Tag: price transparency

The growing shift from inpatient to outpatient care continues. The U.S. ambulatory services market was estimated at USD 289.5 billion in 2023 and is projected to grow at a CAGR of 5.38% from 2024 to 2030. A Deloitte study notes that the gap between inpatient and outpatient revenue has been closing for two decades. But what's driving this boom? Clinical advances, patient demand for lower-risk and lower-cost options and payer pressure all play a role. New technologies, like advances in orthopedics, allow more procedures to be performed at outpatient service centers instead of costly hospital settings. Free-standing ambulatory surgery sites are expected to see a 14% volume boost over the next decade as more service lines, like cardiovascular and neurosciences, begin to shift procedures from inpatient to outpatient facilities. The ongoing growth in outpatient services presents a unique opportunity for revenue cycle leaders to use technology to improve outpatient revenue—and the overall patient experience. Grow outpatient revenue with more digital care Patients want a better experience at every step of the patient journey. They want to see their doctor faster, manage appointments online and understand how much it costs—with as little red tape as possible. A lack of streamlined patient access and transparency often results in no-shows, a rise in claims denials, wasted staff time and patient complaints. However, by opening the digital front door, providers can give patients the self-service tools they crave, improve the care experience, keep outpatient schedules full and increase revenue. Additionally, providers can use technology like artificial intelligence (AI) to lower claim denial rates. Here are five strategies to increase outpatient revenue in 2025. 1. Make patient access simple Patients want to see their doctor faster. In Experian Health's latest State of Patient Access survey, eight in ten patients who reported being unhappy with their provider experience cited waiting for an appointment as a top complaint. When trying to schedule, patients are also frustrated by the friction that comes with complex processes, clunky technology systems and sparse provider communication. Outdated manual workflows, staffing shortages and lack of staff training often result in challenges for both patients and providers. Improved patient access is at the heart of patient-centered healthcare. Technology designed to put the patient in control, like online patient scheduling and digital patient intake tools, offer continuous patient engagement, optimized scheduling, and streamlined administrative processes. By leveraging modern patient access solutions, providers can improve patient experiences and alleviate the impact of staffing shortages. 2. Reduce appointment no-shows Missed appointments cause headaches for patients, providers, and revenue cycle managers. Online scheduling and mobile registration are also top of mind for patients. In Experian Health's State of Patient Access 2024 survey, 89% of patients said they wanted self-service scheduling and 85% reported a dislike for filling out repetitive intake paperwork. Online patient scheduling software puts patients in the driver's seat, providing convenient and secure 24/7 access to book, reschedule, and cancel appointments on their own time. Solutions like Patient Schedule sync seamlessly to an organization's scheduling rules, and patients receive automated appointment reminders by text or IVR. On average, providers that use Experian Health's scheduling solution experience an 89% show rate, a 50% reduction in scheduling time, and a 32% increase in patients per month. Patient intake tools like Registration Accelerator simplify mobile registration with a streamlined text-to-mobile experience. Once registration is complete, automated returns of forms, patient-check-ins and demographic information ease the burden on staff. 3. Help patients prepare for outpatient costs Patients need a clear breakdown of their financial responsibility before receiving care. Without it, they may be unable to prepare for care costs appropriately. While hospitals are now required to share detailed pricing for at least 300 common procedures, confusion around a patient's actual financial responsibility still persists. More than half of patients report turning to their provider for help understanding what insurance covers. Digital solutions that provide accurate, upfront estimates empower patients. More than eight in ten patients say pre-service estimates help them prepare for the cost of care. Patient Payment Estimates provide upfront, real-time estimates of what a patient will owe. Providers can offer convenient and secure payment links, and allow patients to pay their bills online or see customized payment plans. Outpatient providers can further maximize the chance of reimbursement by running health insurance coverage checks across the entire revenue cycle. This can help find billable coverage that may have been forgotten and give patients greater certainty about what they'll owe. 4. Automate healthcare collections Collections are often a major challenge in the outpatient revenue cycle. Outpatient procedures can be costly, even with insurance, leaving patients responsible for potentially large bills. Automating healthcare collections allows for faster, more efficient, and more compassionate collections. Tools like Collections Optimization Manager helped Novant Health achieve an overall recovery rate of 6.5% and increase revenue and cost savings to a rolling average return on investment of 8.5:1. With automated tools like Patient Financial Clearance, providers can assess patients' ability to pay and assign them to an appropriate financial pathway. This allows patients to quickly get the assistance they need while freeing up valuable staff time. 5. Streamline claims to increase outpatient revenue Denied claims continue to be problematic for providers. In Experian Health's State of Claims 2024 report, which surveyed 210 healthcare revenue cycle leaders, nearly three-quarters of providers feel claims denials are increasing, while 67% feel getting paid is taking longer. Claims management software can help end the cycle of denials. However, around half of providers still use a manual claims review process, and only 28% feel confident in their understanding of automation, machine learning and AI. Adopting automated and integrated healthcare claims management solutions can reduce errors, prevent undercharges, and ensure a higher first-pass payment rate. Tools like Experian Health's ClaimsSource® simplify the entire claims process, while Claim Scrubber helps providers submit more accurate claims. Digital solutions can also automate claim status monitoring and eliminate manual denial processes. Implementing AI tools to interpret past claims data and recommend next steps can improve outpatient claim denial statistics. Tools like AI AdvantageTM look at past payer behavior and historical claims data to predict and prevent denials. AI Advantage's two components, Predict Denials and Denial Triage, help providers respond to growing denial challenges by identifying claims with a high likelihood of denial before submission, and focus on remits that have the most impact. See how: Find out more about how Experian Health's revenue cycle management solutions can help healthcare organizations increase outpatient revenue, keep pace with growing patient volumes, improve patient satisfaction and boost their bottom lines. Learn more Contact us

Surprise tends to magnify human emotion. If the surprise is positive, a person's reaction to it will be intensely positive. If it's negative, it will be extremely negative. Such is the case with unexpected medical bills, and that's one reason why the No Surprises Act was passed in 2021. It aims to protect consumers from unexpected bills for out-of-network care in both emergency and non-emergency settings. Thanks to the Act, U.S. healthcare organizations must now provide transparent details of the estimated costs of their services – otherwise known as patient estimates. And, so far, it's working. One 2023 survey by Blue Cross Blue Shield and AHIP shows that "The No Surprises Act (NSA) prevented more than 10 million surprise bills in the first nine months of 2023 — continuing to protect millions of Americans from crippling medical bills each year." And as insurance deductibles and out-of-pocket expenses continue to rise, patient estimates are becoming even more critical. Experian Health's State of Patient Access Survey 2024 shows that both patients and providers would like to see improvement in the accuracy of patient estimates. Surveys show that 4 in 10 patients say they spent more on their healthcare than anticipated, and nearly one-quarter received surprise bills after treatment. Creating service transparency takes an effort, but there are also hidden benefits for providers. With medical debt skyrocketing past the $220 billion mark and the cost of care increasing, patient estimates apply much-needed rigor to healthcare billing and collections practices. Why are patient estimates important? Pricing estimates enhance the healthcare experience by making the financial responsibilities of treatment more transparent and more manageable. The benefits for patients include: Understanding potential treatment costs, allowing them to plan and avoid unexpected expenses Making informed decisions about their healthcare options by comparing the costs and benefits of different treatment plans Fostering transparency and trust between healthcare providers and patients Better coordination with insurance providers so they know what will be covered and what will be an out-of-pocket expense Reduced financial anxiety, allowing patients to focus more on their recovery and less on potential financial stress Increased cost awareness and acceptance, prompting them to comply more readily with treatment plans and not cancel appointments Providing a price quote empowers patients while creating a more efficient healthcare system of services rendered and payments received. Why are patient estimates useful prior to treatment? It's better for patients, and the healthcare system as a whole, if patients are more focused on healing and self-care than the stress and anxiety of an unexpected medical bill. If they know what's coming, patients can take control and make plans to alleviate any financial turbulence. In the case of planned care and procedures, pre-treatment cost estimates also allow patients to shop around for the best balance between service and price. In addition to helping patients make smarter treatment choices and financial decisions, patient estimates also help people understand, navigate and coordinate their insurance benefits. That also helps them avoid medical billing surprises that can later lead to collections and damage to their credit scores. How do patient estimates help providers? In today's healthcare landscape, where value and patient experience are key factors in reimbursement, transparency has become crucial in four ways: More satisfied patients: Estimates build trust and patient and provider relationships. This trust is essential for effective communication and patient satisfaction and can help reduce patient churn. Better adherence to treatment plans: Patients aware of the financial implications are more likely to stick to their treatment plans and follow through with necessary procedures and lifestyle changes. Adherence leads to better health outcomes and a more efficient treatment process. Better resource management: Knowing each patient's expected costs and required resources allows providers to allocate and schedule resources more effectively. Improved revenue flow: Pricing estimates at the front end of the medical journey establish upfront financial accountability, which can lead to providers being paid more quickly. As healthcare costs rise, improving price transparency is a win-win for both patients and providers. Patients want clear, upfront information about treatment costs, insurance coverage and payment options so they can plan ahead with confidence. When providers make this process smoother, it benefits everyone—saving time, reducing stress, and making things more efficient. Plus, it can help avoid those tough conversations when patients are caught off guard by unexpected bills. Providing the right information from the start creates a more positive experience for everyone involved. Technology can help create accurate patient estimates Experian Health's Patient Estimates tool makes price transparency and providing accurate estimates easier. This solution leverages real-time data, including insurance coverage, payer contract terms and provider pricing, so that everyone knows exactly where they stand before the service is rendered. Patients can focus on getting well while providers create the accountability they need to get paid promptly. With the right technology, patients and providers can come together in a mutually beneficial and less stressful encounter that leads to better relationships and better health. Contact us to learn how Experian Health can help your healthcare organization empower patients with clear, accurate cost estimates to enhance transparency, build trust and improve overall care satisfaction. Patient Estimates Contact us

The fine line between getting paid what they're owed and delivering compassionate care puts patient collections among the top challenges for providers. Improvements to collections processes feature prominently in Experian Health's most recent State of Patient Access survey: 94% of providers pointed to the need for more accurate patient estimates, while equally many want faster, more comprehensive insights into what patients' insurance actually covers so they can make the billing process easier for everyone. The challenge is even starker when the patient's perspective is considered. More than four in ten patients are so worried about the bill that will later land on their doorstep that they’d avoid care altogether. Even those who have insurance are struggling: 53% of total bad debt write-offs in 2023 came from patients with some form of insurance. As healthcare becomes more expensive, insurance becomes more complex, and patients become more cost-conscious, providers must find ways to improve the patient collections processes. This article looks at how technology can bridge these competing demands. What are patient collections in healthcare? Patient collection processes cover all the steps involved in calculating, invoicing and obtaining payment for the amount the patient owes for their healthcare treatment. Figuring out the patient's financial responsibility starts when the patient registers for care and when the provider can check for active insurance coverage. Once verification and eligibility processes are complete and the provider knows how much of the total cost will be covered by an insurer (if any), they can estimate the patient's responsibility. The earlier this happens, the better. What makes the process so complex is the number of moving parts: Payer policies change regularly, and staff must keep up to date or there will be gaps and errors in claims submissions and patient estimates Healthcare costs are increasing, leaving providers with tighter margins and less room to maneuver Patients are increasingly worried about whether they can afford healthcare, as household bills continue to increase despite economic improvements Patients expect a wider range of payment options, with 72% of patients emphasizing the need for online and mobile payments to enhance their health experience. Billing staff cannot tell which patients are able and likely to pay due to insufficient data on patients' economic and credit history. Part of the problem for healthcare providers is that their systems are geared more toward traditional collections from government or private payers. Still, the average patient's responsibility is at an all-time high. For healthcare providers to increase the volume of revenues they collect from patients, they must invest in technologies that provide consumers with a frictionless payment experience. How can patient billing and collections be improved? One way to think about improving patient collections is to break it down into its parts: How to calculate and communicate more accurate, upfront estimates to patients How to figure out a patient's propensity to pay based on segmentation data How to compile and share clear and comprehensive bills and financial statements How to offer patients various digital and mobile options to make prompt payments. Advanced technology offers solutions for each step, while creating a seamless experience overall. In a recent byline, Clarissa Riggins, Chief Product Officer at Experian Health, says that manual systems can't cut it any longer: “It's time to move away from the notion of collections as a one-off, manual and labor-intensive process. Instead, let's view it as a part of an ecosystem that begins before patients receive treatment, starting with upfront, self-service payment options and early screening of patients for potential coverage. In this way, we can transform collections from a destination into a process—and perhaps, by doing so, we can even put our traditional collections departments out of business.” How does technology improve patient collections? Prompt and accurate patient estimates Almost nine in ten providers agree that providing accurate, up-front estimates improves patient collections success. Patient Payment Estimates give patients the expected cost of care ahead of time, so they're in a stronger position to plan – and providers get paid faster. Automated estimates increase revenue and help providers stay on the right side of compliance with rules and regulations. Analytics-based collections optimization When compiling accurate bills to patients and payers, providers have a wealth of technical options at their disposal. For example, Collections Optimization Manager uses in-depth data and advanced analytics so providers can identify patients most likely to pay and ensure patient accounts are handled most efficiently. Patients are segmented by propensity-to-pay scores based on behavioral, demographic and credit data. This supports tailored billing and collections strategies and improves financial outcomes by identifying patients most likely to pay and ensuring patient accounts are handled most efficiently. Case study: See how St Luke's University Health Network used Collections Optimization Manager to improve patient engagement and boost cash collections by 22%. Quick and convenient ways to pay Riggins says that improving payment processes is a significant step toward maximizing patient collections in healthcare. Previous research has shown that while credit and debit cards are the most popular payment methods, patients would use them less often if their preferred digital options were available. Providers should consider digital tools such as PaymentSafe® to offer patients fast, frictionless and secure payment options across multiple collection points, including interactive voice response, mobile, kiosks and patient portals. Automating patient outreach to increase collections Another use case for patient access technology is in facilitating direct and efficient communications with patients while reducing the workload for staff. Automated patient outreach tools such as PatientDial and PatientText send patients timely bill reminders and self-pay options via voice or text message to increase collections without the need for agent interaction. These tools bring more dollars in the door while reducing operational costs: PatientDial helped Experian Health's clients collect over $50 million in one year via automated call campaigns, saving many thousands of labor hours compared to manual outreach. Personalizing payment plans for every individual From the patient's point of view, a winning strategy calls for transparency and personalized support. Creating a collections process that accommodates patients' individual circumstances will increase revenue while improving the patient's financial experience. For example, Patient Financial Clearance analyzes each patient's financial situation and creates a personalized payment path that fits their needs. It screens self-pay patients to identify those who need extra support and reroutes them to the proper channels. Where relevant, providers can then offer the option to pay in more affordable installments or connect the patient to financial assistance programs. Together, these tools improve collections by streamlining how patients pay – and how providers get paid. Maximize patient collections with Experian Health Walking the patient collections tightrope demands that providers take bold action and experiment with new approaches. That might feel risky when the stakes are so high, but working with a trusted vendor with experience in delivering leading patient collections solutions should ease concerns. Experian Health's suite of collections management and secure, reliable payment solutions integrate easily with existing systems and processes for a seamless end-to-end collections experience. Contact us today to learn more about maximizing patient collections in healthcare with Experian Health's leading collections management technology.

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

The Price Transparency Rule, effective January 1, 2021, requires hospitals to provide clear and accessible pricing information about their items and services online. Although the rule is simple in theory, hospitals are finding it challenging to implement. Under the rule, hospitals can make their pricing information clear and accessible by publishing it online as a comprehensive machine-readable file (MRF) with all items and services and in a display of shoppable services in a consumer-friendly format for at least 300 shoppable services. The Centers for Medicare & Medicaid Services (CMS) states that the rule aims to "help Americans know the cost of a hospital item or service before receiving it." This rule represents a giant stride towards delivering much-needed and long-awaited benefits associated with price transparency. These include empowering consumers to make informed healthcare purchasing decisions based on the costs and benefits involved, enabling cost predictability and closing the information gap between providers and patients. It is also an eye-opener for consumers, preventing them from falling victim to wide price discrepancies prevalent in an opaque pricing system. As Tricia Ibrahim-Zafari, Director of Product Management at Experian Health, states, "The requirements are meant to help patients become true consumers of healthcare." However, the success of the concept of price transparency hinges on hospitals adhering to and implementing the rule. Unfortunately, reports have found that hospitals have struggled with compliance since the rule was enacted. One of the reports, published in February 2024 by the Patient Rights Advocate, found that three years after the Hospital Price Transparency Rule took effect, only 34.5% (689) of the 2,000 U.S. hospital websites analyzed fully complied with the rule's requirements. One of the barriers to the adherence to and successful implementation of this rule is its constant and frequent evolution, making it challenging for hospitals without efficient price transparency solutions to keep up. Stricter penalties due to low compliance rates, increased public access to pricing and the challenging financial environment prohibiting flexible price changes exacerbate existing pressure on hospitals, Ibrahim-Zafari explained. The good news is that hospitals looking to meet the transparency requirements, including the Price Transparency 2024 updates while delivering high-quality care for all, can explore Experian Health and Cleverley & Associates solutions for Price Transparency compliance. These price transparency tools in healthcare help providers comply with the Price Transparency Rule, improve price defensibility and create financial opportunities, as affirmed by Ibrahim-Zafari. Price Transparency 2024 updates: the latest in the price transparency regulatory environment Jamie Cleverley, President of Cleverley & Associates, emphasized that the earlier language of the Price Transparency rule is grounded in provisions of the Affordable Care Act (ACA) and displays noteworthy similarities. Both require making consumer-relevant information easily accessible for easier comparison shopping and providing insights into negotiated rates between clinicians and insurers in a machine-readable format. However, the Price Transparency rule has evolved ever since. Since its introduction in 2021, the Price Transparency Rule has been continuously updated to better align with its intent, to adapt to the changing healthcare landscape and to encourage compliance. For example, Ibrahim-Zafari noted that in 2022, CMS increased the penalty for non-compliance with price transparency requirements from $110,000 to over $2 million a year. Additionally,  the agency imposed stricter timelines for hospitals to address pricing data issues and streamlined the enforcement process. The Price Transparency 2024 updates required to be implemented by hospitals on January 1, 2024, July 1, 2024 and January 1, 2025, fall under five broad categories: new definitions, good faith estimate and machine-readable file (MRF) attestation, ​​standardization of the MRF format and data elements, improving access to hospital MRFs and enhancing enforcement and compliance. Put simply, CMS established definitions for specific terms in regard to the new definitions category. Let's delve into the remaining categories under the price transparency 2024 updates. Good faith estimate and machine-readable file (MRF) attestation The good faith estimate and MRF update emphasize hospital leadership's obligation to verify the MRF content's comprehensiveness and accuracy. Good faith effort - Starting January 1, 2024, CMS requires every hospital to make a good faith effort to ensure that the standard charge information stored in the MRF is accurate and complete. MRF Attestation - Starting July 1, 2024, hospitals must attest to the completeness and accuracy of the applicable standard charge information in their MRF. Cleverley explains that the good faith effort update does not require hospitals to include any attestation on their website or in their machine-readable file. However, beginning July 1, hospitals will be required to use the CMS template for the MRF, which includes an attestation comment, where they must select true or false. Standardization of the MRF format and data elements CMS also introduced updates that ensure the standardization of the MRF formats and data elements across the board. Starting on July 1, 2024, hospitals must format the contents of the MRF into a specific template. This template can be in either .JSON or .CSV format. According to Cleverley, the .JSON format is digital-friendly, making it the preferred option for hospitals. The .CSV format, on the other hand, is more consumer-friendly. Furthermore, the Price Transparency 2024 updates introduced additional required data elements, including five types of standard charges. Some of the new data elements, including "Estimated Allowed Amount," "Drug Unit of Measurement," "Drug Type of Measurement," and "Modifiers," have been stated to be implemented on January 1, 2025. Improving access to hospital MRFs To make hospital MRFs more accessible, CMS requires that from January 1, 2024, hospital websites must include a .txt file in the root folder containing their MRF and contact information. In addition, hospitals are required to include a "footer" at the bottom of their homepage, linking to the webpage that hosts the MRF. Enhancing enforcement Considering that hospitals have been slow to comply with the price transparency requirements, it's not surprising that CMS is ramping up its enforcement efforts through four measures. Increasing scrutiny of hospital compliance efforts - CMS is increasing scrutiny by authorizing comprehensive compliance reviews. Under the Price Transparency 2024 updates, they can also request hospitals to have an authorized official certify the accuracy and completeness of MRF data and submit additional documentation, including payer contracts, to evaluate compliance. Acknowledging warning notices - Hospitals must confirm receiving warning notices from CMS whenever they receive such notice. Addressing system-wide non-compliance - If CMS finds a hospital part of a health system to be non-compliant, they can notify the health system's leadership to address potential defaults from other hospitals within the health system. Publicizing actions and outcomes - CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. CMS noted that it may publish information related to a hospital's compliance assessment, including details about any actions taken and notifications sent to health system leadership. Experian Health and Cleverley + Associates solutions for price transparency compliance Compliance with the Hospital Price Transparency Rule is indispensable to achieving price transparency. To support providers in adhering to these rules in the best and most efficient way possible, Experian Health and Cleverley & Associates solutions to provide solutions that ensure maximum compliance while improving price defensibility and creating revenue opportunities. Experian Health's Patient Payment Estimates help providers compile a consumer-friendly list of shoppable service items. Cleverley & Associates provides fully compliant and comprehensive machine-readable files for the hospital's "items and services." The price transparency tools in healthcare are available in two options to cater to the specific needs of healthcare organizations: Machine-Readable File - Standard: This solution provides machine-readable files only in the standardized payer-specific negotiated charge format. Machine-Readable File - Premium: This package provides a price transparency machine-readable file and includes consulting services to assist with price changes. Navigating price transparency requirements in the ever-changing healthcare landscape can be daunting. However, the task becomes seamless with solutions from Experian Health and Cleverley & Associates for price transparency compliance. Healthcare organizations can now stay up to date with and meet evolving transparency rules while also improving profitability. Watch the on-demand webinar, featuring experts from Experian Health and Cleverley & Associates, to learn more about the new updates and explore the latest developments and strategies to navigate price transparency in 2024.

Healthcare price transparency is high stakes for both patients and providers. With the average cost of a hospital stay for patients in the United States amounting to $2,883 a day, a patient's bill can quickly add up. Patients need reliable information about the cost of services as early as possible so they can plan accordingly. For providers, transparent pricing helps deliver a more compassionate patient financial experience and reduces the risk of missed revenue opportunities. However, it's also a compliance issue, especially with the introduction of the Hospital Price Transparency Rule. While the Centers for Medicare & Medicaid Services (CMS) found that 70% of hospitals are in compliance as of February 2023, the goal is to reach 100% compliance. Experian Health and Cleverley + Associates have joined forces to address the challenges providers may be facing. Riley Matthews, Lead Product Manager at Experian Health, and Jamie Cleverley, President of Cleverley + Associates, discuss what hospitals need to do to comply with the Hospital Price Transparency Rule. What is hospital price transparency and what is the Hospital Price Transparency Rule? The introduction of CMS price transparency requirements has brought about substantial shifts in the landscape of price disclosure for hospitals across the United States. Enacted as part of the FY19 IPPS Final Rule, these requirements were established in alignment with provisions outlined in the Affordable Care Act. Hospitals are now mandated to provide a comprehensive list of their current standard charges via the Internet in a machine-readable format, with updates required at least annually or more frequently as deemed necessary. This information can be presented in the form of a chargemaster or any other format chosen by the hospital, as long as it meets the criteria of being machine-readable. What are the new price transparency updates coming on July 1, 2024? As of July 1, 2024, CMS mandates that hospitals affirm the completeness and accuracy of their machine-readable file (MRF). This affirmation includes confirming that all applicable standard charge information, as required by § 180.50, has been included in the MRF. Furthermore, hospitals must assert that the encoded information is true, accurate, and up-to-date as of the specified date indicated in the MRF. Also starting on July 1, 2024, CMS will require hospitals to convert the contents of the MRF into a predefined template. This template is available in either .JSON or .CSV format. Additionally, there are new mandatory data elements, supplementing the previously specified ones (e.g., the five types of standard charges). Some of these new data elements have a delayed implementation date of January 1, 2025. What's the difference between the Hospital Price Transparency Rule and the No Surprises Act? The Hospital Price Transparency Rule aims to give patients clear, upfront information about hospital pricing, so they are empowered to make informed choices about their care. The No Surprises Act offers patients protection from surprise billing when they receive certain emergency and non-emergency services from out-of-network providers at in-network facilities. The two sister mandates work together to improve the patient financial experience and help patients navigate their financial obligations. What are the most common price transparency compliance challenges?  Cleverley says there are two main reasons why hospitals may be struggling to comply. First, there is some confusion about what is required to be disclosed (and how). To bridge this gap, Experian Health and Cleverley + Associates have created a standard methodology that satisfies the rule requirements. Second, some providers are hesitant to disclose pay rates amid concerns over financial viability and potential pressure to lower charges. However, the price transparency rule aims to enable market competitiveness and empower patients. Furthermore, making cost estimates freely available improves patient satisfaction by 88%, according to data from PYMNTS and Experian Health. A patient-centered approach to billing and payments not only supports compliance with price transparency regulations, but leads to faster payments and consumer satisfaction. In addition to Patient Estimates and Patient Financial Advisor, which offer patients accurate, pre-service cost estimates, there are a host of other Patient Payment Solutions that allow patients to choose payment plans, manage bills and make payments. How are Experian Health and Cleverley + Associates helping providers comply with the Hospital Price Transparency Rule?  The Hospital Price Transparency Final Rule requires hospitals to display payer-specific rates as a consumer-friendly list of 300 shoppable service items. Experian Health's Self-Service Patient Estimates solution helps providers compile these lists and deliver accurate estimates to patients in a clear and comprehensive way. This puts consumers in the driving seat when it comes to making informed healthcare choices and supports hospitals in providing clear, accurate and legally compliant pricing information. Providers must also make certain pricing information for items and services available as a machine-readable file displayed on their website. Cleverley + Associates has the necessary capabilities to deliver the machine-readable files quickly and at scale. By working together, both organizations deliver a holistic solution to meet price transparency mandates. Jamie Cleverley says this helps hospitals prepare for the changing environment: “It's more than compliance. It’s having trusted partners that are talking through and consulting with hundreds of hospitals across the country.” What is the best approach for providers to ensure price transparency compliance? Riley Matthews says that the first step for providers is to define a strategy that best fits their individual organization. They should identify best practice workflows based on their existing resources and intellectual property and partner with an organization that can bring solutions to areas where the system is lacking. The key is to execute the business strategy while prioritizing the patient experience. Experian Health and Cleverley + Associates can support hospitals in providing an efficient, consumer-friendly workflow, as well as the more robust backend concepts of the machine-readable file. Cleverley says, “We've created a methodology to display aggregated claim payment levels, simplifying the display of information for both hospitals and patients. Many solutions attempt to display just a list of payment rates, but the combination of those lines is really what's most relevant to patients.” For example, a patient coming in for an outpatient surgery has no idea what additional services, drugs and tests they may need. This solution looks at the statistical utilization of services to calculate the charges for that procedure, and then displays that value. This holistic approach meets “not only the letter of the law, but also the spirit of it.” What's next for price transparency? There has been a significant challenge around non-uniformity of data. Hospitals have been using different structures and file formats for displaying required information, but CMS has implemented a standardized file schema for use beginning July 1, 2024.  Cleverley + Associates has a file structure that conforms to the Medicare standard schema and is available to help hospitals understand the new requirements. As the penalties for non-compliance increase, providers need to be proactive in reducing the financial risks associated with price transparency non-compliance. Riley Matthews says that innovation and partnership helps providers get ahead of compliance rules and allows hospitals to focus on patient care. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations comply with the Hospital Price Transparency Rule and improve the patient financial experience.

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.

Prospects for US hospitals that closed out 2022 at a financial loss looked brighter by the end of 2023, prompting cautious optimism heading into 2024. An industry analysis published in October 2023 found that most hospitals were back in the black from March 2023 onward, while the economy more generally ended the year with a strong finish. That said, healthcare margins remain slim, and expenses continue to grow. Finding efficiency savings across all operations remains a top priority. That's where revenue cycle automation comes in. With revenue cycle automation, providers can eliminate many of the persistent pain points in traditional revenue cycle management (RCM). Staff no longer lose time to tedious manual tasks, patients get their queries answered faster, and managers get the meaningful data they need to drive improvements. And the biggest win? It's easier for providers to get reimbursed for the services they provide – faster and in full. What is revenue cycle automation and how does it work? Healthcare revenue cycle management knits together the financial and clinical components of care to ensure providers are properly reimbursed. As staff and patients know all too well, this can be a complex and time-consuming process, involving repetitive tasks and lengthy forms to ensure the right parties get the right information at the right time. This requires data pulled from multiple databases and systems for accurate claims and billing, and is a perfect use case for automation. Revenue cycle automation refers to the application of robotic process automation (RPA) to these repetitive, rules-based processes. In practice, this might include: Automatically generating and issuing invoices, bills and financial statements Streamlining patient data management and exchanging information quickly and reliably Processing digital payments Collating and analyzing performance data to draw out useful insights. Common RCM challenges Automation is already making headway in tackling some of the most pervasive challenges, such as: Stemming the rise in claim denials: Experian Health's State of Claims 2022 survey found that a third of providers had around 10-15% of their claims denied. These often result from errors made earlier in the revenue cycle such as incorrect patient information or overlooked pre-authorizations. RCM automation reduces the propensity for errors significantly. Streamlining patient access: Without a welcoming digital front door, the revenue cycle gets off on the wrong foot. Automation can be deployed in patient scheduling and registration to ensure patient information is collected and stored quickly and accurately. Improving collections rates: Self-pay patients (who are increasing in number) want clear, upfront information about what their care is likely to cost. Providers can find themselves playing catch-up if patients are unsure about what they owe. Automated tools that generate accurate estimates and support pre-service payment can build a more resilient cash flow. Expanding access to data insights: One of the biggest ironies in revenue cycle management is that more data is collected than ever, but managers are struggling to digest it and uncover actionable insights. RCM automation helps identify patterns in claims and collections. Six ways revenue cycle automation accelerates reimbursements Let's break down these opportunities into six specific actions providers can take to improve their organization's financial health: 1. Capture accurate information quickly during patient access Victoria Dames, Vice President of Product Management at Experian Health, says, “Patient access is the first step in simplifying healthcare and revenue cycle processes. Replacing manual processes and disjointed systems with integrated software solutions can reduce errors, improve efficiency, offer convenience and transparency to patients, and accelerate the healthcare revenue cycle.” Patient Estimates automatically compiles an accurate breakdown of what a patient is likely to owe before or at the point of service. It builds in prompt-pay discounts, financial assistance advice and instant payment links, so patients are more likely to pay sooner. 2. Simplify collections and focus on the right accounts Healthcare collections are a drag on resources. Automating the repetitive elements in the collections process helps reduce the burden on staff. Collections Optimization Manager leverages automation to analyze patients' payment histories and other financial information to route their accounts to the right collections pathway. Scoring and segmenting accounts means no time is wasted chasing the wrong accounts. Patients that can pay promptly are able do so without unnecessary friction. As a result, providers get paid faster. 3. Reduce manual work and staff burnout Chronic staffing shortages continue to plague healthcare providers. In Experian Health's recent staffing survey, 96% of respondents said this was affecting payer reimbursements and patient collections. While automation cannot replace much-needed expert staff, it can ease pressure on busy teams by relieving them of repetitive tasks, reducing error rates and speeding up workflows. Hear Jonathan Menard, VP of Analytics at Experian Health talk to Andrew Brosnan of Omdia about how AI and automation are addressing staff burnout and improving revenue cycle efficiency. 4. Maintain regulatory compliance with minimal effort While regulatory compliance may not directly influence how quickly providers get paid, it does play a crucial role in preventing the delays, denials and financial penalties that impede the overall revenue cycle. Constant changes in regulations and payer reimbursement policies can be difficult to track. Automation helps teams continuously monitor and adapt to these changes for a smoother revenue cycle – often with parallel benefits such as improving the patient experience. One example is Experian Health's price transparency solutions, which help providers demonstrate compliance with surprise billing legislation while boosting patient loyalty via a more compassionate financial experience. 5. Improve the end-to-end claims process Perhaps the most obvious way RCM automation leads to faster reimbursement is in ensuring faster and more accurate claims submissions. Automated claim scrubbing, real-time eligibility verification, more reliable coding, and easier status tracking all improve the chances of a provider being reimbursed promptly and fully. And as artificial intelligence (AI) gains traction, providers are discovering new ways to use technology to improve claims management. AI AdvantageTM uses machine learning to find patterns in payer behavior and identify undocumented rules that could lead to a claim being denied, alerting staff so they can act quickly and avert issues. Then, it uses algorithmic logic to help staff segment and rework denials in the most efficient way. Providers get paid sooner while minimizing downstream revenue loss. 6. Get better visibility into improvement opportunities Finally, automation helps providers analyze and act on revenue cycle data by identifying bottlenecks, trends and improvement opportunities. Automated analyses bring together relevant data from multiple sources in an instant to validate decisions. Machine learning draws on historical information to make predictions about future outcomes, so providers can understand the root cause of delays and take steps to resolve issues. A healthcare revenue cycle dashboard is not just a presentation tool; it facilitates real-time monitoring of the organization's financial health, so staff can optimize workflows and speed up reimbursement. Revenue cycle automation is the solution Just like any business, healthcare organizations must maintain a positive cash flow to remain viable and continue serving their communities. Together, these six revenue cycle automation strategies can cut through many of the common obstacles that get in the way of financial stability and growth. Learn more about Experian Health's revenue cycle management technology and see where automation could have the biggest impact on your organization's financial health.

For many Americans, access to healthcare is increasingly a question of affordability. There's no room for error when it comes to determining a patient's medical bill. Helping patients understand and plan for medical bills starts with calculating patient responsibility quickly and accurately. Incorrect charges, unexpected costs and confusing payment processes create poor financial experiences for patients. According to research by Experian Health and PYMNTS, patients are increasingly worried about their healthcare costs. 46% of those surveyed had canceled care after receiving a high-cost estimate, while 60% of those with out-of-pocket expenses said inaccurate estimates or an unexpected bill would prompt them to consider switching providers. As the stakes get higher, providers must reexamine how to calculate patient responsibility in medical billing so all parties are clear about who will pay for what. Providing that clarity will improve the patient experience, streamline patient collections and protect the organization from bad debt. What is patient responsibility? Responsibility for paying medical bills is apportioned between the patient who receives care, their insurance provider (if they have one), and government payers like Medicare and Medicaid (if the patient is eligible). “Patient responsibility” refers to the portion of the bill that should be paid by the patient themselves. Getting these calculations right is critical to the provider's revenue cycle. Determining patient responsibility starts during patient registration. Here, providers have their first opportunity to check that insurance details are up to date and ensure that the patient has not overlooked any active coverage. If the patient does not have coverage, they'll be liable for the whole bill (or will have to find charity assistance). If they do have insurance, the provider will liaise with their payer to check that the proposed care is covered under the patient's plan and establish any prior authorization requirements. Then, the provider can estimate how much of the cost of care should be reimbursed by the payer, and how much will fall to the patient. The amount paid by patients includes the following categories: Co-payment – this is a fixed, flat fee the patient pays toward their medical care at the time of service. If providers do not have accurate co-pay information available at the time of the visit, they may need to bill or refund the difference later. Not all health plans include co-payments, and those that do often specify exceptions. Deductible – this the total amount the patient must pay toward medical care each year before the payer contributes. For example, if a patient has a $1000 deductible, they must pay the first $1000 of medical bills that year, and any eligible costs on top of that will be covered by their payer or shared between the patient and payer. High-deductible health plans are attractive to patients who don't think they're likely to need care, as these plans often come with lower monthly premiums. However, if the patient does need care, they'll be left footing a greater portion of the bill. Coinsurance – this is the patient's share of remaining medical costs after paying their deductible. Out-of-pocket maximum – some health plans set an annual limit to the amount a patient needs to pay toward care, including co-payments, deductibles and coinsurance. Once that limit is reached, the payer will cover the remaining eligible expenses for the remainder of the period. Clearly, this is a complicated formula. To bill correctly, providers need to know whether the proposed treatment is covered by the patient's plan, how much the payer has agreed to pay for specific services, and whether individual service providers involved in the patient's care are in-network or not. Claims will only be reimbursed if all necessary coding and payer policy requirements have been met. Revenue cycle management tools to calculate patient responsibility Traditionally, providers have relied on teams of hard-working coders and billers to manually compile and review each claim. But with so many moving parts – not to mention frequent payer policy changes and staffing shortages – manual processes are no longer viable. When determining how to calculate patient responsibility in medical billing, providers should turn to automation and digital tools. This can help them augment their staff's capacity to calculate patient responsibility more efficiently and accurately and optimize patient collections. Here are a few examples of how they might do that: Automate insurance eligibility verification - Without understanding exactly what the patient's active coverage includes, providers will remain one step behind in the medical billing and claims management process. Payers are already using automation and artificial intelligence to fulfil their side of the equation, and providers cannot risk being left behind. Automating the verification process allows providers to capture up-to-date eligibility and benefits data, including the patient's co-pay and deductible amounts, to calculate the patient's responsibility pre-services. Find missing and forgotten coverage - As more patients switch health plans, more payers join the Affordable Care Act marketplace, and employer-based insurance changes, it's increasingly likely that the patient may not be 100% sure of their active coverage. With Coverage Discovery, providers can run quick, automated and repeated checks to see if any active coverage has been overlooked. This could drastically reduce the patient's responsibility, leaving them with a more affordable bill. Automate prior authorization - Many health plans require specific services to be authorized by the payer before being administered. Providers must check these requirements pre-service, or face a denied claim which could affect the patient's bill. Obtaining authorization from health plans before administering services can be slow and expensive, and often delays care. The Council for Affordable Quality Healthcare (CAQH) states that automating prior authorizations could save the medical industry $449 million per year (or 11 minutes per transaction). Automated prior authorization software gives providers real-time insights into payer requirements, so they can speed up reimbursement and give patients clarity over what they'll owe. Why use a patient cost estimator? With the necessary insurance information at their digital fingertips, providers can then use a patient responsibility pricer to calculate the patient's co-pays, deductibles and other out-of-pocket expenses. For example, Patient Payment Estimates is a web-based price transparency tool that generates personalized estimates for patients before and at the point of service. Patients get a comprehensive breakdown of what they'll owe, so they can plan for upcoming bills or even pay upfront. Patient liability estimator tools give patients more financial clarity, saving staff time and encouraging prompter payments. They're also an important compliance tool, and are specifically recommended in CMS advice on compliance with the Hospital Price Transparency Final Rule. Accelerate and streamline patient collections Early financial clarity encourages patients to pay sooner. This means it's more likely that those bills are paid in full, instead of lingering on the aged receivables list. In addition to upfront estimates, providers should make the payment process itself as easy as possible. This might include directing patients to payment plans or charity assistance, and connecting patients to convenient payment tools at any point in their healthcare journey. Inevitably, there will be some patients who simply cannot pay their bills. Collections Optimization Manager shows staff which accounts, so they don't waste time chasing the wrong accounts. By scoring and segmenting patient accounts based on the likelihood of payment, and adjusting as the patient's situation changes, Collections Optimization Manager helps providers manage resources more efficiently, while supporting a more compassionate patient financial experience. It also enables more effective use of collections agencies to minimize the cost to collect, and incorporates reporting and benchmarking tools to identify improvement opportunities. Find out how Experian Health's revenue cycle management tools can help providers calculate patient responsibility in medical billing, for a more compassionate patient experience and streamlined collections process.