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Published: November 21, 2025 by Adam.Lewis@experian.com, joseph.rodriguez

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Supercharge your COVID-19 vaccine management plan with digital solutions

If President Biden’s two trillion-dollar stimulus package is approved by Congress, support will include funding for a national vaccination program. While the arrival of the vaccine is an immense relief, the logistics for rolling it out across the country present a major challenge. Even at a rate of one million shots administered per day, it could still take 18 months to vaccinate 80% of the population. There are numerous supply, distribution and communication challenges to overcome, both at national and state levels. And for individual healthcare providers, mass vaccine administration calls for a holistic approach, to make sure the right patients get the right dose at the right time and place. Could data analytics and digital automation tools be the key to identifying, engaging and supporting patients as the vaccine program is rolled out? Here are 6 ways digital technology could help your organization improve vaccine management. 6 digital tools to include in your vaccine management plan Segment patient groups with consumer data Deciding who gets the vaccine first is only hurdle number one. Providers must then segment patient populations according to risk categories (such as age or occupation), so they know who should be at the top of the list. Without accurate consumer data, there’s a risk that some vulnerable patients will be missed out. The answer lies in data analytics. By synthesizing thousands of data points for more than 300 million Americans, ConsumerView gives providers the detailed insights needed to segment and target patient populations. At the tap of a button, providers can find out which patients are essential workers or in high-risk groups, so they can be channeled into the vaccine program without delay.  Improve patient access and engagement with data insights According to the Kaiser Family Foundation, six in ten older adults say they don’t know when and where to get the vaccine. Many patients also face access barriers such as lack of transportation or childcare, or poor digital literacy. If providers don’t account for these in their outreach and engagement efforts, their vaccine program will fall flat. Consumer data can again help providers understand who their patients are, to identify those who might have trouble getting the vaccine. Insights on the social determinants of health can point to the best communication channels and support services to offer.  Keep track of patient identities with secure patient portals If providers are reaching out to patients and encouraging them to schedule vaccine appointments through their patient portal, they must have confidence that the person signing up and logging in is who they say they are. The right security protocols can help validate and protect patient information. One example of identity proofing technology is Precise ID®, which uses knowledge-based authentication (questions only the real person would be able to answer) and device recognition to verify patient identities. Prompt patients to book a vaccine appointment with automated outreach Imagine if patients could receive a text or voice message notifying them that it’s time to schedule their vaccine, with a link and simple instructions on how to book. With automated outreach, providers can proactively text or call a segment of patients with self-scheduling options and specific messages about the vaccine and its safety. Not only will this help to increase vaccination rates, it’ll reduce call center volumes at a time when staff are already under pressure. Make it easy for patients to schedule appointments with online self-scheduling In order to meet daily goals for vaccine administration, it has to be easy for patients to book appointments. The last thing any provider wants is no-shows. By deploying scheduling software that ties vaccination qualification rules into the booking process, providers can match patients to a convenient slot, ensure they meet the correct segmentation criteria prior to booking, and confirm whether the appointment is for the first or second dose. And of course, an online self-service scheduling tool such as Patient Schedule allows this part of the patient journey to be completed with minimal face-to-face contact, minimizing risk of infection. Speed up reimbursement with automated coverage discovery Finally, providers must make sure that vaccine-related reimbursements run smoothly. CMS has ruled that every American should have access to the vaccine without incurring any out-of-pocket costs. But although the government may be footing the final bill, providers still need to seek reimbursement by payers, which means they still need a reliable way to check a patient’s coverage status. With Coverage Discovery, providers can run quick, comprehensive checks of commercial and government coverage, and identify the right payer for administrative services. Digital software and analytics can provide efficient, secure and convenient ways for providers to guide patients through the vaccine management process, without delay. Contact us for more information on how Experian Health can support your organization to deliver a vaccine management plan.

Feb 04,2021 by Experian Health

10 ways to schedule your patients effectively

  Consumers today want more flexible and convenient access to care, preferably through the self-service experience they are accustomed to in other areas of their lives. To answer this call, providers are turning to online self-scheduling, which allows patients to book an appointment with the provider of their choice any time of day or night via the comfort of their own home and on a mobile device. Incorporating a self-scheduling solution that reaps long-term success takes a specific strategy, and with the number self-scheduling vendors growing every day, it can be hard to know what to look for in a self-scheduling solution. How can providers be sure that their solution is scheduling patients effectively? Implement patient self-scheduling the right way. Online self-scheduling that automates scheduling protocols with customized business rules drives efficiency while ensuring bookings are accurate. If calling to schedule an appointment, schedulers will walk patients through a series of questions to determine the best possible provider and appointment time for their specific care need. The right scheduling solution should be able to seamlessly facilitate that question and answer process online. It not only ensures that patients are being matched with the right provider but keeps providers’ scheduling rules in mind throughout the entire process. For example, some providers may only designate certain days and appointment slots throughout the week for new patients. With those protocols included as part of the scheduling solution, providers can maintain control of their calendars while filling existing gaps.This is particularly vital during a pandemic like COVID-19 where to avoid further exposure and spread of the virus providers may only want to see patients experiencing those symptoms at certain times of day. The benefits are three-fold: schedulers, including call center agents and patients, see only appropriate appointment availability for a provider in real-time allowing them to book on the spot, providers can experience a more predictable schedule as they know their rules are being maintained, and patients can be assured that their health and safety is a top priority for in-office visits. Integrate with your EMR/PM system. Direct integration with any EMR/PM system is a key component for any successful scheduling solution as it provides everyone (patients, providers, health plans, and call center agents) with a continually up-to-date, real-time view of appointment availability. These integrations improve workflows behind the scenes while enabling the patient-centered aspect of the technology, which is the ability to book an appointment from a computer, phone, or tablet. Additionally, being able to provide a non-integrated scheduling experience for affiliated providers and other services is a vital additional offering that needs to be available outside the integration so that systems can open scheduling to all services. Having a solution that can do both is ideal. Offer a white-labeled experience. Customers remember and go back to brands they love, and that couldn’t be truer in healthcare. That is why it is important for organizations to deliver a consistent brand experience across the board—even with a self-scheduling solution hosted by an outside vendor. Leveraging a white-labeled scheduling solution promotes a strong brand experience and builds trust while saving patients the hassle and confusion of leaving the organization’s website to schedule via another. Moreover, many scheduling vendors require logins to their system in order to schedule, this is an unnecessary barrier to patient access. While useful for current or existing patients, a log-in may actually be a detriment to acquiring new patients or those who don’t yet have a relationship with your organization. Provide real-time scheduling (not just request an appointment). Unfortunately, many organizations claim to offer online self-scheduling, but the reality couldn’t be further from the truth. So many times, patients go through the entire online scheduling process to find out that they’ve only requested an appointment, and still have to wait for the provider to confirm and book, more often than not with a phone call which is what the patient was trying to avoid all along. Real-time scheduling means patients have the ability to view and actually choose their preferred appointment day and time and book right there on the spot. This also means that patients can book an appointment any time of day or night, outside of the provider’s business hours. Allow same and next day appointment scheduling. Many providers set aside appointment slots for their patients to schedule same- and next-day appointments for more urgent needs. These slots can be made available to patients online with a scheduling solution’s ability to automate business rules. Offering same- and next-day appointments online holds a few advantages: it’s certainly a competitive advantage against the growing number of standalone urgent care offices, but it also helps mitigate gaps in care as patients are less likely to present elsewhere for care. Send calendar reminders. The act of booking an appointment isn’t always enough to make a patient show up for scheduled care. Automated calendar reminders, specifically, ones that include .ics calendar files, sent to patients immediately after the booking process increase the chances that patients will show for their scheduled appointments. It’s a feature that dramatically reduces patient no-shows, which are often detrimental to the bottom line. Complement with automated outreach. Many health systems send automated phone and text campaigns to patients about their healthcare needs, but all of them still require a patient to call in to schedule an actual appointment. Minimizing the burden on patients could close more gaps in care, improve the patient experience and reduce call center workload at the same time. Automated, targeted outreach campaigns can help you do exactly this. With a simple text message or voice message, providers can prompt patients to book their next appointment right then and there, on the spot, as part of the text message or voice call.With automation, providers can contact and schedule more patients versus leveraging a call center to contact each person individually. And, when automated patient outreach is paired with digital scheduling, patients are far more likely to show up to appointments. Make referral scheduling easy. Providers can arm referral partners with dedicated scheduling links, making it easier for them to schedule certain services. These links can include a customizable Q&A that walks the scheduler through the booking process and allows them to schedule the referral appointment effortlessly and without a phone call. Internal referrals within a provider organization can be similarly managed with a digital scheduling interface. Where patients traditionally would have left the office with a list of providers to call for a follow-up, provider staff can now locate and book follow-up appointments for patients at the point of care before leaving. This not only improves referral capture rate but offers a better, more connected experience for patients as they can more easily navigate the continuum of care and, ultimately, achieve better health outcomes. Include availability on third-party scheduling sites. As providers open the digital front door to their practice, they will want to meet patients wherever they are online, outside of just the provider’s website. A sophisticated online scheduling solution will enable providers the ability to add scheduling links on third-party websites so that patients searching online for local providers or specialists can immediately see appointment availability down to specific days and times.Also, to ensure accurate bookings, the scheduling solution must be able to ask patients questions to ensure they qualify to book, ensuring that the provider’s calendar is protected while making access easier. Leverage analytics to understand your users. Where are patients dropping off during the scheduling process? What is the conversion rate? How many patients are actually showing up for their scheduled appointments? These are all important questions for providers to ask when gauging the effectiveness of their scheduling solution. The answers to each of these questions can refine and improve the scheduling process, and a sophisticated self-scheduling solution will come with real-time analytics dashboards and data science capabilities to help determine opportunities for improvement.Analytics and reporting can also be used to track capacity and utilization rates to help providers optimize their calendars and referral pathways. Analytics can provide insight into where referrals are being sent so that bottlenecks can be quickly and easily identified, and the behavior modified to better spread referrals across the network. The rise of consumerism in the healthcare industry is no doubt influencing the creation and adoption of self-scheduling solutions, among other digital technologies that improve patient access. As these technologies are more seriously considered, providers need to be aware of what to look for in a self-scheduling solution. Smart technology that incorporates the components above will stand out from the crowd, ready to fit the unique needs of any provider organization. Download our free guide to learn more about online self-scheduling and how it fits within an omni-channel access strategy.

Feb 02,2021 by Experian Health

What is a Unique Patient Identifier?

Editor's note: This blog post was updated on October 2, 2023.  In today's rapidly evolving healthcare landscape, the need for a standardized approach to patient matching and identification has become crucial. Not having a unique patient identifier (UPI) not only poses challenges to managing patient data but also hampers interoperability between healthcare organizations. A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information. A standardized code like this not only protects sensitive health information but supports the exchange of data between healthcare organizations and states as it is a number and format easily read and recognized by all. Advocates for a coordinated approach to patient matching are continuing to make the case for a national unique patient identifier (UPI). In April 2023, healthcare organizations wrote to legislators urging them to reject language in the 2024 Health and Human Services appropriations bill that prohibits the use of federal funding for a national UPI standard. More than 150 healthcare and medical organizations signed the letter, including Experian Health. The coalition argues that a standardized approach to patient matching could save lives, avoid medical errors, reduce unnecessary costs and greatly improve operational efficiency. While federal funding currently remains off-limits, the industry is poised to move forward to develop a national patient identity solution that is cost-effective, scalable, secure and one that protects patient privacy. Let's explore how a UPI can revolutionize the healthcare industry and create a truly connected ecosystem. How a unique patient identifier is used in healthcare UPIs give providers and payers a way to link records for the same patient or member, so they have one complete record. Without a UPI, a provider may inadvertently create a duplicate patient record because a slight variation in the patient's name or address means their original record isn't accurately matched to them. A 2022 survey by Patient ID Now found that 6 in 10 healthcare organizations had estimated duplication rates of 4-8%, while 16% of organizations had more than 15 patients with the same name.  If there's more than one record for a patient, providers may miss important medical information that's not carried through to the version of the record they're looking at. Unreliable records can also lead to misidentification, where patients with a similar name may have their records incorrectly matched. According to the ECRI Institute, misidentification is one of the top ten threats to patient safety. Patients could be given the wrong treatment or medication, with life-altering or fatal consequences.  While patient safety is the top concern for providers, efficiency is another driver of attempts to improve records management. Organizations report spending $1.3 million per year on patient identity resolution, as resources must be redirected to figuring out who patients are and fixing errors. Being able to correctly link records for a complete view of an individual's identity can help circumvent these challenges.  A unique patient identifier is the key to interoperability Managing patient data across the entire healthcare ecosystem is a long-standing challenge. Many organizations rely on master patient indexes to match patients using demographic data. But these single-source databases are rife with gaps, overlaps, and outdated patient information. They can't keep up with simple name and address changes or easily identify and fix data entry errors.   A more effective solution involves combining data sets to create complete identities and profiles, where every piece of new data is instantly updated and verified. Experian Health uses referential matching technology to achieve a fuller picture of each patient's identity. The UPI then acts as a golden thread, linking each patient record correctly within and between systems.  For example, if a provider has a patient in their EHR twice under two spellings of the patient's name, a UPI would link those two profiles, creating a singular view of the patient. If a pharmacy has a patient listed under a birth name but the doctor has them listed under their married name, a UPI can ensure both systems match the patient correctly.  When combined with other patient engagement solutions, data and identity management tools  create the infrastructure needed for healthcare to truly become one cohesive, patient- and member-centric network.  It is important to note that the UPI is not a patient-facing number and is not known to the patient or provider. It does not collect or share any clinical claims or diagnostic information; its purpose is simply to link records together giving providers and payers a complete view of someone's identity.  Improving the patient experience with a unique patient identifier  Healthcare consumers are increasingly seeking digital-first, efficient processes, and they're sensitive to the need for robust data security. Healthcare organizations must demonstrate their ability to manage patient data properly from the patient's first interaction. If data management is inefficient, patients will find themselves being forced to fill out forms they've already filled out multiple times or undergo duplicate tests as they travel between facilities. Patients with similar names may be confused if they're shown someone else's details during the identification process.  In an ecosystem built around a strong healthcare network, these discrepancies can be avoided. The patient's unique identifier remains consistent across every healthcare facility they visit – including physicians' offices, hospitals, pharmacies, specialists and long-term care facilities – so all providers know exactly who they are.   While patients welcome a more convenient, coordinated experience, they'll also be reassured by the reduced risk of medical errors that comes with a well-connected healthcare network.   Efforts to improve patient identity resolution in healthcare  While there may not be a national UPI yet, the industry is trying to find workaround solutions. The Centers for Medicare & Medicaid replaced Social Security Numbers with Medicare Beneficiary Numbers as the primary means of identifying Medicare beneficiaries. But while this addresses the risk of data breaches, it doesn't resolve the interoperability challenge.   Another initiative is Project US@ (Project USA), run by the Office of the National Coordinator for Health Information Technology (ONC). This aims to create a consistent healthcare industry-wide specification for representing patient addresses, to improve address accuracy. This would ensure that, for example, the same street name written as “road” and “Rd.” is not mistakenly viewed as two different addresses by the software.   To support efforts to integrate disparate software solutions, Experian Health announced in 2019 that every person in the United States had successfully been assigned a unique UPI, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™â€¯(the “UPI”).  Combining Experian's expansive data assets and innovative UIM technology along with NCPDP standards, each person who has received medical care or used a pharmacy has been assigned a UPI. As new patients enter the healthcare ecosystem, this number will continue to grow.  Dave Roberts, VP of Platform Products at Experian Health, says that “the technological foundation is already in place for data interoperability through the creation of UPIs that are maintained in a master person index. These solutions are vendor-neutral, meaning data can flow freely between disparate electronic health systems, regardless of size or location.” Utilizing Experian Health's Patient Identity Solutions The implementation of unique patient identifiers holds immense potential for creating a connected healthcare ecosystem. By standardizing patient identification and enhancing data management, a unique patient identifier can improve patient safety, reduce costs, and streamline processes across the entire healthcare industry. Find out more about how Experian Health's patient identity solutions serve as stepping stones towards a more efficient and patient-centric healthcare network.

Jan 26,2021 by Experian Health

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How healthcare providers can prepare for flu season

Flu season is rapidly approaching, which means healthcare providers must ramp up their preparedness efforts. What can they do to ensure they're ready to meet the seasonal surge in demand? Recent data from the southern hemisphere, often a forecast of what's to come in the US, suggests that this year's flu season will likely be similar to last year. The CDC warns that while “we cannot predict what will happen in the United States this upcoming season, we know that flu has the potential to cause significant illness, hospitalizations and deaths.” With hundreds of thousands of people hospitalized each year, providers must find ways to prepare for rising patient volumes and manage the risk of infection among patients and staff to keep services running smoothly. Making it as easy as possible for patients to book and attend vaccination appointments will be critical. Digital patient access will be the key to streamlining patient care. Using digital tools to prepare for flu season 2024-25 As services face increasing pressure, digital and automated tools can help healthcare providers prepare for flu season by easing staff burdens. More patients mean more appointments to schedule, more registration forms to fill out and more people in waiting rooms. Opening the digital front door helps manage high volumes by allowing patients to complete more access tasks online and prevent bottlenecks. Here are three strategies to implement to support staff and patients through a challenging season: 1. Manage infection risk with online self-scheduling An online patient scheduling platform has two clear benefits – it relieves pressure on staff during busy times and gives providers control over patient flow. Fewer calls need to be made by call center agents. No-shows are less likely because patients can book, reschedule and cancel appointments, and receive automated reminders, which makes the best use of physicians' time. Online scheduling also plays a part in infection control as providers can incorporate screening protocols to identify patients with symptoms of COVID-19 or flu, and manage their onward care pathway appropriately. Empowering consumers to take control of their healthcare with a patient scheduling system might encourage vaccine registrations, which could help reduce the burden on health services when staffing shortages remain stubbornly high. What's more, patients now expect the flexibility and convenience of scheduling appointments at a time and place that suits them. Experian Health's 2024 State of Patient Access survey found that six in ten patients want more digital tools to manage their healthcare. This indicates a growing demand for easy, simple and transparent processes. 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 beyond flu season. 2. Offer mobile registration to manage demand Should patient volumes increase, patient access staff will be under even more pressure than usual. Anything that can reduce the administrative burden will be a win. Experian Health's Registration Accelerator allows patients to complete intake forms and insurance checks through their mobile devices before stepping through the door. Their details can be pre-filled automatically, reducing the risk of error. This creates a quicker, more efficient patient registration experience that minimizes issues for staff to resolve. Mobile-enabled registration is also far more appealing for patients, who'd rather complete registration from the comfort of home than sit in a waiting room filling out lengthy forms. Plus, it reduces in-person interactions, thus minimizing exposure to infection among staff and patients. Given that 89% of patients say digital or paperless pre-registration is important to them, providers that offer online patient intake solutions will have a clear advantage in attracting potential new customers during times of high demand. In practice: See how West Tennessee Healthcare replaced clipboards with clicks with Registration Accelerator. 3. Reduce no-shows and increase engagement with automated patient outreach Providers must communicate proactively with patients to keep them in the loop as the situation evolves. With an open rate of 98%, text messages are a direct and convenient way to communicate quickly with patients. Automated patient outreach can increase vaccination rates by notifying patients about flu shot availability and offering a direct link to schedule an appointment. Automated reminders reduce no-show rates and help ensure no slot goes unused as patient volumes increase. Messages can also include tailored instructions for specific at-risk groups to emphasize the importance of timely vaccination and provide directions. This approach helps manage patient flow, increase patient satisfaction and ensure providers are prepared for the seasonal surge. Contact Experian Health today to learn how digital patient access solutions can help healthcare providers prepare for flu season in 2024. Learn more Contact us

Oct 22,2024 by Experian Health

Finding insurance coverage without SSN

Finding previously unidentified insurance coverage is a high-stakes treasure hunt for healthcare providers. If patients are unaware of active coverage or eligibility for Medicare and Medicaid, they will be left footing a bill that could have been covered by a payer. If they can't afford it, their account may end up being written off to bad debt, and providers will miss out on reimbursement opportunities, leaving millions of revenue dollars on the table. Hunting down missing or forgotten coverage on the spot is a challenge for providers, particularly if the patient does not have a Social Security Numbers (SSN) or the payers in question do not use SSNs to verify eligibility. It's a problem worth solving though and can improve the patient financial experience while preventing avoidable revenue loss. The shift away from Social Security Numbers Historically, providers have used demographic information like Social Security Numbers (SSN) to verify patient identities and locate coverage information. Without a unique patient identifier, SSNs were a stable way to link a person's health information across multiple health systems and payers. However, the use of SSNs for identification and verification purposes has dropped in recent years due to concerns about patient privacy and the risk of identity theft: SSNs give identity thieves a mechanism to assume a person's identity and access financial information and health records illegally. Moreover, SSNs are unreliable identifiers, as it is possible for more than one person to use the same number. Recognizing the need for more secure and trustworthy identifiers, many payers have moved away from SSNs. In 2018, the Centers for Medicare & Medicaid Services began the process to remove SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards, replacing them with Medicare Beneficiary Identifiers (MBIs). These are now the primary means of checking a person's identity for Medicare transactions like billing, eligibility status and claim status. Similarly, many health plans also shifted away from using SSNs as primary identifiers, instead opting for member IDs or other secure identifiers to verify and track coverage for their members. Find billable coverage with historical data With demographic searches on the decline, providers need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage. Combining search best practices, multiple proprietary databases and historical information, Experian Health's Coverage Discovery® locates patients' billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process. In 2022, Coverage Discovery tracked down billable coverage in almost 30% of self-pay accounts and found more than $64.6 billion in corresponding charges. Closing the coverage gap caused by Medicaid disenrollment Coverage Discovery offers another important benefit: helping providers offer additional support to patients on lower incomes who find themselves without Medicaid, at least for a short time, following the end of continuous enrollment. As of July 2023, more than 1.6 million Medicaid enrollees were disenrolled. Providers can use the tool to confirm whether Medicaid coverage remains in place, or to uncover any additional billable government or commercial insurance that could give patients peace of mind. Patient Financial Clearance can also help screen patients for Medicaid eligibility before or at the point of service, then route them to the Medicaid Enrollment team or auto-enroll them in charity care if appropriate. Case study: Read the case study to find out how Luminis Health used Coverage Discovery to locate $240k in billable coverage each month. Leverage technology to locate unidentified coverage Thanks to advanced tools like Coverage Discovery and Patient Financial Clearance, it's much easier for providers to locate alternative coverage options for patients, using multiple sources of data. These tools leverage secure identifiers and comprehensive searches across databases, allowing providers to reclaim revenue that may otherwise go unclaimed, and reassuring patients that they won't be left holding an unexpected bill. Find out more about how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.

Sep 13,2023 by Experian Health

6 effective revenue cycle strategies for healthcare providers

Compared to other industries, healthcare tends to be more resilient to economic turbulence. But the weight of the pandemic, labor shortages, rising costs and increasingly complex reimbursement structures are squeezing hospital margins. A Kaufman Hall National Hospital Flash Report in July 2023 found that many hospitals underperformed, and the gap between high-performing hospitals and those struggling continues to widen. Providers must find new and effective ways to improve revenue cycle management, should any new uncertainties emerge. With pressure mounting to increase efficiency and reduce expenses, more providers are turning to automation and artificial intelligence (AI) to eliminate unnecessary manual work and optimize revenue cycle management processes. For example, Stanford Health Care leveraged automation to reduce their cost to collect. Banner Health improved patient collections with transparent price estimates. Schneck Medical Center zeroed in on claims management and incorporated AI to reduce denials. In the face of a cashflow crunch, healthcare providers increasingly turn to data-driven revenue cycle management (RCM) strategies that span the entire patient journey. This article lists six of the most effective income-generating digital RCM strategies that providers are using to maximize profits. Building blocks of a healthy revenue cycle At its core, revenue cycle management is about ensuring providers are fully reimbursed for the care they provide. The true ROI is much broader – efficient financial and administrative processes for patient billing, claims management and collections contribute to better care, satisfied patients, high-performing staff and good financial health. Realizing these benefits calls for revenue cycle processes built on three principles: Efficiency – streamlining processes to reduce resource utilization across the entire billing cycle Accuracy – ensuring all patient and claims data is correct and complete to avoid denials and delays Transparency – giving patients, providers and payers relevant and timely information, so they can act with confidence in each financial transaction. To achieve this, providers are moving away from slow, costly manual systems. Digital RCM tools are becoming non-negotiable. 6 data-driven strategies for effective revenue cycle management 1. Increase efficiency in patient access Revenue cycle management starts when the patient books their appointment and ends when the final bills are settled. Claim denials and delayed payments often arise from data errors and miscommunications in the early stages of the patient journey, which means patient scheduling and registration processes are critical to streamline RCM. With automated, data-driven patient access tools, providers can simplify tasks across the patient journey, so patients can move from one stage to the next with as little friction as possible. Fewer errors mean delays and disappointment are more easily avoided. Automated registration and online self-scheduling can also lead to savings through more efficient use of staff time and reducing the number of appointment no-shows. Experian Health clients find that online tools allow them to make relatively minor adjustments to their workflows, with a major impact on productivity. 2. Deliver accurate and timely patient billing Patients want the payment process to be as painless as possible. In multiple surveys, Experian Health has found that patients are worried about the cost of care, while 63% of providers believe patients frequently postpone care because of cost concerns. Clear, comprehensive estimates, billing and collections practices can make it easier for patients to navigate their financial journey. And with the end of continuous Medicaid enrollment, it's likely that more patients will find themselves unsure of their coverage situation, and in need of greater support to manage the financial process. For Stanford Health, the key to improving revenue cycle management centered around patient billing and collections. To achieve the dual goals of improving the patient experience and increasing collections, they used data-driven insights and automation to remove uncollectible accounts, prioritize accounts with a high propensity to pay, find missing coverage and reduce the manual workload. Collections Optimization Manager helped Stanford Health identify the best possible collections strategy, by scoring and segmenting patient accounts with the highest propensity to pay. Coverage Discovery® supplemented this strategy by checking for any unidentified primary, secondary or tertiary coverages that can potentially reduce self-pay amounts and avoidable charity designations. As a result, Stanford Health achieved a $4.1m increase in average monthly payments and efficiency gains of $109k per month. 3. Provide transparent price estimates Experian Health's State of Patient Access 2023 report suggests that fewer than three in ten patients know how much their care will cost in advance, while nine in ten consider it important. Delivering accurate pre-care estimates to help patients plan for bills could therefore be an easy win to improve the patient experience and recoup more revenue. Banner Health used Patient Estimates as part of a wider strategy to improve patient collections. This solution generates detailed estimates of the patient's financial responsibility along with recommendations for payment plans and financial assistance, if appropriate. Listen in as Becky Peters, Executive Director of Patient Access at Banner Health, talks about streamlining the patient registration process and improving patient access with pre-care estimates. 4. Effective claims management Perhaps the biggest opportunity to improve revenue cycle performance lies in claims and denial management, which accounts for a major proportion of wasted healthcare dollars. Summit Medical Group Oregon–BMC paired Enhanced Claim Status with Claim Scrubber to submit cleaner claims the first time and avoid lost revenue. These tools help providers submit accurate claims and monitor claim status to prevent denials and resolve issues quickly. For Summit Medical Group, this led to a 92% primary clean claims rate, and a reduction in accounts receivable days and volume by 15%. Experian Health also offers a new solution that leverages machine learning and artificial intelligence for predictive reimbursement. AI Advantage™ uses AI to predict and prevent claim denials based on historical claims data. In the first six months, this solution helped Schneck achieve a 4.6% average monthly decrease in denials and decreased time spent on denials by 4x. 5. Easy ways to pay (plus clear pricing and payment policies) How easy is it for patients to pay? This simple but important question points to another vital element of effective revenue cycle management. A compassionate and convenient patient payment experience that matches consumer experience in other industries can encourage earlier payments. Easy digital options are especially important for millennial and younger patients: research by Experian Health and PYMNTS found that 60% of younger patients are looking for digital services. Experian Health's patient-friendly payment tools are designed to help patients navigate their financial responsibilities with confidence and ease. For example, PaymentSafe® allows providers to securely collect payments anytime, anywhere, including mobile payments and patient portals. 6. Operational efficiency with automation, data and analytics RCM processes generate vast amounts of data, providing valuable insights into the organization's operational performance, revenue trends and areas for improvement. Being able to parse and translate this data into actionable insights is essential to determine the right strategies to pursue to optimize financial performance. But this in itself can be a major lift. Revenue Cycle Analytics is a web-based tool that breaks down data into actionable insights across billing, reimbursement and payer performance, presenting KPI data via comprehensive dashboards. Effective revenue cycle management strategies from start to end From labor shortages to rising costs, healthcare providers are finding creative ways to manage cash flow. While each healthcare organization’s needs and goals are different, understanding these six key strategies of successful revenue cycle management can help hospitals manage their revenue cycles more effectively and efficiently, while responding to new uncertainties. Find out more about how Experian Health helps healthcare organizations leverage automation and AI to streamline processes and boost revenue cycle performance.

Aug 16,2023 by Experian Health

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