The health care industry needs revenue cycle reinvention.
Providers struggle balancing the need for change while navigating complex reimbursement rates and payment models. Staffing and resource allocation have become increasingly difficult, with labor shortages affecting 83%1 [AA1] of health care leaders across the revenue cycle. As cash flow sinks and costs rise, providers must reassess their approach to revenue cycle management. Read Optum’s e-book: 5 Provider Strategies to Help Improve Your Margins
To address these challenges, providers can leverage automation, technology-enabled solutions and improved collections to ensure they are achieving their revenue potential. Research suggests that implementing automation and analytics could reduce $200 billion to $360 billion2 [AA2] of spending in the U.S. health care system.
In this article, we will explore how incorporating automation and AI into end-to-end revenue cycle can help health systems overcome complex challenges.
Front-end revenue cycle management
Efficient front-end revenue cycle management is crucial for financial stability. However, health systems face challenges in achieving optimal performance. Operational strains, inadequate patient follow-up and limited technology adoption hinder front-end outcomes. And the fragmented nature of the front-end RCM process leads to negative patient experiences.
To enhance these experiences, health care providers should adopt an omnichannel approach to patient engagement, providing multiple modalities for accessing care, communication, and patient education. Unifying front-end services through a single suite of tools can help eliminate patient friction points and create a more efficient and seamless care journey.
By implementing these strategies, providers can improve front-end revenue cycle management, enhance the patient experience, and achieve financial stability.
Automation in the front-end revenue cycle
Integrating automation and technology-enabled solutions into the revenue cycle management process puts patients at the center. The goal is to create an efficient and effective end-to-end patient experience, including the ability to shop for care, understand costs upfront and access self-service digital tools. Automation improves the efficiency and self-service functionality of these tools, while AI collects and analyzes data to help consumers and providers make informed decisions.
Automation has the potential to revolutionize how your front-end revenue cycle operates. Following are the areas prime for automation:
- Patient chatbots/registration robots
- Appointment scheduling
- Prior authorization ID and submission
- Eligibility and enrollment tools
- Price transparency and estimation
- Proactive patient outreach
- Contact center automation
Middle revenue cycle management
The top 3 reasons for an increase in claims denials were insufficient data analytics, lack of automation in the claims and denials process, and a lack of thorough training. But health system leaders remain skeptical about investing in technology as previous projects have not always yielded the expected results. Contributing factors include labor shortages, high denial rates, complex claims, unstructured data and vendor management fatigue.
To lay the groundwork for successful middle-cycle revenue operations, it's important to enable staff efficiency, minimize errors and ensure revenue integrity. Deploying automation can streamline billing and coding processes, reduce claim denials and bring downstream processes closer to the patient encounter, improving patient and provider satisfaction.
Automation in the middle of the revenue cycle
Automation finds prime application in middle-cycle RCM functions such as:
- Autonomous coding and direct-to-bill
- Accelerate operations with claims status checks
- Automated case finding
- Reduce denials
- Coding services
These automated capabilities provide coders and CDI teams with the tools needed to maximize success and address costs without compromising care.
Back-end revenue cycle management
Back-end revenue cycle management is a vital component of health care operations that directly impacts the financial health and operational efficiency of health care providers. However, many organizations are challenged with limited automation, operational constraints, and financial management issues.
By implementing automation, providers can streamline processes, reduce errors and improve overall revenue cycle performance. Automation enables efficient claims processing, accurate billing and timely reimbursement, leading to improved financial sustainability.
Automation in back-end revenue cycle
Following are the areas prime for automation in the back-end revenue cycle:
- Automated appeals
- Contract management tools
- Utilization review
- Personalized outreach
Automated appeals processes identify and rectify errors, such as missing patient information or incorrect coding, ensuring accurate and timely claims submission. Contract management tools analyze anticipated payments and contracted rates, identifying potential underpayments and improving revenue. Utilization review solutions focus clinician attention on cases that require it most, freeing up time for other patient-focused responsibilities.
Transform your RCM journey with automation
The future of RCM is here, and it's powered by automation. With the right tools, you can redefine health care operations and create a stronger foundation from which to move forward.
Optum, a leader in revenue cycle management, offers comprehensive solutions and partnerships to address the challenges faced by health care providers. With a focus on automation and technology-enabled services, Optum aims to decrease costs, unlock growth, and enhance the patient experience.
Ralph Wankier is Vice President, Product Management for Providers at Optum