How automation can improve a hospital's revenue cycle operations — 6 experts weigh in

Rising labor costs, fluctuations in payer mix and regulatory changes, among other issues, are pressuring hospitals and health systems to reduce costs and increase revenue.

"Our goal is to break the pattern of underperforming revenue cycle programs in the healthcare industry," Michael Duke, principal of healthcare consulting at Baker Tilly, said.

During a May 8 webinar hosted by Becker's Hospital Review and sponsored by Baker Tilly, Doug Sundlof, executive vice president of sales at AcuStream, said ongoing margin compression requires innovative approaches to healthcare delivery.

"What [margin compression] has necessitated on the part of healthcare systems and providers is innovation and its corresponding changes to reflect the way healthcare needs to be delivered going forward," Mr. Sundlof said. To improve revenues, hospitals and health systems must consider exploring various revenue cycle strategies and leverage new technologies, such as exception-based workflows and data visualization tools, to improve operational processes and coding to reduce claims denials, he noted.

Mr. Sundlof joined a panel of five healthcare and finance executives organized by Baker Tilly Healthcare to discuss how automation techniques can materially improve revenue cycle staff performance, operational efficiencies and financial outcomes. The panel, moderated by Mr. Duke, included Michael LeLion, global partner director of Datawatch; Michael Mullins, senior director of enterprise sales healthcare at Ontario Systems; Nelson Norsworthy, a sales consultant at Tableau; and Robert Doxey, senior regional director of Recondo.

Below are four insights into automation solutions for your revenue cycle operations discussed during the webinar.

1. Exception-based workflows

"The goal of an exception-based workflow is to configure a hospital or health system's existing revenue cycle management software to alert officials on an exception basis — for example, when a claim is denied." Mr. Duke said. By automating aspects of the workflow, hospitals can minimize human error and improve efficiency by allowing employees to spend their time "on the next most valuable activity" while the software notifies them of any inconsistencies in a patient's financials.

"Typically, most workflow solutions take more of a queueing or worklisting approach and examine general, high-level information to determine where your accounts should be categorized for your user to work," Mr. Mullins said. "However, exception-based workflows exclude anything that can be automated."

Mr. Mullins also noted executives generally view exception-based workflows as standalone technology. However, that should not be the case, he said. Exception-based workflows should augment the host software and standardize the environment while instructing end-users on how best to solve the issue at hand.

2. Robotic process automation

Robotic process automation (RPA) involves the use of software robotics to emulate the tasks business operations individuals typically conduct via automated solutions. The software exists alongside an organization's IT infrastructure and may potentially cut data entry costs by up to 70 percent, according to Mr. Doxey. The goal of RPA is to obtain a comprehensive and timely snapshot of patient coverage and eligibility, among other functions, before or after services.

Health systems can use RPA to more easily determine what a patient's potential financial responsibility would be "to eliminate a lot of that manual effort and to get data directly from payer websites automatically," Mr. Doxey said. "In the billing process, for example, automating authorization from initiation to submittal can also reduce authorization-related denials and denial write-offs." Mr. Doxey said roughly 92 percent of physicians claim prior authorizations delay patient access to care, while 78 percent claim prior authorizations can result in patients stopping a recommended course of treatment.

3. New data prep tools

Mr. LeLion said the speed of data proliferation in today's society means "any sort of new technology working in the data preparation space must be data agnostic." Not all users accessing the data will be IT professionals. In order for users to access data successfully, management must provide users with the proper prep tools so they can "blend and transform" the data to their visualization tools in a timely fashion.  

"Healthcare organizations have access to so much different data, and users need to be able to easily access it. However, just as important as this access, is the fact that the data must be fully auditable. It has to be good for business but with IT in mind." Mr. LeLion added.  

4. Data visualization tools

During the webinar, Mr. Norsworthy said data visualization can help companies extract insights by amalgamating various data sources and presenting complex concepts in an easily digestible format.

"In this kind of world where we're all drowning in information, the organizations that are going to come out on top are the ones who are going to move quicker and receive more insights from that deluge of data," Mr. Norsworthy said. "Data visualization allows you to interpret numbers [more easily] than you would looking at a spreadsheet. Imagine looking at tens of thousands of rows of information … and trying to get insights out of that. You could boil that down to a simple bar chart … and summarize that information."

The revenue cycle innovation center combines healthcare consulting firm, Baker Tilly, with leading technology organizations to help providers better manage and control their revenue cycle activities.

To view the webinar recording, click here.

To view the webinar slides, click here.

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