The revenue cycle is ripe for automation –– 5 insights for how health systems can get there

It's no surprise that healthcare systems are increasingly focused on how to increase net revenue and cash at a lower cost to collect.

One successful way to achieve this goal is through automation. Revenue cycle processes are often highly repetitive yet still manually performed, making them ideal for automation.

During an October webinar hosted by Becker's Hospital Review and sponsored by Xtend Healthcare, Mike Morris, president and CEO, and Billy Padilla, CIO, discussed why health systems should automate the revenue cycle, steps they can take to get started and the benefits they can expect to see.

Five key insights were:

1. Limited resources, manual tasks, a labor shortage and lack of standardization in the revenue cycle can be improved with automation. "Many IT spend commitments within a health system flow to the clinical side of the house, squeezing the amount of dollars available for innovation and application development to support revenue cycle processes," Mr. Morris said. "There are still too many manual and repetitive tasks that take place every day, and healthcare providers have trouble attracting and retaining qualified staff.” Moreover, a lack of standard processes for people who work in a disparate and geographically distributed environment is another impediment that can be removed with the help of stronger automation, Mr. Morris said.

2. Cleansing and validating data is necessary before automation can happen. Health systems must first centralize the collection, cleansing and storage of different sources of data. "All of these disparate sources have to be mapped and put into a centralized repository so you can do common work events across data sources," Mr. Morris said.

Health systems also must ensure that data accurately reflects reality. "You don't want to automate a previously manual function based on imprecise or imperfect data," Mr. Morris added.

3. Automation can add immediate value by triaging tasks. Ideally, automation addresses simple requests with no human intervention and routes complex tasks to an individual trained to handle the complexities. "You want to triage accounts in a manner that aggregates like-kind claims so an agent sees the same complexity over and over and gets more efficient with those types of accounts," Mr. Morris said. "In addition, we want to send employees tasks that match their skill sets so they can practice at the top of their license."

4. Robotic process automation automates manual tasks quickly and efficiently. According to Mr. Padilla, robotic process automation is the action of taking a manual work event and programming the steps so it can be done by a computer. "Processes that are repetitive, very manual, of low value and high touch are perfect for automation," he said. "RPA is becoming table stakes."

5. Applying machine learning and artificial intelligence to the revenue cycle promises to accelerate automation. "It's the future of revenue cycle," Mr. Padilla said.

For example, Xtend applied artificial intelligence and machine learning to one of its clients who wanted to conduct eligibility checks but encountered an issue.

“The problem was that the payer required patient gender, which was not reliably captured in our data set. We created a machine learning model that allowed us to feed in examples of first names and genders, which then allowed us to accurately predict with a 97% level of confidence the gender of a patient,” Mr. Padilla said.

Automation technologies and revenue cycle management are meeting at a critical crossroad. Health systems can achieve their goal of increasing net revenue at a lower cost by understanding the interplay and adopting new technologies to improve processes.

To register for upcoming webinars, click here.

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