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Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
The current state of healthcare is incredibly costly for providers, payers, and patients. In 2020, hospitals lost $42.7 billion to uncompensated care. They spent $500B on administrative costs, $395B on waste, and $90B on inflated pricing. Payment cycle times exceeded 120 days, driving up costs to collect, and the average family spent $3,000 annually on out-of-pocket costs. 1
The challenges seem to come from every direction. Healthcare providers face shrinking margins as labor and medical supply costs continue to climb unchecked. The payer mix complicates the financial outlook for health systems, with many patients shifting from commercial insurance to Medicare or Medicaid. Over 30 million people remain uninsured altogether due to changes in employment and household income.
Taken together, these issues demand a new approach to revenue cycle management. Providers must embrace innovative, automated technology that combines human knowledge with artificial intelligence (AI) and robotic process automation (RPA). From automated prior authorizations to AI-enabled medical coding to predictive denials management, autonomous revenue cycle technology can make a big impact on the repetitive and error-prone processes that drive production across today’s revenue cycle – and unlock real value in the process.
How autonomous workflows streamline processes across the revenue cycle
Health system leaders are eyeing automation opportunities spanning the full revenue cycle. Front office patient access use cases are capturing the lion’s share of interest, but demand for mid-cycle and back-office automation aren’t far behind. For example:
- Front office automation focuses on cultivating self-service patients.
Health systems are reducing front office administrative workloads by empowering patients with robust self-service tools. Relatively low complexity automation strategies shift basic tasks like appointment rescheduling, insurance verification and payment estimation away from the front desk and into the hands of patients. -
Mid-cycle automation is home to the most comprehensive AI plays in revenue cycle.
Ambient clinical intelligence technology brings natural language understanding (NLU) algorithms to the task of clinical documentation, reducing the need for clinicians to manually enter visit notes. AI-enabled medical coding technology applies pattern-matching algorithms to those notes to code visits with limited human intervention. - Back-office automation tackles denials head-on.
Automation is evolving beyond claims status checking. Predictive models are being deployed in the claims space to forecast denial probability and kick off secondary reviews. AI can identify the root cause of denials, and bots are being deployed to automate the appeals submission and status checking process.
The proven value of autonomous revenue cycle technology
Embracing automation across the revenue cycle delivers meaningful value for providers, their staff, and their patients. When organizations automate revenue cycle processes, they achieve benefits like:
- Reduced costs.
A shortened revenue cycle means reduced costs for all stakeholders. It means quicker payments to healthcare providers and reduced administrative burden for providers and payers. - Enhanced care.
Successful implementation of an autonomous revenue cycle will result in faster access to care for patients and more time for healthcare colleagues to focus on their primary mission—to improve patient health and enhance the patient experience. - A simpler, more user-friendly healthcare system for patients.
An autonomous revenue cycle will create a simpler, faster healthcare system for patients to navigate, with self-service scheduling, good faith price estimates, and digital payment options. - Increased satisfaction for providers and their staff.
An autonomous revenue cycle allows human talent to work on more impactful endeavors. This enables physicians to spend more time with patients and healthcare workers to be more engaged in their jobs.
An innovative, end-to-end approach to revenue management
Realizing these benefits requires more than point products designed to tackle one piece of a very complex puzzle. Modern revenue management must not only be automated, but integrated to deliver on its full potential.
That’s why FinThrive offers a single, centralized, end-to-end platform that irons out the kinks across the cycle, allowing cash to flow freely between payers, patients and providers. Our end-to-end revenue management platform delivers a smarter, smoother revenue experience that increases revenue, reduces costs, expands cash collections, and ensures regulatory compliance. We’ve delivered over $7.6 billion in net revenue and cash to more than 3,245 customers worldwide, and we’re committed to our mission of transforming revenue management.
Read the full guide on how end-to-end autonomous revenue cycle management from FinThrive helps organizations confidently move toward profitability. Or if you are ready to speak to us now, contact FinThrive today!
Source:
1. https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncompensated-hospital-care-cost
