DATA, ANALYTICS & AUTOMATION for better healthcare

Improving Patient and Employee Experience with Revenue Cycle Management Automation

Revenue cycle management (RCM) is a critical component of the healthcare industry, directly impacting both patient care delivery and financial operations. As such, organizations are under increasing pressure to improve the efficiency of processes within the cycle. In 2022, the efforts to counteract cycle congestion were valued at more than $140 billion in the United States with a compound annual growth rate of 12.5%. Dollars are being spent; technology is being sold—but many organizations have yet to realize the full financial benefits attainable from implementing technological solutions.

Much of the frustration about employing technology to solve revenue cycle issues arises from confusion about what types of solutions will provide the most benefit and where to start. Automation is an easy answer to the first part of the question. There are endless processes within the revenue cycle that rely on manual labor, which can easily be automated freeing up time for direct patient care and service. On the other hand, deciding which processes would benefit the most from automation is a far more overwhelming undertaking.
Many providers struggle with automation implementation because it is difficult to determine where to target limited budgetary resources to receive the most benefit. Here are a few areas where every organization can benefit from intelligent automation (IA).

Front of the cycle – creating better patient engagement

Insurance Verification:

Automate the time-consuming administration required before a patient even steps into the exam room, including insurance verification, covered services, and the scope of the patient’s financial responsibility. Automating these tasks frees employees to foster a better, personal experience when registering patients, all while speeding up the transition to active patient care.
Once the registration clerk collects the required information from the patient, intelligent automation can take over to send the information for verification via an online portal or through the electronic health record (EHR). The bot is then able to verify the policy status, check deductible information, confirm authorization requirements and benefits cap, and identify any restrictions. Following the automated entry of the verification into the patient’s file, the registration clerk can then communicate the crucial factors to the patient while the authorization process is initiated by the intelligent automation.

Middle of the cycle – improving patient and clinician experience

Clinical Documentation:

Doctors spend between 34% and 55% of their workday creating notes and reviewing medical records, which deprives them of valuable time they could spend on direct patient care. By leveraging IA, doctors can automate many of the time-consuming tasks involved in clinical documentation. Bots can collect relevant information on EHRs, assist with coding, input data into charts and forms, and review documents for errors. Automation not only improves the efficiency of clinical workflows but empowers doctors to deliver more personalized and compassionate care to their patients.


RCM processes where intelligent automation can help

End of cycle –complete the cycle with a satisfied patient

Third-Party Follow-Up:

After providers submit claims to payer organizations, follow-up is essential to track the status of the claims and resolve any issues that may arise. Claims specialists reach out by phone and email to verify claims receipt, check for discrepancies, and address denials. Insurance billing is complex, and manually conducting follow-up requires careful attention to detail and considerable time.

By leveraging intelligent automation, healthcare organizations can streamline many of the repetitive tasks associated with follow-up. Automated systems can track claims in real-time and flag any issue for immediate attention. With the addition of AI, these systems can also use historical data to predict potential denials. By improving the flow of communication between providers and payers and reducing the administrative burden, automation improves overall efficiency in the final stages of the revenue cycle.

Interested in understanding which revenue cycle processes in your organization are ripe for automation? Our Blueprint process can help you get started. Contact one of our team members.

Visit more of our site to learn what to expect from a Blueprint.