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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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Important regulatory updates for Q1 2018

To help our clients keep up with regulatory changes, Experian Health will provide quarterly legislation updates: Q1 2018 updates  North Carolina Data Breach Legislation In North Carolina legislation has been proposed that would require notice to be made within 15 calendar days of discovery of a data breach. If passed, North Carolina will have one of the most onerous breach notification laws in the country. For comparison, California’s notice requirement is 15 business days. North Carolina’s current statute requires notice without “unreasonable delay.” Alabama Data Breach Legislation On March 21 South Dakota’s data breach notification bill was signed into law, leaving Alabama as the only state without a data breach notification law. However, Alabama is working to change that. On March 1 the Alabama Senate unanimously voted to pass the bill containing the Alabama Data Breach Notification Act, sending it on to the Alabama House. (The House subsequently amended it and returned it to the Senate for concurrence.) The Act would require notification of affected individuals within 45 days of determination that (a) a breach has occurred and (b) the breach is reasonably likely to cause substantial harm. There would be no private right of action, but the Alabama Attorney General would be able to fine companies that fail to notify up to $5,000 per day.

Mar 29,2018 by

Collaborative onboarding for health information systems: How we help our partners get up to speed

Seven years ago, Bill's healthcare group invested in a new health information system, and the dust still hasn’t quite settled. Like most health information system providers, Bill's vendor communicates mostly through the group’s IT leader. He has to pick and choose what updates and features are implemented, and the people who work with the system daily are expected to figure out how to make the most out of it. Fortunately, Bill and the head of IT are great pals. They eat lunch together, go out for after-work cocktails, and try to bridge the gap between their healthcare software vendor and the end users on the frontline. But Bill shouldn’t have to rely on that friendship for his healthcare team members to be able to do their jobs, and it shouldn't have taken seven years for the software to be properly integrated. Bill's not a real person, and his healthcare group is fictitious, but both are archetypes of the new healthcare landscape. Constant market changes and ongoing challenges have forced healthcare systems to partner more closely with medical software vendors. However, it’s challenging to find vendors that are willing to roll up their sleeves and work alongside the end users to design solutions that are tailored to their specific needs. At Experian Health, we want to make sure the first experience your team has with our health information system products is a positive one and that you all look forward to using them every day. Your group’s success is our top priority, and playing an active role in your onboarding process helps ensure that success. Providing health information systems and the knowledge to use them The problem with the archetype of Bill is that the end users in the group had to take on the tasks of learning and optimizing the system themselves. Trainers lacked the deep level of understanding needed to create enthusiasm about the system, and overall adoption lagged. By contrast, we know our solutions like the back of our hands, so it only makes sense for us to share that knowledge and collaborate to implement those solutions through medical software training. With years of experience under our belt working with healthcare organizations across the country, we’ve heard virtually every possible question end users ask. That experience gives us the flexibility to come up with on-the-fly solutions to challenges we haven’t thought of yet and suggest ways to optimize your group’s workflow with the system. We can offer shortcuts, tips, and tricks to make the system work more efficiently for your team. Collaborative onboarding lets our clients dive deeper into learning their new systems than they could by just reading predetermined lesson plans and FAQ lists. It helps us when we help you make the medical software training go smoother and ensure all end users actually want to use the product. In fact, for the first three to five months, Experian will be a physical presence at your organization, helping with change management and the onboarding process. Personalized, effective onboarding The process differs depending on how complex your organization is and what you’re installing, but typically, collaborative onboarding adheres to the following timeline: We start the process with a formal kickoff and demo to get executive leadership and everyone on the frontline up to speed. The demo lays out what the project will look like for the group and gives everyone the chance to start considering how to operationalize it for the organization. After the kickoff, our teams collaborate with specific subject matter experts and start digging into the nitty-gritty design and functionality detail work. We really stress the importance of operational input from people who will be champions for their specific areas, not just the IT teams. These champions need to communicate the details of the system’s design to their peers. When the design is complete, we do all of the heavy lifting to build the product, and then we conduct internal testing to make sure it works effectively. Next, we guide operational champions through user-acceptance testing to make sure the product meets their needs. User-acceptance testing occurs in a real-life, day-to-day setting so users can validate that it fits into their workflow. Once we iron out any changes warranted by the user-acceptance testing, we extend training into the larger workforce and officially go live. A month later, we come back and hold an optimization workshop to observe users in action. We can answer questions and provide suggestions on how to improve efficiency even further or make tweaks to improve user processes. With the rush to adopt faster and more efficient technology, many healthcare organizations have been left in the dust to figure out how to make new technology work best for them. At Experian Health, we stick around after software implementation to make sure your entire organization can hit the ground running. Our mission is to help the healthcare industry succeed in providing better, more comprehensive care to patients, and collaborative onboarding ensures our products do just that.

Mar 21,2018 by

Data-driven technology will transform the health industry

As the health industry faces extraordinary changes, how can leaders better drive efficiency and optimize resources? Recently President for Experian Health, Jennifer Schulz, sat down with The Business Debate to answer this pressing question. In short, the best way to get there is to turn to data-driven technology. In this interview, Jennifer touches on some of the main barriers to efficiency in health systems: Patient financial payments and identity management. Here are some excerpts from her interview. To watch the video and read Jennifer’s editorial, please click here. Patient financial payments and price transparency “The use of technology in healthcare is slim. When a consumer in a retail experience or a financial service experience uses their mobile device, or goes online, that experience doesn't translate into healthcare. Experian Health is very focused on improving the transparency of healthcare from a financial perspective. We've launched things like patient estimators because there’s no other large purchase you make in your life that you don't know what you're about to buy. And healthcare, for the most part, this all happens after the transaction, and that type of transparency in healthcare can come with the use of technology.” Universal patient identification “Another issue is identity isn't the same when you go from system to system. Every hospital, every provider looks at you as an individual, and puts a number associated with you. That number is within their system only, and so you may go across systems, but there is no view of identity. One of the solutions we've launched here at Experian Health is the universal identity manager, and we're offering that with no charge to our clients because we think identity is the one key to provide transparency across systems.” As we have done for other industries, Experian is at the forefront of bringing this type of consumerism to healthcare. Through our data assets and technology, we empower our clients to connect with consumers through a tailored approach that is personalized along the patient journey. To learn more, visit www.ExperianHealth.com.

Mar 13,2018 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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