First Pst after migration to Cloud in Health care Blog

If there's one topic that's sure to elicit groans from claims and billing teams, it's prior authorizations. Despite promising improvements overall, Experian Health's most recent State of Patient Access survey suggests that the efficient and timely management of prior authorizations remains a headache for providers, with 89% citing this as one of their top three improvement priorities in patient access. Obtaining pre-authorizations is time-consuming, often relying on antiquated manual systems that drag staff away from patient care. Ever-changing payer guidelines make an already frustrating process even more difficult. In this context, automating prior authorizations is an obvious choice for the 79% of providers who plan to invest in improving patient access in the near future. Why are prior authorizations required? Prior authorizations are when payers and providers determine in advance if the patient's insurance plan will cover a particular drug, medical item or service. Providers submit information about the patient's medical history and the rationale for the proposed treatment. The insurer evaluates this information and approves or denies the request. If a provider goes ahead without obtaining authorization, they are unlikely to be reimbursed for the cost of that care. The intention is to ensure that tests and procedures are safe, effective and high-quality. It's also a cost-control strategy, ensuring that expensive services are offered only to patients who really need them. Why do prior authorizations get denied? Insurers only approve prior authorization requests for treatment and services deemed medically necessary and aligned with their coverage policies. Authorization may be denied for several reasons: the treatment isn't covered by the patient's plan, the proposed treatment isn't considered medically necessary, or alternative, less expensive treatments are available. Denials often result from simple paperwork errors, such as incomplete clinical documentation or missed deadlines. Automating prior authorizations: an untapped opportunity The prior authorization workflow involves some of the most time-consuming and expensive manual processes in the revenue cycle, making it an ideal use case for automation. Yet, according to the Council for Affordable Quality Healthcare (CAQH), only 31% of providers use electronic prior authorizations. This contrasts with much higher adoption rates for other transactions: 94% use automation for eligibility checks, 98% for claims submissions and 90% for coordination of benefits tasks. With the amount spent on prior authorizations jumping by 30% between 2022 and 2023, switching to automated processes could save the industry hundreds of millions of dollars and many hours of staff time, among other benefits described below. Here are 5 benefits of automating prior authorizations: 1. Prevent costly claim denials and rework Without prior authorization, providers do not get paid. Failure to secure authorization was among the top three reasons for denied claims for almost half of the State of Claims 2022 survey respondents. Often, this is because the authorization does not cover all elements of a patient's treatment, or the information included in the claim submission does not match the original documentation that was authorized. With automation, it's much easier to ensure that all codes, documentation and records are accurate and complete, reducing the risk of claim denials. Automation also gives payers and providers a shared view of account information, minimizing the need for prolonged discussions about the status of authorization and rework requests. 2. Access a central payer database that automatically syncs with changing payer rules Revenue cycle management teams often struggle to keep track of changing payer requirements. Experian Health's prior authorization knowledge base solves this by collating real-time updates to payer requirements. Staff can check what's needed without needing to visit multiple payer websites and cross-check data by hand. Users also benefit from a guided, exception-based workflow, which notes whether submissions are pending, denied or authorized, and flags where manual intervention is required. 3. Improve operational efficiency Almost four in ten providers find timely and efficient management of prior authorizations challenging. Automating prior authorizations reduces the manual burden on staff, so resources and time aren't wasted on low-value activities. Providers can augment efficiencies by combining prior authorization software with other revenue cycle tools to create more coordinated and cost-effective processes. On a webinar about how AI and automation reduce claim denials, Skylar Earley from Schneck Medical Center commented specifically on how AI Advantage was facilitating more efficient prior authorizations: “[With AI AdvantageTM], we've seen the number of authorized outpatient visits increase by about 2.5%. For anyone that deals with prior authorizations and denials relating to prior authorizations, that's incredibly promising. Billers feel like they've got another tool in their belt. For people who spend hours on the phone with insurance companies, fighting for dollars and claims we believe should be paid, any leg-up is a big deal.” 4. Prevent dangerous delays to care with faster prior authorizations A 2022 survey by the American Medical Association showed that the authorization process leads to delayed and abandoned care and even severe adverse events, as patients and doctors wait to hear if paperwork is in order before proceeding with treatment. Automating prior authorizations helps ensure patients don't miss out on essential care because of administrative obstacles. Staff can shave an average of 11 minutes from each transaction, allowing them to initiate more authorizations in less time, and protect patients from the clinical consequences of rescheduling. 5. Deliver a better patient experience Aside from these obvious and significant health effects, the prior authorization workflow also influences patient perceptions overall: in the State of Patient Access 2024, just over a quarter of patients said authorizations were the main reason they considered patient access to be better or worse than last year. Automated prior authorizations free up staff to create a smoother clinical and financial experience for patients. Patients see their accounts processed quickly, with fewer errors and delays. When patients are certain that their insurer will cover their care, they can concentrate on their treatment rather than worrying about how and when it will be financed. Find out how Experian Health's automated prior authorizations help healthcare organizations get on the right path to reimbursement and make these benefits a reality in 2024.

Could patient text reminders play a key role in making healthcare more convenient and accessible for patients? Experian Health's latest State of Patient Access 2024 survey found that six in ten patients want more digital tools to manage their healthcare. Overall, it indicates a greater demand for more transparent, simpler processes. Patient text reminders make this a reality by reducing the cognitive load of scheduling and paying for care. With 98% open rates and an average response time of 90 seconds, text messaging is a simple but powerful engagement tool for providers. For the eight in ten providers gearing up to invest in digital patient access tools in the near future, sending patient text messaging reminders could be a smart choice. Here are three use cases to consider. Use case 1: Patient text reminders can boost patient collections For providers with squeezed margins, every cent counts. While healthcare affordability poses the biggest challenge for patient collections, outdated billing and payment processes hinder patient revenue overall. SMS (text message) reminders prevent unnecessary delays by gently prompting patients to settle their bills. They're direct, convenient and discreet, so they're more likely to be acted upon, as opposed to emails or phone calls that are easily ignored. Texting also supports a tailored experience. For example, Experian Health's PatientText solution integrates with Collections Optimization Manager to segment patients based on their needs and preferences. The Text-to-Pay feature sends patients personalized messages with secure links to payment options, so they can pay their bills when convenient without having to remember a username and password. Case study: See how St Luke's used Collections Optimization Manager and targeted patient outreach to increase average monthly collections by $1.7 million. Use case 2: Reduce no-shows with patient appointment reminders Almost 90% of patients say they want to be able to schedule appointments at any time via online or mobile tools. Automated text reminders ramp up the return on investment in online scheduling and mobile registration tools by reducing no-shows, optimizing patient flow, and ensuring patients get the care they need. Messages can include preparation instructions, so patients know exactly where to go and when, and if they need to fast beforehand or bring anything. It's much easier for patients to click a link in a text to confirm, reschedule, or cancel appointments, than to check their email or wait to speak to a call center agent. That's good news for call centers too – when more patients opt for self-service options, providers can scale targeted outreach while keeping call volumes manageable. Case study: See how IU Health transformed patient scheduling with self-service automation Use case 3: Patient text reminders increase patient satisfaction and care plan adherence with handy alerts Patients actively engaged in their health are more likely to follow through with treatments and care plans, leading to better health outcomes. Text messages can remind patients about post-appointment care, check-ups and medication refills to help them stay on track and reduce the risk of missed doses or appointments. Closing gaps in care and preventing avoidable complications is not just good from a medical perspective – it also reduces the risk of more expensive care being needed further down the line. However, one of the most significant advantages of using patient text reminders is creating a more organized and patient-friendly experience with little effort, benefiting patients and staff. Automated, timely messages through patients' preferred channels ensure they feel cared for and informed, without staff needing constant, high-touch follow-up. Staff members are free to focus on patient support and other revenue-generating tasks, instead of wading through endless admin. Read more: 5 benefits of automated patient outreach PatientText in practice: How one provider used targeted outreach to boost collections by nearly $2M One of Experian Health's clients offers a snapshot of what they've achieved in the year since implementing SMS-based patient outreach: $1.89M in patient collections via Text-to-Pay $168 collected per transaction on average 11K+ transactions via text These results show that offering patients the flexibility to engage with payment processes at their convenience leads to higher transaction amounts and more dollars collected overall. Take advantage of smartphone culture with patient text reminders Many patients have their smartphone with them 24/7, which gives providers a fantastic opportunity to improve patient engagement through automated text reminders. Whether the drive is to increase collections, improve patient flow, or create convenient patient experiences, it's clear that this relatively simple technology punches above its weight. Schedule a demo to see how Experian Health's patient text reminders solution, PatientText, can help your organization improve patient engagement and optimize collections.

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