The Role of Digital Technology in Revenue Cycle Management

role of tech in rcm

To successfully implement efficient  Revenue Cycle Management, healthcare executives must communicate well and work together to yield maximum effectiveness. 

When it comes to RCM performance, every healthcare organization aims to streamline its financial operations. A growing number of government regulations and payer policies ensnare today’s revenue cycle operations. 

Healthcare professionals are considering revenue cycle management as one of their first channels for automating.

Apparently, technology enables healthcare institutions to reduce labor costs associated with submitting a clean claim and receiving timely reimbursements by eliminating manual processes and automating processes.

Automating services across a wide range of business processes is transforming healthcare operations today. 

As a result of this boom, many healthcare providers are embracing cutting-edge management strategies and implementing novel technology. 

Robotic Process Automation (RPA), Artificial Intelligence (AI), Machine Learning are all technologies that can improve efficiency and lower collections costs, which improves cash flow for healthcare providers.

Robotic Process Automation in Revenue Cycle Management

Robotic Process Automation (RPA) refers to a series of technological advancements that enable robots to imitate human behavior. 

As with many healthcare systems, claim management is a burdensome task that requires substantial amounts of resources. Through automation healthcare providers can improve patient satisfaction, optimize healthcare systems, and further reap multiple benefits, saving time, money, as well as resources.

Computer programs called robots automate robotic processes. They are experts at automating repetitive tasks. These BOTs are specially designed for complex, repetitive, rules-based tasks to be performed the same way every time. In RPA, human intervention cannot wholly replace problem-solving, but it sure does strive for that result. 

These BOTs can also assist humans with repetitive tasks that require little analysis or intervention as virtual assistants.

[Prefer Reading: “RPA Use Cases in Healthcare”]

How does RPA improve RCM Operations? 

  • This software application eliminates the need for resource allocation for securing appointments, and at the same time, improves customer relations by making appointments faster. 
  • Documents and data collected, processed, and evaluated during claim management are repetitive and cumbersome procedures. RPA, as a result, streamlines the whole process and saves up on time.
  • Automation of revenue cycle management ensures consistency, efficiency, and effectiveness of multiple healthcare procedures. 
  • By automating repetitive processes, medical professionals tend to make fewer errors and enhance overall productivity.

[Prefer Reading: “Alleviate your Medical Practice’s Operational Challenges via RPA Implementation”]

RCM Driven by Artificial Intelligence (AI): The Roleplay

It is a process of simulating human intelligence employing intelligent computer systems. To achieve a conclusion, one applies contexts and rules to learn skills, self-correct, and reason. In order to perform these actions, AI uses algorithms to identify patterns and plan future actions. 

With artificial intelligence, audits can be automatically conducted, adjusting known values when audit results are unknown. With increasing sophistication, the system reduces chances of error, allowing the health system to recoup revenue by accurate and faster billing operations.

How does AI make Revenue Cycle Management easier? 

  • In-depth estimation of expenses in real-time
  • Computer-Assisted Coding  (CAC): interpreting clinician notes by using native language processing and translation
  • Increasing the quality of clinical documentation
  • Identify errors and discrepancies in the EHR notes and clinical data using the EHR notes and clinical data analysis
  • Deduce analytics report of client’s financial data and process accurate medical bills.

With RPA and artificial intelligence, it is possible to automate an end-to-end process. RPA handles data using preprogrammed logic such as entering numbers on forms, extracting data, information migration, etc. 

Whereas AI creates its logic that handles structured data in virtual assistants, analyzes voice in a telephone conversation, generates a timeline from arranged data, and many others.

How Technological Upgrades Can Enhance Medical Billing?

In light of the pitfalls of the current system negatively impacting healthcare professionals and patients, the healthcare industry is in desperate need of a more intelligent revenue cycle system to drive medical progress. 

Automating revenue cycle management can be achieved through the use of both RPA and AI and yield maximum benefits such as:

#Financial improvement through automation based on analytics

RPA is particularly suitable for improving revenue cycle business processes because it emphasizes workflows and analytics. 

The role of RPA, for example, in Accounts Receivables (A/R) is to streamline upstream processes such as eligibility and authorization while also enabling efficacy in the level of effort required to receive from payers and patients. 

RPA can positively impact the financial performance of healthcare organizations, both large and small when implemented across a unified workflow platform combined with sophisticated analytics.

#Maxing Out Your Reimbursement – Reaching for fading horizons

The need for automation to manage these challenges has never been greater as government and commercial payers decrease reimbursement rates, and providers comply with ever-evolving regulations. 

Without adding complexity or cost, there are few means of addressing this challenge. To achieve this goal, RPA can be leveraged to improve Revenue Cycle Management services, a proven method with significant benefits. 

BOTs can replace repetitive and time-consuming routine tasks within the revenue cycle by supporting existing Electronic Health Records (EHRs) and financial management systems. 

The ability of BOTs to run round the clock inside an organization in perfect harmony with staff can bring great gains in efficiency and productivity.

#Identification of Eligibility and Insurance  

For clean claims that have the greatest chance of payment, determining eligibility and locating insurance is critical. Additionally, these components are vital to managing the accounts receivable process. 

One way to expedite the claims resolution process is by knowing your eligibility in real-time within your workflow system. Even though many systems and clearinghouses can provide coverage discovery through RPA, the results and data can be far more reliable and helpful for quick claims management operations. 

Automation reduces the amount of time needed for the handling of rejected or incomplete claims by providing accurate data with minimal manual intervention. 

Using BOTs, payer data can be quickly searched for coverage and benefit details, minimizing the amount of wrongly filed claims and denials due to incorrect information. EMS billing is an excellent example of this, in which coverage information may not be readily available.

[Prefer reading: “Care-on-Demand: A Visible Approach to Digitize Patient Intake Process [NetSet Digital]

#Healthier Engagement and Patient Experience

Patient expectations are different from what has been expected in the past. There is an increasing expectation among patients that medical services be transparent in their costs. 

The ability to electronically verify real-time insurance eligibility can provide this information – or, at least, an estimate – which directly impacts revenue in the value-based healthcare system. 

The higher likelihood of patients paying their bills and higher satisfaction with the care they receive directly impact both. 

Patient engagement tools, such as mobile apps and online portals enable doctors to communicate with patients about medical billing and services promptly, enhancing the value that is delivered.

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