How next-generation automation technology can improve healthcare revenue management
April 11, 2022, 11:00:00 PM
The revenue cycle is incredibly complex due to shifting payer requirements, continuous regulatory compliance and coding updates, and emerging and evolving payment models. That complexity increases the administrative burden and drives up cost for providers.
Today, nearly every role in every industry is facing some level of disruption. We are tasked with achieving more with less – less time, less resources, less information, and often less support. No industry has experienced this more than healthcare. Healthcare workers, from clinicians to administrative coordinators, are feeling the pressure to simultaneously improve patient outcomes and experience, reduce operating costs and increase billings.
Though it’s not front and center, one major component within any healthcare system that greatly impacts all three of these goals—and where administrative and clinical workflows are intertwined—is revenue cycle management.
According to the Healthcare Financial Management Association (HFMA), revenue cycle management encompasses all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue. Unsurprisingly, the revenue cycle is incredibly complex due to shifting payer requirements, continuous regulatory compliance and coding updates, and emerging and evolving payment models. Numerous touchpoints and stakeholders produce complexity beyond just tracking revenue flows through an organization.
This complexity is costly. Data from the 2021 CAQH Index, which tracks health plan and provider adoption of fully electronic administrative transactions, found that of the $391 billion spent on administrative complexity in the United States healthcare system, $42 billion is spent on administrative transactions. It was estimated that the industry could shave $20 billion off that transactional cost by transitioning to fully electronic transactions. Clearly, there are opportunities to accelerate revenue, streamline processes, and introduce greater efficiency and resiliency into the revenue cycle.
How we got here: the cycle and its challenges
There’s always more than meets the eye when it comes to revenue cycle management.
The cycle starts at the front office, which handles patient scheduling, insurance eligibility and treatment authorization. The middle office then owns the clinical activity and is responsible for the flow of patient data from front to back offices, including diagnostic activities, laboratory services, medical treatments, clinical records, medical coding and more. Finally, the back office handles claims, claim denials, collections and medical billing, which happens after patient care is completed and medical reports and claims have been submitted.
The entire workflow relies on dozens of systems, hundreds of processes, and a competing mix of stakeholders across an already inundated ecosystem. Inefficient processes and mistakes are the inevitable byproduct.
While some organizations have made great strides in their digital transformation efforts to help offset these challenges, many haven’t—and they’re still finding themselves having to complete tedious, repetitive, manual, error-prone processes throughout the workflow. What’s more, according to the Medical Group Management Association, inefficient processes across the revenue cycle cost healthcare practices in this country billions of dollars each year.
Where we’re going: Intelligent automation can take you there
Healthcare organizations aiming to optimize their revenue management need greater visibility across all interconnected revenue cycle systems to understand where efficiencies can be introduced. Yet collecting the revenue cycle data needed for visibility is often a slow, manual and resource-intensive process.
The good news is that robotic process automation (RPA) along with AI technologies—often referred to as intelligent automation—has consistently been proven to be able to turn manual, mundane tasks into automated, consistent processes that generate benefits quickly for many healthcare systems.
Intelligent automation creates software bots that can learn, mimic and execute rules-based processes the same way staff would throughout the revenue management cycle. This allows healthcare organizations to automate the continuous acquisition of revenue cycle process data, at scale, across all systems, ultimately providing staff with the real-time, accurate visibility they need to improve revenue planning and management.
This not only helps to optimize costs, but also gives valuable time back to staff to focus on other, more meaningful tasks, such as improving patient care and saving lives. Healthcare organizations are taking notice of these benefits—so much so that Gartner predicts that half of U.S. healthcare providers will invest in RPA by 2023.
Here’s what it can look like in action:
• Streamlined, secure document management: A secure, precise documentation process is of the utmost importance in healthcare, a highly regulated sector that handles sensitive data, including personally identifiable information (PII) and protected health information (PHI). RPA bots can efficiently prepare and store records, such as a test result or an insurance claim, while also ensuring accuracy and consistency of documentation. Human touches of PHI can be reduced.
• Automated data collection and entry: Data collection within the healthcare ecosystem occurs nonstop, from when a patient calls to schedule an appointment, to doctors entering notes within the EHR, to payers processing claims. When it comes to administrative data entry for tasks like billing and claims processing, it’s often a mind-numbing, repetitive process. RPA technology can collect data from various entry points, curate it as needed, and input the data into systems of record automatically. It’s efficient, it’s accurate, and it saves both time and resources.
• Improved patient experience: RPA bots can help streamline interactions with patients, including managing and scheduling patient appointments—or even manage follow-up communication based on the patient’s treatment plan. The technology can serve as a first-line response to common, repetitive website inquiries. Patients benefit from quick, reliable responses, and staff gain time back that they can use to improve the patient’s care experience.
By leveraging modern solutions to optimize revenue cycle management, healthcare organizations are empowering their workforce to have more visibility into the revenue cycle, better manage revenue end to end, and address top priorities like improving patient outcomes and experience, reducing operating costs and increasing billings. It’s a win on many fronts.