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Why Automation’s Role in RCM Will Continue to Grow

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As healthcare providers struggle with staffing shortages and increasingly complicated regulatory compliance, automation is proving essential to effective revenue cycle management (RCM).

An RCM solution that employs artificial intelligence and automated rules can help providers overcome many of the biggest challenges to their financial health and sustained success. RCM automation can streamline processes related to appointment scheduling, insurance verification, medical coding, billing and claims management.

A comprehensive, AI-enabled RCM solution should improve workflow, reduce coding and billing errors, enhance revenue capture and elevate the patient experience while decreasing the burdens on internal staff. Following is a closer look at some of the tasks RCM automation can tackle and why the role of automation will continue to expand.

Present RCM Challenges

The healthcare labor crisis is so dire that “personnel shortages” ranked as the foremost concern for hospitals in the most recent survey of hospital executives by the American College of Healthcare Executives (ACHE).

Ongoing staffing shortages impact nearly every step of the revenue cycle and patient journey. And the lack of nurses and administrative personnel has increased the workloads on remaining staff at a time when providers are also coping with the lingering covid pandemic, electronic medical record (EMR) conversion, evolving Medicare and Medicaid rules, shifting payer requirements, and supply chain woes.

The cumulative effects include faulty data, coding mistakes, billing blunders and rising claim denials that are collectively costing the healthcare industry billions of dollars yearly and forcing many providers to consolidate or close. Automation augments the revenue cycle from beginning to end.

An advanced RCM solution utilizes automation to help ensure clean data from the start, saving significant time and resources down the road. It provides a single source for patient access, coding, billing and claims management, so all in-house team members are working with the same data in real-time.

An end-to-end RCM solution is also engineered for interoperability. It allows providers to access and share applicable, up-to-date data with other key stakeholders, including patients, external specialists and payers, and to integrate new coding and payer requirements as they change.

The rapidly advancing automation capabilities of an AI-based RCM system help providers and their teams do more with less. An RCM platform can identify details that require manual review and free staff for value-added activities.

Leveraging Automation in RCM

Among the primary benefits of automation in revenue cycle management are improved efficiency and error reduction.

An AI-driven RCM platform can automatically conduct various tasks, beginning with patient scheduling, eligibility verification and prior authorization. Automation further factors in the patient journey and claims management processes by reviewing coding inputs and changes for accuracy and thoroughness; the system flags users when inconsistencies are detected, or additional details are required.

Automation can also be deployed in benefits coordination, claim submissions and billing follow-ups. The interoperability of a modern RCM system also reinforces compliance with coding changes. It can adapt to evolving requirements by the Centers for Medicare & Medicaid Services (CMS) and other payers.

In addition, the automation capacities of a state-of-the-art RCM platform are highly customizable. These can be used to accommodate varying payer guidelines, value-based care plans, medical specialties and other considerations. One example of a custom automation rule is the ability to recognize new patients versus existing patients, then parse relevant coding and payer data.

For instance, onboarding new patients necessitates a different Current Procedural Terminology (CPT) code than the code used for existing patients. A custom rule associated with these codes initiates an automated review of any prior claims made to a payer for a particular patient, verifies whether that patient is new or is established, and assesses whether the proper CPT code was entered.

As value-based care expands, RCM automation can also aid quality measure reporting. For example, a fully integrated RCM system can evaluate a patient’s EMR data in conjunction with preset clinical values and the values associated with a given medical service or procedure, then provide the correct diagnosis code or CPT Category II code.

Automation rules can additionally be applied to telehealth visits (such as knowing when to add the CPT modifier 95) and immunization services (linking the correct immunization with the proper charge and automatically billing the appropriate payer). As the AI that fuels RCM engines continues to develop, its applications throughout the revenue cycle will continue to grow.

RCM Automation: Revenue Benefits and Beyond

Automation accelerates the claims process through improved coding and billing accuracy. Accuracy limits denials, heightens revenue capture and promotes timely payment — all of which are especially beneficial to smaller healthcare organizations that rely on revenue maximization and prompt payments to meet their financial obligations.

According to a Council for Affordable Quality Healthcare (CAQH) report about automation opportunities within healthcare, the widespread adoption of automated electronic transactions could save the industry more than $13 billion annually. The CAQH analysis indicates that more than $400 million could be saved through electronic claims payment submissions alone.

Automation can also boost the patient experience. Automated appointment scheduling, for example, makes it simple for patients to schedule visits, reduces the amount of time they spend on the phone and lessens the load on internal staff.

An automation-enabled system can also make it easier for patients to understand and pay their bills, diminishing the likelihood of invoice disputes or unpaid balances. Automation can be exploited for follow-up services to help patients monitor future appointments, track test results, manage prescriptions and address questions or concerns.

As healthcare providers of all sizes face mounting pressure to reduce costs while increasing efficiency and improving the patient experience, they must recognize automation as a vital step toward these goals and their sustained financial well-being.

Forward Thinking: About GeBBS Healthcare Solutions

GeBBS Healthcare Solutions is an acclaimed leader in health information technology, RCM services and staffing support resources.

At GeBBS, we’re dedicated to helping our partners optimize their revenue cycles while maintaining regulatory compliance. We support our clients through scalable solutions that include AI-based technology systems, certified medical coders and experienced audit professionals.

GeBBS is gratified to be recognized as a Leader by Everest Group’s Revenue Cycle Management Operations, one of Black Book Market Research’s Top 20 RCM Outstanding Services, one of Inc. 5000’s Fastest-Growing Private Companies in the United States, one of Market Research’s Top 20 RCM Outstanding Services and one of Modern Healthcare’s Top 10 Largest Revenue Cycle Management Firms.

Contact us today at gebbs.com to request a consultation and free demonstration.

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