How providers can use EMR tools to bolster RCM efficiency

Labor shortages affect revenue staffs as well, but electronic records systems offer integrated tools to assist with the challenge.

As the healthcare industry faces an unprecedented labor shortage, leaders now understand that embracing advanced technologies represents the best long-term solution for this persistent problem.

For example, a recent survey of healthcare executives on the use of artificial intelligence (AI) in the industry found that about half of the health systems surveyed are using the technology for back-office operations and workforce issues, and among those, 85 percent expect a moderate to significant increase in use of the technology in the next one to three years, according to The Health Management Academy.

Additionally, the survey revealed that health systems are embracing automation to improve the quality and accuracy of business tasks, reduce manual labor, and improve clinical and staff workflows. Among the business tasks that are most ripe for automation are those involving revenue cycle management (RCM), with 78 percent of executives reporting that they are using or evaluating AI for RCM tasks.

However, health systems do not need to invest in new, high-priced AI systems to take advantage of automation for RCM. Leading electronic medical record systems (EMRs) today offer integrated billing tools to help providers manage their revenue cycle more efficiently as well as mitigate ongoing staffing challenges.

Providers’ workforce issues

As wages and supply costs have risen because of underlying economic inflation, health systems across the country have seen their margins compressed. For example, approximately half the nation’s hospitals ended 2022 with negative margins, according to Kaufman Hall.

Much of hospitals’ financial and operational struggles stem from what the American Hospital Association (AHA) called “a historic workforce crisis complete with real-time short-term staffing shortages and a daunting long-range picture of an unfulfilled talent pipeline,” in a February 2023 testimony to the U.S. Senate.

As a result, hospitals have seen a 20.8 percent increase in total labor expenses from 2019 to 2022, according to the testimony. Additionally, the AHA cited recent survey data from the U.S. Department of Health and Human Services that showed that 623 hospitals (or 16.7 percent of reporting hospitals) anticipated a critical staffing shortage in the future.

However, while much of the attention regarding the industry’s staffing crisis focuses on clinical workers such as primary care physicians, nurses and behavioral health specialists, healthcare organizations are also having difficulty filling administrative positions, according to a survey by AKASA. Specifically, 26 percent of survey respondents said their hospital or health system needed to hire more than 20 people to adequately staff their RCM departments.

When hospitals experience challenges filling vacancies, competition for labor rises among providers, who must also contend with escalating demand for labor from other, faster-growing industries, pushing costs increasingly higher.  For health systems, paying increasingly higher wages to RCM workers is not a sustainable solution, leading many to look to automation to fill the gap.

EMR tools can boost RCM

Health systems can overcome many of the RCM challenges caused by short staffing by leveraging automation. Here are three essential practice management tools embedded in leading EMRs that enable providers to employ automation to boost RCM.

Automated payment tracking. With automated payment tracking, the system handles all claim tracking between provider, patients and health plans. The tool enables practices to save on staffing costs by reducing the need for manpower to perform manual entry of information and follow up on claims or payment status while minimizing the risk of errors.

When coupled with an integrated all-in-one EMR, automated payment tracking can benefit providers in several ways, including keeping clinicians educated on the status of accounts receivable, ensuring payments are received in a timely manner, reducing the chances of lost claims and payments, boosting staff productivity and freeing up valuable resources.

Additionally, this tool delivers helpful insights into financial trends, further helping providers understand the overall financial health of their practice, as well as the changes that can be made to create more efficient RCM processes.

Automated claim scrubbing. With automated claims scrubbing, providers can save time and money that might have otherwise been devoted to manual processes that are prone to error. The technology automatically reviews claims for medical coding errors prior to submission, enabling staff to address potential issues, avoid costly delays or rejections and ensure claim accuracy.

Additionally, automated claims scrubbing tools give providers a real-time view into claims status, empowering them to take immediate action when needed.

Automated coding. Automated coding solutions enable providers to quickly and accurately generate medical billing codes based on documentation, while reducing burdens and administrative paperwork on billing staff. These tools detect and apply the most up-to-date codes and rules in real time, ensuring that claims are accurate and compliant with health plan policies.

Further, this technology improves turnaround times, enabling providers to get paid faster and giving them more time to focus on providing quality patient care.

Rising staffing costs and shortages are a fact of life for most providers, but with EMRs that feature advanced automation tools, providers can streamline RCM processes while saving on labor.

Nick Hedges is the chief executive officer of Raintree Systems.

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