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

3-effects-of-rising-healthcare-costs-blog-2024

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Preparing for “after COVID-19” – how can healthcare providers get ready for the pandemic’s re-scheduling aftermath?

The novel coronavirus pandemic crisis of 2020 has plunged the healthcare system, and frankly the whole economy, into a dark place. It will take time, and likely a lot of time, to overcome what may end up being several months of a national shut down. Eventually people will re-emerge from isolation, business will resume a new normal, and healthcare providers will turn their attention to the revenue generating services that they temporarily halted, as well as the patients who delayed care for a myriad of conditions. The Centers for Medicare and Medicaid Services (CMS) recently published “phase one” re-opening recommendations that recognized in some areas the possibility of non-COVID-19 care is already being considered. There will be an overflow of pent-up demand and provider organizations need to position themselves now to be ready. One consideration, with many health systems now feeling the squeeze and not being able to re-deploy staff to serve in the crisis, is to use some of those resources and prepare for the next phase.  Here are few strategies to get ahead of the curve, if you will, as it flattens: Reschedule appointments – Literally hundreds of appointments– for some providers, thousands – that had been cancelled or delayed will require rescheduling. Deploying an omni-channel scheduling platform now can relieve the pressure of that future volume in several ways: Online scheduling can guide patients to the right care with rules automation, allowing patients to accurately self-book and reducing call center volume.Enable patient scheduling via automated outreach messages sent via text message or IVR. (For example, you can target all those who need to reschedule, reaching them via text campaigns and reducing call center workload).Reduce training time with a call center scheduling solution. Agents (such as temps hired to handle the influx of appointments) can be trained in a matter of hours to schedule and book appointments accurately.Harden your telehealth offering – This crisis has shown the necessity for virtual visit technology during a pandemic; however, its value won’t disappear as the crisis fades. Telehealth is destined to become a staple of healthcare delivery. Restrictions have been lifted and the technology has proven practical, convenient and efficient, paving the way for broad acceptance. But what are the digital complements that can be paired with telehealth to harden the solution and make the offering a robust tool into the future? While many providers are now able to offer this type of virtual care, scheduling across a variety of specialties has become a challenge. A  tool that guides patients and call center agents to the right provider across all services, including telehealth, is going to be critical in the months ahead to maintaining scheduling efficiency and delivering an optimal patient experience.Establish your digital front door – Patients aren’t going to want only clinical telehealth options; the whole spectrum of patient-provider interaction is shifting. Scheduling, registration, payments – all these are going to see increased demand for digital self-service. This gets patients out of the waiting room and removes the need to swipe or insert a credit card or use a POS kiosk. Patients, who are consumers, want to use their mobile devices and they will form lasting opinions of those services enabling – or restricting – their ability to do that.Collections optimization – Right now the focus is on caring for patients, as it should be; however, in order to continue operating, providers must collect for the services rendered. Putting in systems that automate collections processes and reduce the human resources necessary to bring in revenue will to be key to capitalizing on the rush of non-COVID-19 care that will soon be required. These are just a few of the ways that healthcare providers can deploy digital technology to prepare and turn this looming challenge into opportunity. The reality is that managing patient engagement and collections through this next phase is critical to the U.S. healthcare ecosystem’s recovery. Organizations that emerge stronger will be those that prepare now and are ready when the time comes. Find out more about patient engagement solutions that can help you respond now and prepare for the future.

Apr 27,2020 by

Three ways automation can help weather the storm of uncompensated care

Can providers do anything to reduce the amount of care they give away for free, or has this become a cost of doing business? Declining Medicaid coverage, salary increases that aren’t keeping pace with rising deductibles and confusion over co-payments are creating a perfect storm for uncompensated care. Patients are responsible for a bigger chunk of their healthcare bills, while at the same time finding it harder to pay. As a result, unreimbursed costs are surging. In health system-owned hospitals, lost revenue jumped from $13.7 million to $15.6 million between 2015 and 2018, while independent hospitals saw losses rise from $4.9 million to $5.8 million in the same period. Not surprising, when more than half of consumers say they’d be unable to pay an unexpected bill of more than $1000. Reducing bad debt calls for more than a few set-and-forget tweaks to your revenue cycle management. From the moment a patient is admitted, you should be able to see exactly what coverage they have (or don’t have), so you can get them on the right track to devise payment plans, find missing coverage, or screen for financial assistance and charity eligibility. To save collections teams and patients from a painstaking manual process, more providers are turning to automated data analysis tools. Here are three ways automation can help reduce bad debt, protect your balance sheet and create a better patient experience at the same time: 1. Avoid missed coverage with better screening Why waste staff time on a treasure hunt for payments and coverage status? If your patient access team can obtain accurate financial data during the admissions process, they’ll be able to confirm active coverage quickly, or screen for Medicaid, charity or other financial assistance. This is increasingly important as the volume and complexity of your collections case mix develops. Brandon Burnett, Director of Patient Financial Services at Kaiser Permanente Northern California, says: “Coverage has gotten a lot more complex – patients show up in multiple venues of care and they don't have their insurance card, or they don't know what coverage they have… It’s critical that our team has tools they can use to help drive decisions and navigate those patients into the appropriate program.” Automation allows this to happen more reliably and more efficiently. Burnett says: “At Kaiser, we’ve implemented the financial assistance screening tools and the patient identity screening tools to help us identify what our members would be able to pay at the point of service, and how we would manage them in the back end if they end up with a patient balance. Before we had these tools, we were really blind as to what our patients were going to be able to pay.” At Kootenai Health in Idaho, an automated financial clearance tool helped save 60 hours of staff time in eight weeks. With an overall accuracy of 88%, patients were assigned to the most appropriate financial pathway (such as customized payment plans or checking for financial assistance). This helped eliminate the need for unnecessary charity applications and avoiding write-offs – such as the $200,000 bill for one patient, later discovered to be eligible for Veterans’ benefits. 2. Provide more compassionate financial counselling According to Burnett, “The ultimate goal is to have a positive impact on our patients. Nobody wants to go to hospital. Nobody wants to have surgery. Having solutions which allow decisions both at the point of care and in the pre-service cycle are critical in enabling patients to make decisions.” When patients are kept in the loop and can be active participants in their healthcare journey, you can work with them to manage their financial obligations in a way that works for them. With data-driven software, you can evaluate their ability to pay so you can offer the most appropriate payment plan and ultimately see fewer amounts written off. Additionally, automated data analytics can help make the whole process more compassionate, allowing you to tailor the way you communicate with patients based on their preferences and offer more convenient ways for them to pay. 3. Reduce manual touchpoints for better use of staff time The volume of patients applying for charity support is trending up, so it’s important that providers are able to manage the rising numbers of complex cases. Automating the coverage checking and clearance process can help reduce pressure on staff, minimize errors and increase productivity. They’ll be able to focus their attention where it’s needed most, and you can cut your reliance on external vendors. The scale of the challenge means providers need to think about a completely different way of working. It’s not enough to paper over existing processes. As Burnett says: “You can't take a solution and put it over an old process. Part of the enhancements with this technology is being able to evaluate your current workflows. That's where the real power is – in the cost savings and the time savings. If you take an updated process along with the updated technology, that's when you get maximum results.” Automated tools can help by giving you the necessary data insights to improve your workflows and processes, while integrating cutting-edge technology for more efficient and accurate patient screening. Find out more about how Coverage Discovery and Patient Financial Clearance could help your organization reduce bad debt and offer a more compassionate patient financial experience.

Apr 22,2020 by

How health plans can prepare now to close gaps in care when COVID-19 subsides

During this time when the whole world is wrestling with the Covid-19 crisis, planning for the future is difficult. However, there is no question that as the nation emerges from its stay-at-home status, there will be huge release of pent-up demand – especially for healthcare. Health systems have streamlined their operations to deal with the influx of COVID-19 testing and treatments. As a result, any non-emergent care or care unrelated to COVID-19 has been heavily gated, if not canceled entirely. This of course includes preventative care, non-critical regular screenings, and other services related to care gaps. Once the patient flow moves out of crisis mode, these services will certainly resume – and they will resume in earnest. This increased demand for services, coupled with the time lost to meet quality metrics, will place a real burden on member services and quality teams as they work to ensure missed preventative care, screenings, and other care related to care gaps are being sought and coordinated. It is possible to make small moves now to strategically prepare for what’s coming, so that when the crisis subsides organizations can be well positioned to serve their members. Here are a few key things payers can do to get ready: Get your data and strategy in order – Now is the time to use data to better understand your members and fill in any gaps you may have. For example, it is going to be essential to understand geographies and associated provider groups where care gap non-compliance is likely to be highest, so you can strategically focus on those areas. Also, understanding what the best channel of communication is and ensuring that you have accurate contact info for those members is critical. Fundamentally, plans will need data that can help them identify who to target and can supply needed, accurate contact info.Understand your members' SDOH barriers – Understanding your members' social determinants of health (SDOH) barriers will be more important than ever. One of the unfortunate byproducts of this COVID-19 crisis is the economic damage. As a result, there will undoubtedly be critical gaps, like transportation, that will affect your members' ability to access care and thus need to be accounted for. Likewise, with the downturn in the economy, additional social determinants will be on the rise, like food insecurity, housing insecurity, and access to medications. These should also factor into your overall plan – and thankfully there are increasing ways to identify and track SDOH.Implement digital tools now – Ensure your member engagement strategy is fully informed and your teams are ready to efficiently execute. While data can round out any information gaps that may exist for you – contact info, SDOH gaps, etc. – tools that can provide quick, convenient access to services will be needed to take action. For example, enabling your member engagement team with a digital scheduling platform that allows them to book appointments with providers without calling the provider, is a proven way to accelerate member engagement and close gaps in care. This type of digital engagement not only provides an efficiency gain, it also greatly improves the member experience as call times are shorter and members are given greater access to care. In times like this current pandemic it can be hard to think about much else beyond the here and now, and especially hard to picture a brighter future. But prudence would dictate that taking a little time now to prepare can make a big difference when things do start to open back up. Find out more about data driven solutions for member engagement.

Apr 16,2020 by

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Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos.

Lorem ipsum dolor sit amet consectetur adipiscing elit. Quisque faucibus ex sapien vitae pellentesque sem placerat. In id cursus mi pretium tellus duis convallis. Tempus leo eu aenean sed diam urna tempor. Pulvinar vivamus fringilla lacus nec metus bibendum egestas. Iaculis massa nisl malesuada lacinia integer nunc posuere. Ut hendrerit semper vel class aptent taciti sociosqu. Ad litora torquent per conubia nostra inceptos himenaeos.

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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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