Tag: Revenue Cycle Management

With 2023 just around the corner, healthcare executives are teasing out their strategic priorities for the next 12 months. Where should they be focusing their attention? Here are the top 3 healthcare predictions to watch in 2023 and the actions needed to help providers prepare. Prediction 1: AI and automation will continue to gain traction “The time is now for providers to get ready, prepare and implement these technologies.” - ­Jason Considine, Chief Commercial Officer at Experian Health Automation came to the forefront during the pandemic, enabling essential access to care and filling in gaps created by staffing shortages. By now, the use of remote and digital tools is pretty well-established. Automation is the norm, but there’s room to leverage these solutions for an even greater ROI. As Jason Considine says, investing in technology that makes it easier for providers to get paid will be a particularly effective use of digital tools. One such example is in the digitalization of healthcare claims. Healthcare claims management processes have typically relied on manual systems. These can be slow and error-prone, creating avoidable extra work for staff and friction for patients. In the State of Claims 2022, 78% of executives said their organization would be likely to replace their existing claims management solution if convinced something else can deliver better ROI. Eliminating inefficiencies and optimizing reimbursement would certainly check that box. Tools like Denials Workflow Manager, Enhanced Claim Status and ClaimSource® use automation and detailed analytics to improve claims management performance. More claims can be processed more accurately, resulting in fewer denials and faster reimbursement. With denials increasing by 10–15%, claims automation is likely to be a top priority for many providers in 2023. Prediction 2: Patients will increasingly choose providers that offer a user-friendly financial experience  “The immediate path to better billing and payment processes may escalate pressures on providers right now, but it will yield better financial outcomes in the future for patients.” - Victoria Dames, Vice President of Product Management at Experian Health The economic downturn has put pressure on providers and patients, which we can expect to last into 2023. Patients are concerned about healthcare costs, but they’ve also come to expect a more transparent and compassionate financial experience. Experian Health's top healthcare predictions finds that reliable pricing estimates, support to find the right payment plan, and convenient and flexible payment options will be table stakes in 2023. For providers, implementing digital payment options to meet these needs may be challenging, but it’s an investment that will yield positive long-term results. More than 6 in 10 patients who have received an unexpected bill or inaccurate estimate would switch healthcare providers for a better experience in future, placing transparent medical billing at the core of attraction and retention strategies. The medical billing software outsourcing market is already experiencing historic growth as providers respond to patient demand for a digital financial experience: the market’s value is expected to grow over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032. Experian Health leads the way when it comes to creating a patient-friendly billing and payment experience, with solutions such as Patient Financial Advisor and Patient Estimates. Giving patients greater control over their financial journey with upfront estimates and tailored payment plans makes it easier for them to prepare for payments. Prediction 3: Providers that fail to create a welcoming digital front door could be closing off revenue opportunities  “Deliver convenience. People are consumers before they are patients.” - Tom Cox, President at Experian Health Automation offers opportunities for optimization throughout the revenue cycle, but one of the most crucial points is in patient access. Making patient access easier is on the list of top healthcare predictions, and for good reason - a frictionless first impression can have a powerful lasting effect. What should this look like? Cox advises that providers should “anticipate the needs of digital-first customers.” Patients expect the same personalized service they are accustomed to in other sectors, with convenience, choice and control at the center. Administrative “relics” such as the traditional waiting room clipboards and repetitive forms must be minimized where possible. A report from Experian Health and PYMNTS found that a third of patients chose to fill out registration forms for their most recent healthcare visit using digital methods. 61% of patients even said they’d consider changing healthcare providers to one that offers a patient portal. Online scheduling software and self-service registration makes it easy for patients to complete these tasks in advance. Providers can then round out a user-friendly patient experience with Patient Payment Solutions. This gives patients a choice of payment methods, leading to faster payments. Providers have realized that many patient access functions can be achieved more efficiently and cost-effectively using self-service and remote digital tools. By streamlining intake operations, organizations can make better use of staff time, reduce errors and increase productivity, while improving the patient experience simultaneously. As revenue cycle technology continues to develop in 2023 and beyond, providers need to ensure they are capitalizing on the latest software to improve their bottom line, deliver on patients’ service expectations, and keep pace with healthcare predictions. Learn more about Experian Health's revenue cycle management solutions and contact us to find out how these solutions can help healthcare organizations open their digital front door and prepare for 2023.

The medical billing software outsourcing market is experiencing historic growth as providers respond to patient demand for digital payment options. The market’s value is expected to grow by five times over the next decade, from $11.1 billion in 2021 to $55.6 billion in 2032, according to a recent Future Market Insights report.  The pandemic has been the main driver of digital transformation in healthcare billing, embedding patient expectations for the same friction-free experience that has become the norm in other retail environments. By implementing medical billing software and digital collections solutions, providers can offer patients the flexibility and choice they desire. They can also capitalize on operational efficiencies ­– but only if they choose the right tools. Without the time or resources to undertake these activities in-house, many revenue cycle management teams are starting to outsource, in order to optimize medical billing processes, reduce costs and improve the patient payment experience. Choosing the right medical billing software Digital solutions can support every step of the patient’s financial journey, from receiving initial pricing estimates to paying at the click of a button. What criteria should providers consider when evaluating solutions that cater to patient demands for a better payment experience? Here are a few to look out for: Automation - Digital solutions do more than simply remove the need for paper-based billing. Software and machine learning can complete tasks to reduce the burden on staff and patients. Patient payment reminders, auto-filled claims forms and coverage checks are just a few examples of how automation can deliver speed and simplicity to patients, while saving staff time. User-friendly interfaces - A digital tool that’s difficult to use is never going to gain traction. Whether patient-facing or for use by front or back-office staff, user interfaces should be clean, simple and intuitive. Tracking and reporting - Digital billing solutions should offer the ability to monitor progress and generate instant status updates on payments and claims. With real-time insights, staff can further optimize collections and reimbursements. Reliable and secure data - Software and digital solutions are only as good as the data on which they’re built. Fresh, accurate patient data is essential. Data should be held in standardized and interoperable formats to streamline data exchange between different electronic records management systems. This will help to avoid errors, keep data secure and ensure compliance with HIPAA. A single vendor - A piecemeal approach can result in tools that don’t speak to each other. Instead, it makes sense to select a vendor that offers integrated systems for greater reliability and ease of use. Information from multiple billing and claims tools can be pulled into a single dashboard, so staff can capture the details they need at a glance. Setting up and optimizing digital solutions can be easier with a single vendor too. That’s why Experian Health offers consultancy and technical support to help users get started quickly. Here are 4 medical billing solutions that check these boxes: 1. Generate accurate estimates during patient registration with Patient Payment Estimates Providers can set the tone for a positive financial experience by deploying digital billing solutions from the start of the patient journey. One example is to offer patients accurate estimates of the cost of care before or at the point of service, so they can concentrate on treatment without worrying about unexpected bills. Patient Payment Estimates give patients a breakdown of their financial responsibility along with information about relevant payment plans and links to convenient payment methods. These can be accessed via a web-based tool or sent straight to their mobile device. Given that 6 out of 10 patients who received inaccurate cost estimates would switch providers for a better payment experience, tools like these could deliver a strong ROI. 2. Verify coverage as early as possible with Insurance Eligibility Verification and Coverage Discovery Verifying a patient’s active insurance coverage is a painstaking task when undertaken by hand. Staff must pore over payer websites and call insurance agents to check what the patient’s plan will cover. Automated tools like Insurance Eligibility Verification and Coverage Discovery can identify coverage quickly and accurately. Not only does this reduce the patient’s financial responsibility, but it also lowers the risk of uncompensated care and saves valuable time for staff. 3. Submit clean claims the first time with Claims Management Software Automating claims management takes a huge amount of pressure off staff teams. It also guarantees a higher level of accuracy than if claims were managed manually. Claims management software can automatically add patient information to claims, incorporate customized edits and review coding to ensure claims are correct before they are submitted electronically. Claims adjudication can be monitored in real-time to reduce the risk of denials. 4. Provide personalized payment plans and point-of-service payment options with PatientSimple Ideally, bills will be settled as early as possible. Neither providers nor patients want a protracted process of overdue statements and repeated phone calls from collections agencies. If patients are offered a choice of convenient payment methods at each touchpoint, they’re more likely to pay before or at the point of service. PatientSimple leverages Experian Health’s unrivaled data to identify the most suitable payment pathway for each patient and helps them manage it through a user-friendly, self-service portal. Patients can view statements online and pay balances immediately with cards kept on file. With the right medical billing solutions, providers can alleviate pressures on staff, reduce the risk of errors and support compliance with new regulatory requirements. But more importantly, it creates a healthcare experience that’s efficient, flexible and simple for patients, resulting in higher consumer satisfaction and faster patient collections. Find out more about how Experian Health’s medical billing solutions help providers maintain a healthy revenue cycle and meet patient expectations for a 21st-century consumer experience.

The U.S. is currently struggling with a critical healthcare labor shortage that is impacting every part of the revenue cycle. In fact, the American Hospital Association has deemed this challenge a “national emergency” that is only expected to worsen. Staffing shortages leave healthcare providers vulnerable to reimbursement delays, low morale and negative patient experiences.  As a result, many healthcare providers are leveraging automation to tackle this staffing crisis. Revenue cycle management (RCM) software and analytics can help providers navigate labor shortages by relieving staff of repetitive, process-driven manual tasks and improving operational efficiency. As healthcare labor shortages continue, how can providers maximize the return on their investment in automation? The snowball effect of healthcare labor shortages The first quarter of 2022 ended with a peak of 11.9 million open vacancies in the United States. Just about every industry is feeling the impact of the Great Resignation, driven largely by the fact that more people are reaching retirement age than are entering the labor market. In healthcare, the challenge of attracting and retaining top talent is felt even more acutely - in May 2022, the healthcare vacancy rate was 8.8%, second only to hospitality services. While the pandemic created greater pressures on healthcare staff, chronic understaffing and burnout were already a problem. Now, healthcare workers are contending with the snowball effect of increasing stress, sickness absences, lack of time to train new staff and loss of morale. Potential recruits may be tempted away to industries touting fewer COVID regulations, competitive pay, and more flexible and remote positions. Healthcare providers need smart and creative staffing strategies to close the gaps. Automation should be at the heart of HR contingency planning Providers may look to traditional market forces to solve the staffing challenge. Reducing services, increasing wages, improving working conditions and partnering with local education facilities to attract new staff are all on the table. But tight margins and inflationary pressures limit the options available, and policy changes can take time to be implemented. Automation can help mitigate healthcare labor shortages in three main ways. It can reduce the workload and increase staff capacity, improve operational performance and free up resources that can be reinvested in the workforce, and create better experiences for staff (and patients). Using automation to increase staff capacity Repetitive tasks that follow the same process every time are perfect for automated programs. Shifting the load from staff to software means that fewer team members are needed for those activities, and available staff can focus on more complex issues. Patient access is a good place to start. Many hospitals have already started to scale back care due to severe staffing shortages. Online scheduling and automated registration can ease the burden as patient volumes increase. These self-service tools cut down call center queues and eliminate labor-intensive data entry. With automated pre-registration, the correct information for each patient can be pre-filled and follow them throughout their healthcare journey, so staff no longer lose entire days spent resolving data input errors. Automation can improve operational efficiency, even with labor shortages Automation is more than replacing human effort with software programs: it also strengthens operational performance. Automated revenue cycle tools can complete tasks such as data entry, coverage checks, pre-authorizations and eligibility verifications much faster – and with fewer errors – than staff. If data-driven tasks can be completed with greater accuracy and efficiency, then the entire revenue cycle will move more quickly, leading to faster reimbursement. This is especially obvious when using automation to streamline collections. It doesn’t make sense for staff to pursue all past-due accounts, but with automation and advanced analytics, they can identify the patients most likely to pay and focus their efforts accordingly. Collections Optimization Manager uses multiple data sources to automatically screen and segment accounts, so staff doesn’t waste time chasing the wrong ones. Accounts are then distributed to appropriate collections channels using specific routing and recall rules. With a better understanding of each patient’s financial situation, staff can engage with patients in a more compassionate way and resolve issues without repeated calls and emails. Alongside this, automated patient outreach can provide personalized and convenient communications about patient collections. PatientDial frees up staff from time-consuming calls by providing automated inbound, outbound and blended calls with live agents or automated interactive voice response (IVR) services. “Queue callback” automatically calls patients back when a suitable agent becomes available, maximizing staff time while improving the patient experience. PatientDial also monitors agent performance so managers can make strategic decisions to improve workflow. Using automation to create better user experiences Existing staff may worry that increasing the use of automation could lead to their jobs becoming redundant. This isn’t really the case: while automation and artificial intelligence (AI) allow RCM teams to “do more with less” and reduce the need to recruit additional staff, they should be seen as complementary to rather than replacing staff. By removing time-consuming and tedious tasks, automation creates a better experience for staff. User-friendly interfaces give patient access, claims and billing teams all the information they need to help patients quickly and accurately. And as prior authorizations and payer policy changes change ever more frequently, staff will be relieved to hand over the task of checking each payer’s website to a software program that can complete the job quickly and accurately. Shifting to online and mobile options gives patients a more convenient and satisfying user experience, too. For example, automated self-service tools can be used to give patients upfront estimates about their expected cost of care, and link to convenient payment methods. It’s a quick win for providers who will find it easier to comply with new price transparency rules and makes it easier for patients to clear their bills faster. And the result? A happier workforce, a better patient experience and a healthier revenue cycle. Find out more about how Experian Health’s automated revenue cycle management solutions can help healthcare organizations build resilience and thrive in the face of healthcare labor shortages.

An efficient revenue cycle management (RCM) system is a win-win for patients and providers. Friction-free solutions that cover everything from booking appointments to paying bills create a more satisfying patient experience and allow patients to focus on their health. Providers can lower administrative costs and generate more revenue from data-driven billing and collections operations. To ensure the patient’s financial journey goes ahead without a hitch and avoid revenue leakage, the RCM system can’t skip a single step. Experian Health’s 10-step healthcare revenue cycle flowchart sets out the necessary ingredients for success. See the healthcare revenue cycle flowchart below: Step 1: Patient registration The healthcare revenue cycle flowchart begins with the patient’s first interaction with the healthcare organization. First impressions count. Patients want to be able to book appointments and complete registration quickly and easily, and providers that offer patient portals are seen as more attractive. Opening up the digital front door with online self-scheduling and self-service registration also helps providers increase operational efficiency and minimize manual errors that could lead to claim denials. Reliable patient intake software can verify patient identities, reduce manual processes and deliver a flexible patient experience – laying the groundwork for the entire RCM process. Step 2: Eligibility and benefits Next, providers need to check whether the patient’s insurance plan covers their expenses. To increase the likelihood of reimbursement, providers should give patients clarity about their coverage status and be vigilant about locating any missing or forgotten coverage. Coverage Discovery allows providers to check for undisclosed coverage at every patient touchpoint. By quickly uncovering previously unidentified coverage, bills will be cleared sooner with fewer write-offs to bad debt. This part of the RCM process is also a good time to help patients plan for their financial obligations. Patient Payment Estimates gives patients accurate estimates and links to financial assistance and easy payment methods, straight to their mobile device. With the right data and digital tools, providers can deliver a transparent, compassionate and convenient patient payment experience that encourages payment earlier in the revenue cycle and supports a healthy cash flow. Step 3: Data entry With RCM processes relying on data like never before, maintaining accuracy is paramount. Providers must be able to verify and protect patient identities to ensure the right information is linked with the right patient. Accurate data entry decreases the costs associated with medical billing errors, and improves interoperability as more patient data is created, collected and shared. A digital patient identification solution can build a single, accurate view of each patient, using a unique patient identifier to hold the information together like a golden thread. Automated patient enrollment using PreciseID® allows existing data to be auto-filled, while tools such as Universal Identity Manager maintains data in an interoperable format, to further protect against errors. Step 4: Prior authorizations Before treatment begins, providers must determine if prior authorizations are needed. If so, they must submit a request to the payer. Without prior authorizations, providers may see their claims denied, which increases costs, causes time-consuming rework, and creates a stressful experience for patients. With online prior authorizations, providers are guided through a workflow that automates inquiries, status checks and submissions. It auto-fills payer data using real-time information about each payer’s prior authorization requirements, stored in Experian Health’s pre-authorization knowledgebase. Prompts for manual involvement ensure the process is as efficient as possible, to expedite treatment and secure timely payments. Step 5: Patient encounter At the time of treatment, information about the services a patient receives will be added to their patient record. This sets the stage for accurate coding and billing. To ensure no essential information is omitted, providers must keep up to date with regulatory changes. For example, the Appropriate Use Criteria program introduces new requirements for providers ordering diagnostic imaging services. Providers should examine their workflows in advance to avoid any costly compliance errors. The patient encounter is also an opportunity to double down on creating positive patient experiences, and to anticipate any potential RCM issues. Communicating clearly about any changes to medical bills and checking again for coverage will keep the revenue cycle moving. Providers may also consider incorporating data on the social determinants of health to support efficient discharge planning and prevent high-cost readmissions. Step 6: Charge posting In the next step of the healthcare revenue cycle flowchart, providers must submit the claims to the relevant payer using the appropriate charge posting or charge entry process. Documentation must include a detailed breakdown of all the services provided to the patient, alongside patient information, history and insurance or payment plan status. Again, getting every detail right will secure more timely payments that match the expected amounts. Step 7: Coding and billing Before patient billing gets underway, providers must check payer codes for the services that have been delivered. Payers use diagnostic (Dx) codes, place of service (POS) codes, current procedural terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and others to determine payable amounts. If codes are not inputted correctly, claims are likely to be denied. Automated claims management software can check that every claim is clean and error-free before being submitted. Experian Health’s claims management software incorporates standard government and commercial payer’s global edits as well as client-specific customized edits so providers can submit claims with confidence. J. Scott Milne, Senior Director of Product Management at Experian Health, says providers can leverage tools such as Claim Scrubber and ClaimSource to automate and prioritize claims to maximize reimbursement: “Both of these solutions are focused on the most important revenue cycle goal – to submit the claim correctly the first time. With the combination of Claim Scrubber and ClaimSource, healthcare organizations give themselves the opportunity to decrease denial rates, increase cash flow and decrease the overall accounts receivables.” Step 8: Claims management After the claim has been filed, the payer’s claims adjudication process begins. Payers will check eligibility, benefits, coding and contract rules to determine their financial responsibility. They may decide to pay in full, pay a partial amount, or deny the claim, with the reasoning set out in an Explanation of Benefits (EOB) statement. If the claim is denied, the provider needs to decide if it’s worth reworking and resubmitting the claim. Rework is expensive and time-consuming, so many providers use a healthcare clearinghouse to check claims before they’re submitted. Providers may also consider using a tool like Enhanced Claim Status, which submits automated status requests based on payers’ individual timelines, and provides responses that include the payer’s proprietary codes and descriptions. This facilitates early intervention into claims that are flagged for denial, which improves productivity and faster reimbursements. Providers also get detailed denial analysis and monitoring reports to pinpoint the root cause of denials, so they can be fixed promptly. Step 9: Payer Contract Management The complexity and volume of payer contracts can leave providers with little negotiating power when it comes to querying and collecting underpayments and delays. Providers need robust processes to audit payer performance and keep track of changing payer requirements to ensure timely reimbursements. Experian Health’s Contract Manager helps providers stay on top of changes to payer payment policies, identify patterns of non-reimbursement, and appeal denials in the most effective way. It identifies inconsistencies between pricing claims and paid amounts, so providers avoid missed revenue opportunities. Positive provider-payer relationships make the revenue cycle management process easier for everyone. With reliable contract management tools, communication and two-way accountability are much more effective. Step 10: Patient Billing and Collections The final step in the healthcare revenue cycle management flow chart is to bill patients for the remaining amount they owe. Balances are collected by in-house collections teams or outside collections agencies. Revenue cycle management software makes this process smoother and more efficient. For example, Patient Financial Clearance assigns each patient to the appropriate financial pathway based on their individual circumstances, while Collections Optimization Manager can be used to build custom segmentation models and workflows. That way, resources can be focused on the accounts most likely to yield revenue. Then, once the patient’s bill has been issued, collections software can be used to create a compassionate and convenient payment experience and complete the revenue cycle. Find out more about how Experian Health’s Revenue Cycle Management Solutions help healthcare organizations deliver outstanding patient financial experiences, optimize RCM workflows and increase cash flow.

Healthcare revenue cycle challenges exist at every stage of the patient journey, beginning with patient access and extending all the way through claims, billing, payment and collections. However, digital tools and analytics can help providers tackle their top healthcare revenue cycle challenges. “The complexity of our reimbursement structures and the complexity of billing mean a variety of aspects impact revenue cycle management,” says Tricia Ibrahim, Director, Product Management, Contract Manager, Hospital at Experian Health. “Technology, regulations, changing contractual obligations and payer policies, people, processes, billing—each of these complexities adds to the challenge.” Revenue cycle management (RCM) issues can also lead to revenue loss if not addressed. Data and analytics, digital tools and automation can help providers manage complexity and adapt to evolving patient needs. Here are seven of the top healthcare revenue cycle challenges and how providers are taking them on: 1. Problems with patient access Consumers accustomed to using mobile apps and online services to shop and do their banking look for seamless digital experiences when they’re choosing a provider, scheduling appointments and managing pre-appointment activities like registration and insurance verification. In a new consumer survey by Experian Health and PYMNTS, 77% of patients who were not currently using digital tools for healthcare said they would be interested in switching to a provider that offered a patient portal. The automated tools that make up your digital front door make a huge difference in how patients engage. Together with accurate estimates and convenient payment options, digitally focused Patient Access Solutions help providers enhance the patient journey and improve registration accuracy. Manual processes require more staff time up-front; human error can lead to claim denials or billing errors later in the cycle. Automating streamlines the process. Offering patient intake software that can be accessed online or via a mobile device provides the flexible and familiar digital experience they expect in today’s world. 2. Poor collections recovery rate As high deductible health plans have patients taking more responsibility for their healthcare costs, patients are finding it more difficult to pay. Bigger bills often translate into a greater potential for confusion, more questions about insurance coverage, and a greater need for financing options. Providers need effective collections strategies to boost revenue and lower bad debt write-offs as more focus shifts to the patient as a payer. A patient-centered payments strategy helps patients better understand their estimated costs, insurance coverage, and payment options. To help patients navigate the financial process successfully and navigate this healthcare revenue cycle challenge, providers will need to support them with: Clear, accurate estimates that show patients how much they’ll owe up-front Payment options that include multiple payment methods, including cards, Apple Pay, and e-checks Navigating payment plans to manage large balances A process that encourages payment before service or at the point of service to reduce collections down the line When providers have to collect, digital tools and analytics can help optimize the collections process by prioritizing accounts that are most likely to pay, automating billing and messaging workflows, and even tracking the effectiveness of outside collections agencies. 3. Billing errors Claim denials are a drag on workflow, sending staff into a repetitive loop of claims submission, denial, correction, and delay—and throwing a wrench into revenue flow. A denied claim typically slows reimbursement by 16 days. Worse, claim denials are on the rise: 69% of healthcare leaders in an MGMA Stat poll reported that denials increased at their organizations in 2021. Replacing manual processes with automated workflows can reduce billing errors and A/R days. Integrated claims management software reviews claims for inaccurate coding before claims are submitted, easing demands on staff time, reducing claims denials, and shortening the time between billing and payment. 4. Underpayments in payer contracts Missed payments and underpayments can add stress and volatility to your revenue cycle. Often, the source of these problems lies in payer contract issues. “Payers often know your book of business better than you do,” says Ibrahim. “When you’re negotiating contracts, you need to be able to go through large amounts of data quickly and efficiently, so you can come to the table armed with information. One of the services we provide is contract analysis to help providers evaluate contract terms in real dollars and cents.” For active contracts, Healthcare Contract Management helps providers track inaccurate payments and hold providers accountable. 5. Changes in healthcare regulatory and compliance standards New regulations are a constant in healthcare. However, this is one of the biggest healthcare revenue cycle challenges that providers need to keep up with. Failing to stay up to date with the ever-evolving compliance landscape can lead to claim denials, payment delays, and administrative and billing backlogs. Healthcare Regulatory Solutions, which includes systems for providing transparent, patient-friendly estimates, can make it easier to make regulatory compliance part of your regular business processes. A free No Surprises Act (NSA) Payer Alerts Portal keeps providers updated on how new NSA regulations are playing out. 6. Lack of data-driven metrics and insights Gaining efficiencies in RCM means using analytics to provide a big-picture view of what’s happening throughout the enterprise. This perspective is not always the default in a busy healthcare practice or hospital. Yet, “Fixing claim after claim on an individual basis isn’t going to get you the efficiency you want,” says Ibrahim. “You need to identify trends to find the biggest opportunities to improve your results.” Comprehensive data and analytics are key for providers that want to pinpoint and address areas of trouble. Here, disparate systems and siloed information can get in the way of creating the single view needed to diagnose the issues that are slowing down claims, billing, and payment. Revenue Cycle Management Analytics integrates client data with non-native standard Electronic Data Interchange sets to reveal opportunities for process improvements. By leveraging the right data, providers can optimize patient access productivity, billing efficiencies, reimbursements, and payer performance. 7. Potential security issues Patient portals engage patients and empower them to schedule their appointments, review test results, or make payments. But as providers digitalize to improve the patient experience and boost the revenue cycle, patient identities and data may be at greater risk. Cases of medical identity theft reported to the Federal Trade Commission rose more than 532% between 2017 and 2021. Medical identity data is particularly valuable to thieves, bringing 20 to 50 times more money than data from financial sources. Securely authenticating patients is critical as a safeguard for both providers and patients. Identity theft damages the patient experience and erodes trust, while dealing with the resource and reputational damage fraud can cause is a major potential liability for providers. Working with vendors that provide extensive Patient Portal Security and digital tools that protect patient identities without causing friction or frustration is essential to keeping patient data safe without alienating the patients in the process. Prevent healthcare revenue cycle challenges with automation Revenue cycle management healthcare challenges are among the great tests facing providers right now. But improvements in digital tools and analytics are helping providers keep revenue flowing while keeping both compliance and the patient experience in focus. Find out more about how Experian Health's Revenue Cycle Management Solutions can help your organization meet the challenges of modern RCM.

Patient experience may not be the first consideration that comes to mind when you're looking to improve revenue cycle management (RCM). However, a positive patient experience can benefit RCM. It can make the complicated process of understanding and managing healthcare finances simpler and more seamless for patients—and facilitate an easy-to-navigate continuum of care that includes RCM. Financial transparency plays a significant role in building trust and confidence between patient and provider. Patients who may find it difficult to understand medical billing and health insurance coverage—and who are paying more out-of-pocket costs thanks to high-deductible health plans—appreciate accurate estimates and a range of convenient payment options. By optimizing back-end claims, billing, payment and collections processes, providers free up staff to provide individualized help to patients who need it. Strategies to bolster patient experience and RCM Patients who have grown accustomed to using digital platforms for everything from online shopping to food delivery, travel, managing finances and entertainment gravitate toward digital tools and expect a high level of functionality. In a Salesforce survey of 15,000 consumers, 68% of respondents said their expectations of companies' digital capabilities increased after COVID-19 drove more of their activity online. Providing a superior digital experience is now synonymous with good service, but healthcare is lagging behind other service sectors. For providers, automation and data analytics can streamline workflows and improve efficiencies. These factors are critical as staff find themselves under increasing pressure to provide accurate patient estimates upfront and to submit claims accurately to reduce denials. How can providers use the patient experience to improve RCM? Here are a few areas of focus to consider: 1. Offer consumer-friendly front-end technology Patients are looking for seamless digital experiences, where they are empowered to search out what they want, choose from a menu of options and pay effortlessly online. In a healthcare setting, they want to find and schedule their own appointments quickly. Providing new and existing patients with 24/7 mobile access to online patient scheduling is critical to early engagement. In fact, a new report from Experian Health and PYMNTS revealed that 61% of patients interested in using patient portals say they would switch to a healthcare provider that has one. Providing patients with an accurate estimate they can review in advance improves transparency and builds trust. This allows patients to ask questions and make decisions about how to pay on their own time and without pressure. Pre-appointment estimates might also offer patients the opportunity to pay conveniently online before their appointments or at the point of service, minimizing the need for post-treatment collections and reducing RCM costs. 2. Simplify and automate in-office technology Automation can boost the experience on both sides of the front desk. Automated processes simplify patient-facing tasks like registration and check-in while making back-office operations like data entry and authorizations more efficient. “When a patient submits photos of their insurance card and identification, software scrapes that information and inputs it into the system,” Serie explains. “This process is more convenient for the patient, faster and more efficient for staff, and reduces the potential for human error.” As healthcare providers continue to experience staffing shortages, automated systems can offer greater workplace flexibility. That's helpful for providers that need to flex their resources, but also for employees who want more options on where and when they work. 3. Provide price transparency and financial information to improve the patient experience In a Policygenius consumer survey, 26% of respondents said they have avoided care or treatment because they were unsure what their insurance covers. Patients might be forgiven for feeling confused and frustrated – healthcare bills are not always patient-centric. In fact, many consumers report a low level of insurance literacy and, unless told, don't know in advance what medical procedures are likely to cost. At the same time, out-of-pocket costs are rising, raising the stakes and increasing the likelihood that medical bills will pose a significant financial challenge. Outlining estimated costs prior to service can help patients understand their expected out-of-pocket payments. Accurate patient payment estimates take away some of the sticker shock and give patients an opportunity to discuss coverage with their insurance companies, choose the right payment methods, or arrange for payment plans before treatment happens. 4. Allow for online bill payments Frictionless payments are now the norm, online and in-app. Experian Health's PatientSimple solution offers healthcare organizations a suite of tools to simplify payment. Using a healthcare-specific algorithm, PatientSimple provides personalized, data-driven insights that help providers deliver the right messaging and payment options, including: Price estimates based on insurance coverage and payer's negotiated rates Guest payment option for patients who don't want to set up an account Online payments and payment plans E-statements, online account access and email payment reminders Qualification for financial assistance A smoother path to payment increases the chances that patients will pay pre-appointment or at the point of service. By offering patients more and better payment options providers can increase up-front revenue and reduce the need for collections. 5. Enable self-service Frictionless payments are just one facet of helping patients help themselves. Enabling the tools that create a “digital front door”—including the ability for patients to register and check-in online, access a virtual waiting room and make “contactless” payments—can boost engagement and give patients greater choice, control and convenience. By mapping a patient journey that flows seamlessly between virtual and in-person interactions, providers can set the stage for receiving payment earlier in the process. This can also help with outreach to patients post-care for follow-up and payment, if necessary. 6. Ensure coding and billing accuracy Clear, accurate patient billing is the goal, but keeping up with changes across multiple payers is an ongoing challenge for healthcare providers. New products, mergers and acquisitions, policy and procedure changes all create the potential for errors, denials, delay and lost revenue. Experian Health's Payer Alerts helps notify providers of payer policy and procedural changes with a daily digest email and an online portal. A simplified estimate process with fewer revisions streamlines the RCM process; it also helps patients avoid confusion, which degrades the patient experience and may cause patients to delay payment. 7. Optimize bill collections Collections can be one of the most difficult parts of healthcare RCM. On the patient side, post-treatment collections feel like a hassle; they may also become a source of significant financial problems. For providers, collections can be costly and time-consuming. Optimizing collections with automation and data analytics can streamline the process and improve outcomes. Experian Health's Collections Optimization Manager uses specialized scoring algorithms to segment and prioritizes accounts based on the likelihood they'll be able to pay. Automated billing and outreach make collections less onerous for staff, while automatic updates keep accounts and communications current. For patients, providing convenient digital payment options takes some of the friction out of the payment experience and removes at least one barrier to bringing an account current. Patient experience and RCM go hand in hand Improving healthcare RCM is certainly not the only reason to work on improving the patient experience. Enhancing the patient journey across the care spectrum can help providers engage new and existing patients, offer the digital tools and seamless experiences they've come to expect, and reduce their anxieties over medical costs. At the same time, using RCM solutions to bolster the patient experience means new efficiencies for staff and, along with this, expanded opportunities for work flexibility and greater success at managing the revenue cycle. Contact Experian Health to learn more about optimizing your patient experience and improving RCM at your organization.

Inflation is giving the cost of healthcare a run for its money. The Consumer Price Index rose by 8.3% year-over-year in August 2022, compared to a rise of just 2.9% in the Health Care Price Index. However, slower price increases do not necessarily mean healthcare will get an easier ride than other businesses. Healthcare contracts are agreed in advance with government and commercial payers, so any effects of inflation could simply be delayed. How should providers factor such economic unpredictability into their revenue cycle management strategies? Healthcare is usually more resistant to wider economic shocks than other service sectors, so rising inflation doesn’t necessarily mean there’s an urgent need to change course. Providers are always working to maintain a healthy revenue cycle and will continue to do so now. That said, the lingering financial effects of the pandemic, staffing shortages and increasing operational costs mean that provider cash flow is sensitive to any added pressure. While there’s currently no sign that patient collections have been significantly affected by inflation yet, patients may assume that health costs will increase too, along with everything else. This might lead them to delay elective care, which could affect providers’ bottom lines. As non-COVID patient traffic slowly returns and state and federal aid ends, rising inflation presents an additional hurdle to providers’ financial health. Providers will need to tighten their patient collections process and safeguard their bottom line. Download the white paper to learn how inflation is impacting healthcare and get strategies to optimize collections and avoid revenue loss. Providers that want to bolster their revenue cycle against the potential impact of inflation should focus on increasing workforce efficiency to manage costs and mitigate the risk of deferred care, to maintain a steady inward cash flow. They’ll also want to be prepared for any potential shift in patient payment reliability that could occur if inflation persists. Automated solutions and self-service digital tools can help to solve these issues. Minimize workforce inefficiency with automation and self-service solutions Questions to consider: How can digital technology and automation improve efficiency and ease pressure on staff? Where can patient self-service solutions help reduce the need for staff input? Inflation is likely to hit providers hardest in relation to payroll expenses. Staffing shortages lead to increased costs as providers raise salaries to attract and retain new staff, pay overtime costs, and hire more temporary workers. Reduced purchasing power will only exacerbate these challenges. Automation and digital tools can help address staffing shortages and keep a lid on payroll costs by increasing efficiency in existing workflows. For example, digital technology can allow patients to take care of many administrative tasks themselves, thus reducing the demand for staff input. Online self-scheduling and registration allow patients to book appointments and fill out pre-service paperwork without taking up valuable staff time. These tools leverage data and automation to pre-fill patient information, which reduces the risk of costly errors and saves time for patients and staff. Further along in the patient journey, automated collections can eliminate much of the manual work that puts pressure on understaffed teams, while increasing the likelihood and speed of payment. Collections Optimization Manager helps increase workforce productivity to make better use of staff time and avoid unnecessary revenue loss. Advanced analytics are used to prioritize accounts by payment probability, which will be increasingly useful should ongoing inflation increase the risk of patient bills going unpaid. Consumer data helps identify the most appropriate communications method for each segment, so the right message can be sent at the right time to boost the chances of collecting a greater percentage of money owed. Automation also helps reduce staff costs to collect, while bumping up the amount of money that comes in the door. As hospital operations become more expensive on the whole, maximizing efficiency in collections is increasingly important. Maximize revenue by removing friction for patients worried about the cost of care Questions to consider: How can providers help patients better understand their bills? How can digital technology make it easier for patients to access and pay for care? The second step is to make sure that dollars keep coming in the door. Managing household bills can be challenging for patients, and there’s no suggestion that the rise in inflation during 2021 has added any new pressure to patients’ ability to pay for healthcare. Experian Health’s clients also continue to see very low levels of delinquency. However, despite pay raises, many consumers are worried that price inflation will overtake any increase in household income, especially as energy and food prices go up. They may decide to cancel or postpone elective care until they’re sure of their financial situation or move their medical bills to the bottom of their priority list. In reality, costs for patients haven’t increased, because of the delayed effect of inflation in healthcare. That’s why it would make more sense for patients to seek elective care sooner rather than later. Given reports of pricing concerns, providers should consider ways to reassure patients about their financial obligations and make sure they don’t miss out on the care they need. Here are some ways that providers can support their patients: Providers can help patients get a better understanding of their medical bills and payment options, by incorporating solutions that offer greater price transparency. Upfront patient estimates delivered directly to their mobile device, with links to appropriate payment plans and payment methods, can help them plan with confidence. This will help to reassure patients that prices have not increased drastically due to inflation, so they are dissuaded from deferring care. Finding missing or forgotten insurance coverage is another strategy to give patients certainty around how their bills will be covered. A tool such as Coverage Discovery can run repeated and automated checks for previously unknown government and commercial coverage, using multiple data sources. Self-service patient access and patient payment tools can help to reduce friction during scheduling, registration and billing, so patients see fewer reasons to postpone care. Liz Serie, Senior Director of Product Management at Experian Health, says, “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” “Automation and patient self-service features can help address the risk of patients choosing to put off visiting their doctor or getting a procedure they need. Many patient access and patient payment activities that would normally require staff attention can be easily pivoted to an innovative patient-facing experience. This will reduce friction for patients and help providers manage staffing shortages and cost pressures.” - Liz Serie, Senior Director of Product Management Find out more about how Experian Health’s digital tools and solutions can help healthcare organizations create a financial safety net and protect their revenue cycle against the possible impact of inflation.

US hospitals have provided more than $702 billion in uncompensated care over the last two decades. To protect profits, healthcare organizations must be vigilant about finding any available insurance coverage for their patient’s care. But for many, recent regulatory changes and pandemic-related disruption have made navigating an already complex reimbursement landscape even more challenging. Checking for missing insurance coverage and chasing payments consumes staff time that could be better spent elsewhere. However, with the right revenue cycle management tools, healthcare organizations can reduce profit-eating write-offs and denied claims. Experian Health’s new white paper sets out an end-to-end strategy to help healthcare providers find missing and forgotten coverage. With a comprehensive game plan for minimizing lost revenue at every touchpoint in the patient journey, providers can optimize the patient experience, reduce revenue leaks, and ease the burden on staff. Here, we explore some of the trends that are challenging reimbursements, identify opportunities to find missing coverage quickly, and present best practices to eliminate the risk of bad debt at every stage of the patient journey. Trends that make revenue recovery tougher Healthcare providers must keep abreast of regulatory changes that affect the reimbursement process, which often challenges profitability. For example, the American Rescue Plan Act of 2021 made some key changes to the Affordable Care Act. This included expanding Medicaid provision, decreasing Medicare premiums, and accelerating the COVID-19 vaccination program. For providers, this means an influx of patients who are newly entitled to government assistance, requiring new processes to avoid delayed claims and payments and recover Medicare debt. Many of these measures are a response to the pandemic. COVID-19 has squeezed household finances, leaving some patients without jobs and access to health insurance. Although employment rates are showing signs of recovery, tracking coverage as patients start new jobs remains highly resource-intensive for collections teams. Chasing self-pay revenue can often be more expensive than writing off the initial bill. The growing focus on price transparency may mitigate some of these challenges. Proactive patient engagement can help patients understand and plan for their bills while improving the overall patient experience. The No Surprises Act, effective January 1, 2022, aims to protect patients from unexpected bills for out-of-network care in emergency and non-emergency settings. The regulation protects patients but creates significant work for providers to modify existing processes and systems in order to meet compliance standards. Dustin Whittier, Senior Director of Product Management at Experian Health, explains that automating early coverage checks can be an efficient way to help consumers manage their changing healthcare obligations. He says, “With the increase in high deductible plans, the urgency surrounding COVID-19, regulations such as the No Surprise Act and Notice of Care, and a strategic focus on patient satisfaction and transparency, the impetus to automate knowing the full scope of insurance coverage – as  close to the point of care as possible – has never been greater.” In 2021, Coverage Discovery tracked down previously unknown billable insurance coverage in more than 27.5% of self-pay accounts. The Experian Health team can help healthcare organizations keep on top of changing regulatory requirements and implement solutions that ensure compliance, improve the patient experience, and protect against uncompensated care. Optimizing for revenue recovery at every step of the patient journey Successful revenue recovery starts with a patient engagement strategy that simplifies the steps to reimbursement at every patient touchpoint. A three-pronged approach can increase the likelihood of payment by identifying the opportunities to check for coverage before the patient comes in for care, at the time of service, as well as aftercare. 1. Pre-service insurance coverage checks Verifying and tracking the patient’s insurance status before they come in for care means their financial obligations will be clear from the start. Advance knowledge makes it much easier for patients to plan – and pay ­– their medical bills. An automated coverage identification solution such as Coverage Discovery can scan patient information as soon as they schedule an appointment to find any previously unknown coverage, using multiple proprietary databases and historical information. 2. Identifying coverage at the point of care When the patient receives their treatment, Coverage Discovery can check for any billable commercial and government coverage that may have been missed during pre-service. Providers should also give patients opportunities to pay for care at this point too, to avoid the need to chase for payments later. A simple and quick payment experience can reduce the risk of additional A/R days and collections agency fees. 3. Post-service checks for unidentified coverage Finally, for any accounts that haven’t been settled at the point of care, providers should run further coverage checks before determining whether to send statements and payment reminders to the patient, to write the amount off as bad debt, or to engage a collections agency. Coverage Discovery can detect any discrepancies that could lead to denied claims. It also offers weighted confidence scores so that accounts are reclassified and rebilled appropriately. Automated scrubbing can eliminate manual processes so staff can use their time more efficiently. These steps will help plug revenue leaks at every stage of the patient journey. Not only will that improve cash flow and reduce the risk of bad debt, but it also helps create a more satisfying patient experience. Learn more about how Coverage Discovery helps recover revenue throughout the patient journey and gives patients peace of mind.

A little over a year ago, Experian Health surveyed healthcare providers for a snapshot of their views on the digitalization of patient access, and the importance of healthcare collections. At the start of the COVID-19 pandemic, patient collections emerged as a top priority, the result of rising unemployment and competing consumer demands that impeded patients’ ability to pay. By June 2021, provider attitudes had changed. Our follow-up State of Patient Access 2.0 survey revealed that patient collections were no longer the number one concern for healthcare providers. Patient perceptions of the billing process have improved too. In our latest Interview with the Expert, Matt Baltzer, Senior Director of Product Management at Experian Health, explains why providers feel more confident about patient collections. He also discusses how automated healthcare solutions can help providers shore up these gains and optimize healthcare collections – especially as consumer behavior returns to pre-pandemic patterns. Watch the interview below:   Why are healthcare collections no longer the number one concern for providers? In the six months between the two surveys, the number of providers saying they were “concerned or very concerned” about collecting payments from patients dropped from 50% to 41%. Baltzer explains that during this time, collection rates were relatively steady (when adjusted for volume), and providers received fewer calls about patient balances. Currently, the bigger concern for both providers and patients is to determine patients’ coverage status quickly and accurately. There are three main reasons for this shift. Firstly, multiple rounds of stimulus payments issued by the government helped consumers pay down their debts, including medical bills. Secondly, the pandemic caused a drop in consumer spending on travel, entertainment and dining out, which meant credit card usage was lower than pre-pandemic levels. Consumers had more cash available to pay healthcare bills. And thirdly, employment rates have started to recover. Around the time of the first survey, providers were faced with a surge in patients who had suddenly lost employer-based coverage, but as unemployment levels improve again, this is less of an issue. Those still affected by job losses have been able to access expanded government support, such as Medicaid. How should providers prepare as consumer spending returns to pre-pandemic levels? As Americans start to return to previous consumer habits and routines, household spending is likely to increase, which could squeeze medical bills again. Baltzer explains that “as we see stimulus programs winding down, and discretionary spending options increase, we can expect to see an increase in the utilization of revolving credit lines. For most consumers, that will mean it’s more difficult to meet unplanned out-of-pocket obligations.” Prior to the pandemic, a survey by the U.S. Federal Reserve found that 40% of Americans struggle to find $400 to pay for an unexpected bill. This means providers may not be able to rely on the steady collection rates seen in recent months. While efforts to improve transparency will help patients prepare for possible financial obligations, many providers are going further, implementing the right data, tools, and strategies to understand and address each consumer’s unique situation, making it as easy as possible for patients to pay. Baltzer says: “Data can help drive attention to the accounts with a higher likelihood to pay. This means you can identify those who just need a little more time to pay, and then help those truly in need of charity support. Things can change quickly, and having fresh, accurate data will be essential. Now is not the time to take our eyes off the ball, as the game may shift quickly.” With access to reliable and comprehensive consumer data and automated patient collections solutions, providers can tailor the patient experience according to individual needs and preferences. They can create a more empathetic financial experience, with upfront pricing estimates, personalized payment plans and flexible payment options. Not only will this be more desirable for patients, but it will also optimize healthcare collections, improve operational efficiency and increase the chances of more bills being settled in full. How can optimizing patient collections offset recent staffing challenges? Staffing shortages remain a growing challenge for healthcare providers. According to Baltzer, technology and automation can help ease the pressure on collections teams. He says, “Automation is key. Providers are being challenged to make the most of limited staff resources, especially for patient collections. It’s important to focus staff attention on the accounts most likely to pay. That means filtering out accounts that might be bankrupt or deceased and using automation for manual tasks – such as checking for charity eligibility or cleaning up patient records. Best-in-class providers are increasingly leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter.” Collections Optimization Manager can help organizations deploy a targeted approach to patient collections, using data and analytics to segment, screen and monitor accounts. By optimizing on the back end with user-friendly interfaces and efficient workflows, staff can focus their efforts on the accounts that need the most attention. On the front end, Patient Outreach solutions can help patients take control of their own financial journey with timely bill reminders and self-pay options, and requires minimal staff intervention. Automated text and IVR messages that connect directly to billing software ensure that more accounts are settled without adding to the organization’s headcount. Watch the full conversation, and download the State of Patient Access Survey 2.0, to find out more about how Experian Health can help your organization spot new opportunities to optimize healthcare collections.