Emerging or evolving technologies have the potential to make a hospital’s revenue cycle management department more efficient and return more value to healthcare organizations.
The following four information trends below can pay dividends for providers that are looking to optimize revenue cycle practices with patients, who are paying for more of their care in the form of higher deductibles.
Bots driving the balance sheet. Whether it’s called robotic process automation or web bots, clever automation scripts are able to intelligently communicate with payers at astonishing scale, and bring millions in revenue back to the hospital’s bottom line. Three factors in particular are behind the trend to use bots to carry out revenue cycle management functions.
First, hospitals are increasingly tasked with asking insurers for authorization of services on behalf of their contracted providers. While this puts hospitals in the driver’s seat of an important revenue function, it also requires considerable staff time or outsourcing to a third party. Both are expensive, yet neither are the scalable solution that’s really needed. As such, claims continue to be denied because they were based on erroneous information, or authorizations weren’t acquired, or any number of items that insurers now routinely demand.
Second, state legislators continue to try and pass laws that require insurers to respond more quickly to authorization requests. If these attempts become actual laws, insurers—not just providers—will become very interested in a scalable solution that can process large batches of authorization requests.
Third, business offices continue to struggle with understanding when—and which—claims will be paid. Expensive employee hours are allotted to following up on these claims, many of which have been or will be approved, only the hospital doesn’t know it yet.
Bots can be programmed to access a payer’s website, using the provider’s credentials, to query for information such as a claim’s status, a patient’s eligibility for services, or if an authorization is required—and then bring the answer back to the provider. That can happen in just a fraction of the time it would take human staff to accomplish.
Artificial intelligence teams with the bot. AI is more hype than reality in some areas of healthcare, but that’s less the case in revenue cycle management, where AI technologies like machine learning and natural language processing are on the cusp of making communication between RCM staff and healthcare insurers a 100 percent “touchless” transaction.
AI technology such as machine learning already pairs with robotic process automation to smartly route answers to assigned staff, systems or workflows. In 2018, expect the entrance of additional AI technology--natural language processing—which negates the need for any human intervention at all to make a query, even for those that require clinical data input.
EHRs finally become revenue generators. For years, providers have bitterly complained about the loss of revenue that results after deploying an EHR. But the same technologies described above can actually be embedded in EHRs to recoup lost revenue from denied claims; specifically, claims that are denied because of eligibility issues or authorization wasn’t properly obtained in advance of a procedure or service. With robotic process automation and rules engines, providers can send an authorization request from the same system they schedule or document a service.
Accommodating the patient as a major “payer.” Despite continued uncertainty over the fate of the Affordable Care Act, 8.8 million individuals signed up through the federal marketplace. Many of these plans, along with a growing number of those offered by employers, require high deductibles and co-insurance. While the good news for providers is these patients have coverage, the focus then needs to shift to helping them pay their out-of-pocket expenses. And soon: already deductibles have reset with the beginning of a new year.
As such, look for robust and accurate tools that assist with producing estimates and collecting from patients. Being proactive, communicative and establishing payment options is a strategy that can help hospitals collect more at the point of service, and collect more accounts in full.
Note, however, that collecting from patients need not fall entirely to front-end and business office staff. In tandem with instituting upfront calculation and collection tools, equally beneficial is making self-service calculators available that let patients obtain their own estimates. Typically these calculators reside on the provider’s website. A prospective patient seeking an accurate price estimate need only input a few data fields—name and insurance number, for example—to receive an estimate that closely reflects the actual bill for services.
Does the increased mainstreaming of automation and other technologies signal the demise of human personnel in the RCM department? It doesn’t have to. While some hospitals may phase out certain positions by attrition, others will finally be paying their employees to work at the top of their licensure—communicating with payers about more complex, nuanced issues. Or even more importantly, communicating with patients. With bots and AI technologies taking on the rest, hospitals can look forward to a year where smart patient relations drives a healthy bottom line.
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