Three considerations for automating healthcare revenue cycle operations

The complex and manual system of claim preparation and billing is a key driver of healthcare costs in the U.S.

As a result, revenue cycle operations are often a key area of focus in digital transformation efforts. This focus has shifted automation in revenue cycle operations from an aspirational “nice to have” to mission-critical for driving efficiency and cost effectiveness. In fact, in a recent survey of more than 500 chief financial officers (CFOs) and revenue cycle leaders at health systems and hospitals across the country, more than 66 percent say their organization is actively using or implementing automation tools in their revenue cycle operations today.

There are a number of important considerations for health system leaders to keep in mind when purchasing and deploying effective automation solutions within their revenue cycle operations — from best practices for the industry to the variables that may be unique to individual organizations. Healthcare is a highly complex and dynamic industry, one that requires automation partners with meaningful expertise in revenue cycle operations and a flexible platform for performing work. Below are three important considerations that can help define the expectations any organization should have of effective partners in automation. 

1. Understand the total cost of ownership. Regardless of the automation solution an organization selects automating revenue cycle operations generally follows the same three-step process:

  • Documenting workflows and processes. 
  • Develop or program the technology that will automate some of the work.
  • The automation technology is deployed and processes for maintaining the automation must be implemented. 

Forward-thinking revenue cycle leaders should consider the cost implications of all three steps when selecting the best automation solution for their organization. Look for automation partners that have proprietary technology tools to document workflows in less disruptive ways. Be sure ongoing maintenance is built into your budgets. Payers are constantly updating plans, claim forms, prior authorization and other requirements. Is the solution you’re considering capable of adapting to these changes as they happen or will you or your vendor need to allow time, talent and budget for reprogramming bots and updating code every time something changes? How flexible are the solutions you are considering? Will they be able to scale and adapt to your organization’s needs over time? 

Automation vendors should be transparent about their pricing and be able to explain how their approach to pricing aligns their financial incentives with their solution’s performance, and how it maps to better business results for you.

2. Take a practical approach in the short term and be ambitious in the long term. For the first deployment, start with a clearly defined area that also minimizes the need for change management. Common areas to start with in the revenue cycle are Eligibility, Prior Authorizations, Claim Status and Denials Management. Many organizations underestimate what they can automate because some technologies, such as robotic process automation (RPA), are very limited in their capabilities. However, with today’s machine-learning based technologies your scope can and should expand.

Make time to work with your solution providers to identify near-term goals and map how they advance your longer-term objectives as a department. This is an important step toward ensuring your automation strategy delivers effective performance at lower costs over the long term.

3. Human Judgment and Subject Matter Expertise are Critical to Automation. Any automation solution is better with human experts in the loop. Companies like AKASA, include  an interface for machine learning algorithms to learn in real time from the company’s team of revenue cycle experts who handle edge cases and exceptions. This ensures the machine learning software can learn, adapt, and handle increasingly complex tasks independently over time while also protecting the bandwidth and focus of health system staff. By blending automation with human judgment, accuracy and efficiency are improved while also ensuring work continues without disruption when something unexpected arises.

Be sure to ask solution providers how their systems handle outliers and edge cases. Do they perform regular audits to ensure the automation solution is performing with precision and reliability? 

The AKASA “Buyer’s Guide to Healthcare Revenue Cycle Automation” provides an in-depth look at the automation process; how to understand the total cost of ownership for automation solutions; and how to evaluate AI solutions, among other considerations. A complimentary copy is available at:

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