Leveraging Advanced Technologies and Automation in Revenue Cycle Management

One of the leading causes of burnout in the healthcare industry is the overwhelming amount of tasks that need to be completed without nearly enough time to do them. And unfortunately, this is a problem that only compounds on itself. The more that you have to do, the more overworked and overwhelmed you get, which means you start to make mistakes and therefore have more work that needs to be done as you now need to go back and re-do your previous work, and the cycle continues until something breaks. This is why implementing advanced technologies and automation into healthcare is crucial for your staff’s and your organization’s wellbeing. So what does that look like for revenue cycle management?

We reached out to our incredible Healthcare IT Today Community to ask them – how are healthcare organizations leveraging advanced technologies and automation in revenue cycle management to optimize billing processes, reduce errors, and enhance overall financial performance? The following are their answers.

Vijay Verma, VP, Product at TeleVox
Applying AI and automation tools can benefit every stage of the revenue cycle and create a more positive experience for both staff and patients. This includes faster and more accurate patient scheduling and registration, fewer manual tasks for staff, fewer claim denials, less time spent chasing claims, and ultimately, more cash on hand. For example, these tools enable right-time, omnichannel notifications that make it simple for patients to pay their bills and send balance reminders to improve the collection of healthcare payments, increase medical practice revenue and improve AR for hospitals and health systems.

More and more healthcare teams are turning to comprehensive patient relationship management platforms to streamline and automate time-consuming patient engagement outreach for bill collection and a variety of other areas that ultimately impact their bottom line. Advanced technologies and automation can deliver timely patient notifications, satisfaction surveys, appointment reminders, and more that get more patients, and more payments, into the health system, while creating efficiencies in a traditionally complex and demanding revenue cycle operation. Utilizing advanced technology that automates the revenue cycle management journey can improve the patient experience and in turn gain their loyalty, which brings back in the revenue to help enhance overall financial performance.

Sandra Johnson, Senior Vice President, Client Services at CliniComp
Healthcare organizations are looking for advanced technologies and automation in revenue cycle management to streamline billing processes, minimize errors, and enhance overall financial performance. By automating charge capture through integrated documentation and order entry, and utilizing sophisticated rules engines for claim creation, these systems can significantly reduce administrative burdens. Intuitive tools that minimize context switching help healthcare providers maintain focus, thereby decreasing confusion and errors. Ultimately, such innovations lead to a simplified revenue cycle that supports optimized billing and improved financial outcomes.

Mark Rodi, Solutions Design Architect at e4health
Robotic Process Automation (RPA) is revolutionizing healthcare billing processes by automating repetitive and rule-based tasks, leading to increased efficiency, accuracy, staff satisfaction, and overall cost savings. RPA enhances revenue cycle billing operations in several ways. It cross-checks patient information against payer databases to identify uninsured patients, reducing denials and patient complaints accurately. Additionally, RPA bots capture and validate data from various sources like medical records and insurance data, minimizing manual errors and costly patient dissatisfaction reviews.

RPA automates the production and distribution of cost estimates for healthcare procedures, enhancing patient satisfaction and reducing the manual workload of billing department staff. It identifies and corrects errors in healthcare claims, automatically re-filing them for reimbursement, which saves significant time. The technology also ensures prior authorization compliance by securing and accurately documenting authorization information into patient records. By automating mundane and labor-intensive tasks, RPA reduces the operational costs of hiring and training staff, addresses staffing shortages and allows staff to focus on meaningful tasks, thereby increasing employee engagement and reducing turnover.

Overall, RPA can transform billing operations and should be considered for improving revenue cycle operations and stakeholder satisfaction. As healthcare organizations evaluate the continuous introduction of advanced technology, RPA should be implemented to improve revenue cycles and combat the ongoing challenges affecting most systems today.

Arnab Sen, Chief Strategy Officer at Omega Healthcare
Increasingly, forward-thinking healthcare organizations are leveraging RCM solutions that incorporate artificial intelligence (AI), machine learning, natural language processing, and automation. These advanced technologies automate repetitive tasks, reduce turnaround time, and increase accuracy across patient access, mid-revenue cycle, and business office functions, ultimately driving improved financial outcomes. By integrating AI, GenAI and rules-based algorithms into RCM workflows, providers can proactively identify eligibility and prior authorization issues, prevent denials, enhance coding accuracy, and prioritize high-risk claims. This approach enables organizations to address potential problems early in the revenue cycle, minimizing financial risk and optimizing reimbursement.

Diana Ortiz, Senior Business Director Revenue Cycle at Solventum
Organizations are seeking the next level of efficiency driven by automation for the mid-revenue cycle. Coding is an area that is steep with regulatory guidance, frequent code changes and updates, all of which can impact turnaround times and organizational revenue and carry compliance risks related to accuracy. This is an area where automation is in high demand, coupled with skepticism around compliance. For example, with automated coding, organizations are looking for oversight and reassurances around their ability to ensure they achieve automation but without the compliance risks of inaccurate or suboptimal coding that could lead to denials down the line.

Starting with service lines that are highly repetitive, such as radiology and ancillary services, allow organizations to achieve automation quickly and build towards more complex coding. For a complete, compliant coding workflow, automation needs to include the necessary oversight and quality assurance checks to ensure and sustain high quality coding.

Huntley McNabb, Vice President at Nordis Technologies
To combat rising unpaid patient balances and improve cash flow, providers and RCM firms are embracing advanced financial communications and payments technologies to optimize the revenue cycle. Cloud-based customer communications management (CCM) platforms personalize patient billing experiences, delivering clear and timely statements across preferred channels including email, text messaging and print/mail to increase engagement and payments. Electronic bill presentment and payment (EBPP) systems streamline the process further, allowing patients to securely view and pay their bills online. These automated solutions minimize errors and free up staff for higher-value activities. A digital-first, mobile-optimized approach to revenue cycle management translates to better patient experience, reduced costs, and a healthier financial bottom line for healthcare organizations.

Thomas Kavukat, CTO at RXNT
Faced with growing demand and challenges around resources, healthcare organizations are turning to automation to optimize their revenue cycle management (RCM) processes. By cutting down on the need for repetitive and time-consuming human input when possible, providers hope to increase billing efficiency, reduce errors, and improve overall financial performance. Robotic Process Automation (RPA) tools like UiPath are one way organizations have been simplifying complex tasks, significantly minimizing manual intervention and potential errors. Advanced data analytics also play a major role—having the right data allows systems to detect missed payments early, predict potential claim denials before submission, and identify billing code errors, which can substantially improve cash flow and financial health. The potential benefit of implementing these tools is undeniable. But not every organization has the time or the proper existing technology to integrate AI effectively, which remains one of the most significant barriers to unlocking these benefits.

Shelly Disser, DBA, Vice President, Innovation and Collaboration at MediQuant
Interfaces that import and export data in standard industry formats continue to be the norm in optimizing billing processes. In addition, organizations are using tools such as AI to automate decision-making on these incoming datasets to facilitate write-offs, follow-up tasks, and agency or payor movement on accounts. This also includes funneling accounts for financial assistance, assigning additional agencies, moving dollars amongst payors, write-off balancing, and proposing payment plans or other financial arrangements with patients based on their ability to pay, as well as credit score, payment history, and other analytics. The automation is making these decisions more streamlined and more consistent, while taking the human element (and thus the increased potential for errors) out of play.

With the integration of data analytics and advanced business intelligence tools, the traditional data points that are used to manage the revenue cycle are now happening in real-time, making for faster financial decisions. As we know, the tight margins of today’s healthcare organizations means that every day in A/R counts.

Florian Otto, Co-Founder and CEO at Cedar
With the rise of high-deductible health plans (and healthcare costs overall), patients are now the fastest-growing payer group—but they’re also the hardest to collect from, impacting provider finances and operations alike. Combined with additional economic pressures like staffing shortages, revenue cycle teams are finding themselves having to do more with less.

The solution lies in harnessing the power of smart digital tools for self-service. In looking at our client contact center data, we found that three in four inbound phone calls could be eliminated through self-service channels—online help centers, AI-powered chatbots and smart check-in systems, to name a few. By leveraging technology, providers can streamline administrative operations, reduce costs and significantly improve the patient financial experience.

Andy Adams, Managing Director, Performance Improvement and Advisory Services at Nordic Consulting
Most healthcare organizations are focusing on automation and leveraging advanced technology, given cost pressures and labor challenges across the industry. By automating repeatable tasks and addressing complex exceptions, significant improvements in revenue cycle management can be achieved. For example, using Robotic Process Automation (RPA) for tasks like claims processing and patient eligibility verification reduces human interactions associated with these tasks, and minimizes human error, thereby reducing key indicators that impact overall financial outcomes, claim error rates, and denials.

Additionally, machine learning is being used in RCM predictive analytics, where algorithms analyze vast amounts of historical data to forecast trends and outcomes. This capability is particularly useful in predicting claim denials, valuing accounts receivable at an individual level, and identifying patterns that lead to payment delays. This allows organizations to take proactive measures to mitigate issues and more accurately forecast throughput and revenue.

Thomas Thatapudi, CIO at AGS Health
Healthcare organizations have always incorporated some form of automation, whether through simple rules-based workflows or analytics dashboards, to improve their billing processes and reduce errors. However, there is a significant inflection point right now, especially with the emergence of ChatGPT, large language models, and Gen AI (generative artificial intelligence). This presents an opportunity for revenue cycle management (RCM) functions to consider adopting new technologies and explore previously unexplored use cases. The financial impact is significant as automation can reduce the cost of manual labor while also increasing net revenue through a seamless process that follows the patient journey, from seeking to prevent denials upfront to reducing coding errors to implementing more assertive accounts receivables (A/R) follow-up processes.

In looking at the front end of the revenue cycle, tasks such as insurance verification and patient scheduling offer an opportunity to create a completely seamless and interactive process for patients and ensure appropriate controls are in place to mitigate revenue leakage. For mid-cycle coding, certain specialties lend themselves to autonomous coding without the need for human intervention, which frees staff to have time to focus on more complex work. At the back end, there is an opportunity to focus on denial management and collection rates, particularly for claims that may have been previously unworked due to capacity constraints, which can be beneficial in cases where payer requirements have become more stringent. The RCM industry has made progress, and there are certainly more use cases to be uncovered in the next 12 to 18 months.

Sunil Konda, Chief Product Officer at SYNERGEN Health
More organizations are turning to advanced technologies and automation to enhance RCM, optimizing frontend to backend processes and reducing errors. With AI and machine learning, organizations are automating increasingly intricate billing tasks and predicting and preventing more dreaded claim denials. This reduces administrative burden and lowers the cost-to-collect. Robotic process automation (RPA) exemplifies how technology can efficiently handle repetitive tasks like data entry and claim status checks, enhancing accuracy and efficiency. We see improvements like a 50% increase in cash collections and a 40% faster turnaround time. With these technologies, organizations are improving their financial performance, allowing them to reinvest in patient care and service enhancements.

Neville Zar, Senior Vice President, Revenue Cycle Management at athenahealth
Nearly six in 10 medical practices ranked staffing as their biggest challenge in 2023, closely followed by expense management. Practices are wasting time on repetitive tasks, facing obstacles in collecting reimbursement for services already performed, and these challenges scale with organization size. Implementing low-touch, automated workflows can significantly benefit practices of all sizes. By integrating tailored revenue cycle management (RCM) solutions into existing clinical systems, leaders can ensure a seamless experience, providing better insight and control over revenue activities without disrupting clinicians’ practice of care.

As artificial intelligence solutions continue to be refined, we’re seeing AI-powered RCM tools transform revenue collection workflows. These tools not only increase efficiency but also reduce staff turnover, enhance cash flow, improve financial performance, and allow clinicians and staff to focus more on patient care. Moreover, continued integration between payer-provider networks requires more robust analytics, necessitating APIs to reduce rework between payers and providers. However, as practices navigate the nuances of RCM, including the transition from fee-for-service to value-based care, relying solely on a product and process is not enough. A comprehensive approach combining advanced technology with expert guidance and partnerships is essential for optimizing billing processes, reducing errors, and enhancing financial performance.

John Squeo, Senior Vice President & Market Head, Healthcare Providers at CitiusTech
Hospitals typically have operating margins ranging from 1%- 6%. The pressure to effectively capture, process, and collect patient services revenue is continually increasing under value-based care documentation requirements and scrutiny. As a result, the capital investment required to implement advanced AI and automation has now reached a point where the return on investment is positive. The shift to automation is driven by a need to improve efficiency and process velocity, reduce errors and labor costs, and ultimately boost revenue. Here’s how these technologies are making a difference:

1. Automation for Repetitive Tasks: Repetitive tasks like claim coding, billing, and data entry are prone to human error; automation tools powered by Robotic Process Automation (RPA) can handle these tasks flawlessly, ensuring accuracy and freeing up staff for more complex work
2. Artificial Intelligence (AI) for Improved Accuracy: AI can analyze vast amounts of Healthcare data to identify coding errors, predict claim denials, and even recommend appropriate coding for procedures; this proactive approach minimizes denials and ensures timely reimbursements
3. Advanced Analytics for Data-Driven Decisions: RCM software with advanced analytics provides valuable insights into billing performance; healthcare organizations can use this data to identify areas for improvement, optimize workflows, and track key metrics to measure their RCM success
4. Streamlined Patient Engagement: Patient portals allow patients to easily access their billing information, make online payments, and resolve discrepancies; this improves communication, reduces administrative work, and promotes faster payments
5. Enhanced Revenue Capture: Automation and AI can identify missed charges or underpayments; additionally, contract management tools can ensure that Healthcare organizations receive the appropriate reimbursement rates from Payers

By leveraging these technologies, Healthcare organizations can achieve:

• Reduced Errors: Automation and AI minimize human error in coding, billing, and claims submission
• Faster Reimbursements: Streamlined processes and fewer denials lead to quicker payments from Payers
• Improved Cash Flow: Efficient RCM translates to better cash flow management and financial stability
• Enhanced Patient Satisfaction: Patient portals and clear communication improve the patient experience

Investing in advanced technologies is a strategic move for Healthcare organizations. By optimizing RCM processes, these organizations can focus on what matters most – delivering high-quality patient care.

So many good insights here! Huge thank you to Vijay Verma, VP, Product at TeleVox, Sandra Johnson, Senior Vice President, Client Services at CliniComp, Mark Rodi, Solutions Design Architect at e4health, Arnab Sen, Chief Strategy Officer at Omega Healthcare, Diana Ortiz, Senior Business Director Revenue Cycle at Solventum, Huntley McNabb, Vice President at Nordis Technologies, Thomas Kavukat, CTO at RXNT, Shelly Disser, DBA, Vice President, Innovation and Collaboration at MediQuant, Florian Otto, CEO and Co-Founder at Cedar, Andy Adams, Managing Director, Performance Improvement and Advisory Services at Nordic Consulting, Thomas Thatapudi, CIO at AGS Health, Sunil Konda, Chief Product Officer at SYNERGEN Health, Neville Zar, Senior Vice President, Revenue Cycle Management at athenahealth, and John Squeo, Senior Vice President & Market Head, Healthcare Providers at CitiusTech for taking the time out of your day to submit a quote for us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.

How do you think healthcare organizations are leveraging advanced technologies and automation in RCM to optimize billing processes, reduce errors, and enhance overall financial performances? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!