Electronic Health Reporter

By Dan Schulte, MBA, CHFP, senior vice president, provider operations, HGS.

As outbreaks of COVID-19 continue to crop up around the country, the ongoing public health crisis is just one facet of the situation; economic disruption is another grim reality, including for the healthcare industry itself. The American Hospital Association estimates COVID-19 will result in losses of $202.6 billion for the country’s hospitals and health systems due to factors such as the cancellation of nonemergency procedures; the high cost of treating a patient with COVID-19; and the millions of Americans who could become suddenly uninsured due to the economic implications of the virus.

Providers must improve cash flow to remain stable, which will require new revenue cycle management strategies supported by technology. Artificial intelligence (AI), machine learning (ML), and robotic process automation (RPA) together can provide an effective automation strategy that will help healthcare systems recover and retain more of their revenue —  while boosting patient satisfaction — as they navigate this costly crisis.

Nine revenue cycle functions ripe for automation include:

1. Prior authorizations: With manual prior authorizations requiring an average of 21 minutes and as much as 45 minutes per transaction, the opportunity to drive cost savings through automation is significant. Because of well-defined business rules in this area and structured data that systems exchange in conducting prior authorizations, RPA can significantly improve this process: Implementing a “bot” that can perform the same tasks repetitively and without variation can help reduce error rates, so patients can get the authorization they need quickly, and lower the likelihood of claim denials.

2. Eligibility and benefit verification: While fully electronic transactions account for more than 84% of all eligibility and benefit verification transactions — a positive development — more can be done to reduce wasteful spending in this part of the revenue cycle. As the starting point for care delivery, this function represents a significant potential for improvement via intelligent automation. The focused manager will ensure that the EDI tools bring the right data across to the patient accounting system (timely, accurate and complete data), and will have the necessary add-ons to find the last 15% of data from screen scraping and outsourcing to a reliable service provider.

Continue Reading