8 Tips for Effective Revenue Cycle Technology Management

As the HealthLeaders 2024 RevTech Exchange kicked into action this week in Nashville, executives from dozens of health systems discussed how they're managing new technology like AI

Today's revenue cycle management leaders need to be agile. The healthcare industry is going through a significant period of change, buffeted by costs and quality concerns and workforce shortages and buffered by new technologies like AI. That's a challenging environment for any leader to navigate.

Roughly 40 RCM leaders from health systems across the country gathered in Nashville this week at the HealthLeaders 2024 RevTech Exchange to talk about those challenges and opportunities.

Here are a few key plot points from the first day of the Exchange:

Train, train, and train some more. And don't stop training. Due in large part to the advances in automation and the potential of AI, the revenue cycle workforce is evolving. Managers need to develop a strategy that prepares staff for that evolution. They need to address that worry that AI is taking people's jobs by pointing out that jobs aren't disappearing, but they are changing. RCM staff will become monitors, overseers and auditors, keeping a close eye on the technology that is doing all the manual tasks they used to do.

And that training won't stop. A key element of generative and predictive AI is that it keeps on learning, and RCM staff will need to keep on learning alongside those tools.

That goes for leaders as well. New technologies like AI are new to everyone, including those in the C-Suite. Healthcare leaders need to have a clear understanding not only of these new opportunities, but how they'll affect staff and workflows. Be ready to talk to people who are worried that AI will replace them, as well as staff who are perhaps a bit too eager to try something new.

Technology isn't the answer. "We look at technology like it's going to solve all our problems," says Derek Dudley, VP of Revenue Cycle Operations at Tidelands Health. "But a $200 hammer isn't going to make you a better carpenter."

As with clinicians, RCM managers need to understand that technology is a tool that will help them become better, but it won't solve all the pressing problems of healthcare on its own. Managers and staff need to understand how to use those tools to improve rev cycle performance.

For example, Beth Carlson, VP of Revenue Cycle at the West Virginia University Health System (WVU Medicine), noted her health system developed a tool to predict denials from a certain payer. The tool was wildly successful—but it was scrapped, because the denials were still happening. In other words, they'd created a great tool, but it didn't have any value.

Look for proactive solutions. Taking the WVU Medicine example one step further, what the health system needed was a tool that would identify the root causes of those denials, and develop a strategy for preventing denials in the first place.

Several health system executives at the Exchange emphasized the need to develop new tools and programs that tackle key pain points in RCM, such as denials, appeals and prior authorization hangups, before they happen. The appeal of AI lies in gathering all the data at hand and predicting when those issues occur, then using that data to plot the best way to avoid them.

Collaborate with IT and especially clinicians. Revenue cycle departments shouldn't exist in their own silos, and yet they sometimes think they do. Because of this, and because many of the sexy new AI tools address clinical care, RCM staff may be feeling a bit inferior to their medical counterparts.

That's a load of baloney. Successful health systems and hospitals thrive on collaboration, and it's important that executives look for those opportunities to collaborate on new tech and programs. Lynn Ansley, VP of Revenue Cycle Management at the Moffitt Cancer Center, said revenue cycle leaders should even go on rounds with clinicians to understand their workflows and see where RCM technology intersects.

In fact, revenue cycle managers should even find clinician champions, much like CIOs and CNOs will do to support the rollout of new clinical technology. Having clinician support and have clinicians understand how RCM technology benefits their workflows will go a long way toward establishing that elusive ROI.

Find that elusive ROI. This is the biggest challenge in healthcare technology today. New tools like AI may look great and even produce amazing results in pilots, but they need to prove long-term value, and that hasn't been easy so far. With health systems and hospitals on razor-thin margins and reluctant to spend money on new ideas (especially something as pricey as AI), there has to be a proven ROI attached.

Balance established tech with new tech. Many healthcare organizations don't have the resources to develop new technology like AI, so they outsource, looking for a company with a good background and product or even a startup that they support. On the other hand, EHR companies are developing their own tools that integrate into the medical record. Is it better to wait for that tool or spend money on an outsourced product that may have to be bolted onto the EHR?

It's not an easy question to answer. Some Exchange participants said they don't want to wait for their EHR provider to develop a tool they need now and are willing to look for help. Others are against bolted-on functionality and are willing to wait. And then there are those who would consider buying a new tool or capability and then switching over when the EHR provider comes along with that tool.

Look at RCM from the outside. Many of the new ideas coming into healthcare have proven themselves in other industries, like retail, banking and travel. And while the healthcare sandbox is a difficult place in which to play with new concepts, savvy leaders will look for ways to adopt them and adapt to the changes. Part of that process includes understanding how these ideas worked in other industries and learning how they might fit in.

Beyond that, RCM leaders also need to look at their departments from the perspective of other parts of the healthcare ecosystem. How does IT see the RCM process? How do doctors and nurses view those operations? This is particularly important when developing a culture of collaboration.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page. 

To inquire about attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.