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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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Maximize collections with Patient Financial Clearance

New research from Deloitte reports that healthcare costs for the average American could jump from $1000 to $3000 per year by 2040, putting pressure on households that are already feeling financially squeezed. Concerns about healthcare bills could push patients to delay or even default on payments. With inflation on the rise, providers must find ways to create a compassionate financial experience for patients to maximize collections. That's where Patient Financial Clearance comes in. While inflation and economic pressures are systemic challenges, the impact is individual. This should galvanize healthcare providers to find out exactly how patients may be affected. Using that knowledge, providers can then tailor the financial journey to make it as straightforward as possible for patients to manage their healthcare bills, whatever their specific circumstances. With data on patients' ability and likelihood to pay, providers can tailor charity care checks and maximize collections by building a collections process with the patient at its heart. Create a compassionate collections experience with Patient Financial Clearance Improving patient collections starts with identifying patients that are unlikely to be able to pay and checking their eligibility for extra support. Traditionally, providers might use manual processes to calculate a patient's propensity to pay or entitlement to financial assistance. This might involve asking the patient to fill out a form with their financial details, calling the patient and the patient's employer multiple times to understand their income, manually checking their information against the Federal Poverty Level to see if it meets the threshold for full or partial charity support, and then having the patient fill out yet more forms. Such labor-intensive work is a drain on staff resources, and often a stressful experience for patients. Patient Financial Clearance helps create a more positive financial experience by automating eligibility checks. That way, patients can be assigned to the right payment pathway without delay. This solution also empowers patients with mobile text-based financial screening and provides them with updates on their charity status. It uses current financial data to screen patients to see if they're eligible for Medicaid, charity support or other financial assistance programs, prior to or at the point of service. Armed with this data, providers can offer the best possible support to these patients and even auto-enroll them in the right program. For those with medical bills, Patient Financial Clearance calculates an optimal payment plan based on how much the patient is likely to be able to afford, so patients are clear about what they'll owe and when. It can also suggest upfront fee collection when a patient can afford to pay but has been historically slow to do so. Personalizing the payment pathway with digital financial solutions Making sure patients don't miss out on financial assistance is just one way to use data and automation to personalize the payment process. Data-driven personalization should be a thread that runs through the entire financial experience, including: 1. Personalized upfront payment estimates Price transparency remains high on the agenda. Patients want to know their bills in advance so they can plan. Surprise bills lead to delays and frustration, to the detriment of both patients and providers. With Patient Payment Estimates, self-pay patients can generate personalized pre-service cost estimates so they can get their financial ducks in a row before treatment even begins. These estimates are based on the patient's individual insurance status, current payer rates and the provider's chargemaster data. The tool also incorporates any applicable financial assistance, applies prompt-pay discounts, and suggests convenient payment plans that fit the patient's individual circumstances. 2. Tailored payment plans for all Once the patient has their estimates, they'll want to know exactly when and how to pay. Some will be able to pay the full amount upfront, while others may need to spread out payments into more affordable chunks. Providers can maximize swift collections by ensuring that individual patients are directed toward the most appropriate option. Oftentimes, it may make sense to collect more payments upfront to alleviate collections costs downstream. One way to deliver this is through a self-service portal such as PatientSimple, which provides a one-stop-shop for patients to view their estimates, consider pricing plans and keep credit card details on file. Being able to plan in this way gives patients more control and avoids any confusion about payments. 3. Consumer-friendly payment methods When it's time to pay, patients want options. Not everyone wants to come into the office, send credit card details in the mail, or exchange details over the phone. Online payment portals, contactless payments and mobile wallets are increasingly popular. Therefore, providers need to offer convenient digital payment options to remain competitive.Offering a menu of payment options early in the patient journey means patients can “frontload” their financial admin, get payments out of the way, and focus on medical treatment. By giving patients control over how they pay, providers can reduce the risk of late and missed payments. 4. Timely and relevant communications If there's one action that can make or break a patient's perception of their financial experience, it's how their provider communicates with them. If information about medical billing is accurate, timely and compassionate, then the patient will feel more positively than if messages seem aggressive or contain errors. Getting this part right will improve patient engagement, drive faster patient collections and boost patient loyalty.Healthcare marketing data can be used to underpin a personalized communications strategy and help providers send the right message at the right time, based on the patient's preferences. When it comes to delivering the message, patient outreach solutions can send automated text and voice messages with bill reminders and links to payment methods to encourage prompt payments. Use Patient Financial Clearance to automate patient financial assistance Building a patient financial experience around the principles of personalization, empathy and convenience puts providers in a stronger position to maximize patient collections than with a one-size-fits-all approach. Find out how Patient Financial Clearance and other digital patient financial solutions leverage data and automation to identify and deliver what each patient needs, to improve patient satisfaction and increase the number of bills paid in full.

Jul 14,2022 by Experian Health

Telehealth and digital tools remain a top priority for healthcare providers

Telehealth adoption has been a bumpy ride. Remote and virtual healthcare services struggled to gain traction pre-pandemic, only to become a life raft for safe access to care when infection rates began to climb. After that initial surge, telehealth usage leveled off at around 38 times pre-pandemic levels for much of 2021. Now, while uptake has dipped slightly as patients return to in-person care, the way healthcare is delivered has changed forever. Having seen what digital healthcare solutions can do, providers are continuing to embrace telehealth and digital tools as a route to improve equity, access and efficiency. According to a new report by Grand View Research, the telehealth market is expected to reach $787.4 billion by 2028 – a compound annual growth rate of 36.5% from 2022. Research from Experian Health and PYMNTS confirms that patients similarly expect digital tools to remain on their healthcare menu, with two-thirds using patient portals. Healthcare providers must keep patients' digital demands firmly in their sights, to improve patient engagement and secure a competitive edge. For providers thinking about their next digital steps, where are the emerging opportunities and pitfalls? How to harness the benefits of digital healthcare solutions: 1. Satisfy consumer demand with hybrid models Research shows that digital-first patients prefer using online tools to schedule appointments, obtain test results and make payments. Providers can satisfy consumer demand by offering hybrid models that include in-person and digital tools. Experian Health's suite of patient access solutions allows patients to choose when and where they engage with their provider and reduces friction around booking and billing. Clean data and reliable patient matching can give patients a seamless experience as they move between online and in-person interactions. 2. Connect with diverse communities to increase access to care Adoption of telehealth and digital opportunities goes beyond consumer satisfaction. Opening healthcare's digital front door enables communities that often find it challenging to access care, such as rural and lower-income communities, to overcome obstacles. Online scheduling tools can give busy families and those who may be juggling multiple jobs opportunities to book appointments at a time and place that suits them best. Data on the social determinants of health and patients' financial circumstances can be used to direct those in need to financial assistance, so patients don't miss care out of concerns about cost. Digital healthcare solutions can also be a better fit for younger patients who automatically reach for their mobile devices to interact with services. 3. Automate to save resources and mitigate rising inflation Automated and self-service digital healthcare tools that eliminate the need for manual input are also far more efficient than analog alternatives. Providers can save valuable staff time and resources and redirect them to where they're most needed. A more efficient and adaptive approach to healthcare delivery can help combat rising inflation and ride out economic shocks. Pitfalls to avoid when implementing digital health solutions: 1. Close the expectation gap – especially around payments Despite these advantages, a gap remains between how patients say they want to use digital tools, and whether they can actually use them. For example, in The Digital Healthcare Gap report by Experian Health and PYMNTS, 32% of patients who don't currently use patient portals said they'd be interested in doing so if one was available. There's a similarly stark gap between the number of patients seeking upfront cost estimates and those who get them. Only 24% of patients said they had access to a patient portal that offered pricing estimates. To increase patient satisfaction (and bump up collections rates), providers must expand portal capabilities to include cost estimates, payment plans and other services that patients repeatedly say they need.Closing the expectation gap will be particularly relevant to providers that want to attract new and younger consumers, who are more likely to expect and use digital healthcare solutions. 2. Eliminate disjointed data with interoperabiliy Digital and data-driven tools are only as powerful as the data they’re built on. If patient information is inaccurate or incomplete, the convenience and ease expected of digital healthcare solutions start to break down. Providers must find digital healthcare solutions that are convenient for patients to use, but also compatible and easily integrated with the wider information ecosystem. A unique patient identifier is one way to ensure that these innovative tools and apps work together and ensure staff have access to up-to-the-minute patient information. Getting the back-end setup right will ease friction in the patient journey. 3. Avoid missed opportunities to scale with actionable analytics As the pandemic has shown, telehealth and digital healthcare solutions have the power to open access to care, but only if they are made available to the right patients at the right time. Experian Health's data and analytics solutions allow providers to identify gaps in digital strategy delivery, understand and segment patients, and adopt a flexible and responsive approach to create a frictionless patient journey. Find out more about how Experian Health can support healthcare organizations to maximize the opportunities in implementing digital healthcare solutions and secure the digital advantage.

Jul 12,2022 by Experian Health

Case study: Boost patient collections and scale patient scheduling with PatientDial

Dayton Children’s Hospital is a pediatric hospital in Ohio with over 300,000 annual patient visits. Ranked by U.S News & World Report as one of the top 50 pediatric facilities in the United States, the facility’s mission centers around providing “optimal health for every child.”  Challenges The Patient Accounts department, led by Richard Gonzales, wanted to reduce his team’s reliance on third-party collections agencies and avoid associated fees. This meant that his in-house team needed to further scale its operations and processes to reach their in-house collections goals. The Pre-Service Operations department, managed by Jason Schenck, pursued efficiencies for resources within the centralized scheduling team, including the goal to quickly respond to referrals and turning those referrals into scheduled appointments within 24 hours. Throughout the pandemic, both teams experienced staffing shortages and pandemic-related absences. Because their dialing methodologies were manual, these disruptions in personnel prohibited them from growing in-house collections and reaching the turnaround times Schenck's team wanted to achieve for scheduling referrals. As Dayton Children’s strived to achieve these ambitious goals, they decided to proactively provide a better patient experience through convenience, connection and an effective communication experience. Resolution Dayton Children’s launched Experian Health’s PatientDial solution in the Patient Accounts department to scale their in-house collections efforts, thereby reducing dependency on their outside collections agencies. The solution was also adopted in the Pre-Service Operations department to automate dialing and conversation readiness so that the team could expedite the scheduling of referred patients. The expertise of a dedicated Experian Health consultant provided unwavering support to the two departmental heads and also gave them full control over the operations to best match their expectations. Streamlining patient payment collections with PatientDial  The Patient Accounts department’s operations revolve around billing a claim, reducing bad debt, increasing patient collections and providing effective customer service. They devised a two-pronged approach when it came to contacting patients for payments. The outbound campaign focused on collections, whereas the inbound customer service team handled the large volume of incoming calls from customers and rerouted them to the correct department. When it comes to collections, the Patient Accounts department found that making phone calls was the most effective medium to support their collections efforts. Billing is a complex process and taking the time to connect with patient guarantors to explain those bills paid off. To refine the communication approach, patient accounts were segmented based on outstanding balance amounts and where they were on the statement cycle. Calls were then made to the accounts with the highest propensity to pay. Waiting on hold not only wastes a patient’s time but also leads to a frustrating patient experience. Many even abandon calls, to call again later, which makes phone lines even busier. To provide a better patient experience, the department was also able to try out an innovative recall campaign, enabled by the queue callback feature. Patients were called back automatically the moment an agent became available, thereby reducing call hold time. By providing patients with this callback option, Dayton Children’s is empowered to accept more inbound calls per day along with having empathetic conversations with guarantors around payment plans to sustain its collections goals. Patient scheduling and preregistration powered through automation The Pre-Service Operations department leveraged PatientDial to improve outbound call efficiency and optimize existing staff resources to schedule appointments rather than leave voicemails. The productivity for scheduling a new patient visit from an outbound call was about 30%. With the centralized team supporting more than 40 specialty clinics, the team needed to improve the number of new patient visits scheduled daily, which meant opening resources to receive inbound calls. The mighty team of 10 was able to strategically use the autodialer feature to make new appointments, send appointment reminders and schedule referrals. Time is of the essence in a healthcare setting, and swift access to pertinent patient information enabled the staff to start their work even before greeting the callers when an inbound call came. Powered by the agent pop feature, staff had immediate access to key patient identifiers such as name, date of birth and specialty clinic from referral. Additionally, the feature enabled the team to reinvest time in creating a positive patient experience through improved hold and talk times, both of which reduce the risk of call abandonment. Results of incorporating PatientDial With PatientDial, the Patient Accounts department has been able to successfully align revenue goals with employee productivity. Previously, the staff was able to make only 50–60 calls per day, out of which 70% went unanswered. By automating dialing, the staff is now able to make 600 calls per day, resulting in a corresponding uptick in collections. The recall campaign, used for following up with patient guarantors, was a new endeavor for the department and has reduced the staff’s burden of making 300 manual calls per day and has also reduced call abandonment rates. The Pre-Service Operations department, has seen a 50% increase in patient appointments scheduled, powered by 600–800 automated calls made per day. The referral-to-scheduled appointment timeline has gone down from 4 days to under 1 day. Two hundred patients can now be reached via text daily and the speed to answer calls has been reduced from 60 seconds to 30 seconds. Lastly, PatientDial has positively challenged the Pre-Service Operations department to rethink productivity and daily operational efficiency. Dayton Children’s investment in dialing automation has streamlined their patient communications around scheduling and far exceeded initial goals. Because of the resulting high volumes of new patients scheduled and improved efficiency and effectiveness the team realized, there’s a strategic plan specific to central scheduling and to implement standard processes for managing new patient referrals across the organization. What’s next for Dayton Children’s? Empowered by their stellar results, both the Patient Accounts and Pre-Service Operations departments want to further explore how PatientDial could help other departments achieve greater productivity and further deliver a positive patient experience. The Patient Accounts department wants to maintain its focus on productivity gains and employee experience through PatientDial, with the ultimate goal of bringing in more collections. The Pre-Service Operations department plans to take on additional scheduling responsibilities across departments, creating time to reinvest in direct patient care and improving patient outcomes. Initial plans are for establishing patient scheduling and improving processes to identify and schedule follow-up visits. Both the teams at Dayton Children's recognize Experian Health’s expertise in revenue cycle solutions, which has made this a successful partnership. Learn more about how PatientDial uses patient outreach and patient engagement processes and workflows to increase your bottom line.  

Jul 06,2022 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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