How to drive topline revenue by optimizing front-end revenue cycle performance

Operational inefficiencies, labor shortages and the fast-changing billing environment that came with COVID have contributed to rising denial rates in the revenue cycle process.

But traditional front-end solutions for addressing these challenges aren't adequate in today's environment.

In an August Becker's Hospital Review webinar sponsored by Notable, Paola Turchi, revenue cycle lead at Notable, discussed the core front-end challenges that hospitals and health systems are facing and described how intelligent automation offers a cost-effective solution for today's revenue cycle processes.

Four key takeaways were:

1.) Revenue cycle leaders face three core front-end challenges. The three main challenges are growing denials, increasing bad debt and staffing challenges.

Denials have been on the rise for the past four years and 69 percent of healthcare leaders reported an increase in denials in 2021. Denials leads to write-offs. Front-end errors have been the top cause of denials since 2016, with half of denials caused by front-end revenue cycle issues, which were exacerbated during the pandemic. "The rules were all over the place and claims were being denied left and right," Ms. Turchi said.

The denial management process is largely manual, resulting in a burdensome patient and staff experience. Notable data indicates that:

  • 30 percent of claims submitted for the first time are denied or rejected
  • 60 percent of denials are never worked due to lack of time or knowledge
  • 90 percent of denials are preventable
  • 70 percent of denied claims can be overturned
  • On average, it costs around $25 to appeal a claim

The second core front-end challenge is that high patient account receivables generate large bad debt. As more healthcare consumers are choosing high-deductible plans, provider organizations must facilitate a better patient collection process.

The third major front-end issue is staffing and workload challenges, with decreased retention and engagement.

2.) Status quo front-end solutions have several pitfalls. Common approaches like outsourcing and buying point solutions have their own flaws. Outsourcing can remove control of the revenue cycle and create communication breakdowns and poor patient experiences. Point solutions, meanwhile, have limited impact and may require multiple technologies.

3.) Intelligent automation is a differentiator that can increase revenue. Ms. Turchi said that if you ask back-end revenue cycle workers where most problems originate, they'll say 80 percent come from the front end. Intelligent automation helps by automating many of the labor-intensive, error-prone, front-end workflows, like intake, authorizations, care gap bridging and referrals. Intelligent automation also simplifies and helps digitize the patient experience by opening the digital front door and enhancing engagement. "Intelligent automation can power growth," Ms. Turchi said.

4.) Implementing intelligent automation at scale calls for a framework. The DMAIC framework — Define, Measure, Analyze, Improve, Control — uses a data-driven improvement cycle that provides structure, with each phase containing solution-driven tasks and tools. By taking a close look at and documenting all workflows, then getting a baseline key performance indicator status and accompanying analysis, followed by improvements and ongoing iterations, organizations can evaluate intelligent automation solutions like Notable to help eliminate the source of front-end problems, and ultimately, denials.

Intelligent automation helps eliminate barriers and repetitive tasks, decrease denials and improve revenue collection by modernizing front-end processes. It also provides enhanced, consumer-grade experiences and solves the core revenue cycle challenges for patients, providers and staff.

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