How next-generation automation technology can improve healthcare revenue management – Natural Self Esteem

Today, almost every role in every industry faces some level of disruption. We are tasked with doing more with less – less time, fewer resources, less information and often less support. No industry has experienced this more than healthcare. Healthcare workers, from physicians to administrative coordinators, feel the pressure to simultaneously improve outcomes and patient experiences, reduce operational costs, and increase billings.

While not the primary focus, revenue cycle management is an important component in any healthcare system that strongly impacts all three of these goals – and where administrative and clinical workflows are intertwined.

According to the Healthcare Financial Management Association (HFMA), revenue cycle management encompasses all administrative and clinical functions that help capture, manage, and collect revenue from patient services. Not surprisingly, the revenue cycle is incredibly complex due to changing payer demands, constant regulatory compliance and coding updates, and emerging and evolving payment models. Multiple touchpoints and stakeholders create complexity that goes beyond just tracking revenue streams through an organization.

This complexity is costly. Data from the 2021 CAQH Index, which tracks the adoption of fully electronic administrative transactions by healthcare plans and providers, found that of the $391 billion spent on administrative complexity in the US healthcare system, $42 billion spent on administrative transactions. It has been estimated that the industry could save $20 billion on these transaction costs by moving to fully electronic transactions. There are clearly opportunities to accelerate sales, streamline processes, and make the sales cycle more efficient and resilient.

How we got here: The cycle and its challenges

There is always more to revenue cycle management than meets the eye.

The cycle begins in the front office, which handles patient scheduling, insurance eligibility, and treatment approval. The middle office then owns the clinical activities and is responsible for the flow of patient data from the front to back office, including diagnostic activities, laboratory services, medical treatments, clinical records, medical coding and more. Finally, the back office handles claims, denials, collections, and medical billing that occurs after patient care is completed and medical reports and claims are submitted.

The entire workflow relies on dozens of systems, hundreds of processes, and a competing mix of stakeholders in an already flooded ecosystem. Inefficient processes and errors are the inevitable side effects.

While some companies have made great strides in their digital transformation efforts to meet these challenges, many have not — and they still have to perform tedious, repetitive, manual, and error-prone processes throughout the workflow. Additionally, according to the Medical Group Management Association, inefficient processes throughout the drug delivery cycle cost healthcare practices in this country billions of dollars each year

Where we’re going: Intelligent automation gets you there

Healthcare organizations looking to streamline their revenue management need more visibility across all interconnected revenue cycle systems to understand where efficiencies can be introduced. However, collecting the sales cycle data needed for visibility is often a slow, manual, and resource-intensive process.

The good news is that robotic process automation (RPA) combined with AI technologies — often referred to as intelligent automation — have a proven ability to transform manual, mundane tasks into automated, consistent processes that are rapidly bringing benefits to many healthcare systems.

Intelligent automation creates software bots that can learn, mimic, and execute rules-based processes just as people would throughout the revenue management cycle. This allows healthcare organizations to automate the continuous collection of revenue cycle process data at scale across all systems, ultimately providing employees with the accurate, real-time visibility they need to improve revenue planning and management.

Not only does this help to optimize costs, but it also frees up valuable time for employees to focus on other, more meaningful tasks, such as: B. Improving patient care and saving lives. Healthcare organizations are taking note of these benefits – so much so that Gartner predicts that half of US healthcare providers will invest in RPA by 2023.

This is how it can look like in action:

  • Optimized, secure document management: A secure, accurate documentation process is paramount in healthcare, a highly regulated sector that handles sensitive data, including personally identifiable information (PII) and protected health information (PHI). RPA bots can keep records, such as a test result or an insurance claim, efficiently prepare and store while ensuring the accuracy and consistency of documentation. Human touches from PHI can be reduced.
  • Automated data collection and entry: Data collection within the healthcare ecosystem is non-stop, from a patient calling to schedule an appointment, to physicians entering notes into electronic medical records, to payers processing claims. When it comes to administrative data entry for tasks like billing and claims processing, it’s often a tedious, repetitive process. RPA technology can collect data from various entry points, curate it as needed, and automatically feed the data into systems of record. It is efficient, accurate and saves both time and resources.
  • Improved patient experience: RPA bots can help streamline interactions with patients, including managing and scheduling patient appointments—or even managing follow-up communications based on the patient’s treatment plan. The technology can serve as the first response to frequent, repetitive website requests. Patients benefit from fast, reliable responses, and staff reclaims time that can be used to improve the patient’s care experience.

By using modern solutions to streamline revenue cycle management, healthcare organizations are empowering their workforce to gain more insight into the revenue cycle, better manage revenue from end-to-end and address top priorities such as improving patient outcomes and experience, reducing operational costs and increasing to tackle billing. It’s a win on many fronts.

Photo: Olivier Le Moal, Getty Images

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