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According to Experian Health's State of Patient Access Survey 2024, eight in ten healthcare providers plan to invest in patient access improvements soon. As they weigh up the pros and cons of different solutions, many will focus on two key areas: making scheduling and registration easier for patients, and streamlining financial processes to boost their profitability. This blog post examines how automated patient access solutions can help providers meet patient expectations and operational demands. Survey snapshot: what do patients want? Experian Health's annual State of Patient Access surveys are useful pulse checks on patient perceptions. What do patients find challenging about accessing care? Where are they bumping up against unnecessary friction? The 2024 survey offers a promising outlook: 28% of patients report improvements in access in the last year, up from just 17% in 2023. Still, there is room for improvement: patients' biggest challenge – seeing a practitioner quickly – has topped the list for the last four years. Other significant challenges include understanding the cost of care and scheduling appointments. The State of Patient Access 2024 survey examines the perspectives from patients and providers on their perceptions of access to healthcare. Download now One key takeaway from the survey is the role of digital technology. Both patients and providers find complex, repetitive and inefficient processes to be the most problematic aspects of patient access – ideal targets for digital tools. Indeed, patients specifically express a desire for online health management tools, while more than half of providers attribute improvements in patient access to automated processes. There's a solid business case for investing in digital patient access solutions to ensure that patients see their doctors quickly and providers get paid without delay. Patient access solutions can open the digital front door with online scheduling and registration The first area where providers may consider investing in digital tools is in the patient's first interactions with their facility. When patients can schedule appointments quickly and complete registration without boring and repetitive paperwork, they're more likely to report a positive patient experience. Survey data backs this up: 89% of patients say the ability to schedule appointments any time, via online or mobile tools, is important to them 89% of patients say digital or paperless pre-registration is important to them. Online self-scheduling gives patients 24/7 access to book, cancel, and reschedule appointments from any device. Based on scheduling rules, they're shown the earliest suitable appointment, which means they'll see their doctor as soon as possible. Patients can be sent automated reminders of upcoming appointments and health checks, which means show rates and health outcomes will be better. It also drastically reduces call volumes so staff can focus on other priorities. Similarly, digital registration lets patients avoid the most dreaded part of patient intake: filling out lengthy forms in the waiting room. Automated registration also ensures that patients (specifically their data) are correctly entered into the system, preventing downstream delays. With text-to-mobile registration, patients are sent a text message prompting them to scan their identity and insurance cards, which are then uploaded and validated against existing records. Securing correct information from the start lays the groundwork for the patient's healthcare experience and the provider's revenue cycle. Interestingly, despite patient demand, self-scheduling and registration did not make the cut for providers' top three priorities. This suggests an untapped opportunity for providers that choose to invest here. Anthony Myers, Director of Patient Access at West Tennessee Healthcare, shares how their organization worked with Experian Health to accelerate and improve the registration process with Registration Accelerator. Watch now Patient access solutions can streamline insurance, eligibility and estimates A second opportunity lies in automating the patient access processes involved in revenue generation and claims submission. The revenue cycle is full of hidden costs for both patients and providers, often resulting from intake inefficiencies. Patients end up with bills that are higher than expected, while providers fall foul of changing payer requirements around prior authorizations and insurance eligibility verification, resulting in lost revenue. Improving upfront pricing estimates and clarifying insurance coverage ranked among the most urgent priorities for both groups in the survey. A few patient access solutions that can help here include: Patient estimates: When patients know in advance how much their care will cost, they can plan better. Web-based and mobile-enabled price transparency tools generate accurate estimates based on chargemaster data, claims history, patient insurance details and payer contract terms, and even account for payment plans and prompt-pay discounts. This improves the patient experience and increases collection rates while easing the burden on staff. Insurance eligibility verification: Manual processes for verifying active coverage are time-consuming and error-prone, causing staff burnout and patient confusion. Automating insurance verification checks at the time of service gives everyone greater certainty and prevents payment delays and claim denials. Personalized payment plans: By using their own data, along with third-party datasets, providers can leverage automation to offer alternative payment plans to patients who cannot pay the full amount right away. For example, PatientSimple® assesses each patient's propensity to pay and recommends the optimal financial plan that works for the patient's unique circumstances. Patients can check estimates and compare pricing plans on the self-service portal, giving them more control over their bills. These options promote financial sustainability by quickly identifying how much should be paid by which party and establishing processes to collect those amounts with minimal fuss. With ongoing staffing shortages, these time-saving tools are crucial for workforce resilience. Integrate patient access solutions with Patient Access Curator While providers may prioritize one of the above areas, the two are complementary: efficient scheduling and registration lead to better patient flow and accurate data collection, accelerating insurance and eligibility verification. This is more likely with an integrated “tech stack” across the whole patient access workflow. However, integration is a challenge for many providers. Nearly a quarter report that their biggest challenge in patient access is wrangling the multitude of tools needed to run pre-registration checks and gather the information necessary for claim submissions. Experian Health's newest patient access solution addresses this challenge by bringing together multiple insurance-related queries together into a single inquiry. With one click, Patient Access Curator automatically captures all relevant patient insurance data in less than 30 seconds. This includes: Eligibility verification, including billable secondary and tertiary coverage, chaining and primacy Coordination of Benefits, analyzing payer responses in real-time using AI to ensure no active insurance is missed Medicare Beneficiary Identifiers, using AI, automation and analytics to check and correct patient identifiers Patient demographics, using in-memory analytics and proprietary algorithms to ensure contact details are current Coverage and financial status, including automatic checks to find any existing coverage for accounts marked as self-pay or unbillable, and generate a summary of each patient's propensity to pay. With over $1 billion saved in prevented denials by clients using Patient Access Curator, it's clear that investing in digital technology is a cost-effective way to address current challenges in patient access. By increasing capacity and reducing errors and delays, these tools not only enhance financial performance, but give providers a head start when it comes to delivering an outstanding patient experience. Learn more about how Experian Health's patient access solutions accelerate access to care and streamline revenue generation from the start.

Once hesitant, the healthcare industry is slowly embracing artificial intelligence (AI)'s potential. Healthcare stakeholders, particularly those in revenue cycle management, are now interested in exploring AI-driven technology solutions to tackle daunting administrative tasks. According to data highlighted by the Journal of AHIMA, two-thirds of health systems are adopting AI to support revenue cycle processes. AI offers solutions that address the complexities of medical billing, insurance claims, and patient payments and enhance hospitals' financial health. The potential savings from AI adoption in healthcare spending could range from $200 to $360 billion annually, making it a compelling option for revenue cycle leaders looking to save more in far less time and with fewer resources. AI-powered tools show strong promise to reshape how revenue cycle leaders manage the most pressing issues in revenue cycle management, offering an efficient and seamless solution to complex revenue cycle tasks, including automated data entry and real-time insurance verification. Read on to discover more about the role of AI in revenue cycle management and how best to take advantage of robust AI solutions to streamline claims processing. How is AI used in revenue cycle management? The state of the average healthcare revenue cycle today reveals a pressing need for improvement. According to Experian Health's State of Claims 2022 report, reimbursement cycles are getting longer and claim errors and denials are rising. Here are everyday revenue cycle management challenges that AI-powered solutions can efficiently solve. AI can help manage complex billing procedures Accurate medical billing is the first step towards guaranteeing claims approval, yet data indicates that revenue cycle managers are falling short in this critical area. Errors in medical billing cost the U.S. healthcare system approximately $935 million weekly, highlighting the urgent need for improvement in the medical billing processes. Navigating the intricate landscape of insurance plans, billing codes, and patient payments can be overwhelming. Each insurance plan has unique nuances and requirements, adding to the complexity. Moreover, the success of a billing process relies on accuracy, which may be near impossible with manual handling. Adopting AI into every aspect of the billing cycle can streamline and improve the billing process while ensuring accuracy at every stage. AI-powered billing solutions like Patient Access Curator effectively manage critical aspects of the process, including verifying a patient's coverage and eligibility and fixing billing errors. Accurate billing significantly reduces the potential for rejected claims, creating opportunities for more efficient healthcare operations and saving money. AI in RCM can help prevent claim denials  According to The State of Claims 2022 report, 200 health professionals surveyed stated that 5% to 15% of claims are denied. These denials result in hospitals losing billions of dollars, approximately $260 billion per year, forcing them to write off massive amounts of debt, as noted in the Journal of Managed Care & Specialty Pharmacy. Insurance claims denials often result from inadequate data and analytics to identify submission issues, manual claims processing, and insufficient staff training. These denials affect the hospital's revenue and create additional administrative work to rectify the errors. The downstream effect is that patients may receive bills in error and end up paying the out-of-pocket bills if resolution does not occur. AI can make a huge difference, turning the bleak trend of increasing claim denials into a more positive experience for hospitals and patients. Encouragingly, The State of Claims 2022 report reveals that over half of healthcare providers use AI-powered healthcare claims management software to prevent claim denials. Among these AI-powered software solutions, Experian Health's AI Advantage™, when used in conjunction with ClaimSource®, an automated claims management system, stands out as a valuable solution for bolstering denial prevention efforts, improving claims management, and increasing revenue savings. Reduce patient payment delays With the rise in high deductible health plans, patients are putting off or not making payments, affecting the hospital's cash flow. According to medical billing analysts, people with health insurance, who previously accounted for only a fraction of hospital debtors, now constitute the majority of debtors in American hospitals. Hence, patient payment delays are now serious roadblocks to seamless revenue cycle management. On the provider end, there's also the challenge of swiftly verifying a patient's coverage and estimating their medical bill without any margin for error. Billing mistakes, surprise expenses, and complex payment processes can make it challenging for patients to manage their finances and make payments as early as possible. On the other hand, early and accurate estimation of patients' financial responsibility can help patients understand and appropriately plan for medical bills in advance. However, achieving the latter experience for patients involves sifting through constantly growing data, compounding the strain on limited hospital resources. That's where AI-powered revenue cycle management solutions can help. With solutions like Patient Access Curator, healthcare providers can quickly and accurately gather and verify necessary information about a patient's insurance, enabling them to promptly provide patients with a clear picture of what's left for them to pay. How can AI help with claims management? AI-powered software offers tailored solutions to simplify and optimize claims management processes and, in turn, improve revenue cycle management. Here are two critical ways AI can help with claims management. Real-time insurance eligibility verification Accurate eligibility verification is a fundamental part of the claims process. It is crucial for an accurate and faster billing process, increasing claims approval rates, and improving revenue cycle management. Conversely, incorrect verification leads to denied claims, contributing to care delays, wasteful healthcare spending, and a poor patient payment experience. By using Experian Health's Al-powered Patient Access Curator solution, healthcare providers can instantly verify and update patient insurance information, ensuring accurate billing and reducing the potential for claims denial. This real-time verification eliminates any need for guesswork and ensures that billing is done based on the most current insurance information. Patient Access Curator is a valuable tool for hospitals looking to save time, money, and staff resources that would have been spent on a lengthy and denial-prone claims process. With just one click and in 30 seconds, it prevents claims denial problems on the front-end. Since 2020, it has been a game changer for the financial health of clients using the platform, helping them save over $1 billion in denied claims. Predictive claims analysis AI can predict potential claim denials or payment delays, empowering hospitals to take proactive measures. By analyzing historical data and patterns, AI can flag potential issues before they become costly problems. AI Advantage™, another AI-powered solution, aims to help healthcare providers prevent and manage claim denials. This solution has two components:AI Advantage – Predictive Denials: reduce claims denials by spotting errors and identifying claims that don't meet ever-changing payer rules, allowing corrections to be made.AI Advantage – Denial Triage: works after a claim has been denied to identify and group denials most likely to be approved after resubmission, allowing organizations to prioritize resubmissions most likely to benefit their finances. As revenue cycle leaders strive to navigate the ever-evolving landscape of healthcare, it is crucial to embrace AI to stay ahead of the game. With Experian Health's expertise and resources, healthcare providers can fully take advantage of robust AI solutions to streamline their revenue cycle processes and achieve financial success. Find out more about how Experian Health helps healthcare providers leverage AI to solve the most pressing issues in revenue cycle management.

Healthcare price transparency is high stakes for both patients and providers. With the average cost of a hospital stay for patients in the United States amounting to $2,883 a day, a patient's bill can quickly add up. Patients need reliable information about the cost of services as early as possible so they can plan accordingly. For providers, transparent pricing helps deliver a more compassionate patient financial experience and reduces the risk of missed revenue opportunities. However, it's also a compliance issue, especially with the introduction of the Hospital Price Transparency Rule. While the Centers for Medicare & Medicaid Services (CMS) found that 70% of hospitals are in compliance as of February 2023, the goal is to reach 100% compliance. Experian Health and Cleverley + Associates have joined forces to address the challenges providers may be facing. Riley Matthews, Lead Product Manager at Experian Health, and Jamie Cleverley, President of Cleverley + Associates, discuss what hospitals need to do to comply with the Hospital Price Transparency Rule. What is hospital price transparency and what is the Hospital Price Transparency Rule? The introduction of CMS price transparency requirements has brought about substantial shifts in the landscape of price disclosure for hospitals across the United States. Enacted as part of the FY19 IPPS Final Rule, these requirements were established in alignment with provisions outlined in the Affordable Care Act. Hospitals are now mandated to provide a comprehensive list of their current standard charges via the Internet in a machine-readable format, with updates required at least annually or more frequently as deemed necessary. This information can be presented in the form of a chargemaster or any other format chosen by the hospital, as long as it meets the criteria of being machine-readable. What are the new price transparency updates coming on July 1, 2024? As of July 1, 2024, CMS mandates that hospitals affirm the completeness and accuracy of their machine-readable file (MRF). This affirmation includes confirming that all applicable standard charge information, as required by § 180.50, has been included in the MRF. Furthermore, hospitals must assert that the encoded information is true, accurate, and up-to-date as of the specified date indicated in the MRF. Also starting on July 1, 2024, CMS will require hospitals to convert the contents of the MRF into a predefined template. This template is available in either .JSON or .CSV format. Additionally, there are new mandatory data elements, supplementing the previously specified ones (e.g., the five types of standard charges). Some of these new data elements have a delayed implementation date of January 1, 2025. What's the difference between the Hospital Price Transparency Rule and the No Surprises Act? The Hospital Price Transparency Rule aims to give patients clear, upfront information about hospital pricing, so they are empowered to make informed choices about their care. The No Surprises Act offers patients protection from surprise billing when they receive certain emergency and non-emergency services from out-of-network providers at in-network facilities. The two sister mandates work together to improve the patient financial experience and help patients navigate their financial obligations. What are the most common price transparency compliance challenges?  Cleverley says there are two main reasons why hospitals may be struggling to comply. First, there is some confusion about what is required to be disclosed (and how). To bridge this gap, Experian Health and Cleverley + Associates have created a standard methodology that satisfies the rule requirements. Second, some providers are hesitant to disclose pay rates amid concerns over financial viability and potential pressure to lower charges. However, the price transparency rule aims to enable market competitiveness and empower patients. Furthermore, making cost estimates freely available improves patient satisfaction by 88%, according to data from PYMNTS and Experian Health. A patient-centered approach to billing and payments not only supports compliance with price transparency regulations, but leads to faster payments and consumer satisfaction. In addition to Patient Estimates and Patient Financial Advisor, which offer patients accurate, pre-service cost estimates, there are a host of other Patient Payment Solutions that allow patients to choose payment plans, manage bills and make payments. How are Experian Health and Cleverley + Associates helping providers comply with the Hospital Price Transparency Rule?  The Hospital Price Transparency Final Rule requires hospitals to display payer-specific rates as a consumer-friendly list of 300 shoppable service items. Experian Health's Self-Service Patient Estimates solution helps providers compile these lists and deliver accurate estimates to patients in a clear and comprehensive way. This puts consumers in the driving seat when it comes to making informed healthcare choices and supports hospitals in providing clear, accurate and legally compliant pricing information. Providers must also make certain pricing information for items and services available as a machine-readable file displayed on their website. Cleverley + Associates has the necessary capabilities to deliver the machine-readable files quickly and at scale. By working together, both organizations deliver a holistic solution to meet price transparency mandates. Jamie Cleverley says this helps hospitals prepare for the changing environment: “It's more than compliance. It’s having trusted partners that are talking through and consulting with hundreds of hospitals across the country.” What is the best approach for providers to ensure price transparency compliance? Riley Matthews says that the first step for providers is to define a strategy that best fits their individual organization. They should identify best practice workflows based on their existing resources and intellectual property and partner with an organization that can bring solutions to areas where the system is lacking. The key is to execute the business strategy while prioritizing the patient experience. Experian Health and Cleverley + Associates can support hospitals in providing an efficient, consumer-friendly workflow, as well as the more robust backend concepts of the machine-readable file. Cleverley says, “We've created a methodology to display aggregated claim payment levels, simplifying the display of information for both hospitals and patients. Many solutions attempt to display just a list of payment rates, but the combination of those lines is really what's most relevant to patients.” For example, a patient coming in for an outpatient surgery has no idea what additional services, drugs and tests they may need. This solution looks at the statistical utilization of services to calculate the charges for that procedure, and then displays that value. This holistic approach meets “not only the letter of the law, but also the spirit of it.” What's next for price transparency? There has been a significant challenge around non-uniformity of data. Hospitals have been using different structures and file formats for displaying required information, but CMS has implemented a standardized file schema for use beginning July 1, 2024.  Cleverley + Associates has a file structure that conforms to the Medicare standard schema and is available to help hospitals understand the new requirements. As the penalties for non-compliance increase, providers need to be proactive in reducing the financial risks associated with price transparency non-compliance. Riley Matthews says that innovation and partnership helps providers get ahead of compliance rules and allows hospitals to focus on patient care. Find out more about how Experian Health and Cleverley + Associates are supporting healthcare organizations comply with the Hospital Price Transparency Rule and improve the patient financial experience.