Setting the Stage for Investing in Revenue Cycle AI and Automation

Automation and artificial intelligence (AI) can play a key role in just about any healthcare organization’s revenue cycle management (RCM) – provided they are properly vetted and optimized. To ensure that happens, a comprehensive automation/AI strategy will include carefully evaluating the revenue cycle department’s people, processes, and current technologies to identify a proper fit. (Download our white paper here.)

• People: Carefully consider labor resource management and skillsets to identify any gaps and determine the team’s technical aptitude, as well as to determine whether outsourcing or bringing in outside consultants might be beneficial.
• Processes: Because every revenue cycle follows unique processes and workflows, it is important to assess current operations to determine which aspects are best suited for intelligent automation, how each process affects other areas of the workflow, what other departments or stakeholders might be impacted, and how labor can be reallocated to other tasks.
• Current technologies: Organizations with highly manual RCM processes will require a solution that is vastly different from those that may have already started to automate specific tasks.

Goal Setting

Once these criteria have been fully considered, the next step is to set goals and expected outcomes for the solutions that are ultimately selected. Clearly defining expectations will have a dynamic influence on the processes that need to be automated.

For organizations with minimal experience implementing intelligent automation, it may be prudent to take a conservative approach by seeking to achieve small wins by focusing on a specific portion of the RCM process and gradually building deeper complexities and integrations. An experienced automation partner can help develop a progressive implementation strategy to achieve identified goals while providing time for the team to acclimate to these technologies.

It is also important to have a clear understanding of where AI and automation make the most sense. For example, one aspect of RCM where it can have a significant impact is in maximizing revenues by reducing denials and payment delays. This is particularly true given that payers are already using AI to deny claims upfront. AI and automation can also go a long way toward helping RCM achieve compliance and ensure the organization’s reputation is in the proper shape.

Timing the Leap

The final step in the AI/automation investment process is determining the right time and situation to make the leap. A few things to consider are whether the organization is financially able to acquire, use, and optimize its investment. Executive buy-in is also crucial and can be secured in part by demonstrating a return on investment.

Finally, the right people need to be in place to optimize automation/AI once it’s implemented, so it’s critical for any staffing or skill gaps to be closed. The maturation of the AI depends on the team’s ability to work in parallel with these systems to train and educate.

By putting in place the proper strategy to ensure the right fit and to identify and eliminate any barriers, the foundation will be laid for a successful investment into AI and automation to optimize the revenue cycle.