Revenue cycle management (RCM) is at a crossroads: as caseloads continue to increase, staff are having to do more with less to keep health systems afloat.
This comes at a time when staffing shortages are a major pain point throughout healthcare, yet adding capacity seems the only way out.
During a May Becker's Hospital Review webinar sponsored by AKASA, Cari Benshoof, director of patient access – financial counseling at Kansas City, Mo.-based University Health, and Kelly Leo, head of product marketing at AKASA, discussed how advanced automation technologies can shore up RCM operations and teams.
Four key takeaways were:
1.) The revenue cycle is facing headwinds. One of the clearest symptoms is that payer complexity is increasing. According to a 2020 survey by the American Medical Association, 83 percent of respondents indicated that prior authorization requirements had increased over the last five years. These elevated requirements represent a barrier to delivering necessary patient care, which apart from a moral obligation is a core source of revenues.
Overcoming that barrier — typically through providing additional documentation — is laborious and time consuming, yet staffing shortages make it difficult to add people. Growing patient volumes are further contributing to high turnover, unfilled vacancies and rising wages. "It just feels like challenge after challenge. . . . Automation can be a key solution to helping you with these challenges," Ms. Leo said.
2.) Advanced automation technologies with experts-in-the-loop can handle complex workflows with minimal human supervision. Such technologies go beyond rules-driven robotic process automation (RPA) and AI-enhanced RPA and have the capabilities to work their way through dynamic, highly variable workflows without increasing overhead. They achieve this by including a human expert who is involved in the process and is ready to take over if the algorithms run into an issue they cannot resolve.
University Health, a safety net hospital, opted for AKASA's solution while preparing for major changes to its patient mix in the wake of Missouri's recent Medicaid expansion. The organization knew its revenue cycle operations would face extreme pressure as many low-income and uninsured patients would transition from financial assistance programs or self-pay status to Medicaid. Submitting reimbursement claims to those plans often involves additional steps that require manual intervention and thus, increased staffing.
"We started the implementation process around July of 2021 and went live with our first product, prior authorization, in late 2021," Ms. Benshoof said, adding that the hospital has plans to automate eligibility verification and the claims submission process. "That human-in-the-loop is really important to help us know quickly when a change [within a payer portal or within UH's EHR] has been made and not cause us unnecessary delays or denials of authorizations."
3.) Automation solutions require staff buy-in and adoption. To prepare staff for the changes that automation will bring, it is important to paint the big picture — in Ms. Benshoof's words: "AKASA serves as a virtual FTE" — and provide upfront guidance, such as:
- Communicating clearly why the innovation is necessary (e.g., not trying to replace staff but to avoid hiring additional staff).
- Explaining the benefits (e.g., taking away repetitive administrative tasks, alleviating the burden of elevated caseloads).
- Showing value by inviting staff to help with workflow design and provide feedback.
- Engaging non-RCM teams and departments that may be affected by the automation process.
4.) To measure automation's business value, use the right key performance indicators. Within RCM, that includes starting with baseline data as a position from which to quantify activity. From there, three stages of meaningful measurement are:
- Early indicators: volume automated, hours automated.
- Impact on the team: reduction in time per task, percent decrease in authorization denials or percent increase in clean claims rate, turnaround time from patient scheduled/admitted to authorization secured.
- True outcomes: reduction in cost to collect, reduction in the number of days in accounts receivable, increase in revenue.
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