Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
By Jonathan Wiik, Vice President, Health Insights, FinThrive
As a long-time attendee of the annual Becker’s Health IT, Digital Health and Revenue Cycle Management conference, it was a great experience spending time at this year’s show in Chicago – one of my favorite cities.
This show is a not-to-miss conference every year, and I attended more than a dozen sessions throughout the four days – here are some of my biggest insights and takeaways.
Dual Nature of Healthcare Technology
A reoccurring theme throughout the conference was the dual nature of technology in healthcare. On one hand, technology aids by recording, automating and analyzing data. Telemedicine, for instance, has efficiently and effectively reached rural regions.
Conversely, technology can also impede efficiency. For example, in electronic health records (EHR), medical staff are spending more time entering clinical data and less time with patients. In the keynote session, Scott Becker, the founder of Becker’s Healthcare, led a panel discussion which explored the topic of “click fatigue,” analytics, workforce and the role of technology.
The solution to this issue was presented in the form of ambient coding. In my opinion, this could be a game changer for physicians. It transcribes words while one makes their point, identifies gaps and prompts for the required proof before final submission. As this technology evolves and integrates more precisely, medical staff can refocus their attention to patient care rather than documentation. In my opinion, this could be a game changer for physicians.
The Relevance of AI and Need for Efficiency in Healthcare
The conference also touched upon the role of AI in healthcare, documentation accuracy, avoidance of errors and maximizing revenue. Generative AI currently holds the focus of their organizations, specifically in clinical applications. Early detection of diseases like cancer becomes more efficient and accurate with Generative AI's assistance.
In addition, healthcare leaders emphasized the need for scalability in technology, the inevitability of competition and the importance of evolution for vendors. The panel stated, “we are masters of multitasking in healthcare…and that is the problem.”
There’s also the need to focus on one thing and complete it well, primarily for the patient. Technology can greatly help here by automating the mundane tasks, especially in RCM to where the team can focus on more complex tasks and interactions and not get distracted. The panelists concluded that there is a need to standardize technology, accelerate its adoption and apply it to achieve better outcomes, clinically and financially.
RELATED: 2024 RCM Transformative Trends Report
Additional Conference Insights
The conference continued with informative sessions on AI, cybersecurity, RCM optimization and digital engagement. One keynote speaker, Dr. Rohit Chandra, Chief Digital Officer at Cleveland Clinic, underscored the importance of understanding AI and partnering with technology vendors to get the information they need.
“We need to have discernment and someone to weed through what is real and what is not,” stated Dr. Chandra.
He also emphasized that when selecting the right partners for tech for the big problems, you need deep engagement with the partner. Dr. Chandra added that redesign with a tech-first mindset is critical, and having an outcome focused approach is not trivial, “The mousetrap is the easy part, the change management is the hard part.”
Shifting focus to patients, Dr. Chandra underscored the potential of technology to improve the patient experience but recognized the current system's shortcomings, describing it as a “painful journey, full of friction.” While Dr. Chandra is unsure of how long it will take for the industry to overcome these issues, it’s an area he plans to focus on greatly over the next year.
RELATED: The Healthcare Finance Leader’s Guide to Improving the Patient Experience
Several other sessions covered areas of denials, coding accuracy, automating RCM tasks and more. With the payers outgunning providers from a tech standpoint, many of the presentations highlighted the critical need to invest in technology to keep pace with the rules. Payer relations is always an opportunity, as relationships are still fragile between provider and payer on many fronts.
Furthermore, many of the sessions pointed out that RCM is ripe for automation, and AI, RPA and ML are the paths to get there. Specific use cases in claim attachments, authorization procurement, reconciling credit balances, and many others were highlighted. Many of the sessions also focused on the front end of RCM – patient access – as an area of the great need for automation. This area is high volume, high data and high labor, and could greatly benefit with innovation to remove the friction of patient entry and financial clearance.
RELATED: Patient Access Software Buyer’s Guide
For many years RCM (and hospitals in general) have been reticent to adopt technology, especially AI. That tide has changed, and it was apparent this year at Beckers. Healthcare has jumped in with both feet – we have to – the time has come to advance the healthcare economy through technology and automation.
Cybersecurity in Healthcare: A Crucial Consideration
Cybersecurity emerged as a key theme at the conference, owing to recent developments. The sessions elaborated on the need for rigorous vetting of all business partners, compliance to certifications like SOC2 and HITrust, and the importance of monitoring data usage.
The necessity for contingency strategies and secondary systems to minimize operational disruptions was discussed at length, specifically in the areas of claims management and eligibility. Having a back-up claims clearinghouse was not something that was ever considered a year ago, but now it’s in strategic plans. Healthcare leaders shared that these investments are an integral component of ensuring financials and patient care are not negatively impacted.
RELATED: [Guide] The Key to Effective Healthcare Cyber Resilience
Roundtable on FinThrive’s Revenue Cycle Technology Adoption Model
Finally, FinThrive hosted an Executive Roundtable discussing the Revenue Cycle Technology Adoption Model (RCMTAM). This strategic alliance between HFMA and FinThrive aimed at developing an understanding of organizational stages in RCM maturity. Miguel Vigo IV, CRO from UC San Diego shared the stage with Evan Goad, FinThrive’s Chief Customer and Strategy Officer, to highlight how this model has been used and some of the benefits of completing the assessment.
If you’re interested in taking the assessment for your organization, click here (Pro tip: it’s free and only takes an hour).
It was a whirlwind week full of insights (it would take pages to share it all)! The conference delivered as it does every year, and I encourage you to take the time to make it next October.
In the meantime, if you would like my detailed notes, or want to chat about all things revenue cycle, reach out to me at jonathan.wiik@finthrive.com or connect with me on LinkedIn.
Have a great rest of the year and until next time, be well.
About the Author
Jonathan G. Wiik, MHA, MBA, FHFMA
Vice President, Health Insights
Jonathan Wiik, VP of Health Insights at FinThrive, has over 25 years of healthcare experience in acute care, health IT and insurance settings. He started his career as a hospital transporter and served in clinical operations, patient access, billing, case management and many other roles at a large not-for-profit acute care hospital and prominent commercial payer before serving as Chief Revenue Officer. Wiik works closely with the market and hospitals on industry best practices for revenue management. He is considered an expert in the industry for healthcare finance, legislation, revenue management and strategic transformation.
