7 Use Cases of Automating Revenue Cycle Management (RCM)

7 Use Cases of Automating Revenue Cycle Management (RCM)

Like many others, the healthcare industry found itself thrust into a whirlwind of change as the pandemic swept across the globe. Amid these challenges, revenue cycle management automation emerged as a beacon of hope. Technological advancements, driven by the relentless march of artificial intelligence and machine learning, have infused new life into healthcare practices. The allure of increased productivity and cost reduction is a siren song that healthcare professionals eagerly heed. As the landscape evolves, revenue cycle automation emerges as a promising solution, offering a glimmer of optimism to achieve both efficiency and financial well-being.

What Is Automating Revenue Cycle Management (RCM)

Revenue Cycle Management (RCM) automation is a transformative solution that is changing modern healthcare's face. But what exactly is RCM automation, and how does it work its magic?

In simple terms, RCM automation is the art of streamlining healthcare financial processes through the power of automation. It takes the mundane, repetitive, and rule-driven tasks that often bog down healthcare administration and transforms them into efficient, time-saving operations. Here is what you need to know.

  • Streamlines Tasks: RCM automation simplifies and speeds up tasks, reducing the burden on healthcare staff.
  • Cuts Costs: It frees up human resources for strategic roles, saving on labor costs.
  • Identifies Opportunities: RCM automation pinpoints inefficiencies, helping you increase revenue and optimize operations.
  • Speeds Things Up: Tasks are completed faster, reducing patient waiting times.
  • Enhances Patient Experience: Quick billing and smoother financial interactions increase satisfaction.

RCM automation is versatile, fitting the needs of both small clinics and large healthcare systems. It's essential for operational excellence and top-notch patient care in the evolving healthcare landscape.

Automating healthcare revenue cycle management is undoubtedly appealing, but the real question is how to effectively implement it to tackle the everyday, monotonous RCM tasks that weigh down healthcare professionals. Let's delve into a few concrete strategies by which automation can revamp and elevate various steps within the revenue cycle and billing processes.

Validation of Eligibility and Patient Enrollment

When managing the financial side of healthcare, the initial steps of insurance eligibility verification and patient registration play a pivotal role in the revenue cycle. Healthcare facilities can reap significant rewards in terms of return on investment (ROI) by introducing automation into these processes.

Automating these processes is a wise investment because it lowers claim denials and improves cash flow. When claims are denied and resubmitted, it slows down reimbursement, increasing the time it takes to collect payments. However, with accurate benefits verification, you can ask patients to pay the correct amount upfront. This reduces patient balances and minimizes the need to send accounts to collections later. It's a win-win solution that keeps things running smoothly in the revenue cycle.

Estimates of Expenses and Additional Cost Projections

The No Surprises Act, which came into effect in 2022, represents a significant stride towards transparency in medical billing. While this development benefits patients by shedding light on their healthcare costs, it does introduce a notable administrative burden for many healthcare facilities and providers. Nevertheless, the silver lining is that this burden can be lightened considerably by automating tasks related to generating reasonable faith estimates and other cost assessments. What's more, this automation isn't just advantageous for patients; it also brings substantial benefits to healthcare providers.

By automating these processes, providers can enhance customer satisfaction, ensure more precise billing, and improve their revenue in the long run. Creating reasonable faith estimates manually can be quite a painstaking and time-consuming task. However, when you incorporate dedicated software into the process, it significantly eases the burden. This results in time and resource savings and simplifies the entire procedure, offering healthcare professionals a more streamlined and efficient experience.

Claims Review and Scrutiny

Revenue cycle automation has a profound impact on claim processing and scrubbing. It simplifies claim submission by eliminating the need for manual entry. Furthermore, it reduces editing time through specific rules, ensuring fewer rejections and denials. For instance, in the case of CPT code modifiers, automation can effortlessly manage the attachment of modifiers, leading to quicker reimbursements and fewer denials.

Pre-Authorization Process

While some insurance companies have promised to reduce prior authorization demands, they remain a significant factor in many medical specialties today. Unfortunately, these requirements often block efficient healthcare and impose an unwelcome administrative burden on physicians and healthcare practices.

However, there's a beacon of hope in the form of AI-powered revenue cycle automation, which can alleviate the pressures associated with managing prior authorizations. Using Machine Learning (ML) and Natural Language Processing (NLP), AI can efficiently process and analyze the data required for prior authorization, including patient demographics, clinical notes, plan specifics, and more. With this trove of information at its disposal, AI can either make informed decisions on behalf of the payer or provide invaluable insights to simplify the decision-making process for physicians, ultimately streamlining the prior authorization process.

Patient Payment Collection

Managing patient billing statements and collections within the revenue cycle can be a real headache. However, the tides are turning, and automation offers a much-needed reprieve from this labor-intensive process. Specific revenue cycle automation solutions can identify a patient's remaining balance once insurance has worked magic. Moreover, these systems can autonomously generate and dispatch invoices, sparing healthcare professionals the need for manual intervention. It's a time-saving and headache-reducing approach that benefits patients and healthcare providers alike.

Streamlining Revenue with Automated Claim Management

In healthcare, where processing numerous claims is routine, even a small percentage of denials can weigh heavily on revenue. Many of these denied claims are eligible for appeals, but manual filing can incur costs that outweigh the benefits.

Automation offers a solution by eliminating human errors, such as data inaccuracies and missing information, often leading to rejections. Beyond denials, automated scripts can uncover these commonly overlooked errors.

Underpayments, though subtler, also impact revenue. Detecting and addressing underpayments should be a priority for revenue cycle management automation. While they might not be as conspicuous as denials, they still warrant appeals and recovery. Many healthcare practices tend to write off underpayments, but automation can help recover this otherwise lost revenue.

Analysis and Reporting of Payer Contracts

Evaluating payer contracts can be complex, often requiring a keen understanding of the intricacies involved. Figuring out reimbursement's whys and how, especially when you're not receiving total compensation, is vital for your practice's financial health. One practical approach is to dissect your reimbursements by scrutinizing the fully executed contracts with your top ten payers against the reimbursement figures per current procedural terminology (CPT).

However, the thought of manually analyzing the top 25 CPT codes per payer could quickly become a labor-intensive nightmare. Fortunately, the advent of automation has transformed this daunting process into a breeze. Automation becomes a practical and efficient solution, allowing you to easily navigate the complex landscape of payer contracts.

Summary

Revenue Cycle Management (RCM) automation is revolutionizing healthcare by streamlining financial processes. It simplifies tasks in eligibility verification, claim processing, prior authorizations, and patient collections, leading to increased efficiency and cost reduction. Embracing RCM automation is essential for healthcare institutions to thrive in a rapidly changing landscape.              

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Published On:

March 5, 2024

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