Artificial intelligence (AI) dominated the headlines in 2023. It was the topic of countless articles, reports and even court cases. Some may be fatigued by it, or even afraid of it, but the reality is AI is here to stay in 2024. The best thing we can all do is learn how to leverage it to make our jobs easier.
In fact, after decades of slogging through manual processes, healthcare organizations are joining the movement and implementing automation and AI solutions to improve revenue cycle processes. According to a December report from Akasa “74 percent of health systems and hospitals have automation in their revenue cycle; 46 percent of these same organizations use some form of AI.”
The problem is that too often financial leaders make assumptions about where the shortfalls or problem areas exist and either make uninformed technology investments or throw more bodies at problems. What provider organizations really need in 2024 is the technology that upgrades the limitations of their existing systems and will make revenue cycle staff more effective by reducing the touches and people it takes to get paid for the services rendered.
When the right data is available, adaptive AI and automation can be effectively applied to not only help staff work smarter but also uncover trends and guide healthcare leaders to performance improvement opportunities. Ultimately these solutions will help maximize the profitability of the business by providing insight into the total number of “touches” and people involved to resolve a claim. Why is this important? Because every touch negatively impacts margin and with the continuing growth in costs to deliver care and the declining reimbursement every penny counts.
In 2024, smarter applications of automation and AI will:
1. Help staff work smarter
Healthcare organizations that are weary of staff shortages and the soaring costs associated with staff turnover will leverage technology in 2024 to create capacity within their revenue cycle teams. The right application of automation and AI can turn a “staffing” problem on its head and essentially enable more work with less resources and better financial outcomes.
One area where advanced technology can generate immediate ROI is patient financial clearance. Error-prone, manual front-end processes associated with registration and insurance verification cause the majority of denials on the back end. This is why teams need work drivers in place to ensure all the necessary steps are taken and patients are properly cleared before their arrival, so claims can be processed without a representative touching them.
Additionally, given that 80% to 90% of claims sitting in AR do not require work on a given day, workflow automation solutions prioritize the claims that need attention to ensure billing staff are focused on the right work. These tools guide representatives to work that has potential to produce the most ROI, rather than having staff waste time on claims that do not need to be touched.
2. Reduce necessary touches to improve margin
Understanding the number of touches a claim undergoes before the desired outcome—and the cost per touch—is critical to elevating revenue cycle performance and automating reimbursement. Yet, healthcare organizations by and large cannot answer simple questions such as: What is our zero-touch rate (differentiated from the clean claim rate in that this is a measure of claims paid with no human effort in the process)? How effective are administrative staff at collecting? How much work effort are they putting in to resolve a claim?
Achieving this goal starts with insight into every unit of work (or touch), the result of that work and the ability to benchmark the desired outcomes. Yet, this kind of visibility is where EHRs and practice management systems (PMs) fall short, leaving revenue cycle leaders unaware of the effectiveness—or ineffectiveness—of staff effort. Organizations must be able to track all action and communication to truly understand the effort of work and where the heaviest burden of human capital is placed in the revenue cycle. For example, it’s not uncommon to see claims with an outstanding balance touched by three or more RCM staff and 10 or more touches.
In the context of cost per touch, healthcare organizations should consider how much waste and spend is already on the open accounts receivable and how much margin is lost because of inefficient claims resolution process.
3. Increase claims processed without a human
The most efficient and effective way to get a claim paid is without human intervention at all (or zero-touch claims). Increasing an organization’s zero-touch rates ensures that healthcare leaders can maximize resources, speed reimbursement and improve patient financial experience.
The heavy lifting for the zero-touch metric occurs on the frontend where shortfalls in the pre-registration and registration process cause downstream issues with a claim. The goal of effective financial clearance is twofold: to ensure the patients are aware and accountable for any balance owed (past, present or future) and that you have all the necessary information (demographics, benefits, eligibility, pre-certifications, etc.) so the claim flows smoothly through the revenue cycle.
When the right combination of automation and adaptive AI exists, pre-registration financial clearance functions can be streamlined to ensure the claim process begins as accurately as possible. Equally important are real time insights into breakdowns impacting the pre-service process that require post-service intervention. Improving the feedback loop to staff is a great way to ensure each touch is a quality touch.
4) Recognize, reward and retain top talent
Workforce optimization has moved center stage and will continue to be a high-level priority in 2024 as the industry continues to grapple with workforce shortages. Making the most of an existing workforce by creating capacity for additional work and retaining high performers—as opposed to continuously hiring warm bodies to fill empty seats—will be the key to success going forward.
Healthcare organizations should consider a culture of recognition that motivates existing revenue cycle teams and rewards high performance. In addition, offering hybrid and remote work options is central to strategies that support retention of top talent as evidenced by a Robert Half survey of 2,500 workers that suggests work-life balance is becoming a higher priority for young and older generations alike.
Revenue cycle will require humans for the foreseeable future, but we need to make sure we have the right humans in the right positions doing the right work to be successful. This will require visibility into the daily work effort of both in-house and remote or outsourced employees to identify top performers and hold staff accountable.
Becoming More Effective in 2024
Effective Intelligence solutions built on automation and adaptive AI can overcome data shortfalls that exist within PMs and EHRs and equip revenue cycle teams with the automation needed to work smarter. Atlas Healthcare Partners, one of the nation’s fastest-growing ambulatory surgery center (ASC) management companies, was able to decrease labor dependence by 31% and reduced denials by 48% across its 28 ASCs by implementing solutions that addressed these areas. The organization also considerably improved its overall financial performance based on cash collections and net collection rate (NCR) percentage.
Operational strategies must be designed with a keen understanding of the human condition and what motivates employees. In addition, forward-thinking organizations understand the need for labor effectiveness and minimizing dependence on labor, especially within revenue cycle processes. Consequently, success going forward will also be marked by infrastructures that support automation and smarter workflows.
Robots will not be taking over revenue cycle anytime soon, but we need to find more ways to help make the humans involved in the process more productive and set them up for success with automation and AI.
About Charlie Falcone
Charlie Falcone has served as the Chief Executive Officer of Verisys Corporation since September 2021. Verisys is at the forefront of providing the most comprehensive healthcare data, coupled with deep industry experience, to facilitate agile technology solutions for screening, verifying, and monitoring individuals and entities in the healthcare sector.
Under Charlie’s guidance, Verisys has positioned itself as the leading provider of governance, risk and compliance data in the industry, contributing to the safety and integrity of the healthcare system. The company’s innovative products, including FACIS, CheckMedic, MedPass, ProviderCheck, VLSS, and more, empower organizations to make informed decisions in their credentialing, enrolling, hiring and overall workforce management processes.
With a commitment to keeping bad actors out of the healthcare system, Charlie dictates the strategy and leads a dedicated team at Verisys. The mission is rooted in the belief that verified and actionable data enables a well-informed healthcare sector that benefits individual organizations and contributes to the community’s overall safety.