How are revenue cycle leaders harnessing the power of automation?

As claim count, denial rates and the complexity of the overall revenue cycle continues to grow, so does the need for meaningful automation.

Innovative applications of automation was a headline topic at a recent HealthLeaders Rev Tech Exchange gathering. Bank of America hosted a discussion at the event with a small group of influential executives, focusing on the evolving ways healthcare leaders are harnessing the power of automation to reduce cost, mitigate risk and help navigate the payor-provider relationship. These executives echoed the concerns and the themes our Bank of America healthcare team has heard in the past year from clients around the country.

Automation adoption is accelerating rapidly

Bank of America’s Simon Abtalion, National Client Solution Executive for Global Commercial Banking, recently shared his observations.

Q: There is a lot of buzz around the concept of automation within the healthcare organization revenue cycle. What do you see happening in the field?

Currently we see automation being deployed for a variety of administrative tasks in healthcare, including document retrieval, letter and email writing and other routine tasks that can be addressed through the deployment of automation — freeing up staff for more strategic work. We all know that as the volume of denials from payer to provider has dramatically increased, staff workloads have also increased, while staffing levels generally have remained the same. These automated tools are one way to help healthcare organizations adapt to the extra work more efficiently, addressing the expanded workload without the expense of doubling or tripling staff.

Q: Where is the healthcare industry in terms of the adoption curve for automation tools?

At the HealthLeaders gathering, the reaction to intelligent automation was more skeptical and reserved, and the adoption rate was much lower. This year, the discussion was much different. That change parallels what our Bank of America team has seen unfolding across the country over the past year: Adoption is now accelerating rapidly; we’re in the steep upward phase of the S-curve. We’re seeing more organizations moving from evaluating technology to deploying it in limited cases. Although still limited in scope, most organizations now have dipped their toes in the water. And most have decided to start with those routine administrative tasks and data management.

What’s behind the shiſt? Again, faced with the pressure of expanding systems, higher claims volume, and rising denial rates but working with the same staffing levels, more and more healthcare organizations are exploring automation as a solution to these operational challenges. But in addition, many in the executive suite are apprehensive about being leſt behind by competitors; that also has spurred their interest in exploring possible applications for evolving technology. Although it’s great to see the industry moving forward, let’s acknowledge that this creates added stress for those who are trying to keep up with the cash posting and collection process. A revenue cycle leader is no longer solely focused on the bill-to-collect ratio nor the overall cost to collect/post, but rather now they must navigate the evolving technology landscape as a shopper and buyer. Making the best decisions for an organization will require a strong, interdisciplinary partnership between not only treasury, finance, revenue cycle and IT, but also procurement, which can provide guidance on the best ways to evaluate possible vendors and technology purchases.

On top of all this, organizations need to be mindful of and align resources to be compliant with the evolving legislative and regulatory landscape. It’s not just about managing new technology. It’s not just about managing payer-provider relationships and patient relationships. These investments also require ongoing tech upkeep and revenue cycle action.

Q: As the technology evolves, what is the next area — or areas — of application in healthcare organizations — and how do you assess the industry’s need and willingness to adopt?

There’s obviously more to come. There’s real potential to leverage technology to improve the claims approval process. That might include the application of real-time payments and possibly the use of blockchain.

Also consider that early automation in payment systems has generally been aimed at traditional sources—Medicare, Medicaid and employer-provided plans. Those traditional sources used to account for nearly all of an organization’s transactions. But nontraditional sources—the more manually processed segments of the payment process (such as Philanthropy, Grants, Retail & Specialized Pharmacy, Joint Ventures & Affiliations, and the emergence of “Pay-viders”)—have grown to represent an increasing segment of hospital revenues. As revenue cycle not only needs to connect to more payers, both government and private, but also take an omnichannel approach to nontraditional revenue streams—like collecting more from self-pay patients—they will be forced to automate in new ways.

Currently the U.S. healthcare system processes 3–4 billion claims annually. The percentage of claims that are initially denied has risen to 10%–15%, in large part because payers have deployed their own automated systems. If the industry can work to limit the overall number of healthcare transactions, reduce the back and forth of denials, we can ultimately remove costs from the system. And technology promises to be an important part of that.

Finally, as more healthcare organizations adopt intelligent automation solutions, having a partner with the connectivity and strategy to automate all payment processes—not just commercial insurance and government payments—will be paramount to achieving success with these powerful new tools.

Contact your Bank of America Healthcare representative to discuss these topics or ways we can help.