How to solve healthcare's accounts receivable problem

Overall cost reduction and efficiency are some of the top financial priorities for today's health system CEOs and CFOs. Faced with problems like shrinking revenue and increasing expenses, executives should start employing technological solutions, such as intelligent automation, to handle claims, increase efficiency and expedite insurance recovery. 

During an Aug. 20 webinar hosted by Becker's Hospital Review and sponsored by Healthcare Financial Resources, Jon Giuliani, vice president of operations at Healthcare Financial Resources, and Daniel Low, director of operations at Healthcare Financial Resources, discussed the areas of operations where intelligent automation can yield the most significant benefits for hospitals and health systems.  

In 2016, 270 billion U.S. hospital claims were initially denied. The number of denial write-offs is increasing, and because of this, the administrative costs of working these claims is now approaching almost $9 billion, according to Mr. Giuliani. Despite the abundance of administrative work, an average of 65 percent of denials are never corrected or resubmitted. 

"Too many hospitals and vendors continue to use an outdated, traditional approach of handling their claim issues," Mr. Giuliani said. "Throwing extra bodies and manual labor at this problem is simply not the answer." 

The answer? Automation 

With more than 90 percent of claims deemed preventable by the Advisory Board, introducing automation and updating technology systems for claims processing will help decrease denial write-offs and cut administrative costs, according to Mr. Giuliani. 

Additionally, as contracts between hospitals and payers grow more complex, organizations are increasingly expecting their entry-level staff to handle these claims processing issues. 

"To be frank, it's a process that's designed to fail. We need to be focused on making the workload easier and more streamlined for our employees," Mr. Giuliani said. 

However, before an organization can introduce intelligent automation into the revenue cycle, it must identify a starting point. Mr. Low identified accounts receivable for payment delay and denial classification mapping as a prime starting point for intelligent automation. The first step is to request or locate any open or closed denial information, then the organization can use historical and current claims data to categorize inventory. Robotic processing automation technology can also be especially helpful for grabbing information the organization may not have access to through its own system. 

Once the payment delay and denial classification mapping data is categorized, the organization can move forward with implementing the intelligent automation and triage process. This ultimately allows claims to be classified and distributed to the organization's remediation team based on denial category, and the automation tool can develop a summary of all relevant claim information and compile a list of action items for staff. 

Seven inventory categories, opportunities for automation 

There is a significant opportunity for intelligent automation in each hospital inventory category, Mr. Low said. 

The seven classifications, or categories, an organization may want to consider automating are: coding and billing problems, coverage-related issues, processing delays with an insurance company, cash posting issues, submission and re-billing, contractual, and use cases such as clinical base rejections. 

To access the full webinar, click here.

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