing delays Increasing numbers of denied claims generate costly rework and wasted time Payer compliance issues that are constantly changing and time-consuming to monitor Growing numbers of self-pay patients struggling to pay their bills Labor shortages increase pressure on staff and leave the door open to sub-par performance Inadequate data insights hindering management's ability to spot opportunities for improvement Rapid technological changes leave providers on the back foot if they fail to keep pace with new developments. The dream scenario would be to avoid all these potential obstacles before they do too much damage. In reality, providers will need to choose a few priority areas to troubleshoot. Check out this guide to choosing the right key performance indicators for your revenue cycle dashboard to ensure the effective implementation of RCM strategies. Revenue cycle management best practices What does a successful revenue cycle look like? For busy RCM leaders, deciding what to tackle first can be overwhelming. While there's no one-size-fits-all RCM strategy, there are a few key issues that all organizations must pay attention to. Here are five areas of best practice to factor in: 1. Streamline patient registration and insurance verification Accurate patient data is the number one factor in building a robust revenue cycle. It doesn't matter how efficient claims management and collections processes are if the data they use is flawed. Automated registration and verification tools reduce the chances of manual errors entering the system to ensure correct billing, reduce denials, and speed up reimbursement. One pitfall to watch out for is the fact that some digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility. Experian Health's latest patient access solution, Patient Access Curator, avoids this by using AI-driven technology to collect and verify patient information with a single click. 2. Automate claims submission and management According to Experian Health's State of Claims 2022 report, 62% of providers feel they lack the necessary data and analytics to identify issues in claims submission processes. A similar number believe the absence of automation prevents improvement. The CAQH Index backs this up, with the latest estimates suggesting the healthcare industry could save $18.3 billion by switching to electronic transactions. As with patient intake, there's an opportunity to leverage automation in claims management to prevent errors and delays so the organization gets paid faster. Experian Health's claims management products—ranked #1 in 2024 surveys by both KLAS and Black Book—automate each step of the claims workflow so providers can submit clean claims quickly and cut the need for time-consuming manual work. 3. Optimize denials management and appeals with AI Despite best efforts, claims denials remain a burden for many RCM teams. However, proactively understanding and addressing the root causes can help keep denials under control. There's an opportunity to go a step beyond automation and see how artificial intelligence and machine learning can help combat the denials challenge. AI AdvantageTM evaluates individual claims in real time to flag those with a high likelihood of denials based on historical payment data, so staff can intervene quickly before submission. Denials are then triaged using advanced algorithms so staff can focus on reworking denials with the greatest chance of payment, rather than wasting time on those that are never going to be approved. Eric Eckhart, Director of Patient Financial Services at Community Medical Centers in California, says that since implementing AI Advantage, “Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in-house and save money. The savings have snowballed. That's really been the biggest financial impact.” Watch the webinar: Hear how Community Medical Centers and Schneck Medical Center are using AI AdvantageTM to prevent and triage denials. 4. Choose the right technology and tools for enhanced RCM The three previous revenue cycle management best practices emphasize the importance of selecting the right tools for the task. Two things to look out for when adopting a new RCM product are how well it integrates with existing tools and systems, and whether it offers meaningful insights to drive ongoing improvements. Experian Health's integrated RCM solutions are designed to fit together seamlessly, often allowing staff to view information from multiple workflows within the same dashboard. By bringing together metrics such as financial performance, billing efficiency and collections rates into one place, these tools help staff make strategic decisions about resource allocation and operational improvements. 5. Keep up with regulatory compliance Finally, ensuring compliance with regulatory requirements cannot be overlooked. The reputational and financial risks are too great. Regular training for staff on compliance issues and maintaining up-to-date knowledge of government and payer requirements will minimize the risk of penalties. Choosing RCM tools that automatically check for relevant updates can help providers stay current. Price transparency is a topical example. While the Hospital Price Transparency Rule is designed to help healthcare consumers understand healthcare costs and make more informed decisions about their care, implementation has proven tricky for providers. With the right technology and third-party support, it's much easier to stay compliant. Watch the webinar: See how Experian Health and Cleverley & Associates have partnered to help healthcare organizations navigate price transparency in 2024. Looking for more insights into revenue cycle management best practices? Contact Experian Health today to discover how our RCM solutions can transform your revenue cycle and increase cash flow year over year. Revenue cycle management solutions Contact us

According to Experian Health's State of Patient Access Survey 2024, eight in ten healthcare providers plan to invest in patient access improvements soon. As they weigh up the pros and cons of different solutions, many will focus on two key areas: making scheduling and registration easier for patients, and streamlining financial processes to boost their profitability. This blog post examines how automated patient access solutions can help providers meet patient expectations and operational demands. Survey snapshot: what do patients want? Experian Health's annual State of Patient Access surveys are useful pulse checks on patient perceptions. What do patients find challenging about accessing care? Where are they bumping up against unnecessary friction? The 2024 survey offers a promising outlook: 28% of patients report improvements in access in the last year, up from just 17% in 2023. Still, there is room for improvement: patients' biggest challenge – seeing a practitioner quickly – has topped the list for the last four years. Other significant challenges include understanding the cost of care and scheduling appointments. The State of Patient Access 2024 survey examines the perspectives from patients and providers on their perceptions of access to healthcare. Download now One key takeaway from the survey is the role of digital technology. Both patients and providers find complex, repetitive and inefficient processes to be the most problematic aspects of patient access – ideal targets for digital tools. Indeed, patients specifically express a desire for online health management tools, while more than half of providers attribute improvements in patient access to automated processes. There's a solid business case for investing in digital patient access solutions to ensure that patients see their doctors quickly and providers get paid without delay. Patient access solutions can open the digital front door with online scheduling and registration The first area where providers may consider investing in digital tools is in the patient's first interactions with their facility. When patients can schedule appointments quickly and complete registration without boring and repetitive paperwork, they're more likely to report a positive patient experience. Survey data backs this up: 89% of patients say the ability to schedule appointments any time, via online or mobile tools, is important to them 89% of patients say digital or paperless pre-registration is important to them. Online self-scheduling gives patients 24/7 access to book, cancel, and reschedule appointments from any device. Based on scheduling rules, they're shown the earliest suitable appointment, which means they'll see their doctor as soon as possible. Patients can be sent automated reminders of upcoming appointments and health checks, which means show rates and health outcomes will be better. It also drastically reduces call volumes so staff can focus on other priorities. Similarly, digital registration lets patients avoid the most dreaded part of patient intake: filling out lengthy forms in the waiting room. Automated registration also ensures that patients (specifically their data) are correctly entered into the system, preventing downstream delays. With text-to-mobile registration, patients are sent a text message prompting them to scan their identity and insurance cards, which are then uploaded and validated against existing records. Securing correct information from the start lays the groundwork for the patient's healthcare experience and the provider's revenue cycle. Interestingly, despite patient demand, self-scheduling and registration did not make the cut for providers' top three priorities. This suggests an untapped opportunity for providers that choose to invest here. Anthony Myers, Director of Patient Access at West Tennessee Healthcare, shares how their organization worked with Experian Health to accelerate and improve the registration process with Registration Accelerator. Watch now Patient access solutions can streamline insurance, eligibility and estimates A second opportunity lies in automating the patient access processes involved in revenue generation and claims submission. The revenue cycle is full of hidden costs for both patients and providers, often resulting from intake inefficiencies. Patients end up with bills that are higher than expected, while providers fall foul of changing payer requirements around prior authorizations and insurance eligibility verification, resulting in lost revenue. Improving upfront pricing estimates and clarifying insurance coverage ranked among the most urgent priorities for both groups in the survey. A few patient access solutions that can help here include: Patient estimates: When patients know in advance how much their care will cost, they can plan better. Web-based and mobile-enabled price transparency tools generate accurate estimates based on chargemaster data, claims history, patient insurance details and payer contract terms, and even account for payment plans and prompt-pay discounts. This improves the patient experience and increases collection rates while easing the burden on staff. Insurance eligibility verification: Manual processes for verifying active coverage are time-consuming and error-prone, causing staff burnout and patient confusion. Automating insurance verification checks at the time of service gives everyone greater certainty and prevents payment delays and claim denials. Personalized payment plans: By using their own data, along with third-party datasets, providers can leverage automation to offer alternative payment plans to patients who cannot pay the full amount right away. For example, PatientSimple® assesses each patient's propensity to pay and recommends the optimal financial plan that works for the patient's unique circumstances. Patients can check estimates and compare pricing plans on the self-service portal, giving them more control over their bills. These options promote financial sustainability by quickly identifying how much should be paid by which party and establishing processes to collect those amounts with minimal fuss. With ongoing staffing shortages, these time-saving tools are crucial for workforce resilience. Integrate patient access solutions with Patient Access Curator While providers may prioritize one of the above areas, the two are complementary: efficient scheduling and registration lead to better patient flow and accurate data collection, accelerating insurance and eligibility verification. This is more likely with an integrated “tech stack” across the whole patient access workflow. However, integration is a challenge for many providers. Nearly a quarter report that their biggest challenge in patient access is wrangling the multitude of tools needed to run pre-registration checks and gather the information necessary for claim submissions. Experian Health's newest patient access solution addresses this challenge by bringing together multiple insurance-related queries together into a single inquiry. With one click, Patient Access Curator automatically captures all relevant patient insurance data in less than 30 seconds. This includes: Eligibility verification, including billable secondary and tertiary coverage, chaining and primacy Coordination of Benefits, analyzing payer responses in real-time using AI to ensure no active insurance is missed Medicare Beneficiary Identifiers, using AI, automation and analytics to check and correct patient identifiers Patient demographics, using in-memory analytics and proprietary algorithms to ensure contact details are current Coverage and financial status, including automatic checks to find any existing coverage for accounts marked as self-pay or unbillable, and generate a summary of each patient's propensity to pay. With over $1 billion saved in prevented denials by clients using Patient Access Curator, it's clear that investing in digital technology is a cost-effective way to address current challenges in patient access. By increasing capacity and reducing errors and delays, these tools not only enhance financial performance, but give providers a head start when it comes to delivering an outstanding patient experience. Learn more about how Experian Health's patient access solutions accelerate access to care and streamline revenue generation from the start.

Once hesitant, the healthcare industry is slowly embracing artificial intelligence (AI)'s potential. Healthcare stakeholders, particularly those in revenue cycle management, are now interested in exploring AI-driven technology solutions to tackle daunting administrative tasks. According to data highlighted by the Journal of AHIMA, two-thirds of health systems are adopting AI to support revenue cycle processes. AI offers solutions that address the complexities of medical billing, insurance claims, and patient payments and enhance hospitals' financial health. The potential savings from AI adoption in healthcare spending could range from $200 to $360 billion annually, making it a compelling option for revenue cycle leaders looking to save more in far less time and with fewer resources. AI-powered tools show strong promise to reshape how revenue cycle leaders manage the most pressing issues in revenue cycle management, offering an efficient and seamless solution to complex revenue cycle tasks, including automated data entry and real-time insurance verification. Read on to discover more about the role of AI in revenue cycle management and how best to take advantage of robust AI solutions to streamline claims processing. How is AI used in revenue cycle management? The state of the average healthcare revenue cycle today reveals a pressing need for improvement. According to Experian Health's State of Claims 2022 report, reimbursement cycles are getting longer and claim errors and denials are rising. Here are everyday revenue cycle management challenges that AI-powered solutions can efficiently solve. AI can help manage complex billing procedures Accurate medical billing is the first step towards guaranteeing claims approval, yet data indicates that revenue cycle managers are falling short in this critical area. Errors in medical billing cost the U.S. healthcare system approximately $935 million weekly, highlighting the urgent need for improvement in the medical billing processes. Navigating the intricate landscape of insurance plans, billing codes, and patient payments can be overwhelming. Each insurance plan has unique nuances and requirements, adding to the complexity. Moreover, the success of a billing process relies on accuracy, which may be near impossible with manual handling. Adopting AI into every aspect of the billing cycle can streamline and improve the billing process while ensuring accuracy at every stage. AI-powered billing solutions like Patient Access Curator effectively manage critical aspects of the process, including verifying a patient's coverage and eligibility and fixing billing errors. Accurate billing significantly reduces the potential for rejected claims, creating opportunities for more efficient healthcare operations and saving money. AI in RCM can help prevent claim denials  According to The State of Claims 2022 report, 200 health professionals surveyed stated that 5% to 15% of claims are denied. These denials result in hospitals losing billions of dollars, approximately $260 billion per year, forcing them to write off massive amounts of debt, as noted in the Journal of Managed Care & Specialty Pharmacy. Insurance claims denials often result from inadequate data and analytics to identify submission issues, manual claims processing, and insufficient staff training. These denials affect the hospital's revenue and create additional administrative work to rectify the errors. The downstream effect is that patients may receive bills in error and end up paying the out-of-pocket bills if resolution does not occur. AI can make a huge difference, turning the bleak trend of increasing claim denials into a more positive experience for hospitals and patients. Encouragingly, The State of Claims 2022 report reveals that over half of healthcare providers use AI-powered healthcare claims management software to prevent claim denials. Among these AI-powered software solutions, Experian Health's AI Advantage™, when used in conjunction with ClaimSource®, an automated claims management system, stands out as a valuable solution for bolstering denial prevention efforts, improving claims management, and increasing revenue savings. Reduce patient payment delays With the rise in high deductible health plans, patients are putting off or not making payments, affecting the hospital's cash flow. According to medical billing analysts, people with health insurance, who previously accounted for only a fraction of hospital debtors, now constitute the majority of debtors in American hospitals. Hence, patient payment delays are now serious roadblocks to seamless revenue cycle management. On the provider end, there's also the challenge of swiftly verifying a patient's coverage and estimating their medical bill without any margin for error. Billing mistakes, surprise expenses, and complex payment processes can make it challenging for patients to manage their finances and make payments as early as possible. On the other hand, early and accurate estimation of patients' financial responsibility can help patients understand and appropriately plan for medical bills in advance. However, achieving the latter experience for patients involves sifting through constantly growing data, compounding the strain on limited hospital resources. That's where AI-powered revenue cycle management solutions can help. With solutions like Patient Access Curator, healthcare providers can quickly and accurately gather and verify necessary information about a patient's insurance, enabling them to promptly provide patients with a clear picture of what's left for them to pay. How can AI help with claims management? AI-powered software offers tailored solutions to simplify and optimize claims management processes and, in turn, improve revenue cycle management. Here are two critical ways AI can help with claims management. Real-time insurance eligibility verification Accurate eligibility verification is a fundamental part of the claims process. It is crucial for an accurate and faster billing process, increasing claims approval rates, and improving revenue cycle management. Conversely, incorrect verification leads to denied claims, contributing to care delays, wasteful healthcare spending, and a poor patient payment experience. By using Experian Health's Al-powered Patient Access Curator solution, healthcare providers can instantly verify and update patient insurance information, ensuring accurate billing and reducing the potential for claims denial. This real-time verification eliminates any need for guesswork and ensures that billing is done based on the most current insurance information. Patient Access Curator is a valuable tool for hospitals looking to save time, money, and staff resources that would have been spent on a lengthy and denial-prone claims process. With just one click and in 30 seconds, it prevents claims denial problems on the front-end. Since 2020, it has been a game changer for the financial health of clients using the platform, helping them save over $1 billion in denied claims. Predictive claims analysis AI can predict potential claim denials or payment delays, empowering hospitals to take proactive measures. By analyzing historical data and patterns, AI can flag potential issues before they become costly problems. AI Advantage™, another AI-powered solution, aims to help healthcare providers prevent and manage claim denials. This solution has two components:AI Advantage – Predictive Denials: reduce claims denials by spotting errors and identifying claims that don't meet ever-changing payer rules, allowing corrections to be made.AI Advantage – Denial Triage: works after a claim has been denied to identify and group denials most likely to be approved after resubmission, allowing organizations to prioritize resubmissions most likely to benefit their finances. As revenue cycle leaders strive to navigate the ever-evolving landscape of healthcare, it is crucial to embrace AI to stay ahead of the game. With Experian Health's expertise and resources, healthcare providers can fully take advantage of robust AI solutions to streamline their revenue cycle processes and achieve financial success. Find out more about how Experian Health helps healthcare providers leverage AI to solve the most pressing issues in revenue cycle management.