Revenue Cycle Automation

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Digital transformation efforts in healthcare are driving the demand for automation in revenue cycle operations, especially as organizations seek to efficiently capture revenue while lowering their cost to collect. Shifting business dynamics driven by the COVID-19 pandemic in 2020 have only intensified the need for automation as organizations face massive financial pressures while abruptly transitioning their teams to remote work. Social distancing practices have also made the ability to deploy new technology quickly and entirely remotely essential.

The scale and scope of healthcare in the U.S. means automation tools have to handle massive complexity and constant change. Over the past two decades revenue cycle leaders have been forced to cobble together a patchwork of solutions that often don’t integrate with one another and only automate a portion of revenue cycle processes. This leaves providers stuck with a trail of broken connections and blown budgets.

Regardless of the automation solution an organization may choose, automating revenue cycle operations generally follows the same three-step process:

First, existing workflows and processes are documented. This is traditionally done by having an army of consultants shadow staff. This can be massively disruptive, and yet, only capture a fraction of the work handled by revenue cycle staff. This is typically followed by a lengthy, time consuming, and expensive assessment that may or may not lay out a plan that aligns with the health system’s strategic initiatives.

Second, develop or program the technology that will automate some of the work.

Finally, the technology is deployed and some process for maintaining the automation must be implemented. Forward-thinking revenue cycle leaders should consider the cost implications of all three steps when selecting the best automation solution for their organization.

When applying automation to revenue cycle operations, its imperative to take a practical approach in the short term. Start with a clearly defined area that also minimizes the need for change management. Work with solution providers to identify specific areas of opportunity within your own operations.

Make time to work with your solution providers to identify near-term goals and map how they advance your longer-term objectives. This is an important step toward ensuring your automation strategy delivers effective performance at lower costs over the long term.

Revenue cycle leaders should prioritize these four areas for automation in order to achieve the greatest efficiencies as quickly as possible:

Eligibility: Leverage automation to check eligibility on the front and back end of the revenue cycle. This will prevent denials and reduce rework out of the business office.

Prior Authorization: Identify authorization requirements, initiate authorization via payer websites, and check authorization status to ensure your patients are supported by their third-party insurance coverage to receive their care with full reimbursement. Today, authorizations are one of the leading causes of denials; this will prevent denials and reduce back-end work associated with denials appeals.

Denials Management: use automation to flag denials and free up your team to tackle more meaningful, higher revenue-generating activities. This should decrease your overall write-offs rate and increase your collections.

These areas will be the biggest drivers in lowering the cost to collect and will ultimately serve as a foundation for automating additional areas of the revenue cycle.

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