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Artificial intelligence (AI) and computer automation are finally beginning to impact healthcare. Payers are implementing generative AI to improve the customer experience. Researchers at Stanford use AI to review X-rays and detect pathologies in seconds. Today, AI and automation can remind patients about appointments and even provide a portion of their treatment via robotic surgery devices. While groundbreaking AI and automation technologies are in the news, adoption by the majority of healthcare providers has been slow despite research showing these tools could eliminate up to $360 billion in spending. It's a startling statistic that illustrates the reality of AI and automation applied to the revenue cycle: These tools quite literally can pay for themselves. The case for applying artificial intelligence and automation in healthcare Successful revenue cycles depend on thousands of daily tasks, which means efficiency lies at the heart of these endeavors. However, there are a lot of improvement to be made. Experian Health's State of Claims Survey 2022 shows the current state of the average healthcare revenue cycle: Reimbursement cycles are running longer. Claim errors are on the rise. Denials are increasing. More than one-half of U.S. hospitals reported financial losses in 2022. A 2023 America Hospital Report (AHA) report showed: 84% of hospitals admit the cost of complying with payer reimbursement requirements is increasing. 95% report spending more time on pursuing prior authorization approval. Over 50% of hospitals and health systems have more than $100 million tied up in A/R for claims six months old. These challenges stem from the increasing complexities of working with third-party payers, but also the by-hand human workflows embedded within provider revenue cycles. The State of Claims Survey 2022 showed that 61% of providers say they rely too heavily on manual processes and lack the automation they need to streamline reimbursement. As costs rise and revenue cycles tighten, there is increasing pressure to do more with less—faster. However, chronic healthcare staffing shortages have only exacerbated how hard it is for providers to get paid. Technology solves many of the problems plaguing healthcare's revenue cycle. AI and automation offer better revenue cycle management tools with fewer errors, less manual work, and more streamlined processes. How AI and automation improves revenue cycles Increasingly complicated reimbursement processes are the perfect testing ground for new technologies. These tools can improve the revenue cycle from the first point of patient contact to collections long after the procedure is over. For example, AI and automation software can greatly reduce errors and increase the accuracy of claims information before submission. When billing becomes more accurate, it lessens the volume of rejected claims, which take up an inordinate amount of staff resources and lengthen the time from service delivery to reimbursement. But AI and automation also impact the backend of the patient encounter by helping collections teams prioritize accounts most likely to pay. Four applications for AI and automation in the revenue cycle include: 1. Applying automation to patient registration The revenue cycle begins at patient registration, and that's also where providers can begin to apply technology to increase cash flow downstream. Patient registration is often cumbersome, an in-person process tied to a clipboard, paper, and open office hours. Yet Experian Health's State of Patient Access 2023 report shows that 73% of patients want to handle these processes online. Self-scheduling offers patients more flexibility for scheduling appointments when they want and on their preferred digital device. It can remove the friction from a frustratingly manual paperwork process while decreasing no-shows with automated messaging by text and email. Experian Health's automated patient scheduling software reduces time spent on traditionally manual scheduling tasks by 50%. Providers that select these tools increase their patient show rate to nearly 90%. From a revenue cycle perspective, providers that implement online self-service scheduling can see up to 32% more patients each month—which is money in the bank. 2. Finding hidden financial resources to reduce bad debt Experian Health's Coverage Discovery® automates the insurance verification process to match patients' responsibility with the best financial resources possible given their policy limits. Coverage Discovery scans proprietary databases and historical information for primary, secondary, and tertiary coverage. The platform seeks to find all available financial resources to lower the volume of accounts that end up as write-offs or in collections. In 2022, Coverage Discovery found $64.6 billion in patient coverage. In 2023, this software discovered previously unknown financial options for 32.1% of patient accounts, giving these customers more options for reducing debt. 3. Preventing denials by improving data quality Many claims are rejected by payers each day simply due to human error. Some of the most common reasons for claims errors include missing or inaccurate information caused by manual processes. From eligibility verification errors to incorrect insurance details, when paperwork is still by hand and this complex, it's far more likely to make an error than not. Experian Health's Patient Access Curator software automatically verifies eligibility and coverage while scanning patient documentation for obsolete or inaccurate data. The software leverages artificial intelligence and robotic process automation (RPA) to apply computer rigor to previously manual workflows to reduce manual errors. Significantly, this new technology performs these tasks in seconds, freeing up staff time and improving the patient experience. 4. Using artificial intelligence to prevent and mitigate denials How much does the endless pursuit of denials management tie up potential revenue? One survey showed half of hospitals report more than $100 million in delayed or unpaid claims at least six months old. The good news is that 85% of the errors that lead to denied claims are preventable with the help of existing technology. Experian Health's AI Advantage™ solution works in two critical areas to prevent denials before they happen—and correct any denied claims quickly: At the front end of the claim, by correcting errors before submission. AI Advantage – Predictive Denials spots the submissions most likely to kick back from the payer. This early warning system reduces the volume of denials by flagging claims with errors stemming from human mistakes or payer requirements changes. At the back end of the claim, for those rejected by the payer. AI Advantage – Denial Triage takes the volume of claims rejections and prioritizes them by those with the highest ROI for the provider organization. Not all denials offer the same volume or potential for revenue collection. This solution helps prioritize the highest returns quickly to increase revenue collection. Benefits of applying AI and automation to healthcare's revenue cycle There is little argument across the healthcare industry that the strategies that once worked to create a healthy revenue cycle still apply. Fortunately, today's AI and automation software allow these organizations to modernize their approach to these complexities—and win the revenue cycle game. The benefits of applying modern AI and automation tools at every point of the revenue cycle are substantial: Faster and more accurate patient scheduling and registration. No more manual data searches that tie up staff time. Fewer data entry tasks that lead to errors. Fewer claim denials. Less time spent chasing claims. Fewer days in A/R. More cash on hand. A high-performing revenue cycle is possible with the latest technology tools. Experian Health offers a suite of technology solutions that utilize artificial intelligence and automation designed to get providers paid faster, free up staff time, and improve the patient experience. Improving the revenue cycle is a necessity, and Experian Health helps healthcare organizations achieve this goal.

As the saying goes, “what gets measured gets managed.” For healthcare providers, this is a reminder that optimizing the revenue cycle relies on monitoring and reporting on the right metrics. Claims, billing and collections teams will struggle to know which of their activities lead to improvements if they don't track key performance indicators (KPIs). The question, then, is how to choose the right KPIs. How can providers gain more visibility into their financial performance? Where are the pitfalls that limit the usefulness of the data? This article looks at how revenue cycle managers may find more opportunities to prevent revenue leakage by building a healthcare revenue cycle KPI dashboard populated with the right medical billing metrics. What is a revenue cycle KPI dashboard? A revenue cycle or medical billing KPI dashboard is part of a revenue cycle management (RCM) platform. It enables real-time visibility into metrics regarding billing and revenue and is customizable based on the KPIs that matter to each healthcare organization. It centralizes critical information related to patient access, healthcare collections, claims management and payer contract management. Challenges and pain points in revenue cycle management The first step in selecting the most relevant KPIs for a revenue cycle dashboard is to identify and understand the thorniest RCM challenges that could be causing dollars to slip through the net. Here is a run-down of some of the biggest obstacles to effective RCM and possible performance measures that may help track improvements: 1. Inefficient patient access for scheduling and registration Revenue cycle management begins in patient access. Unfortunately, so do many of the errors and inefficiencies that lead to claim denials and missed payment opportunities. Confusing and disjointed scheduling systems can lead to underutilization of services and no-shows, as well as falling short of consumer expectations for online booking methods.Online self-scheduling tools make it easier for patients to book appointments so they can start their healthcare journey quickly and conveniently. Cancelled appointment slots can be offered to other patients, to maximize clinician time. Here, it would be useful to track the percentage of unfilled appointments: an increase over time would suggest that patients are finding it easier to book appointments, and confirm better use of doctors' hours.Similarly, digital registration options can quell the frustrations that many patients feel when trying to fill out forms ahead of treatment. No-show rates, percentage of patients using online tools, registration error rates and patient satisfaction scores would all be relevant KPIs. 2. Claims and denial management processes that rely too heavily on manual work From checking payer updates to poring over billing codes, claims management workflows often involve manual tasks that put unwelcome pressure on already-overwhelmed staff. There are many opportunities for errors, which drive up denials and put the brakes on the organization's cash flow. An increase in clean claim rate and a reduction in the rate of denials would be KPIs to look for on the revenue cycle dashboard. An end-to-end claims management solution that uses automation and artificial intelligence (AI) to improve accuracy and lift the load on staff can alleviate these challenges. For example, AI Advantage™, leverages AI to predict and prevent denials using the organization's own historical claims data. 3. Patient collections practices are often inconsistent Patient responsibility for healthcare costs is higher than ever, so the consequences of poor billing practices are severe. Experian Health's State of Patient Access 2023 report found that 63% of providers believe patients frequently postpone care because they're worried about costs. If patients are unsure about what they owe, unable to find financial assistance, or unclear about how and when to pay, the provider is likely to see their accounts receivable metrics and collection rates heading in the wrong direction. Clear bills and convenient ways to pay are key to optimizing patient collections. Collections Optimization Manager supports better financial decision-making for both patients and providers by screening, segmenting and routing accounts based on payment probability. Users get tailored support from an experienced optimization consultant to select the right KPIs and turn insights into effective action. 4. Actionable insights are often out of reach RCM analysts may have a wealth of information to interrogate, but they are often tripped up by disparate systems and legacy processes. Critical information in patient access, collections, claims management and payer contract management may be held in different systems and formats, which makes it much harder to see connections. With revenue cycle analytics tools, providers can make sense of the information they hold, rather than drowning in data. A revenue cycle or medical billing dashboard can enable real-time visibility into the KPIs that matter most while tracking changes over time. What are KPIs for RCM?  Revenue cycle KPIs are quantifiable measures that illustrate the financial viability of an organization's revenue cycle. These metrics indicate if healthcare organizations are achieving their financial goals and are effectively managing revenue inflows and outflows. Specific KPIs will be tailored to the organization's particular goals, challenges and processes. The quality and availability of relevant data will also play into the selection process, to maximize visibility and insights into the revenue cycle. In addition to the suggested metrics discussed above, other common KPIs to feature in a revenue cycle dashboard include: Days in account receivable Aged accounts receivable rate Adjusted collection rate Clean claim rate Claim denial rate Claim appeal rate Bad debt rate Gross collection rate Net collection rate Importance of healthcare revenue cycle KPI dashboards A  revenue cycle KPI dashboard is more than just a handy way to present data. Monitoring an organization's financial health is critical to its ability to serve patients and attract and retain high-performing employees. A healthcare revenue cycle dashboard can enable providers to: Identify if revenue levels are sufficient to keep the organization afloat and know in advance if new strategies are needed to maintain cash flow Locate glaring operational efficiencies in RCM that are costing the organization time and money Forecast future revenue projections to determine the organization's ability to expand and invest Improve all financial decision-making through better use of data that is already being collected Boost patient satisfaction by highlighting opportunities to create a more convenient and transparent financial experience. Driving efficiency and success through RCM solutions Once the revenue cycle KPI dashboard is built, RCM teams can get to work on implementing the specific actions needed to tackle those thorny issues discussed above. With Experian Health's integrated RCM solutions, providers can bring together metrics such as financial performance, billing efficiency and collections rates into one place, to allocate resources more strategically, drive targeted improvements, and accelerate reimbursement. And with these insights, providers are not just managing revenue – they are optimizing for future financial stability. See how Experian Health's revenue cycle management solutions, dashboards and drill-down reports can uncover opportunities to prevent revenue loss and boost profitability.

The relationship between hospitals and payers has often carried an undercurrent of tension. Stacks of paperwork, complex claims rules and manual adjustments are a recipe for disrupted cash flow and time-consuming rework. With profit margins hanging in the balance, providers need the reimbursement process to move forward without a hitch. To the relief of revenue cycle managers, recent developments in digital technology are paving the way for more effective claims management. Case in point: Experian Health's recent acquisition of Wave HDC, which brings together a suite of advanced patient registration solutions for faster and more accurate claims management at the front end of the process. Shifting sands in the hospital-payer relationship could increase denials For healthcare organizations, getting paid in full- and on-time hinges on seamless communications with payers. Any missteps can lead to revenue losses, with denied claims and delayed payments being the outcomes providers most want to avoid. Payers will automatically deny claims that have errors or missing information, while disputes and slow processing times can seriously hamper a hospital's cash flow. The sources of potential conflict have been pretty steady over time, stemming from complex billing processes, frequent changes to payers' requirements, and a lack of standardization between payers.  Tension created by the cost of services and the need to control healthcare costs is a constant in the revenue cycle. Recently, a major shift in dynamics has occurred with the widespread adoption of artificial intelligence by payers. This enables them to process – and deny – claims with unprecedented speed and scale, leaving providers struggling to catch up. On a recent webinar, Makenzie Smith, Experian Health Product Manager for AI AdvantageTM, explained how this change was reshaping the relationship between payers and providers: “So many payer decisions are now being driven by artificial intelligence. Insurers are reviewing and denying at scale using intelligent logic, leaving providers fighting harder for every dollar… Many revenue cycle managers will stick in their comfort zone because operating margins are tight and changing course seems risky. But given this change in payer behavior, the cost of staying the course could put organizations at risk.” How AI-powered revenue cycle management solutions help close the gap between payers and providers Providers are increasingly leveraging digital technology to level the playing field with payers. Integrated software and automation give revenue cycle management teams the right data in the right format and at the right time to respond to queries promptly and accurately. These solutions enable teams to work more efficiently, so they can process more claims in less time. Experian Health's flagship AI-based claims management solution, AI AdvantageTM, is a prime example. This tool predicts and prevents denials by identifying patterns in payer behavior and flagging claims with a high probability of denial so specialists can intervene before the claim is sent to the payer. This works alongside ClaimSource®, which automates clean claim submissions at scale. Using a single application, all claims are prepared and submitted with all necessary documentation, reducing the risk of denial due to missing or inaccurate information. Integrating Wave HDC's data capture technology for comprehensive claims management In November 2023, Experian Health acquired Wave HDC, which specializes in using AI-guided solutions to capture and process patient insurance data at registration with unrivalled speed and accuracy. This gives Experian Health clients access to a single denial management solution, known as Patient Access Curator. This new technology is a single click solution that spans eligibility verification, coordination of benefits, coverage and financial status checks with near-100% accuracy in less than 30 seconds. Crucial registration data can be captured in real time as soon as the patient checks in for an appointment, with no need to chase and update data post-registration. A single inquiry can search for all the essential insurance and patient demographics instantly, enabling better use of staff resources and smoother communications with payers. Tom Cox, President of Experian Health, says the move “allows us to quickly scale our portfolio with advanced logic and AI-powered technology to help solve one of the biggest administrative problems providers face today, which is claim denials.” Accurate patient data from the outset is key to preventing downstream denials, many of which originate in patient access. By reducing errors and enabling faster processing times, this comprehensive approach to denial management will help strengthen the relationship between providers and payers, ensuring timely payments and clean claims. Contact Experian Health today to find out how AI and automation can help build a successful relationship between providers and payers – and drive down denials.