What hospital leaders should know about automation in the revenue cycle

Many healthcare finance leaders understand that automation can be leveraged to cut out manual, repetitive tasks in the revenue cycle to improve efficiency and give time back to staff. However, the right automation solution should be able to do more than just reduce repetitive work, explained Ben Beadle-Ryby, co-founder and vice president of operations for Alpha Health, in a recent interview with Becker's Hospital Review.

"If automation is not impacting each of the key performance indicators revenue cycle leaders hold themselves accountable to, then it's not fulfilling its mission to drive efficiency and improve revenue cycle performance for organizations," Mr. Beadle-Ryby said. 

Here, Mr. Beadle-Ryby discusses three challenges he's seen revenue cycle leaders struggle with, what automation technologies can help providers the most and how Alpha Health is working to improve revenue cycle functionality at hospitals and health systems across the U.S. 

Editor's Note: Responses were edited for clarity and length: 

Question: What are three top challenges you've seen revenue cycle leaders struggle with over the course of your career working with hospitals and health systems?

Ben Beadle-Ryby: Looking specifically at the last 10 years, there are three challenges that rise to the top of the list for revenue cycle leaders. The first one is dealing with how to respond to denials and mitigate the risks associated with them and limit their write-offs. 

The second one that stands out, which took place several years ago, was shifting to the ICD-10 code tech. This was a multidisciplinary effort that organizations had to take on and the revenue cycle was at the heart of it. Providers of all shapes and sizes accommodated this new code tech and it was a significant lift across the healthcare industry and presented challenges. Ultimately it led organizations to look to improve in areas like clinical documentation, charge capture and the mid-revenue cycle. The final area is the challenge of bending the cost curve. Organizations are attempting to reduce cost to collect while doing more with less. As an industry, we have applied all of the different resources that are out there, but over the last several years, organizations have plateaued when it comes to reducing the cost to collect.

Q: What specific problems in revenue cycle operations is Alpha Health solving?

BBR: Alpha Health is dedicated to using modern machine learning and applying it to revenue cycle operations to drive efficiencies and improve overall revenue cycle performance. Typically when I am speaking with a CFO or revenue cycle leader who is evaluating automation, they understand the potential automation has to reduce some repetitive work to support a more efficient revenue cycle. However, our team at Alpha Health would argue that reducing repetitive work alone is not enough.

Automation should be able to tackle more than simple routine tasks, and instead be able to take on complex tasks to lower cost to collect, but also improve overall revenue cycle performance and boost key performance indicators. Automation should be able to help healthcare organizations improve KPIs like lowering A/R days, collecting cash faster, reducing initial denials and preventing or reducing write-offs. 

Alpha Health's Unified Automation™ solution aims to collect the appropriate amount of reimbursement, faster, at a lower cost for organizations. We are well positioned to take on any tasks across the revenue cycle, from the front-end to the back-end, with an approach and methodology that allows us to observe what's happening in existing workflows, learn how that's being performed, synthesize that work and have a machine learning algorithm be able to take that on and ultimately be able to perform those same tasks. 

Q: Why should healthcare organizations prioritize revenue cycle optimization?

BBR: Revenue cycle is at the heart of how organizations fuel their mission of delivering quality care to their patients as it touches so many facets of the care process. The ability to accurately capture the care that's being provided and achieve appropriate and timely reimbursementsupports investments in payroll, the latest technology in medicine and updated facilities. Many providers are operating with razor thin margins. Having a streamlined and efficient revenue cycle is essential to their ongoing operations across the board. 

I think optimization of revenue cycle operations has always been a top five priority for health system leaders. What's been really interesting is in the last couple of years, more organizations have recognized some of the cost challenges that exist in the revenue cycle. They've started to look at the revenue cycle as not just as a revenue generator but a cost center as well. And, subsequently, they're recognizing opportunities within the revenue cycle to lower costs.

Q: How can automated revenue cycle processes benefit providers?

BBR:Every provider has processes that are incredibly manual in nature. Those processes are essential to operations, but automation allows organizations to do them more efficiently. Automation can help providers reduce error rates in those processes. Automation also gives time back to staff sothat they can focus on the more meaningful, higher value functions such as highly analytical tasks or those that require deep thought and skill sets. In that regard, automation is something that can help providers streamline operations. The revenue cycle happens to be one of the areas that is most ripe with opportunities for efficiency. 

Q: What automation technologies can help providers the most?

BBR: It's important to understand there are a lot of different automation solutions, degrees of automation and technical nuances to automation. A lot of people lump robotic process automation, artificial intelligence and machine learning together or use them interchangeably. The reality is there are distinct differences between RPA, AI and ML. 

In my view, RPA can deliver some limited value, but there are some inherent challenges for RPA and limitations in the technology in that it can only tackle very basic stagnant workflows. If there are changes needed in the workflows, those bots are likely to break and require a lot of manual efforts to keep them up to speed.

At Alpha Health we believe that by blending modern machine learning, artificial intelligence and revenue cycle expertise, automation solutions have the ability to tackle complex tasks that have multiple levels of decision points and actions. Overall, the technology should be adaptable and comprehensively apply automation to deliver not only cost savings to the organization, but improved revenue cycle operations. That is what we are doing at Alpha Health. We have developed a system of solutions that combine modern machine learning with revenue cycle expertise to deliver Unified Automation™. Unified Automation™ is able to evaluate existing workflows and identify the key steps and decision points in those workflows. It then can leverage that information to perform those activities at a higher degree of accuracy than we've seen before. 

Beyond that, the technology is able to adapt to the ongoing changes in the environment, which is essential in the revenue cycle. Payers continuously update their contracts, their denial reason codes, prior authorization requirements and provider crosswalk numbers. This makes adaptability and resiliency key components of an anti-fragile, successful automation solution. That is where I think there is one of the biggest differences in what Alpha Health and Unified Automation™ delivers versus some of the automation alternatives that are out there today.

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