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Published: November 21, 2025 by Adam.Lewis@experian.com, joseph.rodriguez

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Addressing pain points of healthcare’s digital front door

Lines at the desk, phones ringing off the hook and a stack of insurance questions waiting to be resolved — this is the daily reality for many patient access teams. Today's patients find these "front door" bottlenecks in healthcare particularly frustrating, especially since they can envision how much smoother the process could be with the digital apps and tools they rely on in other areas of their lives. Despite improvements in patient access, Experian Health's latest State of Patient Access survey suggests that the digital front door in healthcare is still only partially open. Drawing on these survey findings, this article examines how opening the digital front door in healthcare can address common pain points in patient access, improve operational efficiency and better meet the needs of modern healthcare consumers. What is the digital front door in healthcare? Scheduling a doctor's appointment should be as easy as using a food delivery or ride-sharing app. That's the idea behind the digital front door in healthcare. Giving patients secure digital options to book, register and pay for care puts control in their hands so they can manage their care anywhere, anytime. It's part of a larger digital transformation in healthcare, making it easier for patients to connect with services quickly and conveniently. At the same time, it improves efficiency and profitability for providers. From websites and portals to mobile apps, this approach creates a friendly, accessible entry point that focuses on what patients need: simplicity, convenience, and transparency in their healthcare journey. Top pain points in the healthcare digital experience While previous State of Patient Access reports exposed frustrations with patient access, the 2024 survey shows a glimmer of hope. Self-scheduling options are on the rise and telehealth is reducing friction. Patients and providers agree that access is getting better and credit digital tools for many of the improvements. That said, challenges remain. Top 3 pain points for patients Seeing their doctor quickly (27%) Understanding how much their care will cost (17%) Trying to schedule appointments (14%) Top 3 pain points for providers Maintaining staffing levels (45% vs. 55% in 2022) Efficient and timely management of prior authorizations (39%) Improving speed and accuracy of resolving patient information prior to claims submission (31%) When it comes to future priorities, patients and providers agree that accurate pre-service price estimates and clarity around insurance coverage are the top two. Providers believe they're getting better at providing accurate estimates, and while 74% of patients say they did receive accurate estimates, this is down from 78% the previous year. It's a good reminder that the digital front door isn't just about online scheduling: using digital tools to help patients understand and prepare for their bills is a key component. Patients and doctors want more — not fewer digital services The 2024 report reaffirms previous findings that patients want more digital options for managing their healthcare: six in ten say this is important. And among providers, it's clear that digital front door technology is seen as a critical driver of improvement in patient access. Here are just a few ways providers say they're using digital tools to reduce friction: Expanding telehealth services Introducing digital/mobile patient communications Launching patient portal services Enabling online and mobile payment tools Implementing digital self-service registration and online/mobile self-scheduling Mitigating staffing shortages is a major benefit. Staffing issues have lessened since the peak of the pandemic, but remain an obstacle to effective scheduling and registration for 72% of providers. Automation and self-service patient access tools help alleviate these pressures. How digital solutions improve patient access and satisfaction “These digital tools make healthcare more accessible by eliminating barriers and simplifying patient-provider interactions,” says Alex Harwitz, VP, Digital Front Door, at Experian Health. “Automation can take care of repetitive tasks that take up staff time, so staff can focus on helping patients directly. Real-time scheduling, accurate cost estimates and streamlined mobile options meet patients where they are and give them the control and flexibility they want.” Bottlenecks, wait times and costly errors go down, while patient satisfaction is higher. 3 solutions to improve the digital front door Harwitz suggests three ways to use the digital front door to eliminate friction in the patient journey: 1. Simplify patient scheduling Patients' litmus test for patient access is how quickly they can see their doctor. To help patients quickly find and book the earliest available appointment, healthcare organizations turn to Experian Health's Patient Schedule software. This 24/7 digital scheduling platform guides patients to the right appointment and provider in line with scheduling and business rules. Patients can easily cancel and reschedule if necessary, and no log-in is required, so new patients can get started instantly. Automation optimizes scheduling capacity, so no appointment slots are wasted, improving call center efficiency. There's also the option to incorporate automated text, interactive voice response and email reminders so patients don't forget their appointments, which will increase completion rates and reduce gaps in care. 2. Speed up registration times Patients don't want to sit in waiting rooms and fill out manual paperwork, and healthcare staff have limited bandwidth to handle high patient volumes. Tools like Registration Accelerator can streamline the registration process, by reducing manual efforts and paperwork for patients and staff. This patient intake solution sends an automated link that allows patients to register anywhere, and at any time. Patient Access Curator uses AI-powered data capture technology to collect and verify patient information at registration, reducing the need for manual input. In a single click, the tool runs simultaneous inquiries to capture: Eligibility verification Coordination of benefits Medicare Beneficiary Identifiers Coverage discovery and patient financial status Patient demographics Not only does this accelerate the registration process for patients, but it also gathers clean, accurate data for downstream claim submissions. This technology has prevented over $1 billion in denials since 2020. Watch the webinar: How Patient Access Curator is transforming claims management from the front end of the revenue cycle. 3. Provide more accurate estimates With 96% of patients looking to their provider to help them understand their insurance coverage, the demand for better financial communications is clear. More than 80% of patients say accurate upfront estimates help them plan for costs. If they feel they can't afford to pay, 43% say they would consider postponing or canceling care. Lack of clarity is a health risk as much as a financial one. Experian Health created Patient Financial Advisor and Patient Estimates to help providers improve price transparency. Healthcare providers can use these tools to generate precise cost estimates based on real-time pricing information and offer convenient online payment options to expedite collections. Patients can get a personal estimate, customized payment plan and submit a payment in a few clicks. This addresses patient concerns about affordability and transparency, while ensuring providers remain compliant. See it in action: the digital front door in the real world How IU Health used guided scheduling to boost patient satisfaction and improve operational efficiency even as patient volumes increased. How Banner Medical Group uses Patient Estimates to boost patient satisfaction and meet compliance requirements. How West Tennessee Healthcare modernized patient intake with automation. The evolving digital front door in healthcare The digital front door in healthcare isn't just a single entry point — it's a constantly evolving way to connect with patients, bridging digital and real-life interactions. By tackling common challenges like outdated booking systems, unclear financial statements, lengthy waits and limited payment options, healthcare organizations can create a smooth, patient-friendly experience that boosts satisfaction, builds trust and improves results for everyone involved. Learn more about how Experian Health's digital front door solutions tackle the most common pain points in patient access and deliver convenience, clarity and control. Learn more Contact us

Nov 27,2024 by Experian Health

How healthcare payment plans improve the patient experience

As more Americans feel the squeeze on their household budgets, paying for healthcare is a growing concern. A 2024 survey by Pew Research Center found that the number of Americans who rate their personal finances positively has dropped from 50% to 40% over the last three years, with nearly 60% of Americans now saying their financial situation is "fair" or "poor." A West Health-Gallup poll revealed that 35% of US adults would struggle to afford care, with some cutting back on essentials like utilities or food to pay for medical expenses. To address and mitigate these financial pressures, healthcare providers must take proactive steps to support patients and avoid a shortfall in collections. Patient payment plans can help patients manage costs without delaying or skipping necessary care. Providers that go the extra mile to improve the patient experience will boost patient attraction and retention rates, reduce collection costs and support the financial health of their patients and their organizations. The growing importance of healthcare payment plans Cost concerns often influence patients' perceptions of their providers. In Experian Health's State of Patient Access 2024 survey, 54% of patients who thought patient access had deteriorated over the previous twelve months said it was because they were less able to afford care. On the flip side, 32% of those who thought patient access was better said it was because payment plans made care more manageable. Healthcare payment plans allow patients to spread out the cost of their medical expenses into smaller, more manageable chunks, instead of paying the full amount at once. Previous research by Experian Health and PYMNTS confirms that patients welcome the flexibility, convenience and reassurance that this offers. This is particularly true of patients who would struggle to pay an unexpected bill: up to a fifth of these patients would switch providers based on the payment experience alone. The clear message for providers is that patients who struggle to pay bills—especially unexpected bills—are more likely to need healthcare payment plans and to seek out a provider that offers them. How flexible patient payment plans improve satisfaction By letting patients pay at a pace that works for them and their budget, payment plans reduce stress and create a more supportive and compassionate financial experience. When patients know they have options, they're more likely to stay on track with payments and feel more satisfied with their overall care. A major advantage is that these plans can be tailored to each patient's unique situation. For example, with PatientSimple®, patients can use a self-service portal to generate pricing estimates and explore suitable payment plans to make a more informed decision about how they'll pay for care. They can break down bills into smaller and more affordable payments, rather than facing the daunting prospect of a single large bill. Using Experian Health's unmatched data and advanced analytics, PatientSimple offers a richer understanding of each patient's propensity to pay, helping providers make better decisions about the optimal financial pathway for each patient. Patients can access their bills and statements online at any time. This is more convenient for them and frees up staff to give more attention to patients with more complex circumstances. Key benefits of healthcare payment plans for patients and providers Improving the patient experience with healthcare payment plans also translates into financial and operational benefits for providers. Helping patients navigate their financial responsibilities more easily — especially through automation and software-based tools — increases cash flow, reduces admin burdens and boosts overall efficiency. Here are a few examples of how payment plans and other financial tools can benefit patients and providers: 1. Patient Financial Clearance automatically screens patients to determine eligibility for Medicaid or other financial assistance programs. Calculating the optimal payment plan based on the patient's ability to pay gives patients more affordable options and providers more predictable revenue streams. Increasing access to financial assistance also increases access to care, as patients are more likely to follow care plans, leading to better health outcomes. Case study: How UCHealth wrote off $26 million in charity care with Patient Financial Clearance 2. Patient Financial Advisor and Patient Estimates give patients a pre-service, personalized breakdown of what their bill is likely to be, using accurate chargemaster data, payer rates and real-time benefits information. This upfront clarity makes it easier for patients to plan for payments, while providers benefit from fewer payment defaults and improved patient trust. And with fewer bills ending up in accounts receivable, providers can reduce the manual effort needed to manage outstanding balances. 3. Helping patients reduce out-of-pocket expenses is another way to achieve a better financial experience, boosting loyalty and retention. Coverage Discovery® finds any forgotten or overlooked commercial and government coverage, so no costs that should be covered elsewhere fall to the patient. The tool scans for potential coverage from pre-service through the entire accounts receivable file, and automates self-pay scrubbing to detect discrepancies that can be quickly corrected. Accounts that were previously destined for collections, charity or bad debt are instead submitted for payment. Case study: How Luminis Health found $240k in billable coverage each month with Coverage Discovery 4. Finally, removing friction from the payment process will always be a win with patients and providers. Consumers increasingly rely on mobile and contactless payment tools, so it makes sense to offer similar options in healthcare. PaymentSafe® allows providers to collect any payment securely and quickly. Patients can pay anytime and anywhere, while providers benefit from faster, more reliable revenue collection. Maximizing patient experience with effective healthcare payment plans Payment plans aren't just a financial lifeline for patients. They can make or break the whole patient experience. Alex Harwitz, VP of Product, Digital Front Door, at Experian Health, explains the importance of healthcare payment plans and why offering flexible payment options is at the heart of improving the patient experience: “Our most recent State of Patient Access report confirms that many consumers are concerned about how they'll handle their healthcare bills. Having a plan to make costs more manageable can immediately alleviate some of that stress. Providers have an opportunity to step up and help them figure out the best financial pathway.” He says, “At Experian Health, we use data and automated technology to help providers identify patients who need extra assistance and direct them toward appropriate support. Providers that don't offer payment plans, estimates and other financial solutions will struggle to attract and retain patients who can't pay upfront and risk more patient accounts being written off as bad debt.” Paying bills will never be an enjoyable part of the patient journey, but clear and compassionate healthcare payment plans make it easier. With the right technology, providers can simplify and accelerate the collections process, foster patient trust, and most importantly, allow patients to focus on their health instead of their bills. Prescribe the right financial pathway for your patients with Experian Health's industry-leading patient collections technology. Learn more Contact us

Nov 19,2024 by Experian Health

Strategies to boost self-pay collections for mid-size healthcare organizations

Self-pay collections are challenging for healthcare organizations of all shapes and sizes, but particularly for mid-size providers. Caught in an awkward middle ground, these organizations are often too large to operate with the agility and personal touch of small clinics, but too small to leverage the economies of scale available to large health systems. Revenue cycle managers must find the balance between operational efficiency, patient-centered services and financial constraints. With limited staff and resources, many mid-size hospitals feel like they're fighting an uphill battle to maintain cash flow and patient satisfaction as they contend with increasingly complex billing and insurance protocols. Implementing self-pay collections strategies tailored to mid-sized healthcare organizations can boost efficiency, reduce bad debt and create smoother patient billing processes. This article looks at practical strategies to help bring more dollars in the door without compromising the patient experience. Importance of effective self-pay collections in the mid-sized market Like other markets, mid-size providers are squeezed by self-pay collections on two fronts – the hospital's financial health and patient satisfaction. Finding the right collections strategy is vital to protect this “double bottom line.” Financially, failure to collect on bills seriously hurts cash flow. Unlike larger hospitals that might have more resources or smaller practices with fewer expenses, mid-size facilities often operate on tighter margins. Inefficient collections processes lead providers to risk revenue loss, which leads to cuts in services, staff and the ability to invest in new tech. At the same time, the way hospitals handle billing and collections plays a major role in how patients feel about their overall healthcare experience. Confusing bills or aggressive collections tactics can damage trust. An effective self-pay collections strategy that makes payments easy, straightforward and flexible contributes to a positive patient experience and will pay dividends in the long run. How to improve self-pay patient collections for mid-size hospitals and facilities Here is a breakdown of some key approaches and tools that can be adapted to suit the specific needs of mid-size providers and make billing and collections more efficient, patient-friendly and cost-effective: 1. Automate as much as possible One of the fastest ways to make better use of resources is with automation. Why have staff spend hours sending out bills and payment reminders by hand when this can be done automatically? Automated collections tools can also send email and text reminders to patients, set up auto-pay options, and guide patients to appropriate payment plans. Automatic alerts for overdue accounts can be used to help staff focus their limited time on high-value activities. This saves time, reduces errors and creates seamless patient experiences. Read more: Maximize patient collections with automated technology 2. Segment and conquer collections Every patient's financial situation is different, so why handle their accounts in the same way? Segmentation divides patients into groups based on their payment behaviors, financial situations and balance size so that providers can tailor their approach. Collections Optimization Manager screens and segments self-pay accounts to scrub accounts that need special handling (like bankruptcy, deceased status, Medicaid and charity) and focus on patients most likely to pay. Accounts are given a segment code based on the patient's propensity to pay, which then informs how the account is managed. For example, those who typically pay on time can get a simple text reminder, while those with larger balances or financial difficulties may need a more flexible payment plan. This solution can also be used with Patient Financial Clearance to create individualized payment plans for patients who may not qualify for charity care. A targeted approach to self-pay billing strategies for mid-sized healthcare facilities increases the chances of successful payments. 3. Implement interactive voice response (IVR) IVR systems allow patients to get important payment information through an automated phone system, without needing to talk to someone. Patients can receive automated voice messages or call in and follow prompts to pay their bills over the phone. Not only does this give patients far more flexibility to pay when convenient for them, but it also reduces the workload on staff, who don't have to handle so many incoming calls. Experian Health's cloud-based dialing platform, PatientDial, helps patients clear their bills quickly and conveniently, with minimal input from staff. In a single year, this tool helped clients collect over $50 million in self-pay collections and save 900,000 labor hours that would have been spent dialing manually. 4. Work with a dedicated collections consultant Bringing in a collections expert gives patient finance teams targeted support to improve collections rates while maintaining a positive patient experience. Clients who use Collections Optimization Manager get dedicated support from experienced revenue cycle consultants who can recommend the most appropriate collections strategies, evaluate opportunities to improve performance, and oversee scenarios to test and adopt new approaches. Some providers may find it more efficient to manage collections in-house, while others benefit from outsourcing to a specialist third party. Experian Health offers collections solutions to both, enabling mid-sized providers to choose the best fit. Collections Optimization consultants provide personalized attention and customized workflows tailored to the organization's needs, whether they're using Epic, Oracle, Meditech or other electronic health record platforms. Integrating patient-friendly billing practices Whatever the strategy, maintaining a positive patient-provider relationship through patient-friendly billing is essential. For example: Simplifying billing statements and using clear language reduces confusion and helps patients understand what they owe Running coverage discovery checks and offering upfront patient payment estimates gives patients greater clarity about their financial obligations Setting up automated reminders nudges patients to pay on time Highlighting available payment plans gives patients manageable options to reduce the risk of unpaid balances. Experian Health's data insights allow providers to better understand patients and develop strategies for proactive outreach before debts become unmanageable. Collection Optimization Manager's segmentation model draws together credit, behavior and demographic data, incorporating socio-economic modeling and income estimations to build a complete picture of each patient. Unlike traditional segmentation models that rely solely on payment history, the CO model includes estimated household size, income and federal poverty line analytics to generate a meaningful score without needing additional data. Automated communications such as PatientText and PatientDial make the billing and payment process less intrusive. Combining convenience and personalization builds trust and improves collections while supporting a more compassionate patient experience. Enhancing revenue for mid-sized medical groups with improved self-pay collections Going back to that “double bottom line,” Judy Wirtz, Senior Analytics Consultant at Experian Health, explains how Experian's collections toolkit helps mid-sized organizations boost financial performance while maintaining a positive patient experience: “Boosting self-pay collections for mid-size healthcare organizations doesn't have to be daunting,” she says. “Our goal is to simplify collections while keeping the patient experience front and center. We use industry-leading data, smart segmentation and dedicated support to help organizations customize their strategies based on their unique patient mix and resources. Other tools fill in different pieces of the collections puzzle, but Collections Optimization Manager is the only one to give providers the full picture. Our clients have seen an impressive 9:1 return on investment, so we're confident this approach makes a real difference.” Wirtz suggests that those who'd like to learn more about Collections Optimization Manager should watch Experian Health's recent webinar with Wooster Community Hospital. The hospital used CO to collect $3.8 million in patient balances. Find out more about how Collections Optimization Manager boosts self-pay collections for mid-size healthcare organizations. Learn more Contact us

Nov 15,2024 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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