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Outdated scheduling systems, endless phone calls and clunky user digital interfaces cause friction – for both patients and staff. The result? Frustrated patients, no-shows, unused appointment time slots and a hit to bottom lines. Patients want to see their provider quickly, and they don't want to jump through hoops to make an appointment. Online patient scheduling software may be the solution. In Experian Health's 2024 State of Patient Access survey, nearly 8 in 10 patients who reported being unhappy with their provider experience blamed waiting for an appointment as a top frustration. And 89% of patients said they want to schedule their appointments online or using a mobile device. Unsurprisingly, 61% of patients would consider switching to a healthcare provider that offers a patient portal or a digital front door. Now, 63% of providers report offering self-scheduling tools and another 16% plan to implement online patient scheduling in the next six months. But getting patients to use them is still a challenge. With online patient scheduling software, patients get the 24/7 access they crave, and healthcare organizations benefit from increased patient volume, improved staff efficiencies and revenue growth. Understanding online patient scheduling software To enable online patient self-scheduling, organizations need a platform that translates a provider's scheduling rules into an intuitive experience, guiding patients to the appropriate provider and appointment while keeping the provider in control of their calendar. This is achieved with Experian Health's Patient Schedule solution, through decision support and automated business rules that uphold best practices, regardless of how the appointment is booked. The platform then digitizes the scheduling workflow, handles various scheduling scenarios, and includes necessary pre-registration information for the right appointment. It streamlines the process, ensuring patients can easily communicate their needs and be routed to the correct provider. Providers can automate their scheduling protocols, ensuring patients only see available options. Online patient scheduling software puts patients in charge of managing appointments—on their own time. Tools like Patient Schedule integrate with practice systems, making it easy to coordinate care seamlessly. The software is customizable to an organization's scheduling rules, so patients only see the calendars and appointment types providers want them to see. New and returning patients can access systems in real time and find the appointment slots and providers they need easily. Patients can book, reschedule and cancel appointments, making no-shows less likely. Physician time is used wisely, schedule gaps are lessened and staff no longer has to waste valuable time confirming appointments. Instead, text messages, with their 98% open rate, facilitate fast and direct patient communication. Benefits of patient schedule software to hospitals More than 62% of healthcare workers consider patient scheduling to be one of the areas hit hardest by staff shortages. However, when patients have convenient, 24/7 access to patient scheduling software, it eases the burden on overburdened call center staff, administrative resources and operational costs. Patient scheduling software boosts retention of existing patients and makes it easier to acquire new patients. On average, providers using Experian Health's scheduling solution see 32% more patients per month, reduce scheduling time by 50% and enjoy an 89% patient show rate. Key features to look for in online patient scheduling software Patient scheduling software features should facilitate convenient and flexible patient scheduling while increasing care access, streamlining staff productivity and boosting operational efficiency. Here's a breakdown of key features to consider in online patient scheduling software. 1. User-friendly interface Old habits are hard to break. Experian Health data reports that more than half of providers (55%) find getting patients to use digital services to be one of their greatest challenges. Why? Some research indicates that 89% of patients are reluctant to use an online scheduler because they're either not aware of the service or feel they don’t have the computer skills to use it. Easy-to-use online scheduling is common for everyday tasks like booking dinner reservations. However, in healthcare, that's not always the case. Patients struggle to use slow systems and hard-to-navigate interfaces. To encourage widespread adoption, online patient scheduling software needs to be simple to set up, deploy, and use—for providers and patients. Tools like Patient Schedule easily automate scheduling workflows, allowing providers to define appointment criteria and sync with existing calendars. A platform with no login required, unique patient identification and mobile access makes it easy—and secure—for patients to find providers and schedule appointments. 2. Appointment reminders Relying on appointment reminder phone calls can drain your staff and the bottom line. Patients might miss calls, forget to return messages, lose reminder cards or forget about their appointments entirely. This leads to no-shows, time wasted on rescheduling and juggling physician calendars, decreased patient outcomes and reduced revenue. Automating appointment reminders by text or IVR with Patient Schedule makes it simple to send patients updates, confirm appointments, and maximize staff and physician time. Patients can book, reschedule, or cancel appointments in real time—even after business hours. When patients are in charge of their own schedule, no-shows decrease, and revenue goes up, not to mention improved patient outcomes and satisfaction. 3. Integration capabilities Seamless integration is key. Online patient scheduling software works best when it dovetails with practice management systems, electronic medical record (EMR) platforms and other operational technology. This ensures efficient scheduling, fewer gaps in physician schedules and the ability for providers and practice management to communicate effectively with patients throughout the entire patient journey. With the appropriate integration, patients are in control of their scheduling. Status updates are communicated in real time over text when a patient books, reschedules or cancels online – keeping everyone in the know. Patient Schedule's template rules allow providers to optimize their calendars to ensure patients schedule into the right time slots. Practice managers benefit from coordinated workflows and a holistic view of the entire schedule, making it easier to identify gaps. 4. Customization options There's no one-size-fits-all approach to online patient scheduling software. Whether integrating self-schedule into an existing online system or starting from scratch, the software solution should be tailored to every organization's requirements, goals and budget. When selecting a partner, it's important to consider the organization's needs carefully. What's the scope of use? Is it a small practice or a large hospital network? What existing systems will the online patient scheduling software need to integrate with? Is the online patient scheduling software replacing a large call center or a small support staff? For best results, look for flexible solutions that allow room to scale while accommodating changing healthcare environments and privacy needs. Factors to consider when choosing a solution To ensure a successful implementation of an online patient scheduling software solution, consider these additional factors: Accessibility features Staff training and onboarding requirements HIPAA compliance Privacy protection features Time to launch Cost to implement Ongoing technical support Case studies: Successful implementation stories Curious how Experian Health's Patient Schedule solution benefits healthcare organizations? Here's what two clients had to say: In practice: When Indiana University (IU) Health implemented Patient Schedule, they found that “the platform is very new patient-focused with new patients accounting for over 59% of Self Scheduling bookings.” Of those bookings, they saw an 87% show rate and found “around 64% of our patients self-scheduled during non-business hours.” Watch the webinar: See how IU Health used self-scheduling to manage increasing patient volumes with less staff – and gain insights on using digital scheduling to scale operations. In practice: CareMount Medical, a patient-centered organization, implemented online patient scheduling as part of a 24/7 access initiative, enabling real-time scheduling access across all of their providers and specialties. Read the case study: See how CareMount Medical used Patient Schedule to make it easier for patients to get in to see their provider, improve patient satisfaction and boost financial visibility. By adopting online patient scheduling, healthcare providers can streamline operations, improve patient satisfaction and deliver high-quality care. This solution speeds up staff training, streamlines scheduling time, improves patient no-show rates and increases patient volumes and retention. Ready to make the move to online patient scheduling? Contact Experian Health to get started. Learn more Contact us

Patients expect clear information about their insurance coverage when they visit their healthcare provider, but too many leave feeling confused and financially underprepared. Experian Health's State of Patient Access 2024 survey reveals that 56% of patients struggle to make sense of their insurance coverage without provider assistance, while 61% say improving coverage explanations is the most urgent challenge in patient access. For providers, the financial fallout from missed insurance eligibility checks is even more pressing, with 15% of providers citing eligibility issues as one of their top three reasons for denials. Accurate eligibility checks are crucial to keep the revenue cycle on track. This article highlights common challenges and current best practices for improving eligibility verification. Could automated insurance eligibility checks give patients and providers the financial clarity they're looking for? What are insurance eligibility checks? Insurance eligibility checks are carried out pre-service to confirm that a patient has active insurance that will cover their planned treatment and care. Verifying insurance status, coverage details and benefits in advance ensures that the proper claims and bills are sent to the right recipient. Patients and providers get early warnings of coverage limitations and potential out-of-pocket costs, which helps patients access care without any financial surprises. Without these checks, healthcare organizations may deliver services to patients without active coverage — and with no clear path to payment. Therefore, a reliable eligibility verification process is essential to minimize the claim denials, rework and billing errors that often stem from inaccurate insurance information. How do insurance eligibility checks impact revenue cycle management? In the healthcare revenue cycle—which revolves around who pays, when and how—insurance eligibility checks are a first line of defense against revenue leakage. They're a proactive step toward establishing smooth claims and collections processes so no dollar goes uncollected or is lost to avoidable admin overhead. Prioritizing robust eligibility verification systems, as patient survey respondents advocate, is not just an operational necessity; it's a strategic safeguard against slow payments, patient dissatisfaction and financial instability. The insurance eligibility check process The eligibility verification process typically begins by confirming the patient's contact information to match their insurance card and electronic health record details. Staff then initiate an eligibility request to confirm active coverage. Once confirmed, they check that the plan covers proposed services, including any pre-authorization requirements, and review coverage limits to ensure the patient hasn't exceeded annual or lifetime caps. If applicable, providers also cross-check for Medicare eligibility using the Medicare Beneficiary Identifier (MBI) to identify any additional coverage. Common challenges with insurance eligibility checks Findings from Experian Health's State of Patient Access and State of Claims surveys illustrate the extent of the eligibility challenge, pointing to three main areas for improvement: Outdated or incomplete insurance information Sometimes, the insurance details in the provider's system don't match the payer's record. Patients may change jobs, switch insurance plans, or have secondary coverage they didn't know about or forgot to mention. If these changes aren't caught up front, it can lead to claim rejections and billing delays. Besides the obvious problem of lost revenue, this challenge incurs extra work: 43% of providers report that incomplete checks add at least 10 minutes per eligibility check. Changing payer policies and pre-authorization requirements Keeping up with each insurance provider's prior authorization requirements is challenging, especially if the patient's treatment is urgent. Missing a necessary authorization can lead to a denial, delayed payment and extra work. More than three-quarters of providers say payer policy changes are increasing, but only 10% are using automated tracking as part of their denial management strategy. Is there an opportunity to automate prior authorizations and eligibility verification to tackle denials? Inadequate tools to verify eligibility More than 7 in 10 providers say their organization runs eligibility checks quickly and accurately, but significantly fewer think their revenue cycle management technology is as good as it could be. 59% of providers are using at least two different solutions to collect all the necessary patient info for a claim submission. Tool overload is a real problem, as staff must wrestle with different platforms, processes and logins to get the eligibility information they need. Best practices for effective insurance eligibility checks  To tackle these challenges, providers can use automation to streamline their verification workflows. Some key practices for more reliable and efficient insurance eligibility checks include: Automate real-time eligibility checks for faster, more precise verification: For example, Eligibility Verification automatically verifies insurance coverage and plan-specific benefits information before and at the time of service. This not only speeds up registration, but also catches any potential coverage gaps before services are provided. Automation also helps minimize manual work and reduces the risk of human errors that can lead to claim denials. Track payer policy changes automatically: Insurance verification software helps providers keep up with ever-changing payer requirements. Eligibility Verification connects to more than 900 payers with advanced search, to maximize the likelihood of matching patient information. This can be used alongside Experian Health's automated pre-authorization tool, which dynamically updates national payer prior authorization requirements and flags when something is missing. Give patients upfront, automated price estimates: More than 80% of patients say upfront pricing estimates help them prepare for costs. Automating eligibility checks and patient payment estimates help patients understand their coverage, co-pays and deductibles, so they know what to expect when their bill arrives. This improves transparency, boosts patient satisfaction and accelerates collections. Implementing these best practices helps ensure smooth claim submissions and reduces denials due to eligibility issues, ultimately supporting a healthier revenue cycle. Case study: How Providence Health found $30M in coverage and reduced denial rates with automated eligibility checks Within just five months of implementing Eligibility Verification, Providence Health had saved $18 million in potential denials. Read the case study to see how automated insurance eligibility checks reduced denials, increased staff productivity and boosted patient satisfaction. How Experian Health can help healthcare organizations improve eligibility checks While healthcare affordability remains a pressing concern for patients and providers, quickly and accurately verifying insurance eligibility will remain among the top priorities for both groups. Experian Health aims to simplify the process with automated Eligibility Verification. In addition to reducing payment delays and denials, its streamlined workflows support higher patient volumes, especially as patients have more complex insurance arrangements and take on greater financial responsibility. One significant advantage is the ability to provide extra support for the growing number of patients who may be eligible for Medicare. Medicare eligibility checks can be complicated, particularly if patients don't know which component they qualify for. Eligibility Verification includes an optional MBI lookup service to find and validate the patient's MBI number without requiring a manual search. Find out more about how automating insurance eligibility checks verifies coverage quickly and accurately — giving patients and providers early clarity about how the cost of care will be covered. Learn more Contact us

Experian Health's State of Claims 2024 report reveals a worrying trend in healthcare claim denials, with nearly three-quarters of survey respondents reporting a rise. Around four in ten say claims are denied 10% of the time, with one in ten seeing denial rates above 15%. Denials at this scale, driven by various claim denial reasons, represent billions of dollars in lost or delayed reimbursements, so it's no wonder that reducing health insurance claim denials tops healthcare providers' “must-fix” list. However, despite being highly motivated to resolve the challenge, many organizations need more support to overcome operational roadblocks. Prior authorizations are taking longer to come through. Payer policy changes are more frequent. Patient information is increasingly inaccurate. For 65% of respondents, submitting clean claims is more complex than before the pandemic. With some wrangling more than three technological solutions and others lacking confidence about using automation and AI, providers seem to be struggling to find the sweet spot when tackling denials. This article looks at the reasons for increased claim denials, as well as how automation and artificial intelligence (AI) can help healthcare providers overcome these obstacles to increase operational efficiency and improve cash flow. Major operational challenges leading to increased claim denials Clarissa Riggins, Chief Product Officer at Experian Health, says that many providers are increasingly concerned that payers won't reimburse costs as denial rates increase, when discussing the State of Claims 2024 report. These concerns reflect operational challenges, including difficulty keeping track of pre-authorization requirements, inability to keep up with rapidly changing payer policies and inadequate front-end data collection. While staffing shortages are not among the top three claim denial reasons as they were last year, they are a continuing drag on efficiency for 43% of providers. Burdened by limited resources, these revenue cycle teams are more likely to make avoidable errors during claim submission—a problem that is affecting the four in ten providers who say they have limited resources to cross-check claims for errors. Riggins suggests that healthcare organizations look to technology to close the claims gap: “We had hoped to see a decrease in claim denials from our previous survey, but it's clear these significant challenges are continuing, adding immense pressure on providers to improve their revenue cycle management processes. This growing crisis is a sign that traditional approaches are no longer enough, and providers should adopt more proactive strategies and the latest technology to navigate this volatility.” Top reasons for healthcare claim denials Here are the top three claim denial reasons and how automation and AI can solve them: 1. Missing or inaccurate claims data Missing or inaccurate claims data is the number one operational challenge responsible for the increase in medical billing claim denials – among the top three challenges for 46% of respondents in the State of Claims 2024 survey. Submitting clean claims relies on getting data right the first time. It calls for speed and efficiency, which is impossible with slow, error-prone manual systems. Yet almost half of the respondents say their organizations are reviewing claims manually. While 54% of respondents believe their technology is sufficient to meet claims management demands, increasing errors and rising denials tell a different story. Revenue cycle leaders who embrace automation in their claims submission and denial prevention strategy set themselves up for smoother operations and a boost to the bottom line. Without the right automation to increase the speed and accuracy of claim submissions, valuable staff time and effort are wasted on manually processing error-prone claims, increasing the likelihood of denial. The lack of automation also places unnecessary strain on staff, diverting their attention from more complex claims issues. 2. Prior authorizations Claim denials often stem from poor communication between payer and provider systems, with the prior authorization process as a prime example. The process requires providers to seek agreement from the payer to cover a service or item before it is administered to the patient. Failure to do so results in the claim for that treatment being denied. Unfortunately, obtaining prior authorizations is not always straightforward; sometimes, the patient's treatment must begin before the authorization process is concluded. Other times, the authorization only covers certain aspects of the treatment. Not only is the prior authorization process complex, but it is also costly, laborious, and time-consuming to navigate successfully. According to the 2023 AMA Prior Authorization Physician Survey, physicians and their staff spend 12 hours per week completing prior authorizations, with almost all reporting physician burnout as a result. Providers must stay on top of frequent changes to payer policies, and staff must use multiple payer portals to track authorization requests. Unsurprisingly, authorizations are among the top three claim denial reasons for 36% of respondents in the State of Claims survey. As with any challenge involving digital systems “talking” to one another, authorizations are a great use case for automation. Automation can be used to check payer policy changes, alert staff when prior authorization is needed, gather relevant documentation, and review authorization requests for accuracy. This significantly reduces the burden on staff and minimizes the risk of claims being submitted without the necessary authorizations in place. Experian Health's Prior Authorizations technology automates authorization inquiries and checks requirements in real time. It uses AI to help users find and access the appropriate payer portal to speed up the authorization workflow. Users will have confidence that they're looking at the same account information and policy details as the payer, which means lengthy negotiations can be avoided. Staff also get accurate status updates on pending and denied submissions so they can take appropriate action and maximize reimbursement. 3. Inaccurate or incomplete patient data Even the slightest mistake or mismatch in a patient's name, address or insurance details can result in a denial, leading to payment delays and extra work for the staff. These denials are particularly frustrating because they should be avoidable. Automation can be used to pre-fill the patient's information before they arrive to avoid the errors that occur with manual input. This has the added benefit of accelerating registration. These solutions can also check for duplicate charges, missing fields and coding inaccuracies. For example, Claim Scrubber helps providers prepare error-free claims for processing by reviewing each line of the claim before it's submitted. ClaimSource® helps providers manage the entire claims cycle by creating custom work queues and automating claims processing to ensure that claims are clean the first time. Implementing technology to prevent claim denials The report details some of the strategies providers are using to try to reduce denials. These include upgrading existing claims process technology, automating or expanding patient portal claims reviews, and automating tracking of payer policy changes. More than half are motivated to adopt new technology to reduce manual input. This is exactly what Denial Workflow Manager is designed to do. It enables providers to track claim status and appeals and quickly identify those that need to be followed up on. It eliminates the need for manual review, while analysis and reporting give staff insights into the root causes of denials to optimize performance. This solution can be integrated with tools like Enhanced Claim Status, which sends automatic status requests based on the type of claim and specific payer timeframes. It generates accurate adjudication reports within 24-72 hours to accelerate the revenue cycle. The output is viewable in ClaimSource to streamline workflows and manage the claims process in a single online application. Automation and digital technology are also valuable counterweights to the shortage of qualified staff. While staffing shortages aren't as high on the list of concerns as in previous years, they remain a stubborn problem. By reducing the need for manual input, claims management can be accelerated while freeing staff to focus their attention where it matters most. Experian Health was client-rated #1 by Black Book™ ’24 in Denial & Claims Management Outsourcing, Health Systems. Learn more AI solutions for reducing claim denials Healthcare organizations can get more bang for their buck from automation by integrating these solutions alongside AI. Interestingly, the survey suggests that providers have mixed feelings towards AI: 35% of providers say they want solutions that leverage more AI and machine learning, yet only 8% are actually using them. Current ClaimSource users might consider AI Advantage™, which uses AI and automation to generate real-time insights for a proactive approach to denial management. It helps providers combat claim denials from two angles: AI Advantage – Predictive Denials uses AI to identify undocumented payer adjudication rules that result in new denials. It identifies claims with a high likelihood of denial based on an organization's historical payment data and allows them to intervene before claim submission. AI Advantage – Denial Triage comes into play if a claim has been denied. This component uses advanced algorithms to identify and intelligently segment denials based on potential value so that organizations can focus on resubmissions that most impact their bottom line. Doing so removes the guesswork, alleviates staff burdens, and eliminates time spent on low-value denials. This solution complements existing claims management workflows to help providers expedite claims processing, reduce denials, and maximize revenue. Another AI-powered solution helps prevent denials on the front end: Patient Access Curator allows patient access teams to capture multiple data points in seconds. This solution solves the “bad data” problem, using AI and robotic process automation to run checks for eligibility, coordination of benefits, Medicare Beneficiary Identifier, demographics and coverage discovery with a single click. The financial impact of denials and the ROI of technology Another paradoxical finding in the report is that while 47% of respondents see having AI technology as a competitive advantage, less than half say they'd be up for fully replacing their existing claims processing technology, even if presented with compelling ROI projections. Automation and AI can meaningfully impact the claims metrics that keep revenue cycle leaders awake at night – denial rates and clean claim rates being the top two. Patients also want to see improved performance when it comes to reducing denials. If healthcare organizations cannot offer a reliable, error-free system, they risk losing patients' trust and loyalty. Providers who demonstrate a well-managed claims system with swift and accurate results will inspire confidence and improve patient engagement. It's essential to assess how existing solutions perform against these metrics and implement upgraded solutions to deliver a more substantial ROI. AI and automation in practice How are Experian Health's clients using AI and automation to reduce claim denials? Here are a few examples: In only six months of adopting AI Advantage for claims processing and reducing claims denial, Schneck Medical Center saw denials fall by an average of 4.6% each month. In addition, the time needed to correct claims dropped from 15 to less than five minutes. The ambulatory clinic Summit Medical Group Oregon implemented Experian Health's claims management solutions, including Enhanced Claim Status and Claim Scrubber, to improve its registration and coding processes. These two solutions helped the team submit cleaner claims, resulting in a decrease in denials. As a result, the company now maintains a 92% primary clean claims rate. Another compelling example of the positive impact of technology on healthcare claims management is IU Health's experience with the all-in-one claim cycle management platform ClaimSource. With ClaimSource, IU Health managed the transmission of $632 million in claims in five days and processed $1.1 billion of claims backlog. Clients who have implemented Experian Health's Patient Access Curator have saved over $1 billion in denied claims, significantly boosting their bottom lines. Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system – for the second consecutive year.  Learn more Enhancing revenue cycles by addressing claim denial reasons By pinpointing the most common health insurance claim denial reasons and adopting automation and AI-driven solutions, providers can increase the first-pass clean claim rate, ramp up the likelihood of reimbursement, and reduce the overhead of reworking and resubmitting claims. Inevitably, hospitals will witness a surge in their financial performance. Contact us today to learn how data-driven claims management technology can help your organization reduce denied claims in healthcare and increase ROI. Improve claims management Contact us