Revenue cycle leaders are feeling the heat from payers, leading them to pursue more and more technology.
Healthcare organizations are deep in the trenches of technology implementation of all types, and revenue cycle leaders are tasked with finding the best solutions for their organizations, along with managing and measuring performance.
However, with technology continuously evolving, many leaders are learning that yesterday’s investments may not be able to streamline today’s complex processes, especially when it comes to payers.
During the 2023 HealthLeaders RevTech Exchange held in Raleigh, North Carolina, three main pain points emerged: building versus buying tech, making tech work for you, and leveling the playing field with payers.
Build or buy?
With new developments and innovations in revenue cycle technology, many leaders voiced their struggles with finding solutions that are “forward thinking” and able to keep pace with complex processes.
For these reasons, some organizations have looked into creating their own technology in house, much like how Lynn Ansley, the VP of revenue cycle management at Moffitt Cancer Center, helped facilitate its in-house creation of a clinical trial workflow tool.
It’s not an easy lift, though. For those considering developing their own solutions, the lack of technological expertise within their organization holds them back.
If building your own technology in house is not an option, executives in one focus group agreed that determining what tasks can be automated should be the first step, followed by finding a partner who can develop the solution or has a platform with the capabilities an organization needs.
It is also important to take the patient experience into account and factor their needs into the decision making and development process. Having staff in present in settings like appointment check-ins and registration maintains patient’s relationship with their provider.
Making technology work for your organization
The strategy for digitalization must be clear, and that begins with examining the processes within your organization and workflow. The importance of defining the “why” (what is it your organization is trying to accomplish?) and recognizing current processes that may be broken was also emphasized.
One way of doing this is, as Savanah Arceneaux of Ochsner Health illustrated, by utilizing the different revenue cycle management features within your organization’s EHR.
In a presentation, the director of pre-service and financial clearance for the health system walked attendees through the benefits of stepping up its EHR utilization.
“Streamlining EHR data into revenue cycle processes improved patient experience with better patient-provider communication, workflow efficiency, and management of prior authorizations and billing processes,” Arceneaux said.
These efforts also reduced the administrative burden of revenue cycle processes through automation, as well as medical errors.
“If you have a broken process, then technology can’t help,” one leader said during a roundtable discussion.
As an organization’s digitization efforts progress, there needs to a way to measure the solution’s performance and results. There should also be controls in place to make sure that organizational knowledge and information remains the property of the organization. This way, if one solution or vendor doesn’t work, there won’t be as much trouble moving to another.
Many leaders agreed that the purpose of revenue cycle solutions should be to allow revenue cycle staff the bandwidth to perform other tasks. In doing so, leaders should be explaining to staff that they’re not being replaced, but that the nature of their work is changing and will allow them to grow their capabilities.
Keeping pace with payers
A common grievance amongst the leaders were the increasing difficulties combating payers and denials management. While revenue cycle technology is now commonplace, the executives said they’re still struggling to keep up with the technology of payers, for example AI algorithms that deny claims without review and emergency department downcoding.
According to Jonathan Benton, assistant vice president of Atrium Health, there’s one way to fight back: by beefing up your own automation.
Revenue cycle leaders should automate tasks to reduce work burden on people and prioritize processes to steadily speed up revenue cycle operations while reducing the cost-to-collect, Benton says.
Another way to fight payers, he says, is to automate processes across the business office to interact with other departments and with payers to resolve claims and optimize staff resources across revenue cycle.
While the payer/provider relationship isn’t likely to improve anytime soon, adding in automation to level the playing field is key.
“Streamlining EHR data into revenue cycle processes improved patient experience with better patient-provider communication, workflow efficiency, and management of prior authorizations and billing processes.”
Savanah Arceneaux, director of pre-service and financial clearance, Ochsner Health
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
Three main pain points emerged during the 2023 HealthLeaders RevTech Exchange: buying vs. building tech, making tech worker harder for your organization, and cracking down on payers.
Leaders voiced their struggles with finding solutions that can keep up with complex processes.