AGS Health, a leading provider for tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announces the acquisition of the India-based patient access outsourcing business unit of the Florida-based healthcare technology company Availity.
With more than half of U.S. hospitals anticipating a year of negative margins, achieving full and accurate reimbursement for services has never been more critical. With this expansion, AGS Health is positioned to provide faster, more flexible financial clearance solutions at an even greater scale to help increase customers’ first-pass reimbursements rates.
“At AGS Health, our focus is greater financial freedom for healthcare organizations, allowing them to reinvest in their vision for superior patient care,” said Patrice Wolfe, CEO of AGS Health. “With this acquisition, we can better equip our customers with the tools and expert services necessary to help overcome payer complexities, reduce denial rates, mitigate revenue leakage, and accelerate cash flow on the back end.”
The acquisition allows AGS Health to expand the capabilities of the AGS AI Platform with new technology to enhance accuracy and scalability and further streamline patient access operations. The technology platform is capable of automatically determining, submitting, and verifying the status of prior authorization requests. Additionally, estimates of the patient’s out-of-pocket cost can be automatically generated based on payer rules set by the healthcare organization.
The move will also add approximately 200 patient access service team members to AGS Health’s global team of more than 11,000 college-educated, trained RCM experts. With labor shortages devastating all areas of the healthcare system, outsourced services are more critical than ever – particularly as financial clearance performance depends on access to qualified, skilled labor.
“This acquisition is just part of our continued investment in our customers’ success with automation technology and expert teams,” Wolfe adds. “As growth partners, we are committed to equipping our customers with flexible, modern solutions to mitigate risk and adapt to change. This is part of what we call ‘AI with a human touch’.”
By Brian Cafferty, vice president of RPA development, Tebra.
Robotic process automation (RPA) is a software technology that uses “bots” to replace repetitive, rule-based tasks and processes. In everyday life, people use RPA technology anytime they rely on form auto-fills, credit card payments, call center menus, or banking automation.
While the hyper-automation trend has taken root in most industries, bots are just starting to catch on in medical practices. The average practice performs many time-consuming and repetitive administrative tasks that require large amounts of data to be pulled, categorized, summarized, and reported. However, these tasks don’t require specialized knowledge. RPA can provide task automation across the organization, from front-office tasks to operational processes to patient interaction and bill payment. In addition, minimizing manual processes can reduce error rates that cost time and money.
Our customers and early adopters of RPA report that within the first three to six months of implementation, they saw improvements of 50% in operational efficiencies, 200% in claims processing speed, 30% in revenue per clinical encounter, 95% clean claims and only 2-3% claim denial rates.
Automating essential workflow
Onboarding new patients is a process you can automate while improving the patient experience. For example, a bot can provide an integrated data connection between your electronic health record (EHR) and billing platform. As patients complete the intake and insurance forms, this information is automatically entered into your billing platform.
As more patients demand convenient digital touchpoints, bots can maximize back-office efficiency with appointment scheduling. Bots can process patient appointment requests by presenting available time slots and adding selected appointments to the practice’s database. In addition, the RPA tools can assist with patient check-in, validating health plan coverage, and arranging pre-authorizations for planned procedures and treatments. For smaller practices or those with lean office staff, these automations can significantly reduce time spent on non-revenue-generating tasks.
For practices that need to migrate patient EHR data when transitioning from one practice management software to another, bots can initiate keystrokes to create a clinical note for each patient encounter to ensure the patient’s complete medical history is captured accurately.
By reducing the administrative tasks that do not require specialized knowledge or a human touchpoint, your practice staff can focus on delivering better care to improve patient outcomes and grow your practice.
By Joe McMurray, senior vice president of patient experience, Zotec Partners.
A July 2022 report confirmed what most providers have seen coming during this time of rampant inflation: Unexpected healthcare costs can be crippling for the majority of Americans. Many factors have influenced this fact, including rising high-deductible plans, ongoing pandemic stress, and the general truth that patients are often sick, scared, or confused — or a mix of all three. This strain poses many challenges for healthcare providers and their revenue cycle teams, highlighting the importance of patient-centric financial experiences.
Calculating cost estimates on unexpected medical encounters is a very challenging process, and if done so inaccurately, it can push patients to switch medical providers. According to PYMNTS, 46% of unwell patients have canceled an appointment because of high cost estimates, and two-fifths of patients who received inaccurate cost estimates spent more on healthcare than they could afford. Healthcare providers and organizations have seen drastic reductions in payment as a result.
Understanding Why Patients Don’t Pay
According to research by Debt.com, 45% of Americans have outstanding medical debt. Some reasons why patients can’t pay their debts includes financial hardship (which can be from job loss), murky healthcare billing systems, unexpected billings (especially during the holidays), and ambiguities with insurance. Inflation isn’t helping the situation, with almost 60% of people forgoing healthcare due to higher living expenses across the board.
Unpaid medical bills and their resulting medical debt are typically the outcomes of a combination of factors. First and foremost are unexpected healthcare costs, which is precisely what it sounds like: unplanned and unbudgeted medical expenses. The continued hike in high deductible plans and increased out-of-pocket expenses has also hit healthcare consumers’ wallets.
Additionally, uncertainty around billing is an issue for patients who need clarification on their responsibilities, billing due dates, or even which providers they saw during their encounters. Finally, technology can be a barrier to patient payments. When patients can’t access, understand, or act quickly on their bills, they are less likely to make a payment or pay in full.
Improving the Financial Experience for Patients
Health systems and clinicians shape patient care experiences, which can unfortunately lead to medical debt and devastating consequences in certain circumstances. So, what can healthcare providers do to alleviate these financial pressures for patients and set them up for success beyond diagnosis and treatment?
The first and most obvious response is to get the bill covered by the carrier prior to sending it to the patient. With advanced technology partners, this is a goal that should and can be explored. However, if there is still a patient portion, the following four steps will enhance the experience for all:
• Patient Education and Awareness
Healthcare organizations can help individuals make educated decisions about how to plan and pay for their care. Enhancing medical billing transparency means ensuring patients are aware of out-of-pocket expenses, including cost-of-care discussions in provider-patient interactions.
With the federal No Surprises Act in effect, patients now have increased transparency into what scheduled medical encounters cost. However, these estimates can only be accurate if no unplanned medical care or treatment is needed during service. By communicating up front with patients about additional costs, they will be more empowered when making healthcare decisions.
Once a patient receives a bill, it should be accurate, easy to understand, and convenient for them to take action.
• Payment Choices and Flexibility
Healthcare organizations can help patients with medical expenses by expanding, simplifying, and innovating payment options and plans. Offering more ways to pay based on patients’ preferences is essential, as is giving patients more time and flexibility. No two patients are alike, and based on their propensity to pay, providers can offer patients customized communications that offer payments through paper, phone, text, email, or portal access.
Offering payment plans is a proven way to increase collection rates. Patients who are offered additional time, even if it’s just a few weeks more, are more likely to make payments or pay their bills in full, reducing likelihood of medical debt. By adding a few more weeks to the billing cycle, providers can offer patients a more dignified and effective way to pay for services at a time most suitable for their financial situations.
• Compassionate Care Continuum
Healthcare expenses are a source of anxiety for many patients. Intimidating collection steps won’t do them any good, but a more compassionate billing approach could help increase patient payments.
Team members should utilize compassionate language as they guide patients through their journeys. When patients are confused, they should be met with a responsive contact center that leads with empathy and understanding. After all, calm patients feel more confident in their billing and are increasingly more vested in paying for the services rendered.
• Simple and Streamlined Technology
Providers should implement portals that make it easy for patients to pay bills, schedule appointments, review payment plans, and share feedback. Empowering patients with a self-service option enables greater transparency and customized experiences — all leading to higher payment capture.
By developing an extensive and dynamic patient journey by persona, organizations can customize communications by patient demographics and propensity-to-pay. This allows them to use the most innovative, intelligent means to request and receive payment. If providers don’t have a portal that meets these criteria, there are technology-enabled revenue cycle services partners that can further enhance the patient experience.
No two patients have the same pain points when it comes to medical expenses. And considering the economic landscape evolves daily, healthcare needs to be ready to adjust accordingly. Providers need to find flexible and intuitive ways to connect with patients and offer a variety of payment options to engage compassionately throughout the entire healthcare journey.
As the impact of COVID-19 continues to unfold, it is becoming abundantly clear we can no longer separate physical and fiscal care – patients cannot afford it. Provider payment systems and practice management solutions, too often regarded as an afterthought, can play a significant role in the financial well-being of patients by preventing the accumulation of debt and absorbed costs.
In the coming years, the lasting implications of the pandemic will no doubt result in a financial burden that compounds these challenges, creating an urgent need to streamline payments and administrative tasks on behalf of patients.
A Patient Need, Unfulfilled
The effect of inefficient and inflexible payments is best understood on a broad scale. According to a 2021 study by Rectangle Health and PYMNTS1, there is a significant disconnect between the payment solutions patients are interested in and the solutions they are offered. Per the study, 63% of patients are “very” or “extremely interested” in using payment plans, though only 44% were offered them. Many patients are also interested in access to digital payments, but they are not offered options either.
To put this financial disconnect into a medical equivalent, consider a patient with a heart condition who is dependent on the provider administering swift and decisive treatment. Waiting to get treatment would only exacerbate the issue and have potentially fatal consequences. Similarly, an inefficient practice management system that allows a patient to miss payments builds debt. The consequences in practice management, however, are not restricted to a single patient – others may absorb costs, too, build debt of their own and the entire practice can be put at risk.
Medical debt has a significant and well-documented impact on patient health. When patients miss payments, they are more likely to avoid their provider and assume they cannot afford to treat new health issues that emerge. A 2016 study by the Kaiser Family Foundation2 found that about three out of 10 patients reported problems getting health care they needed directly as a result of unpaid bills. Those struggling with bankruptcy are even less likely to seek medical attention when needed, but luckily a bankruptcy attorney on a site like Stoneroselaw.com should be able to help.
While some physicians are beginning to see patient visits return to pre-COVID-19 volume, many independent practices are still struggling. In fact, nearly nine in 10 practice owners or partners that responded to a recent survey indicated they were concerned about the future of their practices, and more than half of all respondents (54%) were “very concerned.”
Months of reduced activity, particularly at practices that suspended elective procedures in the spring, have taken a heavy toll on revenue. As a result, many practices are now compelled to take stopgap measures to contain costs.
High unemployment rates continue to create hardships that can strain patients’ finances. Even an indirect impact, such as a job loss sustained by another member in the household, can affect a patient’s willingness to seek needed treatment or impair their ability to pay for medical services.
To ensure patients can get access to the care they need, as well as their organization’s financial longevity, each health care provider needs to reassess their business strategy with an eye towards improvement in operations. The COVID-19 crisis has exposed many areas of inefficiencies that were already affecting revenues before the pandemic began.
Invest in operational efficiencies for better revenue management
Today, practices have less room for inefficiency and must take decisive steps to invest in technology that will drive increased efficiency at lower costs. Imperatives for a practice thrown into disarray by changes related to COVID-19 are to stabilize the practice by taking better control of the business process. This includes steps to strengthen contingency plans to minimize disruptions and reduce patient liability during the reimbursement lifecycle of the patient, while ensuring the safety of patients and staff during these challenging times.
Reducing patient liability is both a strategy and a desired outcome the practice should aim for as it fine-tunes its management of the revenue cycle, which extends from the patient’s initial appointment through successful payment collection.
The practice can reduce increases in aged receivables by greater attention to pre-visit efforts. Performing eligibility checks and verification of benefits sets expectations and provides improved financial transparency for the patient which sets the stage for a smoother patience experience.
Since the start of the COVID-19 outbreak, the healthcare industry has had to adapt to closures, adopt automated processes and utilize telehealth more than ever before. Providers have been inundated with patient messages, phone calls and payments; in need of mobile-first solutions and custom workflows.
Relatient, a SaaS-based patient engagement company, helped University Physicians’ Association (UPA) to revamp its patient billing process for medical practices across East Tennessee, streamlining revenue cycle management (RCM) operations and extending a patient-friendly financial experience to patients and caregivers. The result was a 43% increase in patient payments with mobile-first billing.
Flexibility is key to meeting patient needs, and Relatient granted UPA the ability to extend self-service tools like mobile payments to the majority of patients who want this kind of access without neglecting those who still prefer to interact over a phone call. In addition to Relatient’s work with UPA, there are many other simple, practical ways to improve the patient experience.
Anesthesia billing can be tremendously complicated. Small errors can result in delays and a failure to collect. To improve revenue cycles, we’ve compiled some key ideas that will make an impact on your billing and collections.
#1: How is the charge established?
There are a number of factors that can affect anesthesia billings, but the process can be broken down to a relatively simple formula. Charges are established by adding base units, time units, and modifiers, and then multiplying by your fee per unit. In other words:
(Base Unit + Time Units + Modifiers) x Fee Per Unit = Charge Amount
#2: Accurate Start and Stop Times
The industry follows Medicare’s definition for anesthesia billing start and stop times. Anesthesia billing start and stop times are based on the continual presence of an anesthesia provider. It is critically important to record accurate start and stop times. Do not round your time, and never guess when the start or stop time was.
#3: Understanding Billing Modifiers
Billing modifiers can have a big impact on your charge amounts. There are a number of modifiers that come into play including physical status, medical direction, anesthetic type, and add-on codes. These modifiers can affect your charge amounts in a variety of ways so it’s important to understand each modifier and the role they play in billing.
#4: Documentation is critical
Accurate documentation is the difference between success and failure in generating cashflow. You can have the best systems available, but if the information that you feed into the system is inaccurate or incomplete, your billings and collections will suffer. Pay close attention to your start and stop times and record them accurately. Keep up with the billing modifiers that we discussed in #3. If you log these accurately, your revenue cycle management is set up for success.
With the new year, healthcare c-suite members are taking a critical look at upcoming market movement to maintain a holistic view of their organizations’ needs. Discussing industry trends at the recent College of Healthcare Information Management Executives (CHIME) CIO Forum, Anna Pannier, senior director of Ascension Technologies at Ascension Saint Thomas, noted the significant change taking place in the value-based care and wellness marketplace as a top concern for healthcare organizations.
As healthcare leaders, like Pannier, look to stabilize their IT strategies and drive meaningful patient outcomes and operational efficiency, they should assess these five c-suite hot-button topics in the next year.
The shift in data analytics
As a more mainstream solution in the healthcare industry, data analytics is not considered the big “game changer” any longer, but it is still a significant investment focus for providers over the next year. Many healthcare facilities assume that once an analytics platform is implemented, they are ahead of the game. Unfortunately though, those same organizations fail to customize dashboards, continuously assess data, or really break down data insights for meaningful change and care decisions. Driving quality outcomes through data analytics to prepare for the future of population health risk management will be a large focus in proactive facilities.
Artificial Intelligence (AI)
Artificial intelligence and machine learning in healthcare has now surpassed data analytics on the new investment frontier. The industry has already seen AI application in pathology and radiology in the past year. Eighty percent of healthcare professionals believe that AI is helping to reduce physician burnout, according to a MIT Technology Review survey. Respondent hospitals said AI has increased patient consult time, improved team collaboration and boosted productivity through workflow enhancements.
Similar to data analytics, the CIO will need to work with leadership groups in both the clinical and business sides to determine AI use cases across their evolving organizations. Thought typically applied to clinical care, applying automation and AI on the operations side will drive workload transformation across key business functions.
Greater emphasis on patient engagement
With most organizations having a fully implemented EHR, healthcare organizations are looking to make the most of their long-term investment. Added pressure from value-based care documentation and reimbursement initiatives, as well as increased consumer expectations, drive emphasis on patient engagement. Yet, meaningfully connecting and interacting with healthcare consumers in their patient care plans still lacks.
In fact, pointing to limited or complicated instructions for the everyday patient, a study in the Journal of General Internal Medicine found that hospitals are not properly preparing patients to take advantage of patient portals. More healthcare organizations are now seeking around-the-clock direct patient portal support, as an extension of their IT service desk’s capabilities. This coupled with remote virtual monitoring will drive improved patient outcomes in the next year.
A key element in achieving end-to-end revenue cycle success in any healthcare operation is proper dedication and maintenance of workflow tools, and those systems that support processes that help organizations meet net revenue expectations.
Workflow optimization and the deployment of tools should be viewed from four perspectives: People, process, technology and metrics/KPIs/reporting.
It is incumbent on healthcare organizations to explore each of these areas related to RCM workflow optimization and consider relevant questions before deploying a fresh approach to workflow processes and automation. First, they must recognize that a balance of concentration of these four components is needed when building operational effectiveness and for the success of workflow strategy, tools and support systems. Furthermore, it is critical for RCM workflows (front, middle and backend) to reflect the uniqueness (location, size, demographics, payer mix, etc.) of the organization.
While there are many benchmarks and strategies in the industry that an organization can follow, adapt to or adopt, the specific characteristics of the organization – whether it’s a rural versus urban facility, the size and makeup of its staff, budgets, effects of recent mergers and acquisitions, and more – must be inputs when building and maintaining effective workflow controls. Principally, dedication to establishing optimization in workflows within revenue cycle operations is a direct result of senior management’s objectives of lowering or maintaining organizational metrics involving departmental and organizational “cost to collect”.
Organizations’ achievement of desired “cost to collect” results comes from their empowerment of senior and middle management and line staff, adoption of sound strategies that are understood and embraced, provision of user-friendly processes and effective deployment of technology – as well as maintenance of technology in a manner that is adaptable and flexible to the user and the organization.
More importantly and in support the first three components, organizations pursuing workflow optimization must have a process in place for measuring and gauging the success of established RCM goals, as well as clear metrics. Metrics are where the rubber meets the road – they’re how organizations know whether the people, process and technology components are functioning efficiently and as intended.
As in any situation where there is a desire to get from one point to another effectively and efficiently, a sound understanding of how metrics support organizational expectations will inform the direction and strategy. It is also important to note that RCM workflow optimization is system agnostic. While each organization has different approaches to workflow support and automation, they need to look at this component relative to the system they have deployed as well as their own uniqueness.
With a dedicated, all-encompassing approach to workflow operations, organizations are better positioned to process patient access, improve eligibility/benefits verification administration processing, improve Point-of-Service (POS) collections, effectively manage claims loads, process appeals in a more timely manner and improve self-pay production and collections. They can also maintain proper coding requirements, improve overall processing, and possibly reduce denials or denial rates, all while improving overall aspects of the revenue cycle continuum to achieve organizational strategic and revenue goals.
While there is no off-the-shelf, cookie-cutter formula to deploy to achieve expected net revenues and RCM optimization, establishing and maintaining benchmarks consistent with the uniqueness of an organization is key to success.
Organizations must address many questions to understand whether workflow operations and technology are hitting the mark. While a holistic approach taking into account people, processes, technology, and metrics is fundamental for true system effectiveness and performance optimization, there are many considerations associated with each of these areas.
People/Resources:
Does your staff have the capacity to perform production requirements needed for organizational success? Additionally, in deploying resources, are team members in the right positions? Are there leaders who can enable others’ success?
Do all RCM staff fully understand their roles relative to the RCM end-to-end continuum? Are staff interchangeable or cross-trained to increase operational understanding or in preparation to fill unexpected gaps?
Does RCM management deploy outsource resources as a stopgap measure?
Are teams looking at “root cause” issues that will affect workflow production goals and objectives?
Processes
In the case of new RCM systems and upgrades to present systems, are workflow processes reviewed or challenged with respect to potential changes in technology?
Are RCM operational workflow processes interchangeable so that any new introducing effects do not create abnormalities, gaps, and workarounds?
Does the organization embrace outsourced help in achieving best practices in workflow processes?
Should the organization consider a central billing office if one does not exist?
While there are more questions organizations ought to consider in reviewing – and correcting – the effectiveness of the RCM continuum, the areas of people and process should guide the use of resources in the most efficient and effective manner. Furthermore, the structure of operations should allow for adaptable departments(s) and an environment that promotes the achievement of organizational goals and the ability to manage expected and unexpected changes.
By Joe Polaris, senior vice president of product and technology, R1 RCM.
Joe Polaris
This year promises many new opportunities to apply technology to improve the healthcare revenue cycle. The recent HIMSS conference, for instance, featured many exciting use cases for machine learning and artificial intelligence (AI). However, before rushing to implement any of the latest solutions, let’s step back for a moment.
While there is plenty of emerging revenue cycle technology, there is also still a fair amount of complexity when it comes to implementing these capabilities. Most organizations typically have a significant amount of disorganization to deal with on the back end of their billing processes, as well as disparate technology systems that don’t work together. Many organizational leaders also are growing tired of only achieving incremental improvements to the revenue cycle through stand-alone revenue cycle management (RCM) technology, especially with rising total administrative costs and cost to collect.
That means we simply cannot afford to implement “quick-fix” RCM technologies that fail to support future goals. In an industry known for emphasizing quarter-by-quarter financials, we must begin taking a longer view. Rather than trying to establish 2019 implementation priorities, think about using the rest of 2019 to set the foundation for a holistic RCM transformation.
Perhaps the question to ask this year is: “Where do we want to be in three years – in terms of process efficiency, cash flow and an experience that delights our patients?”
Map RCM to the patient journey
Answering that question requires a holistic assessment of the entire revenue cycle, especially as it relates to the patient journey. Although that’s not a small undertaking, it allows healthcare organizations to build a thoughtful, realistic roadmap for long-term RCM transformation. In turn, such planning helps organizations realize greater value from all their RCM technology investments. Consider these four steps:
Evaluate: Although some healthcare organizations are further along when it comes to more efficient and patient-centered RCM, most are just starting to explore due to a wide variety of situational limitations. Escaping such constraints will require you to map out the entire patient journey end-to-end. Then, look at the map to identify areas of potential revenue cycle satisfaction for patients, as well as their most significant pain points.
Plan: After evaluating your RCM strengths and weaknesses, prioritize those processes in which technology has the greatest potential to remove waste, create capacity or give back operational expense. When deciding which solutions to implement, remember to take a broader, longer-term focus. Your organization should avoid the temptation of “quick wins” and instead focus on a viable long-term path that will meet your holistic, collective objectives. By generating a long-term plan, you will also incrementally create business value and move toward a more well-defined end-state vision. The most impactful digital transformation might come from phasing in the adoption of a comprehensive platform, as well as combining digital self-service technology and other automation capabilities — some of which may take hold quickly, while others may require more time.
While some physicians are beginning to see patient visits return to pre-COVID-19 volume, many independent practices are still struggling. In fact, nearly nine in 10 practice owners or partners that responded to 
With the new year, healthcare c-suite members are taking a critical look at upcoming market movement to maintain a holistic view of their organizations’ needs. Discussing industry trends at the recent College of Healthcare Information Management Executives (CHIME) CIO Forum, Anna Pannier, senior director of Ascension Technologies at Ascension Saint Thomas, noted the significant change taking place in the value-based care and wellness marketplace as a top concern for healthcare organizations.
