How advanced automation technologies can help solve healthcare's most significant RCM problems

Revenue cycle management is elevating pressure on health systems to do more with less: process a growing volume of increasingly complex coding, billing and collections activities with fewer staff members who are harder to recruit and retain.

During a workshop sponsored by AKASA and moderated by Scott Becker during the Becker's Hospital Review 9th Annual CEO & CFO Roundtable, Ben Beadle-Ryby, co-founder and vice president of AKASA, and Dustin Cragun, vice president of revenue cycle management technology and services at KLAS Research, discussed major challenges facing revenue cycle operations and how advanced automation technologies can help solve these problems.

Three key insights were:

1. RCM leaders are struggling to get through massive volumes of work, but existing approaches are falling short. The enormous complexity of revenue cycle management, which is reflected in coding and billing practices, is compounded by increases in outpatient volume and changing levels of services. "Organizations have traditionally solved these issues by throwing armies of people at the problem," Mr. Beadle-Ryby said. But simply throwing more people at this problem is not a viable solution due to the intense competition for talent and the high turnover rate of RCM staff. New staff members often have significant educational and skill gaps in relation to the specific training requirements for working in revenue cycle management. The result of these challenges is a stagnant or increased cost-to-collect, according to Mr. Beadle-Ryby.

2. Automated technologies that can address dynamic workflows is one way to alleviate pressures on revenue cycle management. Prior to COVID-19, revenue cycle leaders were looking to artificial intelligence, machine learning and robotic process automation . But since the pandemic began, organizations have recognized the need for automated technology solutions that can offset some of the challenges with recruitment, training and turnover, Mr. Cragun said.

The first generation of automated RCM technologies augmented and assisted staff in performing their work more efficiently but could not automate tasks. The second iteration — robotic process automation technologies — could automate simple, stagnant tasks, but not complex workflows such as the ones that define revenue cycle management.

"What RCM requires is a much more sophisticated technology and unified approach so you can respond in real time to changes from your payers and from your patients," Mr. Beadle-Ryby said. He pointed out that AKASA's automated technology solution provides those capabilities while seamlessly blending into existing workflows without requiring any additional staff training.

3. Numerous use cases within revenue cycle management are ripe for dynamic automation. These include patient access workflows such as prior authorization and eligibility checking, outpatient medical necessity, generating accurate price estimates in the mid-revenue cycle, coding, clinical documentation integrity and utilization review.

"The goal of automated RCM technology is not to replace human beings but to lead them to skill up while helping organizations control RCM overhead even in times of expansion," Mr. Cragun said. Organizations that have truly embraced this technology and are using it as a competitive advantage are looking holistically at their entire RCM process from end to end, he said.

Automated RCM solutions can put healthcare organizations on a path to solving important staffing and billing challenges. These solutions can also empower staff to dedicate more time to addressing patient-facing issues

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