Tag: patient access curator

In healthcare revenue cycle management (RCM), the mantra is clear: maximize revenue and minimize costs. It's more complex in practice, requiring RCM leaders to anticipate and adapt to whatever's around the corner. Following the latest revenue cycle management trends is vital, as economic turbulence and labor shortages demand flexibility and resilience. Competition from new players and changing consumer expectations call for constant updates to the latest technology. And currently, as electoral news cycles heat up ahead of the general election, attention is turning to potential policy changes and their implications for revenue cycle management. Keeping an eye on how the industry evolves will help RCM managers hold the course for financial stability and growth. Here are 12 revenue cycle management trends to watch: 1. Investment in managed RCM services Investment in managed RCM services has become an increasingly attractive option for RCM managers grappling with persistent workforce challenges and navigating the intricate landscape of payer policies. Outsourcing has become a strategic solution to address staffing shortages and limited resources. By partnering with vendors like Experian Health, healthcare organizations can get access to specialist expertise, datasets and automated technologies they'd be hard-pressed to develop in-house. For example, Collections Optimization Manager allows users to retain control and oversight of their collections processes but comes with real-time support from a dedicated Collections Optimization Consultant for a bespoke collections strategy built on data insights and industry knowledge. 2. Staff shortages and reimbursement model changes Staffing shortages are particularly problematic when they bump up against changing reimbursement models. Unfortunately, staffing shortages are still common in the future of revenue cycle management. In Experian Health's latest staffing survey, 69% of respondents believe that staffing will continue to be a problem in the future. More providers are moving to value-based care models, which have implications for claims submission processes and provider-payer relationships. High staff turnover leaves providers without the knowledge and expertise to handle more complex claims and billing processes. A tool like Contract Manager and Contract Analysis, recently awarded Best in KLAS for Contract Management, helps monitor and manage payer contracts to stay on top of terms and conditions, mitigate risk and maintain financial stability. 3. Workflow inefficiencies Another way to ease staffing pressures is to improve workflow efficiency. A recent Bain report found that 40% of clinicians reported a lack of effective workflows, while up to 70% had never tried automated workflow management. There's a missed opportunity here, as manual processes and communication bottlenecks seriously disrupt revenue cycle functions. Organizations that leverage more efficient ways of working will secure a competitive advantage as new demands and pressures arise. Reviewing key performance indicators is a good starting point for determining where to focus improvement efforts. 4. Technological advancements in RCM The ongoing evolution of artificial intelligence (AI) has profoundly impacted various sectors, and the realm of revenue cycle management is no exception. AI-based tools will continue to shape the future of revenue cycle management, and providers will have to implement these tools in order to keep up with the competition. Machine learning algorithms increase RCM efficiency and accuracy by automating routine tasks, while advanced tools like AI AdvantageTM analyze vast datasets to identify patterns and predict outcomes. AI Advantage transforms claims management by predicting claims that are most likely to be denied, and then triaging denials so staff can focus on those with the highest likelihood of reimbursement. Eric Eckhart, Director of Patient Financial Services at Community Medical Centers, says, “We were looking for something technology-based to help us reduce denials and stay ahead of staff expenses. We're very happy with the results we're seeing with AI Advantage.” 5. Technology integration The amount of data being collected, generated, processed and shared within healthcare organizations is skyrocketing. More data means greater capacity for personalized services, fewer gaps in care, and more streamlined RCM processes—but only if data systems talk to one another. Opting for a single integrated solution avoids the pitfalls of shoe-horning new tools into legacy systems. For example, Experian Health's acquisition of Wave HDC means organizations can now access a single tool to check multiple data sources at registration. Patient Access Curator uses AI to perform eligibility verification, coordination of benefits, coverage discovery and more, to help healthcare organizations accelerate registration and reduce claim denials. 6. Medical billing errors Whether a coding mistake or an accidental typo, billing errors cost providers dearly in lost revenue and time. Unfortunately, they're a growing risk as more patients show up with coverage from multiple payers and high deductibles. On the upside, organizations should see improvements with relatively little effort—assuming they deploy the right tools and strategies. Patient Access Curator, mentioned above, uses AI and robotic process automation to collect and verify the information needed to compile error-free claims with just a single click. Watch the webinar to find out more about how Patient Access Curator helps providers eliminate errors and reduce claim denials from the front end. 7. Patient-centric approaches A McKinsey report published in April 2024 highlighted a continuing trend in healthcare consumers' keenness to use digital products and services when accessing care. Experian Health's series of patient access surveys show a consistent desire for personalization, convenience, choice and compassion in patient access. These principles underpin Experian Health's approach to helping providers open their digital front door. Online self-scheduling, digital registration, and tailored patient outreach all improve patient satisfaction and engagement, subsequently bolstering revenue generation. 8. Financial clearance and diverse payment options One specific opportunity relating to the above point lies in offering a patient-centered financial experience. Financial clearance tools and flexible payment plans have gained prominence by making it easier for patients to understand and manage their financial obligations. Tools like Patient Financial Clearance automate presumptive charity screening to see if patients qualify for financial assistance programs, provide scripts to help staff deliver compassionate financial counseling, and calculate affordable monthly payments based on individual circumstances. Case study: Discover How UCHealth wrote off $26 million in charity care with Patient Financial Clearance. 9. Financial engagement and omnichannel platforms Patient collections are a growing challenge for providers. Patients similarly complain of unnecessary friction in the payment process: The State of Patient Access 2024 survey found that 72% of patients want more digital payment options digital methods. By providing a unified experience across online portals, mobile apps and point-of-service payments, providers can increase patient engagement with financial processes and accelerate collections. 10. Challenges specific to each revenue cycle segment Organizations are shifting away from uniform solutions for the entire revenue cycle and instead embracing tailored strategies that accommodate the unique requirements of various departments, services, and workflows. By harnessing advanced analytics and automation, providers gain insight into the nuanced challenges within revenue cycle management, enabling them to adopt the best tools. This approach ranges from customizing intake and billing processes on a departmental basis to automating claims processing tailored to different payers' specifications. 11. Customizable RCM solutions Just as patients want tailored solutions, so too do providers. Data analytics and AI advancements enable providers to develop claims management solutions that fit their unique mix of payers and patients. On a recent webinar, representatives of Eskenazi Health discussed their use of Patient Financial Advisor, and how Experian Health consultants helped their organization customize their setup and workflow. 12. The role of strategic partnerships Partnering with a vendor like Experian Health can be a transformative step for healthcare organizations seeking to optimize their operations and enhance patient care. With Experian Health's expertise in healthcare technology and data management, organizations gain access to a comprehensive suite of automated solutions tailored to their specific needs. This also ties in with the first item in this list: implementing new ways of working isn't always easy, but with a trusted vendor, providers can manage and accommodate revenue cycle management trends more confidently, efficiently, and cost-effectively. By partnering with Experian Health: Providence Health found $30million in coverage and reduced denial rates IU Health processed $632 million in claims transmissions West Tennessee Healthcare automated and modernized patient intake The pace of change may be relentless, but with the right tools and support, RCM managers can stay one strategic step ahead and future-proof their revenue cycle for whatever surprises lie in store. Learn more about how Experian Health's revenue cycle management solutions can help providers keep up with revenue cycle management trends while maximizing revenue and minimizing costs.

As revenue cycle leaders continue to navigate an increasingly complex financial landscape, preventing healthcare claim denials remains the number one priority. Experian Health's State of Claims 2022 report found that 30% of respondents see claims denied 10-15% of the time, while 42% were seeing the rate of denials increase year over year. Denials in healthcare, which can be easily avoided, contribute significantly to the waste of healthcare funds. These denials cause providers to lose hundreds of billions of dollars in profits annually. This blog looks at the key questions providers should ask to get to the bottom of why healthcare claims get denied, how to prevent healthcare claim denials and ways technology can support better denial management. Why do healthcare claims get denied? The State of Claims 2022 survey revealed that the most common causes of denied claims boil down to three issues: 1. Missing or incomplete prior authorizations Health insurers use prior authorizations to determine whether a patient's treatment is medically necessary and how much they can cover. Despite being introduced to encourage delivering high-quality, cost-effective care, the authorization process has become an intimidating administrative burden for healthcare providers. Even now, many healthcare providers rely on manual paperwork to execute an already complex and tedious authorization process. This outdated approach to authorization not only consumes time and money but also creates opportunities for missing or incomplete prior authorizations, increasing claims denial rates. Unsurprisingly, 48% identified missing or incomplete prior authorizations as one of the top three reasons for denials. 2. Failure to verify provider eligibility To be eligible for reimbursement, a provider must be a participant in the proposed Medicare or Medicaid program or other private health insurance plan. Eligibility verification involves confirming a patient's insurance information and that the planned services and provider are under their plan, which is critical for successful claims approval. Failure to verify provider eligibility may lead to claims denial if an out-of-network provider provides the services. Likewise, 42% of respondents said failure to verify provider eligibility was a common reason for denials. 3. Inaccurate medical coding Accuracy is the backbone of medical coding, another administrative task indispensable to claims approval. The slightest mistake when translating patients' diagnostic and treatment information into clinical codes can result in rejected claims. Unfortunately, providers are susceptible to coding errors due to the ever-changing coding rules, especially when they do it manually or work with unreliable automation solutions. They may work with outdated or incorrect codes, leading to claims denials. The State of Claims 2022 survey revealed similar shortcomings, with 42% of respondents stating that inaccurate medical coding led to denial. Other reasons for denied claims include: Incorrect modifiers Failure to meet submission deadlines Patient information inaccuracy Missing or inaccurate claim data Not enough staff to keep up Formulary changes Changing policies Procedure changes Improperly bundled services Service not covered 6 in 10 respondents said insufficient data and analytics made identifying and resolving issues with claims submissions difficult. A similar number said a lack of automation was hindering operational improvements. The good news is that these obstacles can all be effectively addressed with the right denial management strategy and digital tools. How do claim denials affect revenue cycles? Denials can be justified as necessary to prioritize spending on high-value care, but they have heavy consequences for hospitals' financial health. As highlighted in the Journal of Managed Care & Specialty Pharmacy, the weight of denied claims adds up to about $260 billion each year. This financial burden is pushed on hospitals, who may need to classify denied claims as debt, which, among other consequences of claims denial, ultimately disrupts their revenue cycles. The ripple effect of denied and underpaid claims on hospital revenue cycles also manifests in how delayed and non-payments restrict cash flow, hampering the provider's ability to operate efficiently and deliver care effectively. Significant staff time is lost to avoidable administrative activities and rework, as claims need to be corrected and resubmitted. This creates a bottleneck in the revenue cycle, which can lead to decreased revenue and additional costs. Extra work is particularly challenging for staff already under pressure due to ongoing labor shortages. For patients, denials can cause stress and confusion around how the cost of care will be met. How can providers reduce or prevent healthcare claim denials? Since most denials result from inaccuracies that originate early in the patient journey, the solution calls for better data management in patient access and robust checks just before claims are submitted. Reducing claims errors will contribute to better claim submission and higher reimbursement rates. Here's a step-by-step guide to improving healthcare claims processing: Utilize prior authorization software to automate the prior authorization process. This software-driven solution automates inquiries and submissions using updated and stored payer data, making the prior authorization process seamless and time-efficient and resulting in higher claim approval rates. Upgrade claims technology with tools such as ClaimSource®, which helps providers manage the entire claims cycle from one platform. By automating claims processing, ClaimSource helps ensure claims are clean before being submitted. The tool creates custom work queues so staff can prioritize high-value tasks and get paid faster. Improve the claims management process and prevent healthcare claim denials with AI Advantage™ — Predictive Denials and AI Advantage™ — Denial Triage. Predictive Denials flags claims that are more likely to be denied before they are submitted to the payer and tracks payer rule changes, reducing denial rates. Denial Triage prioritizes and segments denials most likely to be reimbursed, leading to increased revenue. Automate line-by-line claim reviews with Claim Scrubber to eliminate errors or omissions in claims before they are submitted. Claim Scrubber makes claims management operations more efficient, resulting in less rework, administrative costs, and delays. It can also be paired with Contract Manager, so providers can audit claims before and after remittance. Use an early-and-often approach to monitoring claim status and expedite reimbursement. Enhanced Claim Status eliminates manual follow-up and helps providers react quickly to any pending, returned-to-provider, denied, or zero-pay transactions, further improving cash flow. Experian Health's ClaimSource and Contract Manager solutions were both ranked number one in their respective categories in the 2024 Best in KLAS awards What is the best way to track and manage claim denials?  Most providers rely on manual and automated processes to manage claims and denials. Shifting from manual to digital can save time, reduce errors, and increase overall efficiency. However, providers may be wary of implementing new systems due to concerns about costs, data interoperability, and the staff learning curve. For this reason, it's essential to select a denials management solution that fits the provider's unique specifications. Denials Workflow Manager eliminates manual processes and allows providers to optimize the claims process according to the metrics that matter to them. It generates work lists based on the client's specifications, such as denial category and dollar amount, and incorporates extensive data analysis capabilities to identify the root causes of denials and improve upstream processes to prevent them. It can be easily implemented as a standalone product or integrated with ClaimSource to give users access to the entire claims and denial management cycle on a single screen. Staff training on claims management The State of Claims 2022 report revealed that 46% of respondents admitted that lack of staff training was an operational challenge contributing to claims denial. Training healthcare staff in managing and preventing claim denials is one of the most worthy investments to reduce the rate of claim denials. Hospitals can provide healthcare staff with adequate ongoing training on the granular details of claims processes before and after submission and access to automated claims management solutions. Healthcare staff should also be kept up-to-date on the latest tools and strategies on denial prevention and payer rules for claims submissions to ensure payment receipt after claim submission. Engaging patients in the claims process Though patients are usually not responsible for submitting claims to payers, they are an equal third party in the claims process and can be empowered to actively participate in every stage, from submission to approval and paying copays or deductibles. Effective patient engagement can be achieved by providing patients with an accessible, all-inclusive platform to register, review, and update information related to their care and benefit plan and communicate with healthcare staff as needed. Collaborating with payers to reduce denials The quality of collaboration between payers and providers affects the seamlessness and efficiency of the claims process. Therefore, it is crucial for providers to collaborate effectively with payers, especially given the constant changes in payer policies, to ensure that they stay up-to-date with and comply with the payer claims submission requirements. In cases of claim denials, they can also manage them effectively. By working together, payers and providers can also quickly resolve denial issues, ultimately improving system efficiency. Adopting automation and AI to prevent healthcare claim denials As one of the most complex institutions today, the healthcare industry has always grappled with a critical shortage of healthcare workers, staff burnout, and wasteful medical care spending, which costs $600 billion annually in the US. Despite the potential benefits of automation and artificial intelligence (AI) to ease these burdens and save about $200 billion to $360 billion annually in healthcare spending, their adoption has been lagging and met with resistance. However, more and more healthcare stakeholders are realizing that these technologies are a principal partner in making the healthcare system more efficient, simplifying and streamlining deeply complex processes, such as claims processing. For example, Experian Health's Patient Access Curator, an AI—and robotic process automation (RPA)-driven solution that enables eligibility and coverage verification and more accurate and submission-ready claims. By performing these tasks in seconds, all in one click, Patient Access Curator has helped clients save over $1 billion in denied claims since 2020, significantly boosting their bottom lines. Another example of efficient claims technology is ClaimSource. This all-in-one claim cycle management platform, powered by automation, transmitted $632 million in claims within five days and processed $1.1 billion of claims backlog for IU Health. AI Advantage™, Experian Health's revolutionary claims management solution that offers a two-pronged approach to preventing and managing denials: AI Advantage – Predictive Denials identifies claims that are at risk of being denied, so corrections can be made before claims are sent to payers. AI Advantage – Denial Triage comes into play post-submission, reviewing patterns in denials to prioritize those with the greatest likelihood of reimbursement. Given the volume, complexity and financial impact of the current claims workload, automation and AI are critical elements in the denials management toolkit. In the State of Claims survey, more than half of respondents said they were using automated claims processing, with many using automation to keep track of payer policy changes, automate patient portal claims reviews and digitize patient registration. Despite much media furor, AI is still the domain of early adopters: only 11% of respondents said they were using AI. But while automation can effectively eliminate unnecessary manual tasks, AI is a force multiplier for denials management, offering additional predictive capabilities and “learning” from historical data to prevent denials. Client feedback to date suggests that incorporating AI-powered denial management solutions could be a game-changer for providers looking to streamline operations, prevent lost revenue and free up capacity to focus on their primary mission of delivering quality patient care. Technology solutions for managing and preventing claim denials Efficiently managing the claims process and preventing or resolving claims denial requires robust and reliable technology solutions at every stage, especially in the complex and constantly changing world of claims management, where everything hinges on accuracy. These technology solutions can be responsible for heavy lifting many administrative tasks involved in the claims processes, from accurate data capturing during patient registration and prior authorization to submission to monitoring claim status and addressing claims submission outcomes. Hospitals can adopt claims technology, such as Experian Health's Patient Access Curator, for verifying insurance eligibility and coverage with real-time patient data correction or ClaimSource®, a single platform for monitoring and managing the claims cycle in one place. Find out more about how Experian Health helps healthcare providers prevent healthcare claim denials with automation and AI.

Slow communications, confusing billing and a scarcity of digital options are the last things patients want to deal with when seeking medical care. Yet, this is exactly what happens for too many – and it's a significant financial risk for providers. This article examines why the patient experience matters and suggests four areas for improvement. Specifically, it looks at the digital tools that put patients in the driving seat and boost patient satisfaction and profitability. What is the patient experience? Improving the patient experience starts with answering the following question: what does receiving care feel like to patients at each stage of their healthcare journey? The patient experience includes all the touchpoints between patients and their providers, such as scheduling appointments, attending consultations, collecting prescriptions, and settling bills. There are also intangible components like empathy, respect, trust, and transparency, which shape a patient's lasting impressions of the healthcare organization. The experience goes beyond clinical care and face-to-face moments: back-end processes matter, too. Administrative workflows like insurance verification and claims management may be hidden behind the scenes, but they can soon influence what care “feels like” to patients if they're not running smoothly. Why is the patient experience so important to healthcare organizations? When patients have a positive experience, they're more likely to attend appointments, adhere to treatment plans and make healthier lifestyle choices. Health outcomes improve and the provider can build their reputation as a top choice for quality care. Satisfied patients are less likely to switch providers and are more likely to recommend services to family and friends. Everyone wants their loved ones to get the best possible care. The strong through-line from the patient experience to profitability tops the list for revenue cycle managers. Well-designed patient flows lead to better resource utilization, while improvements in attraction and retention rates directly benefit the bottom line. Positive patient feedback improves staff morale, so performance remains high. Prioritizing the patient experience is not only beneficial for patients, but is an essential strategy for financial sustainability. How to improve the patient experience in healthcare So, what do patients want? Experian Health's State of Patient Access 2024 report shows they want convenience, simplicity and choice, with 60% of patients saying they want more digital options to manage their care. They don't want to be passengers in their healthcare journey: they want to be the drivers, but with the support of a trusted guide. That's where digital tools come in. Here are four ways to use digital tools to improve the patient experience in healthcare: 1. Give patients speedy access to care with online self-scheduling Almost 8 in 10 dissatisfied patients say seeing their doctor quickly is their biggest challenge when accessing care. Online self-scheduling puts patients in charge and accelerates the process by making it easier for patients to find, book and cancel appointments, using an intuitive digital platform. Automated integration with the organization's business rules and calendars means patients only see appropriate appointments. This software maximizes patient show rates with appointments accurately matched to patients' needs. Case study: See how IU Health transformed patient scheduling with automation. 2. Simplify the financial experience with transparent pricing and payment plans Paying for healthcare is notoriously complex. Providers can simplify the patient experience with digital tools that deliver accurate pre-care estimates and flexible payment plans. Experian Health's Patient Payments Estimates solution uses data and automation to help providers give patients an early heads-up about what their bills are likely to be, and directs them to the most suitable financial pathway. In addition, offering hassle-free, secure payment options makes it easier for patients to pay their bills promptly, reducing the risk of bad debt for providers. Case study: See how Blessing Health System used integrated revenue cycle solutions to improve the patient financial experience and increase point of service collections by over 80%. 3. Personalize the patient experience with tailored outreach One of the major advantages of using digital tools is the ability to offer a personalized experience. These tools segment patients for tailored and targeted outreach based on their needs and preferences. This helps providers communicate with patients via their preferred channels and encourages prompt action. For example, text message and interactive voice response campaigns enable target outreach at scale to help accelerate scheduling and referrals and close gaps in care. Case study: See how Dayton Children's Hospital used PatientDial to increase outbound call efficiency. 4. Streamline back-office workflows for a frictionless front-end experience Finally, providers should consider how administrative processes affect what's happening in the front office and waiting room. Neglecting back-end processes can lead to bottlenecks, errors and inefficiencies that compromise the overall quality of the patient experience. Automated, data-driven revenue cycle management solutions not only eliminate time-wasting manual processes and help providers reduce errors and rework, but they also elevate the patient experience by reducing data errors and delays. Implementing tools like Patient Access Curator can also help take the pain out of registration and scheduling for patients, by capturing all patient data at registration with an all-in-one, single-click solution. By making every patient-provider interaction as simple and supportive as possible, healthcare organizations can build a patient experience that inspires loyalty, trust and engagement. With a bit of help from the right data and digital tools, providers can deliver a better patient experience and, in turn, secure financial sustainability. Find out more about how Experian Health's digital patient engagement solutions can boost patient satisfaction and provider profitability.

What do patients and providers really think about patient access services in 2024? Drawing insights from more than 1000 patients and 200 healthcare executives, Experian Health's fourth State of Patient Access survey pulls back the curtain. Previous surveys revealed a persistent gap between patient and provider perspectives on patient access, but could the gap finally be closing? The State of Patient Access 2024 report suggests that while discrepancies remain, the two groups appear closer than ever. This article provides a summary of the State of Patient Access 2024 report, and gives a run-down of patient and provider perspectives on patient access, what they see as top challenges, where opinions diverge and the steps providers can take to continue building a positive patient access experience in the year ahead. How do patients feel about patient access? 1. More patients think access has improved compared to last year 28% of patients believe patient access has improved over the last year, which is up from just 17% in 2023. As in previous years, patients' perception of whether access has improved hinges on how quickly they can see their doctor. Anything providers can do to accelerate scheduling and registration will be a winner. 2. Patients welcome the efficiency and accuracy of digital tools Patients have noticed improvements in scheduling and registration processes. They welcome the ability to book appointments anytime and avoid unnecessary paperwork using digital technology. That said, financial considerations trump convenience: the ability to look up insurance coverage and obtain accurate price estimates before care have risen to the top of the list of what patients consider the most important aspects to improve. 3. Cost of care remains a concern Unfortunately, patient sentiment around healthcare payments has remained relatively flat since 2022. Slightly more patients are receiving upfront cost estimates compared to previous years, but accuracy appears to have dropped, with 74% of patients reporting accurate estimates compared to 78% in 2023. Patients must have faith in their estimates if they are to plan for upcoming bills with confidence, and providers should be able to provide transparent and accurate payment estimates. What do providers think about patient access? 1. Providers are again more optimistic about improvements than patients Like patients, providers are generally positive about the state of patient access, though they may be a little too optimistic about the effect of improvement efforts. Around twice as many providers think access is better than the previous year compared to patients (55% compared to 28%). For providers, perceptions of improvements in patient access are closely tied to the impact of staffing levels. 2. Self-scheduling is back in favor Providers are aligned with patients on the need for digital scheduling and registration options. Interestingly, after the urgency to implement contactless scheduling during the pandemic began to wane in 2022, the latest survey suggests that self-scheduling is back in fashion, with 63% offering self-scheduling compared to 40% in 2022. 3. “Dirty data” remains a stubborn challenge Data collection at patient intake is a persistent headache for providers. Almost half (49%) say that inaccurate patient information contributes to claim denials. Improving the speed and accuracy of resolving patient information prior to claims submission were frequently listed in providers' top three challenges. See how healthcare organizations are using AI AdvantageTM to improve data accuracy and reduce claim denials. Digital technology bridges the gap between patient and provider perspectives on patient access When asked for their top three priorities for improvement, both groups ranked accurate price estimates and efficient insurance verification among their top two. While they diverge on the third – access to online health management tools for patients, and automated pre-authorizations for providers – it's interesting to note that these both reflect a desire to use digital solutions for greater efficiency and convenience. The survey highlights several opportunities to use digital technology to address upcoming challenges and continue to close the gap. Key challenges in patient access in the year ahead 1. Improving accuracy of upfront price estimates The survey showed 79% of providers plan to invest in patient access improvements soon. Given shared concerns about patients' ability to cover the cost of care, and worrying hints that some may postpone care due to cost concerns, prioritizing and providing accurate patient estimates would be a smart choice. While patients and providers are in closer agreement that estimates are accurate most or all of the time (74% and 85% respectively), there's clearly room for improvement. 2. Accelerating insurance verification and claims submission processes Several of the providers' top challenges speak to how difficult it can be to collate accurate information prior to claims submission. The need for better insurance reviews, more efficient management of prior authorizations, and more accurate patient information all contribute to the overarching goal of getting properly reimbursed. Almost a fifth say that managing multiple tools to determine eligibility, coordination of benefits (COB), and other pre-service checks is a top challenge. Could a single solution be the answer? Experian Health's new Patient Access Curator solution checks eligibility, COB, Medicare and commercial coverage, demographics and financial status in less than 30 seconds. Staff can check off several of these tedious tasks with just a single click. 3. Bolstering workforce capacity with technology A final challenge in the year ahead is the ongoing impact of staffing shortages. For the of providers who feel that staffing levels are disrupting delivery of scheduling and registration services, technology may offer a way through. Automation and artificial intelligence not only reduce the burden on staff by eliminating time-consuming manual tasks, but also allow staff to work smarter and faster on remaining tasks by improving data accuracy and insights. Most importantly, digital technology can improve scheduling, registration and payment processes for patients – and bring the patient experience in line with what both groups aspire to see. Download the full report: State of Patient Access 2024, or contact Experian Health to learn how technology can help streamline patient access.

“Is this claim valid? How much is our financial responsibility?” These are the two big questions payers want to answer when adjudicating healthcare claims. Huge amounts of patient information, clinical data, diagnostic and billing codes, and policy specifications must be analyzed and cross-checked to verify that the right amount is paid to the right party. It's a complex process. Even the smallest error can result in a claim being rejected or denied, dragging out payment timelines and eating up provider profits. That's why healthcare providers should reevaluate their claims adjudication process. Experian Health is pleased to announce that we've ranked #1 in Claims Management and Clearinghouse, for our ClaimSource® claims management system, according to the 2024 Best in KLAS: Software and Professional Services report. Learn more The claim adjudication process is a pivotal step in the revenue cycle and determines a provider's reimbursement for services rendered. It's a complex process with many moving parts, which means errors or delays can occur at many points along the way. A smooth, streamlined system can reduce the amount of time and money spent on claims adjudication for both the payer and the provider. Here are six steps to improving claim adjudication processes for a better bottom line. What is claims adjudication? Claims adjudication is the process by which insurance companies thoroughly review healthcare claims before reimbursement or payout. During this process, they decide whether to pay the claim in full, pay a partial amount, or deny it altogether. If more information is needed, the claim will be rejected and marked as “pending.” Insurance companies employ this systematic procedure to determine the validity, accuracy, and eligibility of claims against the terms and conditions of their policy. During claims adjudication in healthcare, insurance payers assess the documentation provided by the service provider, examining factors such as the nature of the services, coverage details, and any applicable deductibles. The process can take weeks to resolve itself. This evaluative process ties up billions of dollars in an endless cycle of claims denials and resubmissions. Following this evaluation, the provider will reject or settle the claim. Additionally, claims adjudication may lead to partial settlements or modifications based on the assessment of the claim. By all accounts claims denials are exceedingly common; a recent Experian Health survey showed that these numbers have increased by up to 15% annually. Healthcare providers can implement several steps to mitigate the risk of denials, enhance the efficiency of claims adjudication and get paid faster. Steps to improving the claims adjudication process The healthcare reimbursement process is bogged down with manual tasks that create errors. Experian Health's State of Claims 2022 report revealed that the most common claims errors include: Missing or incomplete prior authorizations Failure to verify provider eligibility Mistakes in medical coding Yet providers have new technologies at their fingertips to improve how and when they get paid. McKinsey reports on data showing that applying the latest artificial intelligence (AI) and automation digital tools to the revenue cycle could save healthcare providers up to $360 billion annually. That makes these tools a kind of adjudication insurance to protect providers against costly claims denials. Here are six ways to apply technology to improve the claims adjudication process. Step 1: Invest in automation Some of the benefits of automating healthcare claims management include: Streamlined operations with fewer human errors. Less staff time tied up in claims adjudication. Better data with real-time insights into patient and payer trends. Faster claims processing—and faster payment. Better patient experiences. Happier staff. Applying AI and automation to claims management can eliminate errors by allowing the technology to validate and cleanse data at the point of entry. Tools like Experian Health's Claim Scrubber can thoroughly review each line of claim data in seconds. Alerts can flag a human attendant, allowing them to correct mistakes before claim submission. Automation technology like the Enhanced Claim Status streamlines the revenue cycle by tracking the claims adjudication process in real-time. Instead of submitting a claim and awaiting the payer's response, this technology provides claim statuses within 24 to 72 hours. Step 2: Prevent delays with front-end edits and save time spent in claims adjudication How much time could providers save by correcting front-end mistakes before the claims adjudication process begins? During claims adjudication, payers will compare claims data to payer edits, to make sure billed services are coded correctly. Therefore, providers must keep pace with current coding requirements and the universal, local and payer-specific edits that apply. If claims are not correct the first time, they'll fail the payer's initial automated review, and may be denied or pushed into a queue for manual review by a claims examiner, leading to inevitable delays. Front-end claims editing tools can find errors that might prevent reimbursement, such as missing prior authorization or coordination of benefits codes. Patient Access Curator, Experian Health's latest revenue cycle data curator package, helps healthcare providers eliminate errors quickly on the front-end. This solution uses AI to perform eligibility, COB, Medicare Beneficiary Identifier (MBI), demographics and discovery in a single solution, preventing denials at the front end with a single click, within seconds. Experian Health's ClaimSource® solution allows organizations to implement customized edits and rules tailored to specific payer requirements. These edits help catch errors related to coding, billing, or other aspects of the claim, preventing inaccuracies from progressing to claims adjudication. While the industry average for claims denials is 10% and higher, Experian Health clients who use ClaimSource have a typical denials rate of just 4%. That's one reason Experian Health's ClaimSource solution earned the top KLAS ranking for the second consecutive year. Step 3: Streamline record-keeping and data management Electronic record keeping plays a pivotal role in ensuring accuracy in healthcare claims. These platforms allow centralized storage of patient data, including medical history, treatment plans, and billing information. Electronic record systems can enforce standardized coding practices, ensuring that medical codes used for billing and claims adhere to industry standards. They also maintain detailed audit trails, documenting all changes and updates made to patient records. This level of accountability enhances accuracy by allowing organizations to trace any modifications and ensure data integrity throughout the claims adjudication process. Notably, electronic record-keeping systems seamlessly integrate with healthcare claims management systems. Integration ensures that the information entered into electronic health records (EHR) automatically populates relevant fields in the claim, minimizing the need for manual data entry and reducing the risk of transcription errors. Step 4: Automatically review coding for accuracy Coding errors can result in claim denials and delay reimbursements to providers. For example, manual coding introduces the risk of typos or misinterpretation of the medical record. Because of the complexities of payer requirements, an incorrect procedure or diagnosis code could trigger claim rejection. Some procedures require supporting documentation or pre-verification before treatment. At the same time, ICD-10 (codes for patient diagnosis) and CPT codes (that identify services rendered) undergo regular updates. Failing to stay on top of these coding systems increases the risk of a rejected claim. The solution is to apply AI and automation to improve the chance of claims adjudication success. Two solutions from Experian Health include: AI Advantage™ - Predictive Denials uses AI to spot documentation errors before the claim goes to adjudication. The solution automatically flags claims with a higher potential for denial, allowing the revenue cycle team to fix errors before claim submissions. For claims that have already been denied, AI-Advantage Denial Triage identifies and prioritizes high-value denials, so teams can focus on remits with the highest impact. Denial Workflow Manager allows providers to quickly identify denied claims early in the claims adjudication process. Remittance details show providers the steps necessary to amend the claim quickly for a higher chance of reimbursement. Intelligent data-driven denial analytics spot the root causes of denials, so remedial action can be taken. Step 5: Create clear patient communication channels Clear patient communication channels are essential for preventing errors in healthcare claims adjudication. Incorrect patient information can result in claim denials, causing delays in reimbursement and impacting both patients and healthcare providers. Automated patient outreach technology significantly enhances communication while reducing the likelihood of errors. Solutions like Patient Access Curator also work to capture accurate patient data at registration - all in a single click. Electronic patient portals, powered by automation software, can also solve this challenge. These portals empower patients to update their information directly, ensuring the accuracy of data submitted with claims. Patients can verify and input their demographic details, insurance information, and other relevant data through user-friendly interfaces. Electronic patient portals significantly reduce the risk of errors in patient information by minimizing manual data entry and streamlining the information-sharing process. These tools enhance the efficiency of the claims adjudication process, reduce the likelihood of denials, and promote a smoother experience for patients and healthcare providers. Step 6: Advocate for policy change Moving towards claims adjudication automation with uniform industry standards can save providers and payers time and money. Currently, each payer operates within their unique silo of ever-changing reimbursement requirements. A lack of standardization means providers spend hours checking claims against payer requirements. The first step toward industry standardization requires automation technology to eliminate these time-consuming manual processes. Digital solutions like Experian Health's online prior authorization software update requirements directly from payer websites, giving providers a better shot at submitting a clean claim. Advocating for healthcare policy change toward greater automation and more uniform industry standards is a strategic move that will save time and money and foster a more efficient, transparent, and technologically advanced healthcare ecosystem. This transformation will improve patient care and overall system sustainability. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more Improving healthcare claims management with Experian Health Today, nearly 20% of all healthcare claims are denied, and 60% are never resubmitted. That ties up significant revenue in the claims adjudication process. However, better claims management processes can yield reduced denials and faster payments. Experian Health offers a complete ecosystem of tools to deliver cleaner claims and faster reimbursement. This suite of products creates an integrated technology ecosystem with a track record of increasing the speed at which healthcare providers get paid. Find out more about how Experian Health's Claims Management solutions can support a more streamlined claims adjudication process.

Many healthcare providers believe pairing “revenue cycle” with a qualifier like “predictable” is an oxymoron. From healthcare staffing shortages that slow down reimbursement tasks to increasing payer denials, financial regularity can seem like an unattainable goal for these organizations.  The American Hospital Association (AHA) reports over one-half of U.S. hospitals had financial losses in 2022. Another AHA survey shows that 84% of these organizations say the cost of complying with complicated payer policies is climbing. Providers throw an excessive amount of time and staff at chasing revenue, but reimbursement complexities make for anything but smooth financial sailing. How can healthcare providers even out the ebbs and flows of the revenue cycle? Experian Health's suite of revenue cycle management (RCM) solutions can help. Revenue cycle predictability during the life of a claim When it comes to finances, U.S. healthcare providers rarely have an easy go of it. Today, the average life of a claim is anything but average. From registration to collections, hospitals established a new normal over the past decade: Widening gaps between service delivery and reimbursement. How can providers tackle this untenable situation? The answer is two-fold: with technology and at each stage of the life of a claim. Here are three ways healthcare providers can use technology to create reimbursement predictability at each stage of a claim's life. 1. Establish payment accountability at patient registration with price transparency Reimbursement problems begin at patient registration. Healthcare price transparency demands patients understand the cost of care. According to Experian Health's State of Patient Access survey, 81% of patients agreed that an accurate estimate helps them better prepare to pay for their care costs. However, only 31% of patients received a cost estimate before care. There are three significant impacts of this troubling trend: Nearly 40% of patients say they put off needed care due to cost. The number rises to 61% if the patient is uninsured. Patients can't afford to pay for needed care. Currently, 41% of U.S. adults have medical debt. An Experian Health study showed four in 10 patients spend more than they can afford on healthcare treatment. Uncompensated care causes a significant drop in healthcare provider income, which has amounted to almost $745 billion, according to the AHA. Experian Health offers several data-driven solutions to improve price transparency. These tools make it easier for patients to handle their financial responsibilities while helping providers find solutions to help ease their burdens.Patient Financial Advisor creates more accurate service estimates for patients before their procedure. The mobile-first platform offers patients a detailed cost breakdown on their preferred digital device. Patient Estimates is a web-based platform offering real-time service estimates. Blessing Health System uses the tool to provide patient estimates that are up to 90% accurate. The provider increased collections by 58% and credits the software with a 1,200% return on their investment. Patient Access Curator automatically initiates communication with payers to improve coordination of benefits and maximize return. It also automatically identifies missing or incorrect Medicare Beneficiary Identifier (MBI) numbers or errors in patient contact details. This solution also helps providers understand the patient's ability and propensity to pay, allowing these organizations to predict revenue streams after service delivery. Behind the scenes, Experian Health also automates insurance eligibility verification to unlock hidden reimbursements. This software roadmaps the correct coverage, connects to more than 900 payers and verifies insurance coverage at the time of service to improve cash flow and ease patient payment burdens. 2. Reduce claim denials by decreasing manual paperwork errors Claim denials are one of the biggest impediments to revenue cycle predictability. Providers are stuck in an endless cycle of inaccurate payer submissions, rejected claims, and rebilling, creating a chaotic chase for payment long after the service. Today, 35% of healthcare organizations report $50 million or higher in lost revenue due to claims denials. Even worse, Experian Health's State of Claims 2022 report showed that 30% of providers say denials are increasing by up to 15%. According to that data, the top three reasons for claim denials are: Missing or incomplete prior authorizations. Failure to verify provider eligibility. Coding inaccuracies. Experian Health's Claim Scrubber software levels out provider cash flow, creating predictability amidst the chaos. The solution reviews complete claims for errors, generating actionable edits before submission. Claim Scrubber also reviews approved reimbursement rates to prevent undercharging. Transactions process within three seconds and providers reduce the need to rework claims. Experian Health's AI Advantage solution uses the power of artificial intelligence (AI) to evaluate every claim for its propensity to turn into a denial. Instead of submitting claims and hoping the payer will accept them, this solution takes the guesswork out of reimbursement for a more rational, predictable process. The software automatically scans for payer updates to reimbursement requirements that significantly contribute to claims denials. Hospitals like Schneck Medical Center use this tool to streamline the revenue cycle by preventing denials. After just six months, the provider’s denied claims reduced by an average of 4.6% each month. Claim corrections that took up to 15 minutes manually are now processed in less than five. 3. Increase collections efficiency with automation Patients trust their healthcare providers to take care of them. Providers also rely on patients to pay their bills. It's a mutually beneficial arrangement. However, it's also a problem forcing providers to walk a delicate tightrope between caring for a sick patient while still chasing payment for their services. Unfortunately, the increasing cost of healthcare leaves patients on the hook for more than $88 billion in debt. The volume of healthcare payments in arrears is staggering, causing a substantial drain on provider cash on hand. However, technology offers healthcare providers a way to improve the patient collections process. For example, Coverage Discovery impacts the revenue cycle at every stage of the claim: Before providing care, the software scans patient data to determine reimbursement coverage options from Medicaid, Medicare, and commercial insurance. It scans for active insurance 30, 60, and 90 days after care delivery. The tool scans patient data before determining whether the account moves to bad debt collections. A more robust understanding of patient payment options at every stage of claims management allows healthcare providers to forecast reimbursements more accurately, increasing the predictability of the revenue cycle. Collections Optimization Manager provides organizations with actionable insights, so that providers can segment and prioritize accounts by proprensity to pay. This solution increases patient collections by leveraging Experian's data driven segmentation models, and helps providers screen out bankruptcies, deceased accounts, Medicaid and other charity eligibility ahead of time. Experian Health's AI Advantage – Denial Triage prioritizes rejected claims based on their yield potential, automating workflows for claims managers so they focus first on the patients more likely to pay. This tool segments denials based on their potential value to help even out the revenue cycle with a faster rate of financial return. Denial Triage expedites A/R by increasing revenue collection per person per hour. Revenue cycles can be more predictable, but the complexities of reimbursement require technology to achieve this goal. Experian Health offers a comprehensive line of revenue cycle management solutions to help healthcare providers maximize collections and improve RCM. Find out why Experian Health ranks Best in KLAS for 2024 in the categories of Claims Management & Clearinghouse and Revenue Cycle: Contract Management, or contact us for a more predictable revenue cycle, better cash flow, and a healthier organization.

Medical billing is the first line of defense against claims denials. However, medical billing errors cost U.S. healthcare systems approximately $935 million weekly. Not only do preventable errors wreak havoc on providers' revenue cycle, but patients say they're frustrated at the time spent correcting these errors—45% spend up to one month on the back and forth between payers and provider billing teams. Better medical billing software can automate claims management at the beginning of the reimbursement process and eliminate the traditionally labor-intensive processes plagued by human errors. Medical billing software can also make it easier for patients to pay and understand their coverage eligibility for fewer surprises after their care encounter. This article discusses how healthcare providers can implement these tools and set the stage for a better revenue cycle, happier patients, and more efficient care delivery. Common problems with medical billing Experian Health's State of Claims 2022 report showed healthcare denials increasing substantially each year. Some of the most common medical billing errors include: Medical coding transforms a healthcare service deliverable into reimbursable revenue. Yet Experian Health data shows that 42% of providers say inaccuracies in coding reporting lead to frequent claims denials. Coding errors delay reimbursement and, at worst, increase the risk of health system fraud, abuse fines, or even impact patient care with an incorrect diagnostic code. Patient information errors, including missing or incomplete prior authorizations, are among the top three reasons for claim denials. Even a misspelled name or date of birth can cause the claim to return to the provider for correction. Problems with outdated medical records and manual data entry exacerbate these issues. While each provider and payer has unique claims denial numbers to share, Medicare reports that the average volume of errors is just over 7%. Yet providers can't take all the blame for the volume of clerical errors given the complexities of ICD-10 requirements. Medical Economics explains, “The Centers for Medicare and Medicaid Services (CMS) announced 395 new diagnosis codes, 25 deletions and 13 revisions for the fiscal year (FY) 2024 ICD-10 CM code set.” Medical billing software is critical for preventing healthcare claims denials by keeping up with these complexities and avoiding human errors. What can the latest round of automated, artificial intelligence (AI) powered software do for the average healthcare provider? Prevent claims denials with better medical billing software Experian Health's Patient Access Curator solution heads off claims denials before they happen. The solution incorporates AI to improve the accuracy of claims management at patient registration and billing. The system leverages logic that returns multiple data points from a single inquiry in 30 seconds - streamlining benefits coordination, lessening patient identifier errors, and spotting “hidden” eligibility. Some of the benefits include: Faster and more accurate eligibility verification - Legacy medical billing software operates from a clearinghouse model. However, these tools often miss active, billable coverage and require extensive manual workflows to edit claims and appeals. AI eliminates the standard by-hand workarounds correlated with traditional billing software. Better coordination of benefits (COB) - COB denials are common in healthcare. Many patients do not understand the intricacies of government and commercial coverages and how they interact. Patient Access Curator can help. When integrated into the registration eligibility verification process, this AI-powered tool can lessen or eliminate COB denials by identifying hidden payer coverage requirements that outdated software cannot find. Additionally, the software can trigger automatic inquiries to third parties to verify active coverage quickly. Streamlines MBI conversions - How much time do providers spend tracking down Medicare Beneficiary Identifiers during patient registration? The complicating factor is that MBIs change without warning; many patients and providers find out after the payor rejects the claim. Providers can eliminate this frustration by adding software that automatically updates MBIs in real-time. No more searching websites, calling patients—or reworking the claim. Increases accuracy of patient demographic data - The quality of healthcare data can begin to erode at registration. Incorrect or obsolete patient data is a challenge for the entire industry. It makes sense that up-to-date, accurate patient demographic information improves their experience. Providers can eliminate obsolete or incorrect patient data with better medical billing software to lessen claims denials. Patient Access Curator automatically updates outdated information for cleaner claims and more accurate data. Automates coverage and financial verification for increased accuracy - Patients and providers benefit from AI automation that accurately identifies payment details. The solution is particularly beneficial for spotting missed revenue opportunities for self-pay, unbillable, or patients with unspecified payer status records. Patient Access Curator also identifies each customer's ability and propensity to pay, increasing the likelihood of successful revenue capture later while maintaining patient satisfaction and comfort. Reimbursement accuracy, staff efficiency, and patient satisfaction all stem from better medical billing software. Patient Access Curator offers healthcare providers a way to turn claims management into denials prevention. These tools apply a proactive, preventative automated process with artificial intelligence to increase downstream revenue by reducing claims denials. Experian Health, ranked Best in KLAS in Claims Management, Clearinghouse, and Revenue Cycle Contract Management for 2024, is the leading provider of technology solutions to improve healthcare reimbursement. Experian Health solutions have helped many healthcare providers obliterate claims denials. In 2023, the organization acquired Wave HDC, an AI-powered healthcare data curation solution leveraging the latest AI technology innovations for a better revenue cycle. To find out more, contact Experian Health today.

The State of Patient Access 2024 is the fourth in a series of patient and provider surveys that began in 2020. This year's report compares how patients experience access to care and providers' perceptions of those experiences. This blog post highlights findings from the survey, which was conducted in February 2024 and is based on 200 healthcare revenue cycle decision-makers and more than 1,000 patients. The study finds that perceptions of access to care are improving. It's a positive sign that providers are moving in the right direction—but there are still have mountains to climb. What remains the same from prior surveys is that providers believe access to care is much better than what their patients are truly experiencing. The survey showed 55% of healthcare providers believe patient access has improved. It's a big jump from 2022, when just 27% of doctors felt access increased. What's striking, however, is that patients don't completely agree. Only 28% say patient access improved in 2023, an 11% increase from the prior year. Over half (51%) of patients and 26% of providers say patient access has remained fairly static. While the findings show access is improving, there is still a gap between patient experience and provider perception. How can providers improve care access and make their perceptions a reality for their patients? Download The State of Patient Access 2024 report to get the perspectives from patients and providers on their perceptions of access to healthcare. Myths vs. realities of patient access The good news from the survey is that most providers and patients agree access to care isn't worsening. Despite increasing patient volumes and chronic staff shortages, patient access is better than before the pandemic. The findings are a sharp reversal from last year's report, where almost one-half of providers and one-fifth of patients reported care access had grown more challenging. Patient access is: Better Patients: 28% Providers: 55% The same Patients: 51% Providers: 26% Worse Patients: 22% Providers: 20% Consistently, across these annual surveys, providers believe access to care delivery is better than what their patients experience. The survey highlights opportunities to bridge this gap by using digital technologies to align the patient experience and provider assumptions. Opportunity 1: Provide accurate upfront financial estimates 96% of patients want an accurate upfront estimate of treatment costs. 88% of providers agree an accurate upfront estimate contributes to successful patient payments. The survey showed upfront cost estimates are central to a better patient experience. A high percentage of patients (96%) said an accurate estimate of treatment costs is essential before service—so crucial that 43% said they would cancel their procedure without it. Yet 64% of patients did not receive a cost estimate before care, despite increasing state and federal regulations that require this transparency. Perhaps even more troubling, the accuracy for those estimates is questionable. Of the 31% of patients who received a pre-procedure cost estimate, 14% reported the final cost was much higher than anticipated. At the same time, 85% of providers say their estimates are accurate most or all the time. The gap in provider perception and patient reality come together at the point of understanding the need for accurate cost estimates. Understanding what is covered by insurance helps patients manage their healthcare costs. Providers are invested in getting estimates correct because they are a key part of getting paid on time, in full. Patient payment estimates software can automatically create a more accurate picture of costs, reducing the burden on healthcare staff and eliminating unwelcome patient surprises. Consolidating service pricing estimate data from multiple sources empowers patient accountability and decision-making. One health system used these digital tools to increase point-of-service patient collections by nearly 60%, producing estimates that were 80 to 90% accurate. Opportunity 2: Improve data collection at patient intake 85% of patients dislike repetitive paperwork during the intake process. Almost half (49%) of providers say patient information errors are a primary cause of denied claims. The survey showed patients and providers are frustrated with the data collections process during registration. More than eight of 10 providers say automation could improve this process. Yet, in practice, intake remains primarily manual. Patients complain they shouldn't have to complete the same paperwork at each visit. Providers know these manual tasks lead to errors that cause big headaches for claims departments later. However, only 31% consider improving the speed and accuracy of collecting patient information a priority. The top reasons for claim denials are paperwork inaccuracies and missing or incomplete claim information. Human errors cause challenges when it's time for providers to get paid. Up to 50% of claims denials stem from a paperwork processing error at patient intake. As a result, in 2022 alone, healthcare providers spent nearly $20 billion pursuing reimbursement denials. Everyone agrees that providers must do all they can to prevent errors. Providers understand claims denials are a significant roadblock to cash flow. Patients grow frustrated when account balances remain in limbo long after their procedure is complete. Digital technology can streamline patient access and transform the healthcare revenue cycle. Experian Health's Patient Access Curator solution can check eligibility, COB, MBI, demographics, insurance coverage, and financial status in less than 30 seconds, in one click, speeding up the laborious human intake process that creates anxiety—and errors—for patients and providers. Opportunity 3: Give patients online self-service options 89% of patients said the ability to schedule appointments anytime via online or mobile tools is important. 63% of providers have or plan to implement self-scheduling options. According to this year's survey, self-scheduling is hot; waiting on hold with a call center is not. Digital and paperless pre-registration is increasingly important to patients and there is evidence that providers are finally starting to listen. For example, 84% of the providers strongly agreed that digital and mobile access is important to patients. However, self-scheduling did not make the list of the top three provider priorities for improving patient access to care. But the data tells us patients hold out hope for a mobile-first online scheduling process that puts them in the driver's seat to control their access to care. Convenient online scheduling software gives patients control over booking, canceling, and rescheduling appointments. It's a digital front door that's easy to use across any device. Automated notifications can remind patients of annual health exams, replacing the need for staff calls and closing any gaps in preventative care. These tools can reduce time spent scheduling patients by 50% and significantly decrease appointment no-shows. More importantly, they give patients the digital experience they demand. Digital technology brings together patient experience and provider perceptions The State of Patient Access 2024 survey illustrates a narrowing gap between what providers perceive and patients experience. That's good news because a lack of access to healthcare is a contributing factor to a sicker population, which costs much more in the long run. According to Deloitte, barriers to accessing healthcare in this country will grow to a $1 trillion problem by 2040. Patients will continue to experience care access issues in the coming years, from staffing shortages and a lack of rural providers, higher co-pays and more. Can we bridge these future gaps? The answer is a resounding yes. While there's still work to do, the survey showed that 79% of providers plan to invest in patient access improvements soon. Download The State of Patient Access 2024 to get the full survey results, or contact us to see how Experian Health can help your organization improve patient access. 

Technology has a long track record of improving patient care. But humans are now entering uncharted waters as the latest wave of digital tools impact healthcare clinical and administrative workflows. Technology advancements in artificial intelligence (AI) have spawned a fourth industrial revolution. According to the World Economic Forum, it's a time in history “that will fundamentally alter the way we live, work, and relate to one another. In its scale, scope, and complexity, the transformation will be unlike anything humankind has experienced before.” New developments in AI and automation in healthcare will offer numerous benefits to providers. The impact of recent technology advancements in healthcare is staggering. New AI and automation tools can detect human illnesses faster, monitor patients in the privacy of their homes, and streamline laborious administrative healthcare workflows to save providers up to $360 billion annually. The impact of AI and automation in healthcare is just beginning. Here are three ways these tools can help prevent and reduce claim denials, alleviate staff workloads and improve the patient experience. 1. AI and automation helps lessen claims errors Experian Health's State of Claims Survey 2022 reported that 61% of providers rely too heavily on manual processes and lack the automation necessary to streamline reimbursement. Billions of dollars are tied up in rejected claims; healthcare professionals say up to 15% of their claims are denied. However, many denials are preventable simply by eliminating human error stemming from manual workflows. When paperwork is still done by hand, mistakes in eligibility verification or incorrect insurance information are all too common. Some of the typical reasons for claims denials include data entry errors. Claims are complex, and providers handle most revenue cycle tasks manually, so it's common for incorrect insurance details, eligibility verification problems, or other inaccurate or missing information to make it through to claims submission. Far from being science fiction, the newest AI-powered administrative tools can scan patient claims data to detect errors that lead to denials. Given that diagnostic errors alone cost more than $100 billion and affect 12 million Americans annually, this new breed of AI tools offers providers a way to improve care delivery while lessening the endless hassle of claims denials. AI and automation tools can help eliminate up to errors that lead to denied claims. For example: Patient Access Curator automates insurance eligibility and coverage, scanning patient documentation for inaccurate information. The software uses AI and robotic process automation (RPA) to reduce manual errors. AI Advantage™ works to prevent denials before they happen: AI Advantage -Predictive Denials spots claim errors before submission to the payer. It's an early warning system designed to reduce denials by red flagging claims errors. But it also flags claims that fail to meet payer requirements—even if those requirements have recently changed. 2. AI and automation reduces manual processes and staff burnout Manual processes in healthcare contribute significantly to burnout, which affects nearly 50% of staff. The cost of staff burnout and preventable turnover runs around $4.6 billion annually. However, overworked staff leads to mistakes in manual processes and ultimately claim denials, so the cost of burnout directly affects the revenue cycle.Experian Health's 2023 staffing survey shows 100% of healthcare providers say staffing shortages have impacted their revenue cycle. But staff burnout and turnover affect more than reimbursement—more than 80% say it also negatively impacts the patient experience. AI and automation in healthcare can help alleviate the overwork that many staffers feel. Experian Health offers solutions to automate manual tasks, free up staff time, and reduce the volume of claims denials. ClaimSource® reduces the industry's average claims denial rate of 10% or higher to 4% or less. This software automatically scans claims, payer compliance, insurance eligibility, and patient demographics to spot the errors that lead to denials. Automating claims submission lessens the administrative burden and improves the work/life balance for overburdened staff. AI Advantage - Denial Triage covers any claims that end up rejected, prioritizing claims with the highest rate of ROI for providers. The solution uses artificial intelligence to help staff organize their efforts toward the highest revenue generating opportunities to increase revenue collection. It can lessen workloads and help teams work smarter for a higher return and better bottom line. 3. AI and automation in healthcare improves patient experiences Automation improves the patient journey. Experian Health and PYMNTS research show positive patient experience starts with self-service scheduling and registration. This kind of digital front door puts control back in the hands of patients, who are frustrated by time-consuming administrative processes. Patients have high expectations for better tech experiences throughout their healthcare encounters. Experian Health offers solutions that give customers exactly what they demand. For example: Patient Scheduling software allows 24/7 online access to appointment setting tools. In addition to making a more convenient and accessible scheduling process, this tool reduces the time it takes to set an appointment by 50%. The benefits for healthcare providers include a higher patient show rate (89% on average) and higher patient volumes (32% more patients per month). Patient Financial Advisor offers seamless, automated service estimates that go straight to the patient's favorite digital device. The tool creates a transparent payment process to help patients understand their treatment's cost and payment options. Patient Financial Advisor integrates with a secure online payment portal. These tools establish financial accountability up front while eliminating unnecessary surprises that affect the provider/patient relationship. Benefits of AI and automation in healthcare AI and automation in healthcare are changing how patients experience care delivery, how providers interact with their customers, and how clinicians manage getting paid. The benefits of using these tools include: Faster and more accurate patient diagnoses. Fewer patient readmissions and more proactive care management. Streamlined administrative tasks to reduce claims denials and improve the revenue cycle. Experian Health offers a suite of technology solutions, including a revenue cycle data curator package, to help providers get paid faster, free up staff time, and improve the patient experience. These solutions can help healthcare organizations achieve their goals by harnessing the latest AI and automation technologies to work smarter. Connect with an Experian Health expert today.