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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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Healthcare price transparency tools: Because costs shouldn’t be a guessing game

Last year, a Kaiser Family Foundation study revealed that employer-based health insurance deductibles in the U.S. were at an average of $1,505. In 2006, the average was only $303. During this span of 11 years, the majority of responsibility for healthcare costs shifted from insurance companies to patients themselves, and many are still reeling from the sticker shock. Before consumerism and routinely high deductibles, healthcare providers focused most of their collection efforts on health insurance companies. Now, patients are a main source of providers' revenue, and some organizations are struggling to fit their old revenue cycles into the new payment landscape. However, many patients aren’t prepared for the increasingly high costs of healthcare, so they may opt to delay their care until they’ve met their deductibles at the end of the year. This creates a volatile and unpredictable revenue cycle in which organizations are slow in quarter one and quarter two and then slammed in quarter three and quarter four. Other patients could forgo medical care altogether, cutting down revenue for providers. Both scenarios contribute to a less healthy general populace and a vicious cycle in which more patients need increased care but most of them continue to hesitate or refuse it. At Experian Health, we recognize and want to bring change to this unstable healthcare climate. Our healthcare price transparency tools take sticker shock completely out of the equation by stabilizing the revenue cycle and putting transparent pricing in healthcare and payment options at the forefront. Applying consumerism to transparent pricing in healthcare Healthcare might have been a bit slow to catch up, but modern consumerism has already changed virtually every other industry. Today, consumers demand to know what they’re paying for and exactly how much before any transactions are complete. They need payment options that make their lives simpler and the ability to manage their accounts conveniently online without jumping through hoops. All of this is possible for healthcare organizations to provide, but they must be proactive in helping patients overcome the burden associated with modern healthcare costs. From financial education to flexible financing programs, any organization can improve patient satisfaction by providing transparent price information and affordable solutions upfront. With that goal in mind, Experian Health offers a variety of healthcare price transparency tools that can set your organization on the path to financial clarity, education, and advocacy: Patient Estimates A high medical bill is stressful alone, but it’s infinitely more so when the amount of the bill far exceeds what a patient expected. Price transparency is paramount to overcoming that stress. It’s also mandated in several states and will soon be in all others. With Patient Estimates, you can deliver transparent pricing in healthcare to every patient before or at the point of service. Our Patient Estimates tool automatically generates estimates based on treatment costs, payer rates, and a patient’s eligibility for benefits. The platform takes the guesswork out of the process by automatically storing and populating this information so you can provide patients with highly accurate estimates as early as possible.   Patient Statements When patients know what price to expect on their medical bills, they’re more prepared to pay them. Yet if they can’t read or understand the bill, they might still delay paying it until they have time to thoroughly address any concerns. To simplify the final bill, we offer Patient Statements software that combines separate billings into one simple, easy-to-understand statement. Patient Statements not only simplifies a patient’s bill, but it also helps you turn it into a valuable engagement tool. Every statement can be personalized with educational information about the patient’s condition, links to relevant videos and websites, and marketing messages for products that can improve the patient’s quality of life. Patient Self-Service Consumers are used to going online and managing their finances from a smartphone or computer. They often choose retailers based on this availability, and soon, most will choose healthcare providers on the same basis. Giving them convenient, 24/7 access to their healthcare accounts through Patient Self-Service portals will become increasingly more important for organizations to stay competitive. An online, self-service portal allows patients to view their estimates, manage their integrated fundraising accounts, pay their bills, and stay up-to-date with changes to their healthcare. Our self-service healthcare price transparency tools are also protected by highly secure payment processing technology, so patients can be confident that their information is closely guarded every time they interact with the platform. PaymentSafe® Collecting healthcare payments requires the combined security of protected health information and a patient’s personal and financial data. Our comprehensive PaymentSafe solution makes it possible to safely and conveniently collect payments at any point in the care cycle and from any department within the organization. Every payment is automatically settled throughout the system, as well, so patients are never double-billed. PaymentSafe also applies to every type of remittance — from electronic checking and debit cards to cash, checks, and money orders. In addition to satisfying information safety compliance standards, the technology gives patients peace of mind and encourages them to be more proactive in settling their healthcare bills. Transforming your revenue cycle to make it more consumer-centric and price transparent can seem like a daunting task, especially in an industry in which every small change has resounding consequences. At Experian Health, we’ve made it our mission to make that transformation easier by helping organizations provide the healthcare price transparency tools and payment options that their patients demand.

May 01,2018 by Experian Health

Patients before paperwork: Putting healthcare workflow automation into action

Making phone calls, filling out paperwork, and chasing down debt shouldn’t take up the bulk of a healthcare organization’s daily schedule. Now more than ever, physicians have little time to provide high-quality care to their patients. In 2015, the American College of Physicians (ACP) put forth the Patients Before Paperwork initiative to address the burdens that these administrative tasks create for physicians and their staff. The ACP states that defining and mitigating administrative tasks is essential to improve an organization’s workflow and reduce physician burnout. Through utilizing healthcare workflow automation, you can improve productivity without overextending employees' duties. Instead, your team can spend more time caring for patients and helping them with the financial side of their experience, which is something both patients and doctors prefer. Easier access with automated healthcare solutions In the new wave of consumerism, there is a high demand for convenience and transparency in every transaction. Healthcare providers and organizations also face this pressure, but the industry has been slower to transform because patient care transactions are infinitely more complicated than online retail purchases. Despite the slow go, healthcare workflow automation technology and organizations are starting to catch up. For example, engagement is a defining factor for today’s healthcare consumers. However, engagement must be mindfully catered to specific situations. When it comes to scheduling appointments, patients actually prefer an automated healthcare workflow approach over talking to a human. Regardless of its form, engagement is still essential in all aspects of the care continuum, and physicians can find it hard to engage when every administrative task has to be completed by hand. If you’re still devoting time and resources to manual patient access tasks, you're not only falling behind in the competitive healthcare industry, but you’re also missing an opportunity to enhance the overall patient experience. Fortunately, countless tasks — scheduling, preregistration, registration, and admissions — are no longer paper-based and don’t require nearly as much hands-on involvement as they used to. Given this reality, automated healthcare solutions can and should take are of scheduling and other mundane tasks. Ultimately, automation will allow administrative employees to focus on other areas of engagement, like financial counseling for patients. Employees will have more time to help patients understand their financial obligations and perhaps set up a payment plan before procedures, avoiding the sticker shock of a surprise bill months later. The touchless approach In the Patients Before Paperwork initiative mentioned above, the ACP concluded that “excessive administrative tasks have serious adverse consequences for physicians and their patients.” At Experian Health, our automated healthcare solutions reduce those consequences by creating a touchless approach that only requires human intervention for exceptional cases. A touchless, automated healthcare workflow makes patient access predictable so you can spend more time serving patients. For example, our eCare NEXT® solution is a single platform that automates every step of the revenue cycle. Users only work on prescreened accounts with actionable follow-ups. Touchless Processing™ takes care of the rest through intelligent automation. You can effectively implement Touchless Processing throughout the rest of your organization by integrating eCare NEXT with Experian's other solutions: Registration QA When eCare NEXT is integrated with Registration QA, for instance, you can automatically access patients’ insurance eligibility in real time and identify registration inaccuracies early in the revenue cycle. This significantly reduces claims denials that can cut into revenue and take up more time to correct and resubmit. Payer-specific information can also be stored and automatically updated to ensure accuracy every time that payer comes up. Authorizations You can carry the touchless approach even further by expanding your suite of solutions with our Authorizations.The platform automates authorization management using the payer authorization requirements already stored and updated in the system. Authorization completes inquiries and submissions without user intervention to further reduce denials and expedite reimbursements. When done manually, administrative tasks related to orders, scheduling, preregistration, registration, and admissions are a drain on any healthcare organization’s resources. Minimizing staff involvement in these tasks improves the experience for physicians and patients alike, but it requires automated healthcare workflow solutions that can be seamlessly integrated into the workflow. With Experian Health’s Touchless Processing solutions, providers can exercise greater control over these tasks and significantly improve revenue recovery. This will give physicians and employees more time to focus on creating a more efficient, effective, and positive experience for everyone involved.

Apr 24,2018 by

Healthcare is personalized — your healthcare group’s software should be, too

No two healthcare organizations are the same. Each has varied workflows that optimize efficacy and overall care for patients. That’s why healthcare software solutions should never be considered one-size-fits-all approaches. It isn’t fair, or terribly productive, to force healthcare organizations to adapt to new software. Rather, the healthcare software should adapt to them. At Experian Health, we’ll never supply a software product and then expect you to adjust workflows to suit it. Instead, we embed ourselves into your company to ensure we deeply understand your productivity needs and the reasons behind them. Only then can we tailor the solution we provide around you. It’s never too early to get it right The conversation about customizing your healthcare organization's solution begins before you even sign up. As soon as a solution interests you, we’ll start looking at how to tailor it to your unique needs. We’ll hold a meeting that includes subject matter experts and implementation leadership groups to uncover your greatest usability needs. Then, we’ll document those needs to better prepare whoever runs your project and ensure he or she has all the necessary information upfront. Then, gears start moving during the sales process. After choosing a solution, our team of experts works with members from every department in your organization to iron out the appropriate design and functionality details. We believe the people who will be using and relying on the solution every day should have a significant say in these details. However, we’ll do all the legwork of actually building and implementing the solution itself. By the time we’re ready to run internal tests to make sure the software works, members of every department will already know what to expect. Consequently, when they run user acceptance tests to check whether the solution fits into their workflows, they can accurately measure the solution’s performance against their input into its design. Afterward, we can iron out any hiccups they run into before initiating the organizationwide training and “go live” steps of the process. It’s never too late to make adjustments Our deep involvement in customizing your solution also begins before you select it, and it continues long after it's successfully implemented. We don’t go away just because we marked you as “live.” Instead, we understand that the healthcare industry is in constant flux and you might experience operational changes that warrant additional tinkering and tailoring to our solutions. We’ll stick around for a couple of days after going live, and we’ll stay available forever after, just in case. For example, if you purchase a new physician group six months after going live, you’ll face quite an uphill battle onboarding them all into your software system and, in turn, getting them up to speed. Because the group is new, you might face opposition to bringing on any change in general. In this case, you could use help facilitating the training and the adoption of your system into this new group, and that's where we step in. Additionally, what if this implementation requires a work queue structure that’s vastly different from yours? If the new group operates in a different area of the state, they might also have unique rules for some of their payers. These rules have to be incorporated into their system to accommodate the patient population. None of this, though, should fall solely on your shoulders. We can worry about the system's features so you can focus on the operational change management aspect. For our clients, we’re always on call. This devoted availability could range from six months or even six years. Whatever the situation, we know that you’ll eventually face circumstances that your software wasn’t originally designed to address. Instead of feeling stuck and frustrated, clients can find comfort in knowing we are here for every step of the process. And beyond tailoring your solution before implementing it, we also offer continued customization to help you tackle new circumstances without compromising workflow. Overall, here at Experian Health, we understand the pressures facing healthcare organizations today, and we are eager to be partners with you in securing the best solution for you needs and guiding you through the challenges ahead.

Apr 03,2018 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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