The complexity and volume of transactions in healthcare revenue cycle management (RCM) often lead to inefficiencies, increased costs, and delayed revenues. However, intelligent automation, which combines human intelligence with robotic process automation (RPA), artificial intelligence (AI), and other forms of workflow automation, is poised to modernize traditional RCM processes, optimizing resource utilization, enhancing workflow efficiency, minimizing denials, and speeding up earned revenue.
The Case for RCM Automation
A survey by Sage Growth Partners highlighted that 79% of respondents identified RCM as the primary beneficiary of automation. McKinsey & Company further supports this optimism, projecting that intelligent automation could cut between $200 billion to $360 billion from U.S. healthcare expenditures, including RCM. This reduction is not just about saving costs; it's about reducing clinician burnout, enhancing patient experiences, and, ultimately, delivering better healthcare.
Additionally, a revenue cycle automation survey by the Healthcare Financial Management Association (HFMA) found that 74% of U.S. hospitals and health systems have begun automating aspects of their RCM operations. This includes 46% utilizing AI and machine learning (ML) and 43% implementing RPA solutions. Of these adopters, 46% of institutions employing intelligent automation report positive returns on investment (ROI) and reduced cost-to-collect averages, amounting to significant financial savings as a benefit of embracing automation. Approximately 80% of healthcare organizations yet to adopt automation in RCM report it as a top priority to consider by 2025.
Understanding the Technology Landscape
Distinguishing between the core technologies of intelligent automation is essential for leveraging its full potential. While AI and automation aim to streamline operations, they offer distinct benefits. AI equips systems with human-like intelligence, enabling them to learn from data, adapt to new inputs, and make informed decisions to perform tasks without direction to do so. This includes denial prediction by analyzing attributes of at-risk claims, employing machine learning (ML) algorithms for coding completion, and utilizing natural language processing (NLP) in chatbots for questions and answers.
On the other hand, automation focuses on using technology to augment manual efforts in performing routine and predictable tasks with increased speed and accuracy. RPA mimics human actions to complete tasks or automate workflows based on predefined rules, such as automating payment processes within electronic health record (EHR) systems, updating claims statuses, and streamlining charge entries.
Integrating Mindset with Technology
Embracing a culture that welcomes innovation and continual improvement is fundamental to leveraging the benefits and full potential of intelligent automation in RCM. The mindset includes understanding the capabilities and limitations of AI and automation technologies as well as a willingness to invest in the necessary infrastructure and training.
It's important to work with a partner that has operating experience as well as a proven record for problem-solving with technology. A cloud-based, configurable platform can lead to greater efficiency, easier upgrades, and ultimately, more successful outcomes, and any gaps in current automation technology should be addressed with the use of skilled professionals.
Download our white paper, Transforming Revenue Cycle Management with Intelligent Automation, for more insights into successfully merging human intelligence with the cutting-edge capabilities of robotic process automation, artificial intelligence, and workflow automation to increase efficiency, reduce costs, and accelerate revenue collection for improved financial health and excellence in the patient experiences.
Conrad Coopersmith
