By Andy McDonald, vice president of operations, Salucro.
Every profession has its own ‘bucket list’ — a collection of goals that people aim to achieve during their career. For revenue cycle leaders in healthcare, their bucket list items tend to center on strategic objectives designed to modernize the healthcare financial experience, enhance the patient experience, and streamline operations.
As vice president of operations at Salucro, a payment technology company exclusively focused in the healthcare space, I talk to clients, partners, and revenue cycle leaders every day and these are five of the most common priorities I hear:
Upgrading and Consolidating Revenue Cycle Tools
With the complexity of modern health systems comes a continuous influx of new technologies designed to optimize revenue cycle management. But the key to truly reaping the benefits of these advancements lies not in simply adopting the latest tool on the market, but in integrating and streamlining these solutions into a single, efficient system.
Patients have also begun to recognize the digital shift in their financial experience, with 93% saying they expect healthcare providers to use more and more technology to collect payments, according to a recent report.
The integration and consolidation of tools can dramatically improve the productivity of your staff. When they are spending less time navigating multiple systems, rectifying errors, and piecing together data from different sources, they can focus more on enhancing the patient financial experience and other high-value tasks that cannot be automated.
Improving the Patient Financial Experience
The patient experience encompasses all touchpoints of a patient’s journey, from the first call to schedule an appointment to the final payment transaction. Patients expect and deserve a seamless, intuitive, and personalized experience at each of these touchpoints – and with 50% of patients stating that their last billing encounter was bumpy, painful, or confusing, the quality experience that providers strive to offer doesn’t always carry throughout the full patient journey.
Leveraging technology can greatly enhance the patient experience. According to a 2023 survey of healthcare consumers throughout the U.S., 62% of patients pay their bills by credit or debit card via an online patient portal. These digital platforms not only cater to the modern patient’s preference for online interactions, but also help to improve revenue cycle efficiency.
Revenue cycle tools can automate patient communications, ensuring that patients receive timely billing notifications and follow-up messages. Survey data shows that patients are responding positively to these tools, as 51% of patients said a text message reminder would prompt them to pay their bill faster.
Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.
This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.
The appearance of artificial intelligence (AI), specifically conversational AI, is promising to change that, making it possible to convert the highly unstructured data populating the audit process into information that can be both analyzed and automated.
The Audit Environment
Ferreting out fraud and abuse remains high on the federal government’s priority list. In fiscal year 2022, the U.S. Department of Justice (DOJ) collected more than $1.7 billion in improper payments, while the Office of the Inspector General (OIG) reported identifying more than $200 million in expected audit recoveries and over $277 million in questioned costs in its 2023 Semi-Annual Report to Congress.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is expected to claw back $4.7 billion from Medicare Advantage plans over the next decade thanks to recent adjustments to its risk adjustment data validation (RADV) program. Add to all that the influx of demand letters in the wake of the expiration of the federal PHE – along with many of the waivers that kept external audits in check – as well as claim changes and heightened regulatory and billing practice scrutiny by federal contractors and commercial payers.
All this comes at a time when hospital margins remain “well below historical norms,” per Kaufman Hall, and revenue cycle leaders are facing severe labor shortages, with more than 41% reporting that up between 51% and 75% of RCM and billing department roles are currently vacant.
By Teri Gatchel-Schmidt, vice president, consulting and business development, SYNERGEN Health.
Almost a quarter of U.S. national health expenditures go toward administrative costs. In revenue cycle, rising costs continue to escalate which negatively impacts the bottom line. There is a silver lining in all of this; as a potential recession looms, these costs can be reduced with automation.
By simplifying daily routine tasks with automated tools like robotic process automation (RPA) and machine learning (ML), nationwide spend could be reduced from 25% of the national healthcare expenditure to 18%.
Automation: The key to improving efficiency
As it stands, manual revenue cycle processes burdens staff with repetitive, mundane tasks, causing staff burnout. Additionally, the reimbursement landscape evolves in complexity year after year. Staffing issues also continue to plague health systems, leaving chief financial officers playing defense, with high turnover rates causing a decrease in productivity and an increase in aged receivables.
When it comes down to it, organizations must either add more resources to support the manual way of working – which can prove to be costly and inefficient – or invest in automation. Simply put, revenue cycle is ripe for automation which results in reducing cost-to-collect and creating large-scale cost savings throughout the revenue cycle. When pairing automated technology with best practices to empower operational teams, revenue cycle leaders will streamline workflows to reduce manual work and increase efficiency, all while boosting revenue.
Denial Avoidance
Many providers are not fully aware of just how deeply denied claims can affect their bottom line. According to HFMA, providers lose nearly $5 million on average per year due to claim denials.
With ever-changing reimbursement and collection requirements, providers and their staff need tools to analyze and prevent denials to reduce the workload required to avoid an increase in denials.Instead of assigning denial management and appeals to staff members, providers should look to automation as a champion for claims and denials management.
