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Contracts govern the revenue cycle, but negotiating contracts and ensuring compliance can feel increasingly unmanageable as mergers and acquisitions, ongoing staffing challenges, and the sheer volume of contracts, plans, and provisions make contract management a massive project for healthcare providers. Tricia Ibrahim, Director of Product Management at Experian Health, shares her insights on a challenging environment heading into 2024. Providers are grappling with mounting complexity, an explosion of data, and continuing pressure to maximize efficiency and revenue. But, according to Ibrahim, healthcare contract management software is evolving to meet these challenges—and helping providers find clarity amid the complication. Q1: What are the major challenges with healthcare contract management as we move into 2024? “I think what clients are most concerned with, especially leading into 2024, is the complexity of payer contracts,” says Ibrahim. A typical provider may manage hundreds or thousands of contracts, each one with a range of plans and provisions that affect the bottom line. “Being able to negotiate better contracts is a key concern,” says Ibrahim, “but clients increasingly feel outgunned and overwhelmed by the amount of information involved.” Accessing and analyzing data effectively is more critical than ever. “When providers come together with payers to negotiate contracts, it can be difficult for them to evaluate the contract that the payer is putting in front of them,” in part because it's hard to know how their current contract is performing or how contract provisions will play out in dollars and cents, Ibrahim explains. “Underpayments and denials are a constant struggle. Also, providers need to understand how volume and patient mix will factor in.” Contract management has a direct effect on revenue and the bottom line. Negotiated terms may or may not cover actual costs. A small change in terms might have an outsized effect due to high volume. Denied claims, underpayments, downcoding and late payments can slow the revenue cycle and reduce the amount of revenue providers receive. “At the same time, we're also starting to see a greater interest in collaboration between providers and payers,” says Ibrahim. “Having additional visibility allows both parties to have more meaningful discussions and move toward solutions that work for everyone.” Q2: What are providers doing to take on these challenges? “Many providers are investing in technology,” says Ibrahim. “A 2023 analysis by Bain & Company found that 80% of healthcare executives had accelerated software and IT investment over the past year in response to mergers and acquisitions, staffing shortfalls, and an increasing need for efficiency.” As contract management becomes more complex, providers are also reaching for more powerful healthcare contract management software tools to manage data—and leverage it to negotiate contracts effectively and monitor contract compliance over time. Q3: How can healthcare contract management software like Experian Health's Contract Manager and Contract Analysis help providers negotiate better contracts? “Having meaningful information backed by data changes the dynamic,” Ibrahim says. “It allows you to have a more strategic conversation. You can say, 'You're supposed to pay us 45 days from the receipt of the claim, but it's been taking 140 days.'” Data provides objective information and can point the way toward measurable improvements going forward. “Our Contract Analysis module allows for the provider to audit payer contract performance,” says Ibrahim. That's not only helpful for tracking what's happened to date; it's also useful for projecting how a new contract might work going forward. “We're able to use historical claims to create scenarios that show how a new contract would affect payment. Sometimes, payers will keep reimbursement rates the same where you have a lot of volume and give you an increase where you don't. When you use our solution to run these types of analyses, you get a more effective understanding of proposed terms.” Q4: Once contracts are in place, how can healthcare contract management software help providers improve compliance? “Detailed analysis is key, and small discrepancies can have a significant impact,” says Ibrahim. “One of our clients, a large academic provider on the medical group side, spotted a trend where they were being underpaid by 10 cents to 50 cents on their EKGs. These kinds of variances typically go unnoticed, but they found 20 or 30 claims to submit.” The payer acknowledged the underpayment and issued the few dollars' difference. “Then the provider decided to look at their contract to see how far back they could appeal. It turned out they were able to go back a significant amount of time. When they added up the underpayments, it equated to $850,000. They ended up settling for $750,000,” Ibrahim says. OrthoTennessee, a Knoxville-based orthopedic practice with multiple locations and more than 50 physicians, uses Experian Health's Contract Management software for healthcare to find inaccuracies, make appeals, and audit contracts at scale. Using Experian Health's Contract Management platform, OrthoTennessee had an 86% success rate for appeals in 2022. “That's the power of the solution: You can really identify trends,” says Ibrahim. Monitoring compliance is a continuous effort: “We’ve done a lot of work with our clients to understand what their evolving needs are. We’ve been named Best in KLAS [by healthcare IT research firm KLAS] multiple years in a row. That recognition has centered around engagement—being engaged with our clients, so we understand what the trends are, what challenges they’re facing, and how we can help solve problems in the most efficient manner.” Q5: What role do regulations play in shaping contract management solutions? “Regulation drives different reimbursement methodologies, [such as] bundled payments or value-based care,” says Ibrahim. “Part of our challenge is making sure we are always evaluating new regulations and ensuring that our system is agile enough to support these new methodologies. “Because regulation never stops, it actually drives a lot of the innovation we do. The No Surprises Act, which came into effect in 2021, requires providers to provide patients with a good faith estimate of costs. We've been able to help clients establish an estimated median rate, which can be useful for estimates that involve non-contracted payers.” As an additional benefit, healthcare contract management software also helps providers spot opportunities. “One of our clients identified 26 plans with enough volume to support additional contracts,” says Ibrahim.  “Providers can even use these solutions to evaluate whether a market exists for a new piece of technology to deliver state-of-the-art care. Understanding performance is a powerful tool.” Q6: Early in our conversation, you said there was a growing interest in collaboration among providers and payers. What does it mean to take a collaborative approach in this context? “I think it's really important for providers and payers to have collaborative communication, to engage in productive conversations where they can work together instead of against each other,” says Ibrahim. “That's how we're going to deliver more integrative care and reduce costs. It’s how we’re going to arrive at coverage options that work for all parties, by developing good relationships between providers and payers. “For our part, Experian Health is continuing to expand Contract Manager to provide data analytics that clearly show the cost of care and the expected reimbursement for various types of services, so providers can evaluate contract performance, identify potential areas of improvement, and have meaningful conversations with payers. “At the end of the day, we all have a common goal: delivering appropriate care at the right time for patients,” Ibrahim concludes. “To progress toward that goal, payers, providers and partners like Experian Health are going need to work together.” These conversations start with a common set of data, so that everyone at the table understands where the opportunities to collaborate and improve may lie—and where the path forward may begin. Learn more about Experian Health's Healthcare Contract Management software and how it can help your organization negotiate and manage contracts effectively and efficiently, even in an increasingly complex environment.

Experian Health ranked #1 in Best In KLAS for our ClaimSource® claims management system and Contract Manager and Analysis product – for the second consecutive year. The rankings were revealed in the annual 2024 Best in KLAS Awards – Software and Services, published on February 7, 2024. The Awards recognize the top software and services vendors that are helping American healthcare professionals deliver the best possible patient care, based on feedback from thousands of providers. Experian Health topped the list in two categories: ClaimSource ranked #1 in Claims Management and Clearinghouse. This automated and scalable solution reduces denials and increases revenue through a single application. The addition of an artificial intelligence component this year (AI AdvantageTM) is helping providers cut denial rates to just 4%, compared to an industry average of more than 10%. Contract Manager and Analysis ranked #1 in Revenue Cycle: Contract Management. This product levels the playing field with payers by monitoring compliance with contract terms and recovering underpayments. It also arms providers with financial models of proposed contracts, so they can negotiate more favorable terms. Case study: See how Hattiesburg Clinic in Mississippi uses ClaimSource to automate claims management and reduce denials. The awards come as the industry grapples with ongoing staffing challenges and rising claim denials. In Experian Health's 2023 report on the healthcare staffing crisis, 100% of respondents saw staffing shortages affect revenue cycle management and patient engagement. As the pressure continues, revenue cycle technology offers a way to increase efficiency and improve financial performance.  “Healthcare professionals face immense pressures, ranging from financial strains to staffing shortages and the very real issue of clinician burnout,” says Adam Gale, CEO and Founder of KLAS Research. “We want to provide actionable insights that will ultimately alleviate burdens and enhance clinician success.” For Tom Cox, President of Experian Health, the awards reflect a continuing commitment to help providers optimize operations and patient engagement using data-driven insights and technology. “This recognition from KLAS recognizes our dedication to deliver innovative solutions that not only improve the financial health of providers but also the patient experience. Receiving this award two years in a row is an honor as we remain steadfast in our commitment to simplifying healthcare through technology.” Find out more about how ClaimSource and Contract Manager and Contract Analysis helps healthcare organizations increase efficiency and boost financial performance.

By all forecasts, the healthcare worker shortage isn't going away. More than 80% of healthcare executives admit talent acquisition is so challenging it puts their organizations at risk. The latest survey from Experian Health shows complete agreement across the industry—the inability to recruit and retain staff hampers timely reimbursements. The side effects of the healthcare worker shortage are increased errors, staff turnover, and lower patient satisfaction. With the healthcare worker shortage becoming a chronic red flag on the list of industry challenges, is throwing more revenue at hiring the best answer? Experian Health's new report, Short-staffed for the long term, polled 200 healthcare revenue cycle executives to find out the effects of the continuing healthcare worker shortage on the bottom line. Respondents unanimous agreed that healthcare's recruitment problem is limiting their ability to get paid. Could investing in better revenue cycle technology to automate manual human functions be the answer to the healthcare recruiting dilemma? Effect of the healthcare worker shortage on healthcare revenue cycle Result 1: Providers losing money and patient engagement simultaneously. 96% of respondents said the healthcare worker shortage negatively impacts revenue. 82% of survey participants said patient engagement suffers when providers are short-staffed. Experian Health's latest survey showed almost unanimous agreement that the revenue cycle suffers significantly when providers are short-staffed. The only area of disagreement among revenue cycle leaders is whether patient collections or payer reimbursements are affected the most by the industry's lack of human talent. As revenue cycle teams struggle to cover their workload, the need for speed increases manual error rates. The Experian Health survey showed that 70% of revenue cycle teams say healthcare worker shortages increase denial rates. This finding reinforces an earlier survey showing nearly three of four healthcare executives place reducing claims denials as their top priority. As errors snowball, patient engagement and satisfaction begin to decline. Data entry errors impact claims submissions, resulting in billing mistakes that confuse and frustrate patients. Data errors often start at patient registration and persist through claims submission, creating denial reimbursement snarls and tying up cash flow. With the average denial rate above 11%, that's one in every 10 patients facing uncertainty around whether their bill will be paid. What's worse is that Experian Health's State of Claims Report shows denial rates increasing. While providers are leaning into increasing recruiting efforts to find the employees they need, is staffing up even possible in an era of chronic labor shortages? Technology offers healthcare providers new ways to handle revenue cycles without hiring more staff. For example, patient access software reduces registration friction, where up to 60% of denied claims start. Patient scheduling software automates access to care and gives customers greater control over their healthcare journey. It's a digital front door that engages patients with online options for managing care. On the backend of the revenue cycle, automation also offers a way to decrease reliance on manual labor to handle claims submissions. Automating clean claims submissions alleviates the denials burden, freeing up staff time and provider revenue streams.  Result 2: Staffing shortages heavily impact payer reimbursement and patient collections. 70% of those saying payer reimbursement has been affected the most by staff shortages also agree that escalating denial rates are a result. 83% of those saying patient collections have been affected most by staff shortages also agree that it’s now harder to follow up on late payments or help patients struggling to pay. Addressing healthcare staffing shortages is crucial for providing quality patient care, maintaining financial stability, and maximizing reimbursement in the complex healthcare reimbursement landscape. Staff shortages lead to reduced productivity within healthcare facilities, and existing teams may need to take on extra work to fill the gap. Overworked staff may be more prone to errors, leading to claims denials. Medical Economics says manual collections processes suffer due to the healthcare worker shortage. They state, “Mailed paper statements and staff-dependent processes are significantly more costly than electronic and paperless options, yet the majority of physicians still primarily collect from patients with paper and manual processes.” Technology exists for self-pay receivables that allow patients easy online payment options. Experian Health's Collections Optimization Manager offers powerful analytics to segment and prioritize accounts by their propensity to pay and create the best engagementstrategy for each patient segment. Advocate Aurora Healthcare took control of collections by using this tool and automated their collections processes, so that existing staff could focus on working with the patients who had the resources to handle their self-pay commitments. The software's automation and analytics features allowed the provider to experience a double-digit increase in collected revenues annually. Patients also benefit from collections optimization software. For example, Kootenai Health qualifies more patients for charity or other financial assistance with Experian Health's Patient Financial Clearance solution. In addition to automating up to 80% of pre-registration workflows, the software uses data-driven insights to carve out the best financial pathway for each patient. It's a valuable tool for overburdened revenue cycle teams that struggle to collect from patients. Kootenai Health saved 60 hours of staff time by automating these manual payment verification processes. Result 3: Recruiting alone isn't solving the healthcare worker shortage. Healthcare hiring is a revolving door, with 80% reporting turnover as high as 40%. 73% said finding qualified staff is a significant issue. A significant contributor to the healthcare worker shortage is the grim reality that these organizations are losing human resources to burnout and stress. Being short-staffed drags down the entire organization, from the employed teams to the patients they serve. But it's impossible for recruiting alone to fix the problem when more than 200,000 providers and staff leave healthcare each year. A recent study suggests that if experienced workers continue to leave the industry, by 2026, more than 6.5 million healthcare professionals will exit their positions. Only 1.9 million new employees will step in to replace them. The news worsens with the realization that nearly 45% of doctors are older than 55 and nearing retirement age. Artificial intelligence (AI) and automation technology in healthcare can cut costs and alleviate some of the severe staff burnout leading to all this turnover. However, one-third of healthcare providers have never used automation in the revenue cycle. A recent report states that providers could save one-half of what they spend on administrative tasks—or close to $25 billion annually—if they leveraged these tools. For example, Experian Health's Patient Access solutions can automate registration, scheduling and other front-end processes. AI can also help increase staff capacity and output without adding work volume. Experian Health's AI Advantage™ solution works in two critical ways to help stretch staff and improve their efficiency: The Predictive Denials module reviews the provider's historical rejection data to pinpoint the claims most likely to bounce back before they are submitted. The tool allows the organization to fix costly mistakes before submission, eliminating the time spent fighting the payer over a denial. The claims go in clean, so the denial never happens. The revenue cycle improves, saving staff time and stress. Denial Triage focuses on sorting denied claims by their likelihood to pay out. The software segments denied claims by their value so internal teams focus on remits with the most positive impact on the bottom line. Instead of chasing denials needlessly, this AI software allows revenue cycle teams to do more by working smarter. Revenue cycle technology to fill healthcare worker shortage gaps There is no question that the healthcare worker shortage is causing a significant burden on patients and providers. Experian Health's Short-staffed for the Long Term report illustrated the effect of this crisis on the healthcare revenue cycle, patient engagement, and worker satisfaction. Technology can solve staffing challenges by allowing the healthcare workers we do have to spread further and work more efficiently. AI and automation technology in healthcare can cut costs, alleviate staff burnout and can even help healthcare providers retain their existing workforce. By implementing these new solutions, healthcare providers can help stop the bleeding of existing staff that contributes to the healthcare worker shortage, while improving the efficiency of the revenue cycle. These tools save time and money and improve the lives of everyone touched by the healthcare industry. Contact Experian Health to see how your healthcare organization can use technology to help eliminate the pressures of the healthcare worker shortage.