The healthcare industry needs a revenue cycle reinvention. Providers are challenged by the need for change while navigating complex payment models. Staffing and resource allocation have become increasingly difficult, with labor shortages affecting 83% of healthcare leaders across the revenue cycle. As cash flow sinks and costs rise, providers must reassess their approach to revenue cycle management.
To address these challenges, providers can leverage automation and technology-enabled solutions to improve collections and ensure they reach their revenue potential. In fact, research suggests that implementing automation and analytics could eliminate $200 to $360 billion of spending in the U.S. healthcare system. Deploying automation can help ease workforce challenges and reduce escalating costs with improved efficiency and accuracy.
Let’s explore how incorporating automation and artificial intelligence into end-to-end revenue cycle can help health systems overcome complex challenges and enhance financial performance.
Front-End Revenue Cycle Management
Efficient front-end revenue cycle management is crucial for financial stability in healthcare facilities. Operational strains, inadequate patient follow-up and limited technology adoption hinder front-end outcomes. The fragmented nature of front-end revenue cycle management processes leads to patient frustration and negative experiences.
To enhance the patient experience, healthcare providers can adopt an omnichannel approach to patient engagement. This involves providing multiple modalities for accessing care, supporting ongoing communication and providing patient education. Unifying front-end services through a single suite of tools, or a consolidated team, can help eliminate patient friction points and create a more efficient and seamless care journey.
Automation in the Front-end Revenue Cycle
Integrating automation, AI and technology-enabled solutions into revenue cycle management can more successfully put patients at the center. The goal is to create an effective end-to-end patient experience, where patients have the ability to shop for care, understand costs upfront and access self-service digital tools. Automation improves the efficiency and self-service functionality of these tools, while AI collects and analyzes data to support informed decisions.
Automation and AI can potentially revolutionize how the front end of your revenue cycle operates. Areas prime for automation in the front-end revenue cycle include:
- Patient chatbots.
- Patient registration robots.
- Appointment scheduling.
- Prior authorization/ID submission.
- Eligibility and enrollment tools.
- Price transparency and estimation.
- Proactive patient outreach.
- Contact center automation.
By implementing these strategies and leveraging automation, healthcare providers can improve front-end revenue cycle management, enhance the patient experience and achieve financial stability.
Middle Revenue Cycle Management
According to a recent article on the importance of reducing denials, the top three reasons for an increase in claims denials were insufficient data analytics, lack of automation in the claims and denials process, and a lack of thorough training. But some health system leaders remain skeptical about investing in technology as previous projects have not always yielded the expected results. Contributing factors include labor shortages, high denial rates, complex claims, unstructured data and vendor management fatigue.
To lay the groundwork for successful middle-cycle revenue operations, it's important to enable staff efficiency, minimize errors and ensure revenue integrity. Deploying automation can streamline coding and billing processes, reduce claim denials and bring downstream processes closer to the patient encounter, improving patient and provider satisfaction.
Automation in the Middle Revenue Cycle
Automation finds prime application in middle-cycle RCM functions such as:
- Autonomous coding and direct-to-bill.
- Coding services
- Claims status checks.
- Automated case finding.
These automated capabilities provide coders and clinical documentation improvement teams with the tools needed to maximize success and maintain a distinct advantage, all while addressing costs without compromising care.
Back-End Revenue Cycle Management
Back-end revenue cycle management is a vital component of healthcare operations that directly impacts the financial health and operational efficiency of healthcare providers. However, many organizations face challenges in this phase, including limited automation, operational constraints, financial management issues and staffing challenges.
By implementing automation solutions, providers can streamline processes, reduce errors and enhance overall revenue cycle performance. Automation enables efficient claims processing, accurate billing and timely reimbursement, leading to improved financial sustainability.
Automation in Back-End Revenue Cycle
Here are some areas prime for automation in the back-end revenue cycle:
- Personalized outreach.
- Utilization review.
- Automated appeals.
- Contract management tools.
Utilization review solutions focus clinician attention on cases that require it most, freeing up time for other patient-focused responsibilities. Automated appeals processes help identify and rectify errors, such as missing patient information or incorrect coding, ensuring accurate and timely claims submission. Personalized outreach supports patient billing and follow-up to ensure seamless communication and timely payments. Contract management tools analyze anticipated payments and contracted rates, identifying potential underpayments and ensuring appropriate revenue.
The future of RCM is here and it's powered by automation. With the right tools, healthcare providers can redefine operations and create a stronger foundation from which to move forward.
Ralph Wankier is vice president, Product Management for Providers, Optum
A Premier Corporate Partner of ACHE, Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. For more information, visit ache.org/Optum.