“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 below 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 instructed them at check-in, with out figuring out if that data was full or present. Pressured to make judgment calls about whether or not to run Coordination of Advantages (COB) or examine for Medicare Beneficiary Identifiers (MBI), employees 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 incorrect insurance coverage just because employees 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 grew to become extra pressing when a nationwide cyberattack hit the business in early 2024. They wanted a trusted income cycle companion 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 way of a single course of. This answer gave employees 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 immediately into current workflows, so OhioHealth’s 800+ employees members didn’t must be taught a brand new device or change their day by day processes. And with real-time insurance coverage discovery and auto-population of protection information into Epic, employees now not wanted to depend on guesswork and handbook information entry. The device’s skill to robotically decide primacy and take away expired protection meant employees 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 handbook work of income cycle a lot simpler on the registration groups, which in flip improves productiveness, empowerment and morale,” mentioned Gabel.
Consequence
When Patient Access Curator went stay, the results have been felt virtually instantly. Registrars who as soon as spent worthwhile time debating which checks to run discovered that PAC dealt with these choices robotically, and far quicker. Handbook searches have been now not needed, and the system’s accuracy drastically decreased the variety of errors.
These front-end enhancements have boosted efficiency all through the income cycle. Clear registrations meant fewer denied claims, much less handbook cleanup and quicker reimbursements. PAC even uncovered insurance coverage for accounts that had already been despatched to collections, serving to OhioHealth scale back reliance on contingency distributors and minimize avoidable dangerous debt.
PAC continued to show its worth lengthy after it went stay. Inside the first 12 months, OhioHealth achieved:
- 42% discount in total 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 employees 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. This may enable sufferers to finish registration themselves and discover their very own protection with out ready for a employees member to develop into accessible to assist. Resolving extra insurance coverage points upfront will ship a quicker, simpler and extra clear registration expertise from the beginning.
With Patient Access Curator, OhioHealth has gone from dropping money and time coping with the downstream results of claims errors to making sure protection accuracy on the supply – whereas slicing denials by virtually half. Together with a greater expertise for employees and sufferers, these positive factors have created a extra resilient income cycle, prepared to resist no matter sudden 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 scale back denials.
