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Paying for healthcare has long been a complex experience for patients. Inflation means more families are tightening their wallets, so the demand for clarity and flexibility is increasing. At the same time, the pandemic’s digital legacy means patients have had a taste of contactless and online payment methods – and they want more. This means that providers will have to focus on creating a better patient payment experience. Could a modern financial experience that benefits patients and providers finally become the norm? Experian Health President Tom Cox addresses this question in a recent PYMNTS publication of healthcare leaders’ predictions for the second half of 2022. Concerns about economic uncertainty, along with a desire for more financial predictability, means that providers can benefit from delivering a better patient payment experience. How? These 3 emerging trends could guide the way: 1. Patients expect a frictionless payments experience As patients bear more financial responsibility, they expect paying for healthcare to be as easy as buying a new sweater. Experian Health and PYMNTS data found that one-quarter of consumers used digital methods to pay for their most recent healthcare visits, with patient portals being the most common at 14%. Contactless and mobile payments are also becoming more popular. To eliminate friction, providers must start by identifying the pain points in their payment processes. Do patients know in advance how much their bills will be? Are they given advice and options to spread out payments if they can’t afford to pay the entire bill in one shot? When it comes time to pay, can they find a familiar and convenient payment method? Providers that can answer yes to these questions will have the edge when it comes to delivering a satisfying patient payment experience. When it takes an average of more than 30 days for providers to get paid, any strategies to make it easier for patients to pay sooner and in full will help provider cash flow. Offering quick and convenient digital payment methods that patients can access anywhere, pre-and post-service, will be the key to delivering a better patient payment experience and accelerating collections. 2. Amidst concerns about cost, patients want transparent pricing New research by Experian Health and PYMNTS found that consumers who were under financial pressure were more likely to cancel appointments out of concerns about costs. More than 2 in 5 patients who received inaccurate estimates ended up spending more on healthcare than they could afford. It’s no wonder that 6 in 10 patients who received an unexpected bill or inaccurate estimate say they would switch healthcare providers for a better experience. Cox notes that alongside consumer demand for a better patient payment experience, regulatory change is giving providers a further nudge toward price transparency: “The Hospital Price Transparency Final Rule and the No Surprises Act have put accurate data at the forefront of efforts to transform the patient’s financial experience. Together, these regulations can create the same pricing experience that consumers enjoy in other verticals, namely knowing the cost before making a purchase.” To date, implementation has been patchy. In August 2022, only 16% of hospitals were found to be compliant with the federal price transparency rule. In a recent conversation with Healthcare Finance News, Experian Health’s Chief Commercial Officer, Jason Considine, acknowledges that providing accurate estimates takes work: “Getting these estimates involves having information about the patient's benefits and insurance plan to create an accurate estimate… On top of mind for most provider organizations is an expectation of spending to increase for technology as regulations expand.” Investing in the right technology can help providers deliver financial clarity to patients. For example, Patient Estimates is a web-based price transparency tool that generates accurate estimates for patients before and at the point of service. It can also direct patients to payment plans and charity care, to help them plan and spread out the cost of care. Similarly, Patient Financial Advisor gives patients a pre-service estimate of their expected financial responsibility delivered straight to their mobile devices, and offers methods to make a secure payment. 3. Digitalized patient payments require better data and analytics Maximizing the impact of the above strategies relies on having the right data and technology in place. For example, in Accessing Healthcare: Easing Digital Frictions in the Patient Journey, Experian and PYMNTS found that patients may pay in person most often, but at least a quarter would prefer to pay online. Some may want to pay in full while others want to spread the cost. How can providers tailor their approach if they don’t know which patients want which option? Considine says that “Providers have to figure out the right financial pathway. It takes leveraging data to know the right financial experience." Achieving this requires a combination of consumer data, financial information and demographic details to create a complete picture of each patient’s needs and preferences. Patient Financial Clearance leverages Experian’s unrivaled datasets to calculate an optimal payment plan for each patient, based on their unique situation. Patients are guided to the right plan, giving them a sense of confidence about what to expect. It automatically screens those who can afford to pay upfront and those who may need more time. It’s a more supportive experience for patients and increases point-of-service collections for providers. Another option is PatientSimple®, which identifies the optimal financial pathway for consumers and makes that pathway available through its consumer-friendly, mobile-compatible, self-service portal. In short, patients want better payment methods, upfront price estimates and personalized payment plans. Data and technology can bring these to life. Find out more about how Experian Health can help healthcare organizations deliver a payments experience that meets and exceeds patient expectations, complies with regulatory change, and accelerates collections to help providers ride out financial uncertainty.

Does a patient’s age influence their experiences with rising healthcare costs? A recent report from Experian Health and PYMNTS points to a generational gap when it comes to the impact of and responses to medical bills. The study takes a deep dive into how Gen Z, millennials, Gen X and seniors are reacting to the growing cost of care. From canceling appointments to being surprised by out-of-pocket expenses, this article looks at the key differences in generations and healthcare costs, and the tools and solutions providers can implement to support their patients. Millennials are most likely to cancel appointments due to high-cost estimates A worrying proportion of patients are choosing to delay or forego care because of concerns about cost. This seems to be felt most acutely among younger patients. According to the new data, 74% of millennials and 56% of Gen Z patients have canceled a healthcare appointment after receiving a cost estimate that was higher than they could afford, compared to 13% of baby boomers and seniors. Gen X patients fell in the middle, with just over half canceling appointments after receiving high estimates. That said, healthcare costs affect all generations. While older patients seem less likely to cancel appointments due to cost, the “Medicare Effect” suggests that many hold off seeking care in the first place, until their costs are covered at age 65. Many households, regardless of demographic, are walking a financial tightrope as inflation continues to climb and patients bear responsibility for a greater portion of healthcare costs. Providers can help minimize the number of patients forgoing essential care by helping to track down any available coverage, so patients aren’t inadvertently billed for care that could have been covered by a forgotten health plan. Coverage Discovery continuously scans commercial and government coverage using multiple proprietary data repositories, advanced search heuristics, and machine learning matching algorithms. Finding missing coverage means upfront estimates will be more accurate, and patients will be likely to see a lower co-pay amount. In 2021, Coverage Discovery tracked down previously unknown billable coverage in more than 27.5% of self-pay accounts and found more than $66 billion in corresponding charges, removing a huge burden for patients and providers alike. Gen Z patients are most surprised by out-of-pocket expenses Overall, 19% of patients found they spent more on healthcare than they could afford in the last 12 months. As would be expected, those who received inaccurate estimates (43%) experienced more financial distress than those who received accurate estimates (26%). Among those who paid out-of-pocket expenses for their most recent healthcare visit, Gen Z patients were the least aware that they would be required to make a payment, with 32% not knowing that they’d need to make co-payments. Only 20% of Gen X and 10% of baby boomers and senior patients were unaware. One way to alleviate the strain of unexpected bills is to issue cost estimates automatically, before the patient’s visit. Only 34% of surveyed patients received estimates automatically before their visit, so it’s no surprise that many are caught unaware when the final bill arrives. With Patient Estimates, patients get a breakdown of their expected costs based on real-time provider and payer data. The estimates are delivered automatically to the patient’s mobile device (along with links to convenient payment methods. An earlier report by Experian Health and PYMNTS found that patient satisfaction rose by 10% when billing estimates were provided, underscoring their value. Millennials pay the highest out-of-pocket expenses Millennials appear to have been hardest hit by out-of-pocket bills. The average across all respondents was $363, but millennials paid an average of $619. This could explain why millennials were more likely to cancel appointments. Providers can help patients manage balance bills by providing tools that make it easier to plan and pay their bills. For example, Patient Financial Clearance screens and segments patients so providers can help guide them to the most suitable financial pathway. PatientSimple and Patient Financial Advisor help patients access cost estimates, identify best-fit payment plans, apply for financial assistance and make payments, via their patient portal or mobile device. Baby boomers and seniors are most satisfied with the healthcare payment process Most patients were generally satisfied with the payment process for their medical bills. Older patients appeared to be slightly more content, with 77% of baby boomers and seniors saying they were satisfied, compared to just under 70% of Gen X and millennial patients. Gen Z was the least satisfied, at 60%. With 22% of unsatisfied patients saying they’d consider switching providers, getting the payment experience right is high stakes for providers. So, how can providers improve the payment experience for those who are less than completely satisfied? Accurate estimates, tailored payment plans, clear communication and convenient payment methods will all be in the mix. For most healthcare organizations, this will mean embracing digital tools and automation. Experian Health’s State of Patient Access 2.0 survey revealed that while younger patients may be especially receptive to a digital patient payment experience, it crosses generational lines. Members of “Gen C” – digitally-connected consumers of all ages – are looking for a streamlined payment experience. When patient loyalty and decisions about when to receive care are so heavily influenced by the financial journey, it makes sense to offer digital estimates, billing and payments where possible. The good news for providers is that prioritizing patient satisfaction doesn’t mean sacrificing efficiency. Automation and digitalization can facilitate greater choice and convenience for patients, without requiring additional staff input. In fact, it’s likely to yield productivity gains and free up staff to focus on delivering an even better patient experience, and support patients to get the care they need. Find out more about how Experian Health’s suite of patient payment solutions can help providers deliver a financial experience that satisfies patients of all generations and healthcare costs.

Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily increasing over the last few years. An MGMA Stat survey found that nearly seven in ten providers witnessed a jump in denials during 2021, although the trend took hold even before COVID-19 hit. If providers rely on outdated systems and tools to process the growing volume of claims, it's inevitable that denial rates will continue to climb. It's not surprising then that a new Experian Health survey revealed almost 3 in 4 providers stated that reducing claim denials takes precedence over other priorities. Getting claims right the first time is no easy task. Traditionally, the claims management process has been labor and time intensive. Claims teams spend hundreds of hours gathering documentation, preparing claims for submission, engaging with medical clearinghouses, and then monitoring claims adjudication while they await the payer's verdict. Should a claim be denied, more staff hours may be required to rework it for a second attempt at reimbursement. Even if administrative budgets and staffing numbers increased in line with demand, inefficient manual systems can no longer bear the burden of data to be managed. With more providers heading into the danger zone of claim denials, automated claims processing tools are growing in popularity. These enable more efficient claims management, boosting productivity, easing pressure on staff, and above all, minimizing denials. Experian Health's survey found that 78% of providers are open to replacing current technologies if they are presented with compelling ROI projections, reflecting the urgency of the situation. What is automated claims processing? Automating claims involves the use of digital technology, software, machine learning and advanced analytics to optimize healthcare claims management. This can include: pre-filling data into digital forms to avoid data input errors using intelligent document processing to pull unstructured information into a single, usable format comparing data from multiple sources and flagging inconsistencies providing real-time insights and status updates allowing multiple parties to work from interoperable data Tools such as robotic process automation (RPA) can be used to replace manual activities, using data, logic and business rules to make decisions within certain parameters. This eases pressure on busy staff and improves efficiency, for example, when prioritizing claims to be reworked. Imagine how much faster a software program can synthesize hundreds of current and historical data points, compared to a human trying to do the same job. There are opportunities to automate just about every stage of the claim lifecycle, from the patient's first interaction with their provider to reimbursement. For example, automation can be used to: Streamline patient onboarding and automate identity checks to avoid errors in patient information Verify insurance eligibility and run continuous coverage checks to see if the patient's status has changed Maintain a complete electronic health record that follows the patient throughout their healthcare journey, so claims contain correct information Track payer policy changes and apply custom edits so that coding information is correct Scrub claims to find and fix any errors before they are submitted Submit claims to payers and monitor the claims adjudication process Optimize the denials management workflow and prioritize denied claims for resubmission Verify reimbursements and initiate patient billing processes. Virtually any repetitive, process-driven, or paper-based task from claim creation to claim reimbursement is an opportunity for automation. As technology advances, so do the opportunities to streamline operations, reduce time to reimbursement, optimize decision-making, reduce costs and improve the patient experience. Here are the 5 benefits of automated claims processing: 1. Automated claims processing streamlines operations Automation's number one benefit is allowing providers to move away from inefficient and error-prone manual processes. Staff no longer need to sift through disparate and complex coding lists, medical records and payer edits looking for the correct information to attach to a claim. Together with electronic records management, automation allows for standardized workflows, so the entire claims cycle is more consistent, and decisions are based on real-time accurate data. It helps to eliminate time spent searching for missing information, reformatting data to meet payer requirements, and trying to figure out which claims are worth reworking. Multiple digital tools are available to optimize different tasks within the claims processing workflow. But for maximum efficiency, providers should look for solutions that work together within an integrated system. Using a single vendor makes it easier to manage data consistently and simplifies system-to-system interactions. A comprehensive claims management solution also creates a smoother user experience, for example, by allowing staff to check real-time insights within one dashboard, using one log-in. Experian Health's suite of healthcare claims management solutions connects each step in the claims workflow to speed up claims processing. For example, ClaimSource manages the entire claim cycle in a single, scalable online application that serves individual hospitals and physician practices through to large multi-facility health systems. It creates custom work queues and integrates electronic remittance data directly, to allow staff to prioritize high-impact claims and speed up reimbursement. 2. It saves staff time and resources Outdated and clumsy processes can contribute to staff burnout, poor performance and difficulties attracting and retaining top talent, even more so as patient volumes return to pre-pandemic levels. By removing many time-wasting manual tasks, automated claims processing allows staff to use their time more productively. It's particularly important amidst ongoing staffing shortages, which put additional strain on existing staff. Some of the most time-consuming manual activities occur in the prior authorization workflow. Prior authorizations are also a common cause of claim denials. Because payer requirements around prior authorizations change frequently, staff must painstakingly check each payer's website before submitting authorization requests to ensure that the necessary documentation is in place. Once submitted, they must log in to different payer portals to track progress. According to the American Medical Association, some physician practices spend more than two full days processing prior authorizations each week. But with automated prior authorizations, staff can prevent delays and denials. Online prior authorizations automate inquiries and submissions without the need for user intervention, instead drawing on payer data that are already updated and stored in the system. It auto-fills the necessary information and flags where manual intervention is required. It can initiate more authorizations in less time, and guide staff to the highest-priority tasks using dynamic, exception-based work queues. By reducing the error rate, automation also facilitates faster claims processing, which means payments can be processed and issued more quickly. 3. Automation generates more accurate and actionable insights Automation doesn't just save time; it also gives staff greater clarity and control over the claims process. Automated digital solutions facilitate more reliable data management to reduce errors, and generate real-time insights based on accurate information. A large proportion of claims are denied because patient information doesn't match the payer's records. This can be easily avoided using robust electronic medical records that hold data in standardized formats and automatically populate forms with the correct information. Electronic data management also gives staff richer and more reliable insights, by pulling together all the information they need into a single, accessible interface. Using an automated tracker such as Denial Workflow Manager makes it easy for staff to monitor claims, denials and remittances in one place. Not only does it track denials, holds, suspends, zero pays and appeals, but it also provides detailed analysis to help root out the causes of denials, so they can be avoided in the future. Staff can immediately see which claims need attention and resolve them much more quickly, as opposed to using manual processes. Enhanced Claim Status complements Denial Workflow Manager by automatically generating work lists for staff, complete with actionable data to help them check off the tasks quickly and accurately. The software sends automated status requests based on each payer's claims adjudication timeline, to see if claims are pending, denied, returned-to-provider or zero-pay transactions. This takes place before the Electronic Remittance Advice and Explanation of Benefits are processed, so staff can respond quickly and avoid unnecessary denials or delays. 4. Faster claims processing equals faster payment According to the Council for Affordable Quality Healthcare (CAQH), the time saved by switching from manual to electronic claims processing could save the medical industry up to $1.7 billion each year. The increase in accuracy leads to more first-time pass-through rates and optimized decision-making around which claims to rework. While automation requires some upfront investment, the output tips the balance in favor of faster, higher reimbursements. Experian Health's Claim Scrubber solution is one example of how automated claims processing can reduce undercharges and denials, optimize staff time and improve cash flow. This program reviews each pre-billed claim, line-by-line, to check that coding details are accurate. It then applies general and payer-specific edits and verifies that the claim is free of errors before it's submitted to the payer or clearinghouse. As a result, more claims are correct – and therefore paid – the first time, and staff can spend less time chasing old accounts receivable. Case study: Read how Summit Medical Group Oregon – Bend Memorial Clinic reduced A/R days and volume by 15%, and achieved a 92% clean claims rate with Claim Scrubber and Enhanced Claim Status. 5. Automation can transform the patient experience Getting claims right the first time starts at the beginning of the patient journey. A digital patient access experience is more convenient and satisfying for patients and helps prevent errors that can lead to denied claims later. Patient contact information can be automatically pre-filled so the patient can check for errors. If a patient adds new data when they're scheduling or registering for care, that information can be automatically checked against the data already on file, and flagged if there are inconsistencies. Further along, the efficiencies afforded by claim process automation mean patients don't have to wait so long for confirmation that their medical expenses have been handled. Or, if they have an out-of-pocket amount to pay, they'll get clarity about their financial responsibility much sooner. Patient portals are a great tool for helping patients track claims when and where it suits them, rather than having to wait to speak to a call center agent. And by making the claims process more efficient, automation also releases staff from time-consuming repetitive administrative tasks so they're free to support patients with more complex queries. Automation can elevate the customer experience with personalized communications and simplified transactions, from patient access to patient payments. Transitioning to automated claims management As the volume and complexity of claims to be processed increases, providers need to find ways to manage the workload, alleviate pressure on staff and prevent unnecessary revenue leakage. Working with a trusted vendor can ease the transition to automation and maximize potential cost savings. Experian Health provides industry-leading software solutions to improve healthcare claims and denials management so that more claims are clean the first time. In fact, Experian Health was voted as the top claims vendor for hospitals in the 2022 Black Book vendor survey, for the second year in a row. Find out more about how Experian Health's suite of healthcare claims management products can help providers reduce denials, rebilling and drive up reimbursements with automated, clean and data-driven claims processing.