More than 44% of claim denials are caused by front-end revenue cycle problems. Of these, 24% can be traced to registration and eligibility, and another 16% are the result of missing or invalid claim data.ⁱ  These eye-opening statistics underscore the importance of capturing complete, accurate patient information at the beginning of the patient encounter, typically during patient scheduling or registration.

Efficient, effective revenue cycle management starts with rock-solid patient demographic information. The basics, including verified full name, DOB, SSN, and current address are the foundation for identifying all sources of commercial, government, and third-party liability coverage and essential for submitting a clean claim.

Most providers rely on the patient to provide accurate demographic data. It is reasonable to assume that the patient is the best source for this information, yet the truth may be surprising. For many reasons, patient demographic data is notoriously flawed. For example, the patient could have provided incomplete or outdated information, or perhaps they fat-fingered a digit or two while entering information in the patient registration portal. Very often, the patient provided their information with pen and paper and errors occurred later, when staff transcribed information incorrectly into the EHR.

Get Patient and Payer Information Right from the Start

Rather than relying on the patient to provide accurate and complete information, providers can streamline and improve their intake process by focusing on verifying the patient’s identity and obtaining basic information. This can be accomplished in four simple steps:

1. Review the patient’s identification and ask them to verify that they have provided their full and correct name, date of birth, address, social security number, and where appropriate, their MBI number.
2. Take their insurance card, but do not rely on this information as the gospel truth — it could be outdated, inactive, or there may be additional coverage
3. Utilize automated demographic verification technology to find, fix, and verify patient information
4. Run an insurance discovery tool on the verified demographic information to identify all payer sources prior to sending the information to the billing team

Use RCM Optimization Technology To Drive Clean Claims

A best-in-class demographic verification solution can search multiple databases in real time to find and validate information for better billing performance. It can correct or add information such as name, DOB, SSN, phone number and type, current and previous addresses, and address reporting date. Accurate core information helps billing teams reduce denials, improve the clean claims rate, and accelerate the revenue cycle.

Once demographic information has been verified, running a high-performing insurance discovery tool can automatically find, correct, and verify payer information to capture more revenue, reduce administrative burden, and improve the patient financial experience. Expansive searches can find more hidden coverage, confirm active status, and even enable retroactive billing.

Provider billing teams that harness automated RCM optimization technology can do more with less. The best solutions turbo-charge the billing process and include configurable settings for customized workflows and refined results based on providers' needs. Running automated demographic verification and insurance discovery processes can yield impressive results, such as:

• Find, fix, and verify SSN on 60% or more of patient claims
• Enhance core demographics for 82% or more of patient claims
• Correct and replace faulty or missing demographic data for 60% or more patient claims
• Improve statement delivery, reduce the cost of claims, and accelerate payments
• Discover active, billable coverage for more than 40% of claims, including retroactive Medicaid
• Save countless hours of staff time by leveraging powerful, automated technology in real time

Front-end revenue cycle challenges are solvable, especially with help from RCM optimization technology. It’s time for providers to stop relying on patients and arcane, manual processes and start taking full advantage of the automated tools available. Those who deploy best-in-class solution suites like ZOLL® AR Boost® can expect to see immediate results, uncovering more billable coverage, increasing clean claim rates, and optimizing reimbursement with a shorter time to cash.

ⁱThe Optum 2024 Revenue Cycle Denials Index, 2024, https://www.optum.com/content/dam/o4-dam/resources/pdfs/e-books/2024-denials-index-for-providers.pdf, Accessed May 2025