The Importance of Automated RCM Solutions for Health Systems

Posted in GeBBS Healthcare Solutions, Inc.

Hospitals and other players in the health care system don’t need to be told twice about the impact of the coronavirus on operations and practice management. What many administration executives may have missed, however, is just how quickly facilities and systems transitioned to new technologies and automation to soften the damaging operational impact of the pandemic.

Traditionally slow to roll out new processes, a staggering 75% of health systems implemented revenue cycle management (RCM) technology or underwent active technology deployments over the past year. While RCM may seem like a back-of-house tech stack, the vast majority of health care systems in the U.S. quickly realized the opportunities offered by automation in processes desperate for reduced in-person interactions.

Many health system administrators have found more than just quicker, easier medical billing and risk adjustment with the introduction of outsourced RCM technology. Disparate systems, manual review and entry processes, and prolonged reporting progressions eat into time, profits, and patient outcomes. Now more than ever, health care systems must implement RCM technologies and uncover new methods to gain the most out of their investment.

The right platforms, coupled with automation, can streamline financial, operational, and logistical functions across the health system. And with losses due to COVID-19 projected at more than $323 billion for health care provider networks, administrators have an urgent need that outsourced automation can fill far beyond the pandemic.

Automation Technology in Revenue Cycle Management

Amid the disruption caused by the coronavirus, RCM allowed the shift to fully remote working teams while maintaining key operational tasks for billing, insurance, and operations. However, even those health care systems with RCM already in place missed some of the benefits from automation. Approximately 30% of health systems have not integrated automation into their RCM processes.

Where RCM allows for more consistent metrics, reliable charge capture, streamlined claims submissions, and myriad benefits related to operations, running these systems with manual data entry and physical – even remote – teams leaves a number of gaps in productivity, reliability, and compliance. Adding artificial intelligence to automate billing, coding, and collections can save $7 billion yearly.

Reduce Waste

In health care administration, inefficiencies are beyond costly. It’s estimated that the health care system loses $200 billion in administrative waste from inefficient RCM. Even with an RCM system, relying on administrative hires – prone to natural human error, as well as costly onboarding and training – can contribute to losses on claims, fraud, and even payroll.

Automation is one answer to this growing problem. From programmatic workflows to natural language processing, automation can cut down on resources spent on time-consuming paperwork and repetitive tasks – and the errors that come along with them.

Reallocate Resources

While many workers worry that automation will make their jobs obsolete, health care system administrators can use outsourced automation and RCM to empower and better equip their employees for success. But the focus here should be on retention and reallocation, rather than replacement, with the advent of RCM automation.

Automation can take on redundant tasks and position staff to manage processes that require human interaction, creativity, and problem solving. Administrators can also improve their ROI on payroll expenses as team members are freed up to focus on work that is top of license.

Report Accurately

Data drives business decisions. Whether monitoring system-wide cash flow or determining performance for teams, departments, or facilities, administrators are at a disadvantage when their data is slow, spread out, or spoiled with errors. RCM systems can limit the damage by creating consistency for intake, form capture, and processing.

With automation, health care systems can take data reporting to the next level. These insights can help with process change management and predictive analytics to improve outcomes in patient care, customer experiences, and operations.

Common Challenges with RCM Rollout in Health Care Systems

With all of these benefits potentially making a positive impact on the bottom line, why have so many health care systems been hesitant to implement RCM at scale and with proper automation in place?

For the longest time, the health care industry was notoriously laggard when it came to implementing new technologies. Gaps in tool sets designed for hospital and clinical practice, as well as old-school providers resistant to change were clear obstacles. Two key challenges remain despite clear operational benefits: budgets and implementation.

Cost and ROI

As system capabilities improved, prohibitive costs became a leading reason for technology dissent. Health care system administrators and IT leaders were hesitant to roll out platforms that required expensive maintenance, time-consuming training, and constant oversight. New cloud-based technology cut down on these costs while allowing for scalable subscription models.

Modern RCM systems produce ROI when implemented across an organization. While the initial expense can seem daunting, the results are worthwhile. Automated admin transactions, such as verifying patient coverages, preauthorization, and sending/receiving payment, saved over $122 billion in a 2020 report. Just by reducing costs to collect and lowering bad debt, RCM can pay for itself.

Implementation

Large-scale deployment of new technologies has traditionally been managed through in-person installations and trainings. The implications of COVID-19 have stalled these efforts, with more than 90% of pandemic RCM rollouts experiencing delays.

Despite these challenges, health care systems stand to benefit from the process. Third-party implementation partners and experts in the RCM field can advise on key steps in the planning process. Much success is attributed to proper evaluation of available tools, features, and expectations. By applying best practices in assessment, alignment, and accountability, implementation does not need to be a struggle.

Why RCM Automation Will Remain Vital in Post-Pandemic Health Care Operations

Think automation and RCM are a passing pandemic trend? Think again. The level of investment and transformation that this new operational ecosystem has created is here to stay. Despite unique challenges, concerns, and nuances, health care systems cannot afford to be left behind in RCM automation.

Work from Home

Office and administrative staff quickly transitioned to remote work out of necessity. But after a year of change, 57% of work remains remote and 40% of workers will likely stay home through 2021. RCM will enable health care systems to keep up with employee expectations for flexibility and be agile enough to deal with future challenges.

Recover Costs

According to a report by The Advisory Board Co., “90% of claim denials are preventable and 67% of denials are recoverable.” RCM and automation can significantly cut down denials attributed to process and human error. And with automation, follow ups, data collection, and submissions can be expedited to recover costs more quickly.

Improve Efficiency

While the pandemic brought cancelations in elective procedures and preventative care, visits and expenses soared from coronavirus-related ailments. As COVID-19 becomes less predominant in daily life and things return to normal, health service spending is rising. The efficiency gains that RCM systems brought to the industry stand to offer benefits well beyond the pandemic, as volume increases and payer rules become more complex.

Optimize Billing

Core to the value of RCM, medical billing and coding stand to be revolutionized through automation. Reducing manual transactions, maintaining accurate ICD-10 databases, and expanding payment options can alleviate strain on health care system billing departments. Automation can increase productivity – and help optimize billing – up to 15-20% just with consistent workflows alone.

Meet Patient Expectations

Patient portals, online payment options, and pre-screening check-ins have gone from concepts to consider to expected norms. Health care systems will need to get up to speed, and remain on the cutting edge of technology to keep pace with patient expectations. Automation can fill this gap with RCM workflows that engage patients pre- and post-appointment, which creates consistent data collection and more efficient bill pay along the way.

Artificial intelligence (AI) was already producing clinical advancements for medical practices, but the technology is now being used to improve operational and financial aspects of health care, as well. By streamlining manual processes with automated data collection and smarter workflows, using AI for revenue cycle management enables accurate, efficient, and cost-effective systems that allow providers to focus more on patient care.

Operational Wins for Outsourced Automation and RCM

RCM solutions were critical to survival for the majority of health care systems during the COVID-19 crisis. Administrators can position their organizations for long-term success in a permanently changed ecosystem by furthering their commitment to RCM technology solutions and automating their systems.

Outsourced revenue cycle management offers the same benefits for saving time, creating efficiencies, and providing quality patient experiences. Choosing a reliable technology provider that not only presents software solutions, but also actively partners with your specific health care system can make a massive impact on the success of your deployment and on your ROI.

GeBBS offers comprehensive RCM solutions with a tailored approach to building out workflow processes that automate for high output and optimize for seamless integration with existing systems. Request a consultation and learn how teaming up with GeBBS can propel your RCM automation in a post-pandemic environment.

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