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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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Asking the right questions to protect patient identities

They used to be little more than clunky messaging platforms, but today, patient portals are the key to a frictionless digital healthcare experience. Consumers can check their medical records and test results with a few clicks. They can schedule appointments, pay bills and renew prescriptions whenever they want. Shifting patient information to portals also increases staff productivity and smooths out several sticking points in the revenue cycle. And with improvements in engagement and efficiency leading to better health outcomes, no wonder 90% of healthcare organizations are putting portals at the heart of the patient experience. But these benefits aren’t without risks. Privacy and security are big concerns for consumers and organizations alike. Patients want to feel reassured their data is safe, while providers want to avoid any reputation-killing headlines about data breaches. Identification and authentication can’t be too complicated though, or the patient experience will suffer. The safest strategy is to use a risk-based multi-layered approach, including identity proofing, fraud management, device recognition and even biometrics. Different levels of security checks can be applied, depending on the likelihood of the person being an imposter. If the information being accessed is particularly sensitive, or when the log-in information doesn’t quite add up, your system should trigger additional checks, such as identity proofing questions. But what are the right questions to ask? The right questions balance risk, trust and proportionality There’s no point seeking security information that could be easily guessed, obtained through a quick Google search or stolen from a patient’s wallet. You need questions only the true consumer would be able to answer – “out of wallet” questions, or knowledge-based authentication. This means the traditional “mother’s surname” question would not be a great choice, as it’s easily discoverable by potential fraudsters. Better questions might relate to the consumer’s city of birth, first car model, first pet’s name or previous address. Of course, these identifiers could still be obtained by nefarious parties, but when used in combination with other identity proofing tactics, it’s a significantly reduced risk. The sweet spot lies in the difference between the consumer’s ability to answer correctly and that of a potential fraudster. Your questions should also be relevant to the consumer and appropriate to the context. For example, a common out-of-wallet question used by financial institutions is to confirm a recent transaction. This ticks the box for security, as only the true consumer would likely know the answer, but in the context of a healthcare portal it could seem odd and out of place. It might make the patient wary and actually do more harm than good in terms of building trust. Progressive questioning lets you use smart logic to select a range of appropriate, varied questions, rotated over time and layered up for additional checks when a certain threshold of risk is perceived. In this way, the patient experience will be flexible, seamless and reassuring, without the burden of excessive admin. How Sutter Health System used better questions to increase enrollment and reduce help desk contacts With around 1.8 million patients actively enrolled, Sutter Health System wanted to offer easy access to their self-service portal, but without accidentally giving anyone access to someone else’s information. They had no true identity proofing process for patients, which led to cumbersome checks, errors and high numbers of calls to the help desk. Introducing the PreciseID® identity-proofing tool meant the team could authenticate users more quickly and reliably, using knowledge-based questions without an arduous process. Now, patients have just four or five simple questions to answer, which are checked against a robust dataset. An online risk assessment verifies the patient’s device and determines whether additional checks are required, balancing security with convenience. Tom Mitchell, Applications Manager at Sutter Health System Office describes working in partnership with Experian Health to find the right set of questions: “It took about a month to really hone in on the types of questions and the frequency of questions needed to achieve a level of accuracy that would equate to properly identified patients. You need to select what is important to you and Experian will work with you to make sure you ask the right questions.” Not only has this increased the number of positive patient matches, it’s also reduced the number of people trying to contact the help desk with password issues. Tom says: “We’re always trying to reduce the number of contacts to the help desk. Before integrating with self-service enrollment, patients would have to fill out a paper form or call our contact center, in which case a live person would have to go through some validation processes of our own. It was a fairly cumbersome, long process without this piece of validation.” Find out more about how PreciseID could help you ask the right questions for better portal protection.

Mar 25,2020 by Experian Health

How healthcare providers are tapping into unique scheduling solutions to manage COVID-19 patient testing

COVID-19 is beginning to stress the healthcare system, and typical protocols are being upended. But health systems and medical groups are already rising to the challenge of getting patients tested while, at the same time, prioritizing the protection of their communities and staffs. Below are some solutions being implemented: Online screening Many providers are tapping into online scheduling solutions, responding to the COVID-19 crisis with simple splash pages. Posting questions that screen for symptoms can channel patients seeking testing/treatment for COVID-19 down a specific pathway to get the care they need. Those who need other types of care can still book through the solution, directing them to the right provider and appointment. Screening paths allow access to be prioritized and managed accordingly. Mobile testing Providers are also using mobile test units. These enable providers to administer more tests in a geographically diverse manner, without having to expose their internal clinic and hospital environments to contagion. Patients can simply drive through and receive a test while remaining in their car. Some health systems are combining this with online scheduling, allowing patients to schedule appointment slots for testing. This helps manage the flow of patients, reducing call center volume. Health plans are also modifying Some health plans are taking a similar approach, using mobile testing units and a call center scheduling platform to book testing appointment slots for members. Likewise, they can send a link enabling members to self-schedule for a testing slot via text message or email. This type of proactive member engagement to vulnerable populations is key to reducing the impact on Emergency Departments, while helping diagnose individuals so they can get the care they need. Call center operations Call centers are being overwhelmed with volume – and there is more to come. New methodologies to handle the response are complementing normal operations. Some providers have started to publish a dedicated line for COVID-19 calls that connects to a separate call center pod. Others have quickly added scheduling protocols in the scheduling system to route patients to the right care, or mobile-testing unit, based on responses to the questions agents ask. By automating the Q&A in the platform, patients are guided to the right care, and agents need minimal training to assure accuracy. As the number of COVID-19 cases continues to grow in the U.S., more tactics will be introduced to streamline scheduling, testing and care. Technology will certainly be one key lever for healthcare providers to better serve their communities and keep patients and staff safe.

Mar 18,2020 by

A four-part strategy to find missing healthcare coverage faster

The number of uninsured American adults has been rising steadily since 2016, reaching a four-year high of 13.7% in the last quarter of 2018. The challenges have been well-documented: low levels of health insurance contribute to health inequality, poor population health, and worse outcomes for individuals as people hold off seeking care. For providers, a growing uninsured population usually leads to an uptick in uncompensated care and a hefty blow to their balance sheet. Affordability is the main driver of this trend (due to rising premiums and tighter household budgets), but a big part of the problem is simply confusion around who is entitled to what. People may have coverage they don’t know about or have forgotten. Media reports and reduced outreach for Obamacare have left many wondering whether support from public insurers is even still available: a Kaiser Family Foundation study in 2018 found that around a third of Americans believed or weren’t sure if the Affordable Care Act had already been repealed. No wonder fewer people are signing up. Finding missing coverage is a challenge for most providers, but with the right discovery strategy, it’s possible to drive down the number of accounts ending up in bad debt collections or written off as charity designations. Top-performing providers use a four-part strategy, encompassing the following: 1. Look beyond self-pay patients For most healthcare providers, the search for missing coverage usually focuses on self-pay patients. In fact, many Medicaid, Medicare and commercially insured patients also have unknown additional coverage. Unearthing this secondary and tertiary coverage can help ensure the full amount is paid. Jason Considine, Senior Vice President and GM of Patient Experience at Experian Health, says: “Finding missing secondary or tertiary coverage for patients with Medicaid or Medicare can help hospitals capture the full amounts they’re entitled to and reduce the risk of revenue loss. Hospitals can claim against any balances not covered by public payers, but only if they look for additional coverage.” This means hospitals shouldn’t focus solely on scrubbing self-pay accounts. By searching additional commercial coverage and combing through Medicare and Medicaid coverage, you might be surprised at the level of reimbursement available for amounts that would otherwise have been written off. 2. Perform coverage checks as soon as possible The sooner you check for coverage, the sooner you can verify the accuracy of the account – and the sooner you can get paid. Essentia Health in Minnesota implemented a coverage discovery strategy that ran comprehensive coverage checks throughout the whole patient process. Patient accounts were scanned before they received care, then again at the time of service. Finally, searches for active insurance were performed 30, 60 and 90 days after service. Kathryn Wrazidlo, Patient Access Director for Essentia Health, says: “We found 67% of coverage for patient accounts that were self-pay or uninsured at the time of pre-service, and 33% at the time of post-service. This has helped patients because we’re actually billing their insurance versus billing them for self-pay. It’s helping staff because they’re billing the insurance company much quicker. There’s less rework. We’re decreasing the amount of time the account is sitting in AR by billing much sooner in the process.” 3. Access the widest possible datasets The whole point of the coverage discovery process is to track down coverage your patient doesn’t know about. So why would you limit your search to what they can tell you? Equally, searching through payer databases within what are often very limited search parameters can be a painstaking process. A more logical approach is to use a search strategy that covers historical data, demographic information and multiple proprietary datasets to cross-check patient accounts for previously unknown coverage. A tool that offers weighted confidence scoring and discrepancy checks can further reduce the risk of false positives and errors. With this approach, Experian Health’s Coverage Discovery tool analyzed more than 16.6 million accounts and found 3.6 million coverages, resulting in $5.8 billion billable charges found in 2018 alone. 4. Digest the data with reliable reporting tools Of course, checking more accounts and accessing wider datasets means you’re going to have far more data to handle. Automated scrubbing tools, quick-look dashboards and reporting software can give you instant access to the information you need. Working with a reliable partner can help you sift the data for additional coverage, and also provide insights into ways to boost workflow efficiencies and make life easier for your team too. Wrazidlo says: “We use the power reporting that’s offered with the Experian product and we also do reporting internally. The reporting helps us know whether the product is working for us or not. We can see how much we are recovering… My staff really enjoy using it.” Find out more about how Coverage Discovery could help you find additional coverage more easily, so you can get paid sooner and in full.

Mar 16,2020 by

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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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