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RCM Automation and Mitigating COVID-19’s Long-Tail Recovery

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With COVID-19 cases declining and vaccination rates increasing, associated mask mandates and other precautionary measures are being lifted as society returns to a relative normal. But the pandemic’s effects on the healthcare industry at large — and health systems’ revenue cycles specifically — persist.

One crucial revenue cycle recovery tool for healthcare providers and payers alike is revenue cycle management (RCM) automation. Modern, end-to-end RCM solutions present several opportunities to automate tasks and subsequently enhance productivity and grow revenue.

And automation options will continue to expand with the evolution of artificial intelligence and the widespread adoption of AI-enabled RCM platforms. Health organizations that successfully emerge from the pandemic will be those that possess a fully integrated RCM strategy and leverage RCM automation capabilities.

Revenue Cycle Recovery: Post-Pandemic Challenges

More than 30 percent of hospitals carried negative operating margins in 2021, and hospitals nationwide lost more than $50 billion in net income last year, according to projections from an American Hospital Association (AHA) report on the pandemic’s financial effects on the healthcare industry.

Although non-COVID healthcare visits and spending are beginning to rebound, they still lag behind pre-pandemic levels. In its ongoing COVID-19 survey of primary care providers, the Larry A. Green Center found that fewer than one-third of primary care practices are financially stable.

And most utilization forecasts don’t offer signs of a prompt recovery. In its post-pandemic recovery outlook, the healthcare analytics firm Sg2 predicts inpatient volume decreasing 1 percent by the end of the decade with outpatient volume increasing 14 percent, emergent care volume rising 5 percent and urgent care volume declining 15 percent.

Meanwhile, the healthcare labor shortage continues to worsen even as demand for non-COVID health services creeps upward again. The Great Resignation’s impact on the healthcare workforce is so great that “personnel shortages” replaced “financial challenges” as the top concern for hospital executives in an annual survey conducted by the American College of Healthcare Executives (ACHE), marking the first time since 2004 financial challenges has not held the top spot.

Supply chain disruptions have also slowed healthcare revenue cycles. A staggering 99 percent of U.S. hospitals and healthcare systems report issues obtaining medication, medical devices, technology and supplemental items.

Longer wait times for supplies can delay procedures, which cuts off revenue streams. And as costs for many healthcare goods rise, providers’ and payers’ profit margins continue to shrink.

Concurrently, healthcare organizations are struggling to accomplish information system changes to achieve interoperability as hackers continue to exploit cybersecurity shortcomings. More than 40 million individual health records were affected by data breaches and ransomware attacks in 2021, according to HIPAA.

The average cost of a healthcare data breach is more than $9 million per incident, according to an analysis cited by HIPAA. Healthcare ransomware attacks cost more than $4.5 million per incident.

It should be noted that the deeper healthcare organizations are into their cloud migration plans, the faster they can detect and respond to cybersecurity threats. The HIPAA report indicates that organizations at a “mature” stage of cloud migration could address breaches 77 days faster than those at a lesser stage of cloud implementation.

Automation Key to an Effective RCM Strategy

The workflow and financial disturbances wrought by COVID-19 emphasized the need to automate manual duties within the revenue cycle. With a comprehensive RCM solution and optimal management of its capacities, the cost savings are substantial.

A transition to electronic transactions alone would save the healthcare industry more than $13 billion a year, according to a Council for Affordable Quality Healthcare (CAQH) report about opportunities for automation. More than $400 million could potentially be saved just through the utilization of electronic claims transactions, according to the CAQH assessment.

Automation is instrumental to healthcare interoperability, and it can help organizations cope with and recover from many current revenue cycle obstacles. Nearly every step of the revenue cycle may be fully or partially automated, including:

● Scheduling

● Eligibility and health benefits verification

● Prior authorization

● Claim submissions

● Benefits coordination

● Claim status inquiries

● Claim payments

A cohesive RCM strategy balances human resources and technological needs and partners them to maximize the best of both. Medical coding, for example, is a contemporary pain point for many providers.

Healthcare claim denials have soared with the pandemic and the Great Resignation. The high denial rates, which have put many providers in a financial danger zone, are partly fueled by medical coding errors. The coding errors, in turn, are the result of mass healthcare resignations, a lack of qualified coders to replace those who left their jobs, and provider confusion over COVID-19 coding and other new claim-related coding requirements.

One solution to the medical coding dilemma, in particular, is an RCM platform that unites experienced coders with AI-enabled technology to reduce coding errors, improve efficiency and increase profitability. Automation, in general, allows internal staff to focus on patient care and other functions more directly related to cost savings and revenue growth.

Automation among interoperable RCM processes also fills the escalating need for detailed analytics. Automated electronic procedures offer accurate, consistent and timely data that financial leaders can use to make confident, knowledge-based decisions.

Expanding RCM automation may not be a magic pill that will solve all the healthcare industry woes left in the pandemic’s wake. Yet the benefits of automation, whether total or in conjunction with human resources, cannot be denied, and they extend throughout the revenue cycle, all the way through the entire patient experience.

About GeBBS Healthcare Solutions

GeBBS Healthcare Solutions is a leader in health information management, risk management and RCM services for healthcare providers and payers.

GeBBS is dedicated to offering scalable solutions that deliver measurable results. GeBBS has earned widespread acclaim for its expert human resources and innovative technology.

GeBBS is proud to be ranked among Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States. Visit gebbs.com today to schedule a consultation and learn how we can help your organization recover from the pandemic’s financial effects and flourish into the future.

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