Hyperautomation in Action: Enhancing Revenue Cycle Management for Healthcare Providers

May 22, 2013 By: Asmita Pillewan

The healthcare industry is facing a multitude of daunting challenges, including increased healthcare costs, the high burden of chronic diseases, complex billing processes, and the disruptive effects of a global pandemic. To ensure continuous cash flow, providers have to optimize the revenue cycle. By leveraging the power of Hyperautomation in RCM, healthcare providers can achieve optimal financial success and operational efficiency while providing quality care at the same time. With this all-encompassing framework, hyperautomated RCM enables a more streamlined and automated environment that not only improves patient experience but also delivers long-term advantages for all stakeholders within the healthcare industry.

Role of Hyperautomation in Revenue Cycle Management

Revenue cycle management (RCM) is a process by which providers get reimbursed for the services they have provided to patients. Errors in the process lead to the denial of claims resulting in revenue loss. Healthcare expenditures in the US reached nearly $4 trillion each year, with a large portion dedicated to administration. A streamlined RCM process can create a more efficient workplace and lead to significant savings. Denial of claims and write-offs can drain resources, but a proper RCM structure can cover up to 67% of denials and prevent up to 90% of them, resulting in an additional $5 million in revenue annually for US hospitals, as reported by Becker’s Hospital CFO Report.

Due to the shift from volume-based care to value-based care, providers have higher pressure to maintain the quality of care and document it to get paid for the same. According to the latest study, the US healthcare industry spends $2.1 billion annually on imperfect and unreliable manual tasks. The automation of revenue cycle management provides a unified solution, to reduce manual intervention and time required for administrative processes. It also helps to decrease errors due to which the clean claim rate is elevated, and revenue is maximized. An efficient revenue cycle management offers a variety of benefits to optimize cash flow and enable providers to focus on care delivery instead of administrative functions.

From streamlining healthcare provider tasks, recommending appropriate ICD codes to monitor billing processes, and even scheduling patient appointments, automated solutions have helped healthcare organizations succeed more efficiently than ever before. According to KPMG World Report (2020), 41% of the respondents believe digital healthcare solutions improve electronic records management, and 90% voted for an improved patient experience.

Some of the ways hyperautomation uplifts traditional RCM processes are discussed below:

  • Enhance the efficiency in the RCM process: RCM is a complex and ever-evolving process, requiring different teams work in coordination for submitting error free claims. Different technology and analytical solutions can assist in revenue cycle management process by enabling healthcare providers to understand the loopholes in the process and requirement for successful imbursement and act accordingly. Along with this, advanced analytics helps to extract required data from appointment scheduling systems and predict no-shows of patients, which helps reduce the wastage of resources- plus, it offers price transparency to all stakeholders in the ecosystem. Text message appointment reminders are also available – as well as hyperautomation in prior authorization reduces the burnout of physicians and healthcare personnel, helping them to dedicate their time to patient care resulting in positive patient outcomes.
  • Standardize RCM processes across all group practice facilities: By standardizing RCM processes across all clinic locations and within the entire healthcare system, each patient can feel confident that they are receiving consistently high-quality care regardless of any changes in location.

Automated Revenue Cycle Management – Transforming Healthcare

An optimized revenue cycle management ensures the survival and sustainability of provider organizations. It is an end-to-end process that consists of a complete journey from a patient encounter with a physician to claim remittance. Revenue cycle management encompasses different milestones which play a vital role in optimal revenue generation for healthcare providers.

You will be able to understand it better if you look at these use cases:

  • Patient Registration: Hyperautomated RCM solutions provide patient-centric operations that can revolutionize their experience with fast and accurate registration. Rather than tedious paperwork requirements, data input is automated using validation techniques to ensure accuracy while reducing costs for the healthcare organization.
  • Medical Coding and Charge Capture: Incorrect medical codes have been a major reason for claims denial. It poses a threat of revenue loss and manual medical coding incurs cost of human resource and errors as well. Computer assisted coding helps to reduce manual intervention and time required for coding. It accelerates the billing process with human in loop verification and maps diagnosis and procedures with correct ICD and CPT codes, respectively.Charge capture is plagued with overbilling, underbilling, and missing charges. Hyperautomation helps to optimize the efficiency of process by extracting correcting charges from the payer contracts and recommending it to billing team.
  • Account Receivables Management: Despite being a critical component of the revenue cycle, collecting patient debts can pose an immense challenge. According to the U.S. Department of Commerce, accounts become increasingly difficult to recover as time passes- after two months, only 70% are retrieved, and by six months, that number drops further to 30%.By utilizing hyperautomated RCM Solutions, organizations can use cloud-based solutions to take over manual tasks related to claims filing and payment follow-up, as well as provide insights that streamline compliance regulations – all while increasing accuracy and efficiency.
  • Claims Denial Management: Digitizing the claims process holds the opportunity to streamline RCM solutions through hyperautomation and has tremendous possibilities to enhance claims operations. Hyperautomation in RCM helps to analyse claims data and identify important data attributes for denial. Machine learning models predict claims denial before submitting claims to payers and clearing houses. It enables providers to save cost of rework on claims and helps in timely collection of payments. RPA bots have significant importance in appeal management for denial claims. It helps to extract and understand denial reason codes as per contracts and smoothens appealing process.
  • Patient Data Migration and Processing: With near-instantaneous migration capabilities and actionable insights into revenue cycle performance, hyperautomated RCM solutions provide HCPs with access to massive datasets quickly, securely, and in compliance – vastly improving how they process this information. Claims and EHR data are widely used for disease prediction models or population health. This not only leads directly to increased efficiency of care but also substantial savings on long-term costs associated with the running of a hospital; helping them deliver better treatment while leveraging more financial resources where it counts.

Reimagining Healthcare RCM with Hyperautomated Solutions

The adoption of AI and automation technologies has rapidly increased in healthcare organizations, resulting in significant ROI. According to a study by CAQH, revenue cycle automation saves $17.6 billion annually in administrative costs. Additionally, electronic claims submissions could save 22 minutes per claim compared to manual processing. Healthcare organizations can now rely on advanced automation for reliable income and swift collections.

Step into the future of healthcare automation with JK Tech’s innovative revenue cycle management solutions. Our team offers a comprehensive strategy to help the healthcare industry maximize potential – creating perfect harmony between operations and security while increasing speed and efficiency. JK Tech’s innovation and focused approach to solve business problem by leveraging hyperautomation helps to ease the burden of administrative tasks and bridge the gap between providers and payers. We offer an array of solutions and services around different components of RCM like patient registration, eligibility verification, prior-authorization, medical coding, charge capture, superbill generation, EDI processing, claims denial management. We maximize utilization of data and technology to make the processes efficient and maximize revenues while also enabling providers to give effective care delivery.

About the Author

Asmita Pillewan

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