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:
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.
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.
By Donna Martin, senior vice president, Healthcare Business Development, HGS.
Hospitals and health plans are competing ever more fiercely to gain and retain patient/member relationships. This means changing with the times to bring differentiators that address today’s challenges. In light of COVID-19, for example, hospitals nationwide are deploying bot, AI, IVR, and telemedicine solutions to support the growing need for patient self-guidance.
Tech adoption is fast emerging as a strategy for those in need to access quick, accurate advice and the coronavirus is only accelerating the pace. Before COVID-19 hit California, the all-time daily high for Stanford Children’s Health, as an example, was 35 televisits. But, recently, their clinicians conducted 500 in one day.
As healthcare organizations constantly work to enhance their brand adoption — first impressions are critical. With millions of healthcare calls overwhelming call centers, there’s a need to satisfy customers with a mix of digital technology and traditional service, like for example, nurse support of COVID-19 calls.
Partnering to add critically needed professionals, using an omni-channel nurse triage service, staffed with qualified registered nurses providing front-line support for COVID-19 callers, will enable healthcare providers to focus on critical case requirements. HGS recently launched a full suite of business continuity solutions designed to immediately help clients and employees manage contact center spikes during the COVID-19 crisis.
From virtual chat, to pivoting to other non-voice channels and social media management, healthcare organizations understand the lifecycle importance of these new technologies—from brand awareness to offering patient access options. Think of a patient who simply wants to schedule an appointment, ask a question about a treatment plan, or request a referral. Are they confronted with a myriad of questions, outdated legacy options or poorly automated selection menus? Are they routed endlessly among call service operators and forced to relay the same information over and over again?
Ultimately, patient contact centers should drive accuracy and efficiency with seamless patient engagement , reducing frustration and time spent by caregivers and patients fishing around for answers to their questions. If airline carriers know their customers’ preferred seating arrangement and hotels know their visitors’ preferred floor and room inclusions, then healthcare provider contact centers should strive to anticipate the needs of their patients in a much more proactive manner.