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“For too many, coverage is either unavailable or insufficient.” This is the harsh reality the American Hospital Association highlighted in a recent statement to the US Senate, urging action to address growing medical debt. Despite efforts to expand insurance coverage, hospitals continue to lose billions of dollars through unpaid bills. The statement notes that hospitals provided over $42 billion in uncompensated care in 2020 alone. Guiding low-income patients to appropriate charity care programs can mitigate a significant portion of this uncompensated care. Unfortunately, many eligible patients are either unaware of these options or choose not to apply, causing hospitals to waste time and money chasing bills from people who cannot afford to pay. Helping those patients find and apply for financial support is critical to reducing bad debt. But that's a challenging prospect without automation. Presumptive screening with Patient Financial Clearance offers a faster route to reliable charity care classifications and a reduction in uncompensated care. What is charity care? Charity care programs provide free or discounted healthcare to patients who can't afford to pay their bills, covering medically necessary inpatient and emergency room services. Typically, programs offer full or partial discounts to uninsured patients, but those with insurance may be entitled to assistance if their plan doesn't cover their care. Eligibility depends on the hospital's financial assistance policies and relevant state regulations. Hospitals do not expect to be reimbursed for charity care, though tax exemptions and government funding may offset some of the cost. In this way, charity care is distinct from “bad debt,” which refers to unpaid patient bills that hospitals expect to collect. Frustratingly, too many accounts that could have been eligible for charity care are written off to bad debt—perhaps because patients don't realize they're eligible, don't know how to fill out the application, or feel embarrassed to seek help. The problem is further exacerbated by the growth in high-deductible and “skinny” health plans, as patients without sufficient coverage assume support is only for the uninsured. Several states are tackling medical debt by bolstering charity care programs. For example, North Carolina plans to boost federal payouts to hospitals that agree to waive medical debt for low-and middle-income patients. In Milwaukee, County Supervisors are taking a preventive approach, using income data to automatically enroll at-risk patients into charity care programs to stave off bad debt before it takes root, in a process known as presumptive charity. What is presumptive charity? Checking eligibility and helping patients apply for charity care is predictably form-heavy. Patients must provide tax returns, pay stubs, and bank statements to confirm their household income and financial status. Manual reviews are time-consuming for providers, while the overall experience can feel intrusive or confusing to patients. Presumptive charity screening expedites charity care checks by automatically screening patients for financial assistance eligibility. It uses automation and data analytics to quickly evaluate the patient's credit information, financial data and demographic details to make a 'presumptive' determination of eligibility for charity care, regardless of coverage status. Better charity care classifications reduce bad debt Automated charity care checks mean more patients will be classified correctly so hospitals can confidently seek reimbursement from the appropriate source. This offers several advantages, such as: Reducing bad debt: Presumptive charity screening results in fewer eligible patients missing out on financial support, so they're less likely to be sent bills they can't pay. Increasing efficiency: More accurate screening allows staff to cut time spent on administrative tasks and stop chasing collections from patients who are unlikely to be able to pay. Expediting classification decisions: Automation means eligible patients don't have to wait for long periods to find out if they'll get financial support, which is especially important in urgent and high-volume services, such as emergency departments and large hospital systems. Improving the patient experience: Speedy systems with fewer forms reduce the patient's involvement to a minimum, contributing to a more convenient and compassionate financial journey. Maintaining compliance: Hospitals comply and maintain their non-profit status by providing charity care to their community. Supporting patients: Providing accessible healthcare to those who are low-income and are most vulnerable. How can Patient Financial Clearance help providers improve charity care classifications? Patient Financial Clearance (PFC) is a presumptive screening tool designed to help providers quickly determine which patients may be eligible for financial assistance. It then connects those patients with relevant charity care programs and automatically enrolls them, or establishes tailored payment plans for the amount they owe based on their financial situation. First, Patient Financial Clearance triggers automatic checks before or at the point of service to rapidly assess whether the patient qualifies for Medicaid, charity care or other financial assistance programs. It uses Experian Health's superior data and analytics to accurately estimate the patient's income, household size and Federal Poverty Line (FPL) percentage, and it calculates a Healthcare Payment Risk Score to predict their propensity to pay. Unlike alternative models which are built to estimate incomes for consumers with higher incomes, PFC's income estimates are optimized to predict incomes below 400% of the FPL. Then, if patients are likely to be eligible for charity care, the tool pre-populates application forms and initiates auto-enrollment to reduce staff manual input and the risk of errors. There needs to be a prompt process to help patients who do not qualify for charity care manage their bills. For patients who do not qualify for charity care, there also needs to be a prompt process to help. Patient Financial Clearance recommends optimal payment plan amounts per the organization's terms and policies. Staff can pull up summarized and detailed views of the patient's credit history and custom scripts to guide financial counseling discussions. Alex Liao, Product Manager for Patient Financial Clearance at Experian Health, explains how better charity classifications help reduce bad debt and increase collections: “The obvious benefit is that clients can accelerate the charity care application process and ensure eligible patients get assistance quickly. However, having a more accurate picture of patients' financial needs offers wider benefits across the revenue cycle: it ensures each patient account is handled appropriately to increase upfront collections and reduce bad debt. Those with a low ability to pay receive a payment plan they can afford, while those with a greater capacity to pay are not just paying the minimums.” Patient Financial Clearance in practice See how UCHealth used PFC to create a more streamlined approach to charity care classifications, resulting in: $26 million in disbursed charity care. More than 1,700 patients covered. 600 charity cases closed in one month alone (August 2023). To hear more about how automating charity care classifications with Patient Financial Clearance could help your organization reduce bad debt, contact us today for a demo. Patient Financial Clearance Contact us

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

Maintaining a healthy cash flow is the only way to deliver quality patient care, invest in state-of-the-art technologies and keep daily operations running smoothly. But that's easier said than done: data errors, delayed payments, denials and staffing disruptions leave providers vulnerable to escalating admin costs and revenue leakage, with little left over to reinvest. By adopting a few key revenue cycle management (RCM) strategies, providers can sidestep these challenges and bring in more dollars. This guide summarizes five revenue cycle management best practices healthcare leaders should follow to optimize RCM workflows and promote financial stability. Key challenges in revenue cycle management Common issues that can get in the way of a healthy revenue flow include: Inaccurate patient data leading to coding errors, claim denials and billing delays Increasing numbers of denied claims generate costly rework and wasted time Payer compliance issues that are constantly changing and time-consuming to monitor Growing numbers of self-pay patients struggling to pay their bills Labor shortages increase pressure on staff and leave the door open to sub-par performance Inadequate data insights hindering management's ability to spot opportunities for improvement Rapid technological changes leave providers on the back foot if they fail to keep pace with new developments. The dream scenario would be to avoid all these potential obstacles before they do too much damage. In reality, providers will need to choose a few priority areas to troubleshoot. Check out this guide to choosing the right key performance indicators for your revenue cycle dashboard to ensure the effective implementation of RCM strategies. Revenue cycle management best practices What does a successful revenue cycle look like? For busy RCM leaders, deciding what to tackle first can be overwhelming. While there's no one-size-fits-all RCM strategy, there are a few key issues that all organizations must pay attention to. Here are five areas of best practice to factor in: 1. Streamline patient registration and insurance verification Accurate patient data is the number one factor in building a robust revenue cycle. It doesn't matter how efficient claims management and collections processes are if the data they use is flawed. Automated registration and verification tools reduce the chances of manual errors entering the system to ensure correct billing, reduce denials, and speed up reimbursement. One pitfall to watch out for is the fact that some digital tools still require staff to check multiple payer websites and data repositories to verify insurance eligibility. Experian Health's latest patient access solution, Patient Access Curator, avoids this by using AI-driven technology to collect and verify patient information with a single click. 2. Automate claims submission and management According to Experian Health's State of Claims 2022 report, 62% of providers feel they lack the necessary data and analytics to identify issues in claims submission processes. A similar number believe the absence of automation prevents improvement. The CAQH Index backs this up, with the latest estimates suggesting the healthcare industry could save $18.3 billion by switching to electronic transactions. As with patient intake, there's an opportunity to leverage automation in claims management to prevent errors and delays so the organization gets paid faster. Experian Health's claims management products—ranked #1 in 2024 surveys by both KLAS and Black Book—automate each step of the claims workflow so providers can submit clean claims quickly and cut the need for time-consuming manual work. 3. Optimize denials management and appeals with AI Despite best efforts, claims denials remain a burden for many RCM teams. However, proactively understanding and addressing the root causes can help keep denials under control. There's an opportunity to go a step beyond automation and see how artificial intelligence and machine learning can help combat the denials challenge. AI AdvantageTM evaluates individual claims in real time to flag those with a high likelihood of denials based on historical payment data, so staff can intervene quickly before submission. Denials are then triaged using advanced algorithms so staff can focus on reworking denials with the greatest chance of payment, rather than wasting time on those that are never going to be approved. Eric Eckhart, Director of Patient Financial Services at Community Medical Centers in California, says that since implementing AI Advantage, “Now I have almost a whole week a month of staff time back, and I can put that on other things. I can pull that back from outsourcing to other follow-up vendors and bring that in-house and save money. The savings have snowballed. That's really been the biggest financial impact.” Watch the webinar: Hear how Community Medical Centers and Schneck Medical Center are using AI AdvantageTM to prevent and triage denials. 4. Choose the right technology and tools for enhanced RCM The three previous revenue cycle management best practices emphasize the importance of selecting the right tools for the task. Two things to look out for when adopting a new RCM product are how well it integrates with existing tools and systems, and whether it offers meaningful insights to drive ongoing improvements. Experian Health's integrated RCM solutions are designed to fit together seamlessly, often allowing staff to view information from multiple workflows within the same dashboard. By bringing together metrics such as financial performance, billing efficiency and collections rates into one place, these tools help staff make strategic decisions about resource allocation and operational improvements. 5. Keep up with regulatory compliance Finally, ensuring compliance with regulatory requirements cannot be overlooked. The reputational and financial risks are too great. Regular training for staff on compliance issues and maintaining up-to-date knowledge of government and payer requirements will minimize the risk of penalties. Choosing RCM tools that automatically check for relevant updates can help providers stay current. Price transparency is a topical example. While the Hospital Price Transparency Rule is designed to help healthcare consumers understand healthcare costs and make more informed decisions about their care, implementation has proven tricky for providers. With the right technology and third-party support, it's much easier to stay compliant. Watch the webinar: See how Experian Health and Cleverley & Associates have partnered to help healthcare organizations navigate price transparency in 2024. Looking for more insights into revenue cycle management best practices? Contact Experian Health today to discover how our RCM solutions can transform your revenue cycle and increase cash flow year over year. Revenue cycle management solutions Contact us