The complex and highly manual system of claim preparation and billing is a significant driver of healthcare costs in the U.S. As a result, revenue cycle operations are often a key area of focus in digital transformation efforts.
This focus has shifted automation in revenue cycle operations from “nice to have” to mission-critical for driving efficiency and cost-effectiveness. In a recent survey of more than 500 chief financial officers (CFOs) and revenue cycle leaders at health systems and hospitals across the country, more than 66% say their organization is actively using or implementing automation tools in their revenue cycle operations today.
Are you considering investing in an automation solution for your revenue cycle operations? Here are five best practices to keep in mind:
1. Understand the total cost of ownership
No matter what solution or technology partner you choose, automating revenue cycle operations generally follows the same three-step process:
- Documenting workflows and processes
- Developing or programing the technology that will automate some of the work
- Deploying the automation technology and implementing the processes for maintaining the automation
Consider the cost implications of all three steps when you select the best automation solution for your organization. Look for automation partners that have proprietary technology tools to document workflows in less disruptive ways. Build ongoing maintenance into your budgets. Automation vendors should be transparent about pricing and be able to explain how their approach aligns their financial incentives with their solution’s performance and offers better business results for you.
2. Take a practical approach in the short term and be ambitious in the long term
For the first deployment, start with a clearly defined area that also minimizes the need for change management. Common revenue cycle areas to start with include: eligibility, prior authorizations, claim status, and denials management.
Many organizations underestimate what they can automate because traditional technologies, such as robotic process automation (RPA), have limited capabilities. But today’s machine-learning-based technologies can actually expand your scope.
Work with your solution providers to identify near-term goals and map how they advance your department’s longer-term objectives. This helps the automation strategy deliver effective performance at lower costs over the long term.
3. Understand how critical human judgment and subject matter expertise are to automation
Any automation solution is better with human experts in the loop.
Companies like AKASA include an interface for machine learning algorithms to learn in real-time from revenue cycle experts who handle edge cases and exceptions. This ensures the machine learning software can learn, adapt, and handle increasingly complex tasks independently over time, while also protecting the bandwidth and focus of health system staff.
Blending automation with human judgment means that accuracy and efficiency are improved, while also ensuring work continues without disruption when the unexpected arises.
4. Know that maintenance matters
Consider the maintenance requirements of an automation solution before investing in one. It will help the project stay on schedule and on budget, and also provide the greatest return.
Payers are constantly updating plans, claim forms, prior authorization, and other requirements. Make sure your solution is flexible, capable of adapting to these changes as they happen, and can adjust to your organization’s needs. Or decide if you or your vendor need to allow time, talent, and budget for reprogramming bots and updating code every time something changes.
5. Consider security and compliance issues
One of the first security topics you should discuss with an automation vendor is their certifications and auditing procedures. Give priority to solutions that are compliant with HiTRUST and SOC2 requirements. These certifications are a clear indicator that the solution provider is likely to meet or exceed the security and compliance requirements of your organization.
Your provider should also be able to speak to how they operate in alignment with HIPAA compliance. Table stakes for any vendor serving healthcare organizations.
Want more details? AKASA’s “Buyer’s Guide to Healthcare Revenue Cycle Automation” provides an in-depth look at the automation process; how to understand the total cost of ownership for automation solutions; and how to evaluate AI solutions, among other considerations. View your complimentary copy of the Buyer’s Guide to Healthcare Revenue Cycle Automation.