Healthcare Automation with Revenue Cycle Operations

Healthcare Automation with Revenue Cycle Operations


Automation in healthcare involves the use of different software that promotes efficiency in the provision of medical services. This technology employs modern techniques and tools for efficiency reasons. When it comes to claim preparation and billing, it is a key driver of healthcare costs. Revenue cycle operations has shifted automation in revenue cycle operations for driving efficiency and cost effectiveness. In a recent survey of 500 CFO’s and revenue cycle leaders; 66% say their organization is actively using or implementing automation tools in their revenue cycle operations. It is important that health care leaders understand that when purchasing and deploying effective automation solutions within their revenue cycle operations — from best practices for the industry to the variables that may be unique to individual organizations. Healthcare is a highly complex and dynamic industry, one that requires automation partners with meaningful expertise in revenue cycle operations and a flexible platform for performing work. Below are three important considerations that can help define the expectations any organization should have of effective partners in automation.

1. Understand the Total Cost. Regardless of the automation solution an organization selects automating revenue cycle operations generally follows the same three-step process:

  • Documenting workflows and processes.
  • Develop or program the technology that will automate some of the work.
  • The automation technology is deployed and processes for maintaining the automation must be implemented.

Revenue cycle leaders should consider the cost implications of all three steps when selecting the best automation solution for their organization. Look for automation partners that have proprietary technology tools to document workflows in less disruptive ways. Be sure ongoing maintenance is built into your budgets. Payers are constantly updating plans, claim forms, prior authorization, and other requirements. It is important that the solution you’re considering is capable of adapting to these changes as they happen or will you or your vendor need to allow time and budget for reprogramming bots and updating code every time something changes. There should be flexibility for solutions you are considering. Be able to scale and adapt to your organization’s needs over time.

2. Define Areas That Minimize Need for Change. Priority areas to start with in the revenue cycle are Eligibility, Prior Authorizations, Claim Status and Denials Management. Many organizations underestimate what they can automate because some technologies, such as robotic process automation (RPA), are very limited in their capabilities. However, with today’s machine-learning based technologies the process is more defined.

Make time to work with your solution providers to identify term goals and define how they advance your overall objectives. The focus should be geared towards ensuring your automation strategy delivers effective performance at lower costs over the long term.

3. Human Expertise is Critical to Automation. Any automation solution is better with human experts in the loop is managed along with machine learning algorithms in real time from the company’s team of revenue cycle experts. This ensures the machine learning software can learn, adapt, and handle increasingly complex tasks independently over time. By blending automation with human judgment, accuracy and efficiency are improved while also ensuring work continues without disruption when something unexpected arises.

Be sure to ask solution providers how their systems handle outliers and edge cases. They perform regular audits to ensure the automation solution is performing with precision and reliability.

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