Artificial intelligence (AI) and automation are revolutionizing almost every industry, and healthcare is no different. However, not everyone can gauge its full potential. It is impossible to cover all the facets of healthcare that could benefit from this technology in a single blog.
BUT! As a healthcare provider, you must be concerned with keeping your practice profitable and operations running. Hence, we have decided to dedicate this guide to the role of automation and AI in revenue cycle management.
If this is something that interests you, read this guide till the end!
What is Healthcare RCM Automation?
RCM automation refers to replacing manual, rule-based, repetitive tasks with tools powered by AI, machine learning (ML), and robotic process automation (RPA).
Leveraging these advanced technologies ensures a care continuum while helping healthcare practices with the following benefits:
- Improved patient satisfaction
- Eliminating the need to hire additional resources
- Streamlined manual and repetitive tasks
- Reduced time and labor costs to complete tasks
- Insights into opportunities and inefficiencies in your revenue cycle workflow
Use Cases of RCM Automation
Do you want to know in which areas of your organization’s revenue cycle management can automation and AI assist? Below are the top 7 use cases to help you determine its potential:
1. Patient Eligibility Verification and Enrollment
In healthcare revenue cycle management, the initial steps of patient enrollment and insurance eligibility verification play a pivotal role. Introducing automation at this stage can help healthcare facilities reap a higher return on investments (ROI).
Automating patient insurance eligibility verification and enrollment can help reduce the denial rate while improving the cash flow. The reason?
SIMPLE logic! When you face claim denials, you may appeal it. However, it costs an average of $25 to rework the claims and it further slows down your reimbursements.
But if you are better prepared, you can ask for the right payment upfront by verifying patient insurance coverage and benefits before the encounter. As a result, patient balances are reduced, and the need to send accounts later for collections is eliminated. It is a winning situation, guaranteeing a healthier financial situation for your practice.
2. Expense Estimates and Additional Cost Projections
The importance of transparency in medical billing accelerated with the introduction of the No Surprises Act. Undoubtedly, it is a great initiative to help patients understand their healthcare expenses. However, it burdened the healthcare facilities with added administrative duties.
But the good news is you can offload your shoulder with this burden by automating activities related to healthcare cost estimates and other cost projections. Automating this facet of the patient journey will keep your patients satisfied, ensure precise billing, and enhance your overall revenue cycle.
Developing reasonable faith estimates is a tedious task if done manually. However, leveraging RCM automation will significantly ease the burden, save staff time, and reduce overhead costs.
3. Claims Review and Scrutiny
AI in revenue cycle management can significantly improve your claim processing and scrubbing process. It eliminates the need for manual entry and minimizes editing time via specific rules, reducing claim denials and rejections.
For instance, missing or wrong modifiers can lead to claim denials, but when you automate the process, it seamlessly manages and attaches relevant modifiers, leading to faster reimbursements.
4. Pre-Authorization
Most insurance payers ask for prior authorization before you provide a particular care service. These requirements add an administrative burden and block efficient healthcare.
However, revenue cycle management automation can help you by automating prior authorization. With natural language processing (NLP) and ML, you can efficiently analyze and process prior authorization data, including clinical notes, patient demographics, insurance plan specifics, etc.
With this information, AI can make data-driven decisions on your behalf or offer insights so you can make informed decisions yourself, streamlining the authorization process.
5. Patient Payment Collection
Healthcare facilities often find it challenging to manage patients’ billing statements and collections. You can also automate this aspect of the healthcare revenue cycle with AI. Specific automated RCM solutions can determine patients’ remaining balances and generate and dispatch invoices, freeing up providers from manual intervention.
6. Automated Claim Management
Handling hundreds or thousands of claims is routine for some healthcare facilities. As a result, when even a fraction of these claims face rejection or denial, they can heavily weigh down your facility’s revenue cycle. Luckily, you can appeal most of the claim denials. However, manual filing is costly and time-consuming.
AI in revenue cycle management can streamline this process by eliminating manual errors, including missing information and data inaccuracies. Besides, you can leverage automated scripts to identify commonly overlooked reasons behind denials and issues related to underpayments. You may not be able to appeal all underpayments, but it is still a good idea to find some instances that warrant it and recover the lost revenue.
7. Payer Contracts Analysis and Reporting
Another area where RCM automation can do wonders is evaluating payer contracts. It simplifies the intricate and time-consuming process, offering insights into reimbursement hows and whys. This information will help you rise above the billing challenges, especially when you struggle to receive total compensation.
One way to approach this issue is to scrutinize your reimbursements from fully executed contracts from your top insurance payers against the compensated amount per CPT.
However, manually attempting it will drain your resources. That’s where automation can help you out! It is an efficient and practical solution to help healthcare facilities navigate the complexities of different payer contracts for higher reimbursements.
Automate Your Revenue Cycle with MediBill MD
Transform Healthcare RCM with AI & Automation
Automation and AI are leading technologies revolutionizing the healthcare landscape. In this section, we will discuss their role in front-end, middle-cycle, and back-end revenue cycle management.
Front-end Revenue Cycle and Automation
The Challenge
If you want financial stability for your healthcare practice, efficient front-end RCM is optimal. However, limited technology adoption, operational strains, and inadequate patient follow-up can negatively impact your front-end outcomes. Moreover, it may lead to negative reviews and dissatisfied patients.
The Solution
Healthcare facilities can rise above front-end RCM challenges to enhance patient experience by adopting an omnichannel approach. It may involve supporting ongoing communication, offering multiple points of access to care, and educating patients.
Creating synergy through a single suite of solutions and unifying the front-end services can help streamline the patient journey and mitigate patient friction points.
Role of AI and Automation
Integrating automation and AI in revenue cycle management with other tech-enabled solutions enables healthcare facilities to keep patients at the center of their operations.
Simply put, the aim is to create an end-to-end patient experience where they can understand estimated healthcare expenses upfront, leverage self-service digital tools, and acquire care efficiently.
Now, you may be wondering how AI and automation fit into all this. AI collects and analyzes data to provide valuable insights, facilitating you to make informed decisions, while automation boosts the self-service functionality and efficiency of digital tools. Thus, AI and automation can transform your practice’s front-end RCM operations.
Following are the areas that may benefit most from it:
- Patient registration robots
- Patient support chatbots
- Contact center automation
- Price estimation and transparency
- Prior authorization
- Appointment scheduling
- Proactive patient outreach
Middle Revenue Cycle and Automation
The Challenge
As per an article featured in Health Leaders Media, the top three reasons for claim denials are insufficient staff training, lack of automation in claim and denial management, and inadequate use of data analytics.
Despite these findings, many healthcare leaders are uncertain about investing in technological advancements because previous implementations failed to produce their desired outcomes.
Some major contributing factors that make it challenging to handle middle RCM are unstructured data, labor shortages, vendor management fatigue, complex claims, and a high claim rejection rate.
The Solution
Yes, there are ways to overcome the middle-cycle revenue management challenges. These may include ensuring revenue integrity, minimizing coding and billing errors, and optimizing staff efficiency.
Role of AI and Automation
You guessed it right! Automated revenue cycle management and AI take center stage to bring out the desired results, as mentioned in the solution. Automating billing and coding workflows can significantly reduce the denial rate and close the gap between patient encounters and downstream processes, enhancing provider-patient relationships.
Following are the areas where implementing AI and automation in middle-cycle RCM can help:
- Medical coding
- Automated case finding
- Claim status check
These automated RCM functions will enable teams that handle clinical documentation and coding to maximize financial success and reduce costs.
Back-end Revenue Cycle and Automation
The Challenge
Back-end RCM is integral and directly impacts the operational efficiency and financial health of healthcare organizations. However, many facilities find it challenging to handle due to operational constraints, limited automation, staffing shortages, and financial management issues.
The Solution
Healthcare organizations can streamline back-end RCM operations by implementing revenue cycle management automation, leading to enhanced financial performance and a steady cash flow.
Role of AI and Automation
Automation and AI in RCM enable accurate billing, efficient claim processing, and faster reimbursements, contributing to healthcare organization’s financial stability.
Some areas of the back-end revenue cycle that can benefit from automation are as follows:
- Utilization review
- Contract management tools
- Automated appeals
- Personalized outreach
For the unversed, automation in utilization review directs providers to focus on cases requiring extra attention. As a result, providers free up time to focus on other patient-facing activities.
Contract management automation software helps you analyze anticipated reimbursements and payer contracted rates. So you can determine potential underpayments and ensure appropriate revenue.
On the other hand, automated appeal workflow enables you to identify and correct errors. These may include inaccuracies in claims, missing patient information, and approaching claim filing deadlines.
Besides, personalized outreach is integral for patient follow-up and collections.
Bottom Line
An automated revenue cycle management can expedite patient eligibility verification and enrollment, expense estimates, claims review, pre-authorization, patient payment collection, claim management, and payer contacts analysis and reporting.
Moreover, AI and automation can transform the front-end, middle-cycle, and back-end operations of healthcare revenue cycle management.
We hope this guide has helped you understand the significance of incorporating automation and AI into the financial aspects of your organization. If you are looking to outsource your practice’s RCM operations, MediBill MD can help with its team of revenue cycle specialists.
