First Pst after migration to Cloud in Health care Blog

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

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.

“We ran a pilot across 10-15 service lines, and the team was able to schedule without any training. It makes it extremely easy to work in different service lines that you're unfamiliar with.” — Justin Baur, Manager of Patient Access and Referral Management at IU Health Challenge Indiana University Health (IU Health) is the largest network of physicians in Indiana, with over 36,000 team members across five patient regions and 16 partner hospitals. IU Health plans to launch the Unified Medical Group in 2025, combining its five patient regions. In preparation for this move, the health system sought an enterprise call center scheduling solution to manage growing patient volume while maintaining its current staff size. Solution IU Health selected Experian Health's Patient Schedule – Call Center Scheduling, an automation-powered digital scheduling platform, because it can effectively manage complex service lines in primary and specialty care. This decision was backed by Experian Health's track record in providing call center scheduling solutions for large health systems. Patient Schedule supports seamless self (patient) and staff scheduling.  This solution helps IU Health staff handle the increasing patient numbers with minimal training. Front office staff and call centers can swiftly and accurately schedule appointments and resolve patients' queries. Schedulers no longer have to memorize complex scheduling rules or work with lengthy notes, increasing staff efficiency, morale, satisfaction, and productivity. Listen in to an on-demand webinar to hear how IU Health transformed patient scheduling with Patient Schedule. Outcome Thanks to Patient Schedule, IU Health achieved the following results: 52 departments now use Call Center Scheduling 114% increase in patient utilization within a year 600 referrals on average scheduled each month Staff cross-trained across multiple specialty service lines Patient Schedule optimized IU Health's scheduling capacity, making the call center more efficient and increasing specialty referrals. This solution has also brought more and unexpected benefits, including improving referral management, which means that patients can schedule cross-speciality appointments before the patient leaves the office. Call Center Scheduling also enabled the implementation of a single phone line for all patient bookings. Additionally, the product's analytical features are helping IU Health discover ways to improve its scheduling infrastructure, as it works to standardize and expand the solution to all regions as part of the Unified Medical Group. Altogether, this solution has improved provider, staff, and patient flexibility, satisfaction, and experience so much that it has become indispensable to IU Health's scheduling operations. “Now we have pods of four people managing seven or eight service lines because it's so easy to work,” said Justin Baur, Manager of Patient Access and Referral Management at IU Health. “The team wouldn't be able to go back to the old way. You don't have to keep track of who you can schedule at what time or at what location because the algorithm does it for you.” “We really could not have started this initiative without the platform, because we had to make sure we had staff who were well versed in the product and service lines that were properly embedded in the product before rolling it out. This was a big success and we probably could not have started this launch without Experian,” he concludes.  Watch the webinar to hear examples of how guided scheduling was implemented in specific specialties and learn more about using automated patient scheduling to create a resilient and efficient scheduling infrastructure that works better for patients, providers and staff.