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Revenue Cycle Automation: Re-engineer the flow of revenue

SYNERGEN Health
April, 2021
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16 Pages | 4 MB

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What is a digital workforce and why does it matter

When our world is turned upside-down and we’re faced with new challenges, à la COVID-19, healthcare providers and administrators have to rethink how to engage and position their operations for maximum efficiency. Physician groups and health systems alike find themselves at a crossroads of balancing human resources while optimizing its operations from both the supply side and demand side. Luckily, innovative technologies like Robotic Process Automation (RPA), Machine Learning (ML) and Artificial Intelligence (AI) offer a reprieve in streamlining administrative functions like revenue cycle management, finance and supply chain. Incorporating these technologies creates a new talent structure simply described as the “digital workforce.” The adoption of automation and AI within the healthcare system opens doors for organizations to digitize all aspects of their business. Specifically, these technologies are a game – changer for administrative leaders in revenue cycle management. By implementing the idea of a digital workforce, organizations can deliver consistency in an ever-changing environment that requires agility, accuracy and scalability. Intelligently automated processes can think, act, and analyze in the same manner as humans.

A digital workforce – a reference to bots deployed via a RPA process that can include ML and AI components has become a necessary platform in healthcare operations. The automated processes of the digital workforce can live as its own program, be managed as a service, or come embedded within software programs.

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As other industries like manufacturing have evolved automation for more than 75 years1, it has become table stakes for areas like healthcare to reduce administrative burden and focus only on complex, value-added tasks for their human workforce. On the administrative side of care, an automated digital workforce means repetitive low-value tasks are digitally replicated, removing wasteful overhead costs. Critical human thinking and judgement is still needed to address edge cases the bots cannot resolve. ML, on the other hand, can be implemented either in parallel to or supplementally with automation, allowing an algorithm to react dynamically & take action on unpredictable outcomes. Together, automation and ML, when thoughtfully applied, should generate efficiencies that both provider groups and health systems can benefit from. On the administrative side of care, an automated digital workforce means repetitive low-value tasks are digitally replicated, removing wasteful overhead costs. Critical human thinking and judgement is still needed to address edge cases the bots cannot resolve. ML, on the other hand, can be implemented either in parallel to or supplementally with automation, allowing an algorithm to react dynamically and take action on unpredictable outcomes. Together, automation and ML, when thoughtfully applied, should generate efficiencies that both provider groups and health systems can benefit from.

The current challenges facing revenue cycle automation

Administrative staff and the healthcare system as a whole are under consistent pressure to maintain razor-thin margins amid fluctuating dynamics in the industry. Considerations range from how to accelerate cash flow while reducing the cost – to – collect to maintaining regulatory compliance without forgetting to stay current on new and emerging payment models. With those pressures it is essential for organizations to incorporate automation and intelligence bearing in mind the continued rise in healthcare consumerism and financial margin erosion, all to improve, or at the very least, sustain current performance levels. Despite the overall consensus to automate all or part of the revenue cycle continuum, there are hurdles to overcome. First, there are changing consumer expectations that are shifting the digital needs to guide the patient financial experience. That coupled with the continuous shift of financial responsibility to the patients via high deductible plans creates new patient journeys that must be considered. It is no longer enough to automate what impacts only the administrative staff. Automation and intelligent solutions must also positively impact the patient financial experience.

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  1. Operational and administrative processes should be treated as a living organisms that need frequent reviews & enhancements.
  2. A complete discovery exercise should take place to identify the most optimal process, including the proper amount of process intelligence, and pair it with the right level of human intervention.
  3. This will allow the organization to increase the scale to value so that a return on the technology investment is more rapidly delivered back to the organization.

Deploying intelligent revenue cycle workflows to optimize accuracy and efficiency

Leaders in the healthcare industry are exploring and adopting intelligent automation solutions to drive transformation at the enterprise level to demonstrate tangible returns on investment for their existing technologies. Innovations such as RPA and ML can be combined to digitize and automate even the most complex end-to-end processes and functions, allowing organizations to improve the bottom-line while scaling resources to focus on complex, value-added activities. Getting tactical, let’s look at how intelligent automation can be applied to the patient financial services claim status lookup process. The daily routine of accounts receivable (A/R) staff entails an extensive amount of time performing manual claim status lookups.

ML and AI can further enhance employee productivity by prioritizing the claims that need to be worked on. For example, ML can predict which claims are more likely to be paid if an employee follows up or appeals the claim with the payer as well as predict which claims are unlikely to receive payment. This allows the appeals process to be further automated leading to powerful gains in efficiency and output, enabling teams to prioritize their work and focus on claims that will get paid the fastest.

First, they open a work queue containing assigned claims with an open balance. Secondly, the A/R staff member navigates to the payer website looking for the patient claim status which can take considerable time depending on what data elements they have. Based on information available from the payer website, A/R staff members can take necessary action and process the claim or they have wasted time that could have been spent on a task with a higher return on value. As the digital workforce takes shape and stabilizes, monitoring and maintenance will be required. Any changes to core or ancillary systems could break a functioning bot. This requires a support team that can consistently and intelligently sense for failures and make necessary updates. For many organizations, having a strong technology partner to enable automation as a managed service is the best model to care and feed the digital workforce. An automation solution does not replace existing technology investments but rather supplements the shortcomings of core and ancillary systems. Automation for administrative functions offers a layer which helps organizations to improve their productivity while minimizing costs that arise from repetitive tasks. The benefits of implementing a digital workforce can be realized regardless of where an organization may be in their transformation journey.

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A conversation with Duminda Gunawardena on how SYNERGEN Health fast-tracks automation adoption to empower and scale revenue cycle operations

As hospitals and healthcare professionals look to the future, the revenue cycle still plays a central role in supporting the return to financial health. The current pandemic has the potential to hasten the adoption of new technologies such as AI and RPA to advance digital transformation like never before. We sat down with our very own Duminda Gunawardena to discuss the most pressing questions healthcare leaders should be asking on automation and intelligence as the technological future of revenue cycle continues to evolve. Duminda is the co-founder and co-Managing Partner of SYNERGEN Health and has led the growth of the company from startup to being listed as one of Inc. 5000’s fastest growing private companies.

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