Today’s healthcare systems are facing decreasing reimbursement, new payment models, regulatory changes and more. With shrinking margins and an increasingly complex revenue cycle, the time to automate, innovate and transform is now. It’s the trifecta, and the key to future success for healthcare organizations.
Automation already plays a key role in various area of the revenue cycle – and new technologies designed to automate or improve on automation techniques are introduced each year. Technologies such as artificial intelligence (AI) and natural language processing (NLP) to robotic process automation (RPA) can streamline various functions. AI does this by using computers to mimic human intelligence, which allows them to solve problems (such as eligibility checks, and patient payment estimation) quickly. NLP uses computer science and AI to get computers to think and process text the way people do and is commonly used for risk adjustment coding. RPA uses a set of rules to complete repetitive tasks that are prone to errors, such as reducing manual data entry, assisting with pre-authorizations, automating simple claim denials, and improving the customer experience through the use of chatbots.
When it comes to innovation, healthcare systems are slowly coming around to investing in sophisticated technologies. According to an October 2020 article in Healthcare Finance, 57 percent of health systems say they are optimistic or very optimistic that innovation in the RCM space can happen this year.
But, what does innovation look like in the revenue cycle management (RCM) space? Truth be told, innovation is everywhere, but finding the right combination of technology and expertise is the true sweet spot for organizations looking to maximize the performance of their revenue cycle. And getting it right has its value – using automation and innovation to transform your RCM strategy can save time, improve quality and accuracy, reduce waste, increase predictability of outcomes, and provide data-driven insights. Together, they can help organizations avoid revenue leakage, streamline operations, and improve the bottom line. When looking to transform your revenue cycle, here are a few best practices to keep in mind.
Understand your issues. Every RCM solution has its strength and weaknesses, so it’s important to understand your organization’s greatest challenges and opportunities. Whether it’s timely claims submission, denial management, coding accuracy, accounts receivable, or credit balance resolution, be sure to focus on those products and/or vendors who have demonstrated strength in these areas. Identify goals and key performance indicators prior to implementing any new solutions to ensure you can track your progress.
Automate where it makes the most sense. While the revenue cycle will never be 100% automated, there are numerous areas where deploying best-of-breed technologies that automate certain functions can be very beneficial. Advanced technologies such as artificial intelligence (AI) and robotic process automation (RPA, aka ‘bots’) can not only take over certain defined functions, but the technology has also evolved and is powerful enough to take on more complex tasks such as prior authorizations, patient eligibility and on the back-end, account resolution. Using these technologies can save staff time and resources, while also accelerating certain workflows.
Employ predictive analytics. Another innovation in the RCM space is the use of predictive analytics. Using machine learning, these technologies can use historical data to make predictions about the future of specific areas within the revenue cycle. A 2019 Black Book Research study revealed that health system leaders were likely to allocate at least ten percent of their 2020 IT budgets to the use of predictive analytic technologies for revenue cycle management. Frequently used to predict cashflow, identify potential denials before they occur, identify inefficiencies, and decrease the reliance on IT resources for accessing RCM information, predictive analytics can be very powerful for large health systems.
Think patient first. While healthcare executives have historically thought of the revenue cycle as a back-office business, it’s actually a function that touches nearly every phase of the patient experience. From scheduling and up-front payment collection to final claims submission and billing and every step in between, these processes have an impact on patients. As such, organizations are thinking about creative ways to make healthcare billing more transparent and consumer-friendly. With the digital transformation finally making its way into healthcare and patient financial responsibility increasing with the prevalence of high-deductible health plans, innovative self-service portals that help patients better understand their financial obligations and allow for secure online payment can help improve key RCM metrics.
Find the right partner. Success is about the right combination of people, process and technology. While the innovative RCM tools you choose are critical, having the right partner and extended staff to help you maximize the investment you’re making is just as important. When evaluating outsourced RCM partners, ensure you find a client-centered team that works well with both your executives and your RCM staff.
In conclusion, 2021 is the year of RCM automation and innovation. Technology has made remarkable progress in the areas of automation, AI and analytics to help streamline and enhance revenue cycle performance. When automation and innovation are paired with the right team to transform your revenue cycle, you’ve achieved the trifecta of RCM success.
GeBBS Healthcare Solutions offers a wide range of innovative revenue cycle management solutions to support your efforts in 2021. To learn more, visit gebbs.com.