Today, nearly every role in every industry faces some level of disruption. Our mission is to achieve more with less time, less resources, less information, and often less support. No industry experiences this more than healthcare. From clinicians to administrative coordinators, healthcare workers are feeling the pressure to simultaneously improve patient outcomes and experiences, reduce operating costs and increase bills.
Although it’s not front and center, a major component in any healthcare system that has a major impact on all three goals — and where administrative and clinical workflows intertwine — is revenue cycle management.
According to the Healthcare Financial Management Association (HFMA), revenue cycle management includes all the administrative and clinical functions that help capture, manage, and collect revenue from patient services. Unsurprisingly, revenue cycles are complex due to changing payer requirements, ongoing regulatory compliance and coding updates, and emerging and evolving payment models. Many touchpoints and stakeholders create complexity beyond just tracking revenue streams across the organization.
This complexity is expensive.data from 2021 CAQH IndexTracking the adoption of fully electronic administrative transactions by health plans and providers found that of the $391 billion the U.S. healthcare system spends on administrative complexity, $42 billion is spent on administrative transactions. It is estimated that the industry could save $20 billion in transaction costs by transitioning to fully electronic transactions. Clearly, there is an opportunity to accelerate revenue, streamline processes and introduce greater efficiency and resiliency into the revenue cycle.
How We Got Here: Cycles and Their Challenges
When it comes to revenue cycle management, there is always more than meets the eye.
The cycle begins with the front desk, which handles patient scheduling, insurance eligibility, and treatment authorization. The middle office then owns the clinical activities and is responsible for the flow of patient data from the front office to the back office, including diagnostic activities, laboratory services, medical care, clinical records, medical coding, and more. Finally, claims, claim denials, collections, and medical bills are processed in the background, which occurs after patient care is completed and medical reports and claims are filed.
The entire workflow relies on dozens of systems, hundreds of processes, and combinations of stakeholders competing in an already overwhelmed ecosystem. Inefficient processes and mistakes are inevitable by-products.
While some organizations have made strides in their digital transformation efforts to help address these challenges, many have not — and they still find themselves having to go through tedious, repetitive, manual, error-prone processes throughout their workflow.More importantly, according to Medical Group Management AssociationInefficient processes across the revenue cycle cost healthcare practices in this country billions of dollars each year
Where are we going: where intelligent automation can take you
Healthcare organizations aiming to optimize revenue management need greater visibility across all interconnected revenue cycle systems to understand where efficiencies can be introduced. However, gathering the revenue cycle data required for visibility is often a slow, manual and resource-intensive process.
The good news is that robotic process automation (RPA) and AI technologies (often referred to as intelligent automation) have been proven to transform manual, mundane tasks into automated, consistent processes that quickly yield benefits for many healthcare systems.
Intelligent automation creates software bots that can learn, mimic and execute rules-based processes just as employees do throughout the revenue management cycle. This enables healthcare organizations to automate and continuously capture revenue cycle process data at scale across all systems, ultimately providing employees with the real-time, accurate visibility they need to improve revenue planning and management.
Not only does this help optimize costs, it also frees up staff to focus on other, more meaningful tasks, such as improving patient care and saving lives.Healthcare organizations are taking notice of the benefits—so much so Gartner forecast By 2023, half of US healthcare providers will invest in RPA.
Here’s how it actually works:
- Simplified, secure document management: Secure, accurate documentation processes are critical in healthcare, a highly regulated sector that handles sensitive data, including personally identifiable information (PII) and protected health information (PHI). RPA bots can efficiently prepare and store records, such as test results or insurance claims, while also ensuring document accuracy and consistency. The artifact of PHI can be reduced.
- Automatic data collection and entry: Data collection within the healthcare ecosystem is non-stop, from patients calling to schedule appointments to doctors entering notes in the EHR to payers processing claims. This is often a mind-numbingly repetitive process when it comes to administrative data entry for tasks such as billing and claims processing. RPA technology can collect data from various entry points, manage it as needed, and automatically enter the data into a system of record. It is efficient, accurate, and saves time and resources.
- Improve the patient experience: RPA bots can help streamline interactions with patients, including managing and scheduling patient appointments and even managing follow-up communications based on a patient’s treatment plan. The technology can serve as a first-line response to common, repetitive website queries. Patients benefit from a fast, reliable response, and staff save time to improve the patient care experience.
By leveraging modern solutions to optimize revenue cycle management, healthcare organizations are enabling their employees to gain greater visibility into revenue cycles, better manage revenue end-to-end, and address improved patient outcomes and experiences, lower operating costs, and increased billing wait for the primary task. This is a victory in many ways.
Photo: Olivier Le Moal, Getty Images
