Did you know 80 to 90 percent of active claims require no immediate follow-up? Then why is your staff wasting time on them?
Increasingly complex revenue cycles with blind spots and inadequate revenue intelligence are preventing health systems from optimizing their operations and slowing down their revenue cycles.
COVID-19-driven changes in business dynamics and the healthcare environment have only intensified the need for precise and efficient revenue cycles as organizations face more and more intense pressure to manage financial margins. With more than half of healthcare admins reporting erratic and unpredictable volume, health systems are now looking to reduce cost and operational redundancies to protect and reinforce their revenue stream. In a recent survey on primary revenue challenges by Forbes, responders have identified three main targets:
- Reduce their cost to collect
- Optimize net revenue
- Improve the patient financial experiences
As the healthcare industry expands, its revenue cycle has also grown more complex and become more critical. Efficient revenue cycle management is now the foundation of predictable cash flow and competitive advantage.
Opportunities to streamline complex workflows
The majority of waste and redundancies in revenue cycle management comes from lack of visibility, human errors, and overall scalability of processes and systems. Back to our example at the beginning of this article: why do your staffs fail to prioritize claim follow-ups? The answer is in manual claim status inquiry. Human resources are limited, and just the process of identifying priority is time-consuming and labor-intensive. Many organizations are starting to use bots instead of humans to speed up and increase accuracy in this process.
Claim status inquiry is not the only process that can benefit from automation. Each of the stages in revenue cycles, from prior authorization to claim preparation, submissions and collection, depends on the accuracy and efficiency of the previous steps. Quick cash flow, as a result, can only be achieved through optimizing the entire process. This opens up the opportunity to implement automation at a large scale to leap in efficiency.
According to a survey by the Healthcare Financial Management Association’s (HFMA) Pulse Survey program, 78% of participants, or 400 chief financial officers and revenue cycle leaders at major health systems in the U.S., shared that they plan or are in the process of implementing automation in their revenue cycle operations. That number saw a 12% increase from 2020, signaling a solid sense of urgency toward digital transformation in healthcare finance. 37% of organizations that were not using automation planned to do so this year or sometime in 2022.
Revenue cycle automation solutions can be deployed quickly and with minimal disruptions to the existing infrastructure. Instead of identifying multiple small, isolated use cases and implementing one solution at a time, healthcare leaders should consider a more ambitious plan and a larger scope of automation. This will allow organizations to capitalize on the cost of deployment, setup and maintenance. The goal is to innovate the entire functions with end-to-end automation and drive giant efficiency leaps.
Benefits of revenue cycle management automation
Revenue cycle automation can increase revenue, decrease denials, speed up prior authorization and claims, and remove repetitive clicks that hinder daily operations. With robotic process automation, health systems can have more seamless execution of administrative actions, appointment management, billing and enrollment, and data management.
When done right, the ROI is tangible and significant.
- Claim Status Inquiry: $11.71 in savings per transaction
- Prior Authorization: $9.64 in savings per transaction
- Eligibility and Benefit Verification $8.64 in savings per transaction
Some of the top candidates for automation in healthcare with strong and quick ROI include:
- Eligibility verification and benefit determination
- Prior Authorization Automation
- Charge entry automation
- Payment posting and AR management
- Claims Denials
- Patient communications
Want to learn how to identify your top processes with high automation ROI and how to jumpstart your automation project?
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