Will the vendor hold itself accountable if their solution makes a mistake?
It’s important to read the terms and conditions of any contract, and with RCM partnerships the stakes are that much higher. Seth Katz, vice president of revenue cycle and health information management for University Health KC recommended three questions that RCM executives should ask when considering a vendor partnership.
What’s the cost of maintenance?
RCM partnerships require a significant investment, so it’s important to consider future costs and staffing needs before signing on the dotted line.
“When considering automation, such as using RPA (robotic process automation) bots within your EMR or RCM platforms, it’s crucial to account for the additional licensing costs that may arise,” Katz said. “These bots require access to your core systems, which can increase your license counts and lead to significant cost implications.”
In addition to licensing, executives should consider the maintenance costs for smaller changes, like system updates. They should evaluate the full scope of costs, including support and maintenance for AI solutions.
“Without careful consideration, the cumulative costs—both up front and recurring—could easily outweigh the benefits,” Katz said. “Making it critical to thoroughly assess the financial impact as part of you decision-making process.”
Does the vendor have experience working with your organization’s core RCM platform?
In the revtech space, Katz explained that it’s good to be early but not first.
“Healthcare systems are inherently fragmented, often relying on a complex web of interfaces to keep data connected and synchronized,” he said. “The objective should be to move beyond mere integration and aim for solutions that are fully embedded within your core EMR or RCM platforms.”
In doing so, organizations can minimize the need to manage multiple data feeds and eliminate the inefficiencies of switching between different systems.
How will the vendor be held accountable?
AI and machine learning solutions are programmed to mimic human behaviors and complete complex tasks by picking up on patterns in data. But what happens if the solution makes a mistake? How hard is it to correct that mistake?
“In coding, for example, we only expect humans to be right 95% of the time, but if your AI coding vendor’s work leads to more and more denials, [the vendor] needs to be part of that conversation,” Katz said. “They need to take some level of ownership for what’s happening the same way a frontline coder would eventually have to take accountability.”
There’s also the question of how long it will take to get the solution back up and running. Business continuity plans have grown in importance as cyberattacks have become more prevalent, capable of shuttering revenue cycle operations for weeks at a time.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Finance and AI Mastermind series features ideas, solutions, and insights on the current capabilities and future potential of RCM solutions in revenue cycle operations.
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Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
Executives should consider additional recurring maintenance costs in addition to the upfront cost in their decision making.
Look for vendors that have experience working with your organization's EMR or RCM platforms.
Vendors should be willing to take accountability any mistakes their solutions may make.