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Navigating an increasingly complex reimbursement landscape remains challenging for today’s healthcare providers, with too many claims still underpaid, delayed or outright denied. In fact, nearly 70% of providers said the problem of denied claims had worsened during 2021. Naturally, relationships with payers suffer, adding friction to the process. To this end, revenue cycle leaders are relying on claims management software to create more visibility into complex contract and claims management processes. These data tools can resolve or prevent the snags that often interfere with claims processing and billing workflows, which allow providers to streamline claims processing, improve communication with payers and accelerate a patient’s payment lifecycle. The path through that bureaucratic jungle requires high-quality information at every step. Accurate patient data, error-free clinical documentation, up-to-the-minute payer policy updates, and verified billing software and claims edits are all essential to help reduce denials and ensure faster-flowing payments.  With so many options on the market, providers should look for healthcare claims management software that provides support in four critical areas. 1. Simplified contract management Managing and understanding the tangled web of payer contracts, insurance rules and regulations can be time-consuming and overly complex. Keeping up with ever-changing reimbursement methodologies is resource-intensive for teams that are already suffering from staffing shortages. A system like Contract Manager and Contract Analysis can ease the pressure by streamlining workflows and showing revenue cycle management teams how payers are performing against agreed-upon terms. Contract Analysis seamlessly integrates with Contract Manager to provide all the data needed to make informed decisions about whether potential contract terms are in line with business goals – before any commitments are made. 2. Claims management software should help with error-free claims submissions In a perfect world, all claims would be completely accurate every time. But errors inevitably do creep in, leading to confusion, delays, and non-payments. Healthcare providers lose massive sums of money each year due to inaccurate claim submissions, denials, corrections, and rebilling. A good claims management strategy ensures that claims are error-free before they’re submitted. Claim Scrubber is an automated solution that reviews every line of each pre-claim and verifies that it is coded with the correct information before being sent to your claim’s clearinghouse. The result? Fewer undercharges and denials, optimized staff time and better cash flow. 3. Visibility of submitted claims With multiple steps, stakeholders, and milestones, keeping track of what’s happening with a claim can be cumbersome. Regardless of the workplace setting – individual hospital, large physician practice or a multi-facility Centralized Business Office – revenue cycle leaders need streamlined workflows, custom provider and payer edits, and superb customer support. ClaimSource is a solution that ensures all hospital and physician claims are clean before submission to government or commercial payers and creates custom workflows for easy prioritization and organization. With ClaimSource, providers can manage the entire claims cycle, from eligibility validation, claims editing, claims submission to the payers, claim submission reconciliation, remit retrieval, and reporting, in a single online application. 4. Claims management software should help prevent claims denials Denial rates vary widely between issuers. One 2020 study of HealthCare.gov issuers found that 1% to 57% of in-network claims were denied, while over 70% of major medical issuers had a claims denial rate of over 10%. Many reported denying one-third or more of all in-network claims. A tool such as Enhanced Claim Status makes it easy to respond early and accurately to denied, zero-pay, pending or returned-to-provider transactions before the Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) get processed. By removing the need for manual follow-up tasks and automatically submitting status updates based on each payer’s adjudication timeframe, providers can improve productivity and get paid the correct amounts faster. The claims management process is fraught with challenges. But with the right tools, data and analytics, these hurdles can be overcome. By integrating pre-claim (encounters) and post-claim (837) claims management software into the revenue cycle workflow, it's easy to review every line of every encounter. In this way, providers can verify that each claim is coded properly and contains the correct information before the claim is invoiced and submitted for reimbursement. Simply getting paid may not yet be as easy as providers would prefer, but technologies like Contract Manager and Contract Analysis, with their reliable customer support, can certainly oil the wheels. Find out more about how Experian Health’s Claims Management solutions with global payer edits and custom provider edits can help providers streamline the payment process and improve efficiencies, simplify the process and ensure speedy and accurate reimbursements.

Healthcare’s digital transformation promises patients ever-growing choices in how to access, experience and pay for care. Providers know that opening their digital front door is the key to attracting and retaining loyal consumers. However, deciding on the exact technologies and services to offer can be challenging. A good place to start is to follow the patients’ lead: what digital tools do they say they want? How are they using existing services (or not)? By understanding patients’ attitudes and behaviors, providers can design a digital patient journey that leads to increased patient satisfaction. A new collaborative report by Experian Health and PYMNTS provides fresh insights to inform digital patient engagement strategies. This survey, conducted in January 2022, interviewed over 2000 patients to understand how they’re using digital methods to access healthcare services and their biggest pain points. The findings revealed a need for digital services that foster convenience and choice. Digital-savvy consumers expect user-friendly online options across the care continuum, from scheduling and registration to final payment. Improving these services is also likely to encourage the less digitally confident consumers to try alternative methods and increase access to care. This article offers a snapshot of the key findings that will help providers identify gaps in their digital offerings and build a digital experience that meets consumer expectations. Finding 1: Patients are looking for digital methods to perform most healthcare activities. Patient portals are the most popular method for obtaining test results, with 44% of patients choosing this option. A quarter of patients have used digital methods to pay their medical bills. Digital methods are widely used across the patient journey, from scheduling appointments to receiving test results. Patients expect convenience, flexibility and choices, with many reporting frustrations when they can’t access the digital services they desire. Providers that offer a broad selection of digital patient engagement solutions will be best placed to respond to changing consumer demands. Beyond patient satisfaction, digital tools facilitate better care plan adherence, improve workforce efficiency, and contribute to higher patient collections rates. Finding 2: Patients are satisfied with their healthcare experience but find it challenging to confirm costs and select new providers. 15% of patients report difficulties when obtaining accurate cost estimates for appointments and procedures. Predictably, digital-first patients have the highest expectations of digital systems. They are accustomed to convenient and accessible digital processes elsewhere in the consumer world. Healthcare organizations with an open digital front door will be more attractive to these potential new patients. Digital payments could be a worthwhile investment in this regard. A previous PYMNTS survey found that 63% of patients would consider switching providers if the payment experience wasn’t up to par. To improve the payment experience, providers should consider offering upfront pricing estimates to make it easier for patients to understand and plan for their bills. A tool such as Patient Financial Advisor can act as an online financial concierge for patients, by connecting them with appropriate payment plans and contactless payment methods directly through their mobile devices. Finding 3: Two-thirds of patients use patient portals, but many find portals lack essential payment features. While 62% of patients use portals, this rises to 82% among digital-first consumers and drops to 19% among non-digital consumers. 64% of patients say cost estimates are very or extremely important, but only 24% say they receive estimates. Closing the gap between what patients expect of portals and what’s actually delivered could help narrow the differences in portal usage between different patient groups. Credit and debit cards are currently the most popular payment methods, but patients would use them less often if their preferred digital payment methods were available. Providers should consider combining high-performing patient portals with a range of payment options. Finding 4: Frictionless patient portals could prevent patients from switching providers. 61% of patients say they would switch to a healthcare provider that offers a patient portal. Improving patient portal capabilities is likely to be an important driver in attracting new patients. However, it’s also essential to retain existing patients. More than six in ten patients say they’d switch to a provider that offers a patient portal. This number rises to nearly eight in ten younger patients. A digital-first experience is no longer simply a preference, but an expectation for many consumers. To better engage and retain consumers throughout the patient journey, providers must explore the use of patient portals and other digital solutions to remove digital pain points and meet consumer expectations for a frictionless patient access experience. Download the full report to learn how healthcare providers can relieve digital pain points to offer improved patient care and satisfaction.

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