How to Effectively Manage the Revenue Cycle and Reduce Cost.

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While the term' Revenue Cycle' is relatively new, the concept of it is not. It's the process a healthcare provider goes through from the moment a patient is presented with an illness until that person is healthy again and able to be discharged. The cycle is complex, time-consuming, and expensive for practice. Therefore, any provider needs to establish a solid revenue cycle management plan. Here are five ways to improve the revenue cycle using automation:

Improve Claims Processes

The revenue cycle begins long before an invoice is processed. The first step in the cycle involves submitting claims to insurance companies. This can take a long time because of all the paperwork involved. Paperwork, such as enrollment forms, billing codes, etc., all add to a large pile of work that humans must review before submitting a claim. With automation, reviewing this paperwork is simple and fast and ensures all relevant forms are present before submission.

Streamline Patient Billing

While many people think of the revenue cycle as being limited to just claims, in reality, it includes everything from patient registration through follow-up post-treatment care. Any step that can be reduced in time or simplified through automation will improve the revenue cycle.

Reduce Costs with Efficient Workflows

Because processing time for claims is lengthy, providers must keep more staff than needed. This increases costs and negates any positive impact of submitting claims in the first place. To offset this, creating an efficient workflow for claims processing is essential. Automation allows for quick and easy workflow review, which helps identify problem areas that can be addressed to reduce costs over time and make workflow more efficient overall.

Identify Top Performers Experiencing High Denial Rates

It's no secret that claims can be denied for many reasons. While some denials are legitimate, others are due to simple clerical errors on the provider's end. Automation helps identify these problem areas so they can be addressed before higher levels of management are notified and frustrated by lengthy delays in payment processing. With this information at their fingertips, leadership can easily tackle these problem areas and reduce general denials, improving revenue cycle efficiency immediately

Develop Stronger Relationships with Insurance Companies

By implementing a robust and efficient workflow for claims processing coupled with automation where appropriate, healthcare providers can develop strong relationships with insurance companies because they know they can rely on them for payment when required. This helps them maintain strong relationships with their patients, who value knowing their healthcare provider does their best to make things easy for them by doing their best to make things easy for their insurer!

How do you get started with automation?

Like most business owners, you probably started by reading about RPA, OCR, AI, and ML as much as possible. That's a great place to start. But, if you want to be more effective in your implementation, there are other steps you can take to be sure you get the results you want.

Here are the main steps we recommend to start your Automation project off right:

Step 1: Develop a Business Case and Look for Funding

The first step is determining how much ROI you could get from automation.

A simple way to do this is to look at your 'direct costs' of performing manual tasks. For example, if a job takes 10 hours per week from every 50 employees, that's 500 hours per week or 25,000 hours per year completely wasted on just one task! Now multiply that by 100 jobs or more, and you can see how easy it is to justify investing in automation.

Another way to justify your automation project is to look at increased revenues or decreased expenses it can bring. For example, if your sales team saves 4 hours each day because they no longer need to spend time entering orders manually into your system, that's over 100 person-years saved each year! And those saved person-years can be used to generate additional revenue through new sales.

Once you know how much you could save or make by automating a process, it will be much easier to convince management of the benefits. If they still need convincing, suggest they use their savings to invest in other business areas. Regardless of how they decide to use their savings, you'll at least be able to move forward with your automation project knowing it's the right move.

Step 2: Develop a Proof of Concept (POC) for automation.

Once management has signed off on an automation project, developing a proof of concept (POC) for automation is time. A PoC is a simulation or testbed that proves an idea will work without implementing it in production. In other words, it saves time and money by ensuring an automation project will result in the expected benefits without taking resources away from other essential tasks.

Step 3: Start Identifying Manual Tasks for Automation

Now that you have a proof of concept for automation and management is on board with investing in automation, it's time to start identifying which tasks to automate first. There are many factors to consider when selecting which tasks to automate first, but here are some of the critical elements

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Published On:

March 12, 2025

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