“Registrars used to surprise, ‘Do I run Coordination of Advantages? Which insurance coverage is major?’ Now Patient Access Curator does all that work and removes the guess work, and it does it in beneath 20 seconds.”
Randy Gabel, Senior Director of Income Cycle at OhioHealth
Problem
OhioHealth confronted rising denial charges and inconsistent insurance coverage discovery. Registrars relied closely on what sufferers informed them at check-in, with out realizing if that info was full or present. Compelled to make judgment calls about whether or not to run Coordination of Advantages (COB) or examine for Medicare Beneficiary Identifiers (MBI), workers may do little to keep away from errors and denials. Randy Gabel, Senior Director of Income Cycle at OhioHealth, says, “We have been sending claims with the flawed insurance coverage just because workers didn’t know what to do subsequent.”
They wanted a dependable answer to establish protection upfront – with out asking sufferers to dig out previous insurance coverage playing cards or involving pricey contingency distributors.
OhioHealth’s search turned extra pressing when a nationwide cyberattack hit the trade in early 2024. They wanted a trusted income cycle associate to shut the gaps in claims and eligibility workflows and stop denials from the beginning.
Resolution
To strengthen front-end income cycle operations, OhioHealth chosen Experian Health’s Patient Access Curator® (PAC). This all-in-one answer makes use of synthetic intelligence (AI) and machine studying to examine eligibility, COB, MBI, demographics and insurance coverage discovery by a single course of. This answer gave workers extra correct information in real-time.
Though that they had not labored with Experian Well being earlier than, the OhioHealth crew was instantly satisfied that Patient Access Curator match the invoice. Gabel says that throughout the analysis, “Patient Access Curator found a whopping 18% extra insurance coverage on self-pay accounts than our present vendor. No different firm or product discovered that a lot.”
PAC matches straight into current workflows, so OhioHealth’s 800+ workers members didn’t need to be taught a brand new instrument or change their day by day processes. And with real-time insurance coverage discovery and auto-population of protection information into Epic, workers now not wanted to depend on guesswork and guide information entry. The instrument’s means to robotically decide primacy and take away expired protection meant workers may submit claims with confidence.
“One of many major causes we selected Experian and Patient Access Curator was as a result of it makes the guide work of income cycle a lot simpler on the registration groups, which in flip improves productiveness, empowerment and morale,” stated Gabel.
Final result
When Patient Access Curator went stay, the results have been felt nearly instantly. Registrars who as soon as spent invaluable time debating which checks to run discovered that PAC dealt with these selections robotically, and far sooner. Guide searches have been now not essential, and the system’s accuracy drastically lowered the variety of errors.
These front-end enhancements have boosted efficiency all through the income cycle. Clear registrations meant fewer denied claims, much less guide cleanup and sooner reimbursements. PAC even uncovered insurance coverage for accounts that had already been despatched to collections, serving to OhioHealth cut back reliance on contingency distributors and lower avoidable unhealthy debt.
PAC continued to show its worth lengthy after it went stay. Throughout the first yr, OhioHealth achieved:
- 42% discount in general registration/eligibility-related denials
- 36% lower in COB-related denials
- 69% drop in termed insurance-related denials
- 63% fewer incorrect payer-related denials
- $188 million in claims unlocked by reassigning workers and enhancing productiveness
What’s subsequent?
Constructing on this success, OhioHealth’s subsequent steps are to increase their use of PAC by launching a affected person monetary expertise initiative. It will permit sufferers to finish registration themselves and discover their very own protection with out ready for a workers member to turn into obtainable to assist. Resolving extra insurance coverage points upfront will ship a sooner, simpler and extra clear registration expertise from the beginning.
With Patient Access Curator, OhioHealth has gone from shedding money and time coping with the downstream results of claims errors to making sure protection accuracy on the supply – whereas chopping denials by nearly half. Together with a greater expertise for employees and sufferers, these beneficial properties have created a extra resilient income cycle, prepared to resist no matter surprising modifications could also be in retailer.
Discover out extra about how Patient Access Curator prevents declare errors earlier than they start, serving to groups submit clear claims and cut back denials.
