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 Jeff Becker, Vice President, Portfolio Marketing, FinThrive
Last week, the Orange County Convention Center in Orlando turned into a central hub for information gathering for healthcare executives and professionals across the ecosystem, at HIMSS 2024. Among the large crowds, networking opportunities and endless exhibitors, a few key themes emerged, reshaping our view of the vital link between health and tech.
Cybersecurity: Shifting from Recovery to Proactive Prevention
The fallout from the healthcare cybersecurity crisis was top of mind among attendees. With the announcement that systems are expected to be restored this month, conversations have started to move beyond recovery toward future prevention. Two prevailing themes stood out to me:
- Health systems are investigating options to establish redundant clearinghouse services to ensure they have a real-time failover option in the event something like this happens again in the future.
- There’s a need for payers to follow suit by establishing redundant clearinghouse services, moving away from exclusive payer gateway relationships.
Attendees from both payer and provider organizations were discussing pathways toward a more redundant infrastructure that would allow for a more seamless recovery in the future. Given the widespread impact this cybersecurity attack has had – for patients, payers, and providers - it’s imperative we learn from this as an industry and put the technology in place today to better prepare ourselves for potential events down the road.
AI Driving Better Outcomes and Unparalleled Innovation in Healthcare
2023 was a transformative year for AI in healthcare, with the arrival of Large Language Models (LLMs) and generative AI spurring innovative projects across the industry. As healthcare organizations respond, embracing more automation and AI into workflows, it’s no surprise the outcomes of this work was a popular discussion point at the event.
Current pioneering applications are streamlining medical professionals’ daily routines—a strategic choice given physicians are a crucial yet costly part of the healthcare team. Innovations include intuitive chart search capabilities tailored to the clinician's context, healthcare-trained chatbots adept at answering patient inquiries and systems that transcribe medical visits with precision.
In the revenue cycle management (RCM) landscape, we learned about advancements such as clinical documentation improvement (CDI) chart review support, automated coding functions, and the automated generation of authorization and appeals documentation.
Governance discussions also highlighted AI’s role in clinical operations and patient care. For example, Microsoft announced the launch of TRAIN, a new consortium of healthcare leaders focused on the ethical implementation of AI in patient care. It’s not just about what AI can achieve, but how it serves patients and clinicians.
As with all technology markets, AI is poised to meaningfully reshape the healthcare landscape in 2024.
RELATED: 3 Ways to Optimize Automation in Revenue Cycle Management
Deciphering Prior Authorizations: Seeking Intelligent Solutions
At the HIMSS conference, a key focus for both IT and financial leaders was enhancing automation in the prior authorization process. This emphasis is hardly surprising, as prior authorizations remain notably behind other healthcare sectors in adopting technological advancements.
The 2022 CAQH Index found only 28% of prior authorization transactions were fully electronic, compared to 97% of claims submissions and 75% of eligibility and benefits verifications, respectively.
Providers see prior authorizations as an area where significant gains can be made, especially considering older solutions have struggled to produce real value. As a result, there’s greater demand for newer solutions that offer greater intelligence and automation in prior authorization workflows.
In fact, FinThrive’s 2024 RCM Transformative Trends Report discovered that investing in a prior authorization solution is a top priority for more than 50% of healthcare finance executives this year.
At HIMSS, FinThrive launched Authorization Manager, which brings predictive analytics and automation to front office teams, helping to streamline each stage of the authorization process, from determination to submission to status monitoring and successful approval – driving significant time savings.
RELATED: Fixing Inefficient and Costly Prior Authorization: A Path to Modernization
As we look ahead to the rest of 2024 and beyond, I’m excited to be a part of this exciting time in our industry as we move towards a smarter healthcare model that prioritizes high-quality patient care and a better working environment for healthcare professionals everywhere.
See you next year in Las Vegas for HIMSS 2025!
About the Author
Jeff Becker
Vice President, Portfolio Marketing
Jeff Becker’s digital health background spans sales, marketing, product development, management consulting and industry analyst research. Becker has advised many of the largest technology firms in the world on their healthcare vertical growth strategy and has guided some of the largest payer and provider organizations on adoption of emerging technologies. He is a trusted healthcare technology expert quoted in the New York Times, Wall Street Journal, Newsweek, STAT, Modern Healthcare and others. Industry keynote speaker and regular HIMSS global conference presenter and panelist. Occasional guest on NPR Marketplace. Named a top contender among HHS Innovation Challenge competitors in the SDOH arena.
