OhioHealth Cuts Claim Denials by 42% with AI-Powered Insurance Verification
Columbus, OH – OhioHealth, a leading healthcare provider, has announced a significant reduction in claim denials and a boost in revenue cycle productivity after implementing an artificial intelligence-powered solution to streamline insurance verification processes. The health system reported a 42% decrease in overall registration and eligibility-related denials within the first year of launch.
The mounting Challenges of Insurance Complexity
Prior to the new system, OhioHealth faced persistent issues with rising denial rates stemming from inconsistent insurance discovery. Registration staff frequently enough relied on facts provided by patients at check-in, which was frequently incomplete or outdated. Determining correct insurance order and eligibility, including Coordination of Benefits (COB) and Medicare Beneficiary identifier (MBI) verification, proved a significant source of errors. According to Randy Gabel, senior Director of Revenue cycle at OhioHealth, staff were frequently submitting claims with incorrect insurance details.
The need for a robust solution intensified following a widespread cyberattack impacting the healthcare industry in early 2024,forcing OhioHealth to seek a partner capable of bolstering its claims and eligibility workflows against potential disruptions.
Experian Health’s Patient Access Curator® Powers conversion
To address these challenges, OhioHealth chose Experian Health’s Patient Access Curator® (PAC). This all-in-one platform leverages Artificial Intelligence (AI) and machine learning to automate eligibility checks, COB verification, MBI validation, demographic confirmation, and insurance discovery in a unified process. The system delivers real-time, accurate data directly to staff.
Initial evaluations demonstrated PAC’s superior capabilities, identifying 18% more insurance coverage on self-pay accounts compared to the organization’s previous vendor. Gabel emphasized the tool’s ability to eliminate guesswork, stating, “Patient Access Curator discovered a whopping 18% more insurance on self-pay accounts than our current vendor. No other company or product found that much.”
Seamless Integration and Empowered Staff
A key benefit of the PAC implementation was its ability to integrate directly into OhioHealth’s existing workflows, minimizing disruption for its 800+ staff members. The system’s real-time insurance discovery and automated data population into epic eliminated manual data entry and reduced reliance on subjective judgments.Furthermore, PAC’s automatic determination of insurance primacy and removal of expired coverage empowered staff to submit claims with greater confidence.
“One of the primary reasons we chose experian and Patient Access Curator was as it makes the manual work of revenue cycle much easier on the registration teams, which in turn improves productivity, empowerment and morale.”
Significant Outcomes and Financial Impact
The impact of PAC was immediate and substantial. Registrars, previously burdened with manual checks, found the system automated these processes, drastically reducing errors and speeding up the workflow. This led to cleaner registrations, fewer denied claims, reduced manual cleanup, and faster reimbursements.
Notably,PAC also identified previously undiscovered insurance coverage for accounts already sent to collections,allowing OhioHealth to lessen its dependence on costly contingency vendors and reduce bad debt.
Here’s a snapshot of OhioHealth’s key achievements in the first year:
| Metric | Improvement |
|---|---|
| Overall Registration/Eligibility Denials | 42% Reduction |
| COB-Related Denials | 36% decrease |
| Termed Insurance-Related Denials | 69% Drop |
| Incorrect payer-Related Denials | 63% Fewer |
| Claims Unlocked (Staff Reassignment & Productivity) | $188 Million |
Expanding Patient Access and Future Initiatives
Building on this success, OhioHealth is now launching a patient financial experience initiative aimed at empowering patients to complete registration and verify their own coverage online, reducing wait times and improving transparency. The goal is to resolve more insurance-related questions proactively, streamlining the registration process for everyone involved.
Through the implementation of Patient Access Curator, ohiohealth has shifted from reacting to the consequences of claim errors to proactively ensuring coverage accuracy. This has not only improved staff and patient experiences but has also created a more resilient revenue cycle, prepared to navigate future industry changes.
The Growing Importance of Automated insurance Verification
The healthcare industry is facing increasing pressure to improve revenue cycle management and reduce administrative costs. According to a report by Healthcare Financial Management Association (HFMA), claim denials continue to be a major challenge for healthcare providers, costing the industry billions of dollars annually. Automated insurance verification,powered by AI and machine learning,is emerging as a critical solution to address this issue,allowing providers to identify coverage gaps and errors before claims are submitted.
Frequently Asked Questions About Insurance Verification
What challenges does your organization face with insurance verification? How coudl AI-driven solutions like patient Access Curator perhaps address those issues?
Share your thoughts in the comments below or share this article with your network!
How did OhioHealth’s Patient Access Curator specifically address the issue of incorrect patient data leading to claim denials?
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OhioHealth’s Success: A 42% Reduction in Denials with Patient Access Curator & Source-Level Error Resolution
The Challenge: Healthcare Revenue Cycle Management and Denial Rates
Healthcare providers constantly face challenges in managing their revenue cycle. One of the most notable issues impacting profitability is the high rate of claim denials. Thes denials lead to delayed payments, increased administrative burden, and ultimately, financial losses. OhioHealth,a leading non-profit healthcare system,understood this pain point and embarked on a mission to revolutionize its patient access and revenue cycle processes. Key areas of focus included denial prevention, revenue cycle optimization, and patient access enhancement.
Understanding the Problem: Common Causes of Claim Denials
Before implementing any solutions, ohiohealth meticulously analyzed the root causes of its claim denials. This revealed several key areas contributing to the problem:
- Incorrect Patient Data: data entry errors during patient registration, including demographic facts, insurance details, and medical history, were common culprits. This led to claim rejections.
- Coding Errors: Inaccurate or incomplete medical coding (CPT, ICD codes) resulted in denials.Proper medical coding accuracy is a critical area.
- Lack of Prior authorization: Services performed without the necessary prior authorization from insurance companies were often denied. Effective prior authorization management is essential.
- documentation Deficiencies: Insufficient or missing medical documentation to support the services rendered also contributed to denial rates.
The Solution: Implementing Patient Access Curator and Source-Level Claim Error Resolution
OhioHealth’s strategy involved a comprehensive approach focusing on two primary components – the Patient Access Curator and Source-Level Claim Error Resolution. The implementation aimed for revenue cycle acceleration, improving patient access workflows, and enhancing claims processing efficiency.
Patient Access Curator: Centralizing & Streamlining Data
The Patient Access Curator served as a centralized platform to manage and validate patient data from various sources. this system allowed for patient data validation, reducing data entry errors at the point of origin. The Curator integrated with multiple systems to ensure data consistency. Key benefits included:
- Automated Insurance Verification: Real-time verification of insurance eligibility prior to the patient encounter.
- Data Quality Checks: Automated checks to ensure accuracy and completeness of patient information.
- Simplified Workflows: Improved workflows,reduced manual processes and streamlining patient intake. The key goal of this stage was patient engagement.
Source-Level Claim Error Resolution: Addressing Errors at Their Origin
Rather of reacting to denials, OhioHealth focused on preventing them. Source-level error resolution involved identifying and correcting errors at their source, within the department or system where they originated. This preventative approach drastically reduced the number of claims that could be incorrectly submitted and later denied. Key features included,claims data analytics,and denial management software.
- Training Programs: Implementation of comprehensive training programs that focused on proper coding,documentation,and insurance verification.
- Coding Audits: Regular audits to identify coding errors and ensure compliance with industry standards.
- Workflow Optimization: Revising workflows in patient access workflows to prevent claim errors.
The Results: Dramatic Reduction in Denials and Improved Financial Performance
The implementation of Patient Access Curator and Source-Level Claim Error Resolution yielded remarkable results.The primary outcome: a 42% reduction in claim denials.these efforts led to significant improvements in key performance indicators (KPIs) and patient satisfaction. They saw improvements in denial prevention strategies and revenue cycle management software. In their key performance indicator,there were results in improved net patient revenue.
Key Benefits and KPIs of This Comprehensive Strategy
- 42% Reduction in Denials: The most significant outcome, dramatically improving financial performance.
- Faster Reimbursement: Reduced delays in payments as a direct result of fewer denied claims.
- Reduced Administrative Costs: Less time and effort spent on resubmissions and appeals.
- Improved Patient Satisfaction: Smoother, more efficient patient experience.
- Enhanced Revenue Cycle Efficiency: Simplified and streamlined end-to-end.
- Enhanced Revenue Cycle Performance: Improved financial stability.
Practical Tips for Implementing Similar Solutions
Healthcare providers looking to replicate OhioHealth’s success can implement similar strategies. Here are a few tips:
- Thorough Assessment: Start by performing a thorough analysis of your current denial trends to identify root causes.
- Technology Investment: Invest in patient access and revenue cycle management software.
- Training & Education: Implement extensive training on proper coding, documentation, and insurance verification.
- Data Integration: Ensure seamless integration of your systems and optimize data quality across the board.
- Continuous monitoring: Regularly monitor your KPIs to track progress and identify areas for improvement. Implement claims denial analysis to further fine-tune processes.
