Advancing Revenue Cycle Management Maturity through Technology and Interoperability

As healthcare organizations strive to enhance their revenue cycle management (RCM) processes, a revenue cycle management maturity framework is crucial to achieve greater maturity and optimize revenue cycle performance. The three key pillars include service delivery, technology and interoperability, and analytics categorized into four stages: emerging, foundational, advanced, and high performing. Our recent article shared the overview of the AGS Health revenue cycle maturity framework and detailed the journey to enhance service delivery capabilities. Next, we explore the technology and interoperability pillar, which encompasses the integration of various technologies, data flow between systems, and the automation of exception-based processes within an organization's revenue cycle processes.

1. In the emerging stage, organizations often rely on standalone technology solutions that lack integration and fail to communicate with each other effectively. This limited system integration, particularly between electronic medical record (EMR) systems and other technologies, leads to manual processes and resource-heavy operations. As a result, these organizations often add staff, which increases labor costs without addressing the root cause of inefficiencies. Struggles also arise with scalability, while post-M&A integrations can be lengthy and costly.
2. In the foundational stage, organizations recognize the need for integration and strive to connect their EMR systems with other technologies. They introduce automation to handle exception-based processes that are rules-based and require no judgment. By automating tasks such as eligibility verification, these organizations improve the patient experience and reduce manual effort. While they utilize technology vendors to address specific challenges, they are often isolated solutions that are fragmented and do not communicate with each other, creating data silos and limiting operational efficiency between systems.
3. Advanced organizations embrace an integrated tech infrastructure that facilitates data flow and communication between different systems. Real-time data exchange interfaces between technologies enable seamless collaboration and enable efficient exception-based processing across the workflow, often using computer-assisted coding (CAC). Organizations leverage automation for tasks like prior authorization and claim status inquiries, achieving high automation rates and delivering superior patient experiences. Intelligent automation pilot programs yield promising results and are transitioning into production, reducing manual dependencies, and introducing predictive or prescriptive next-best-action recommendations.
4. High-performing organizations achieve a highly configured and optimized system that aligns with their operating model across all locations, adopting CAC and computer-assisted professional coding (CAPC). They leverage technology to consolidate data from in-house coding and external vendors, providing real-time insights into operations and performance. Autonomous coding solutions are implemented to further enhance efficiency, especially in less complex specialties such as radiology and emergency departments. These organizations anticipate payer-driven innovations and actively adopt them, ensuring a seamless patient experience while embracing intelligent automation across the RCM workflow.

The technology and interoperability pillar of the RCM maturity framework showcases the journey healthcare organizations undertake to enhance their RCM processes. From emerging organizations struggling with standalone technologies to high-performing innovators leveraging integrated tech infrastructure, each stage brings unique benefits and challenges. By embracing automation, system integration, and predictive analytics, healthcare organizations can streamline operations, reduce manual effort, optimize patient experiences, and position themselves at the forefront of revenue cycle management.

View our webinar, “A Four-Stage Journey Toward RCM Transformation and Maturity,” and watch for the next article in our series that discusses the maturation of analytics.