For years, healthcare organizations have been keeping revenue cycle operations in-house and investing in one-off software applications to address various challenges. Leaders are seeing little-to-no return on these investments and are left with disjointed technology that makes it harder for staff members to collect the information needed to complete day-to-day revenue cycle tasks. Patients have also become increasingly frustrated with complicated billing processes and the lack of transparency they receive when it comes to their total cost of care.
There are more efficient ways to streamline the revenue cycle, using intelligent automation which incorporates innovative technologies such as artificial intelligence (AI) and robotic process automation (RPA). While technologies such as AI and RPA traditionally have been used to execute upon clearly defined actions, they have evolved to imitate and simulate more complex tasks that contain considerable variability and require data from multiple sources. Because of this, automation and AI have become ideal methods for completing time-consuming tasks associated with the revenue cycle such as prior authorizations, pre-registration, patient eligibility, and account resolution. Intelligent automation is not only accelerating RCM workflows, but also giving valuable time back to practice staff. As a result, practice staff can focus more on patient-facing, strategic activities, thus improving overall patient satisfaction.
Because intelligent automation is being applied to every aspect of the revenue cycle from scheduling to registration to financial counseling and billing, historic complexities are being removed to deliver a straightforward, easy-to-navigate patient financial experience. To fully understand the value this technology can bring to practices and their patients, let’s look at how the internal revenue cycle process and overall patient financial experience can be enhanced through AI-enabled digital self-service and price transparency.
Healthcare has evolved into a much more consumer-centric industry, with patients expecting the same kind of personalized, easy-to-use financial experience they receive from the airline, banking and retail industries. According to a 2017 Accenture research report, by the end of 2019, 66 per cent of U.S. health systems will offer digital self-scheduling and 64 per cent of patients will book appointments digitally. To remain competitive, all healthcare organizations—including hospitals, physician practices, and ancillary services—must provide patients with digital solutions that offer online scheduling, pre-registration, and an expedited check-in process.
Digital self-service platforms allow patients to complete required revenue cycle tasks and access financial information anytime and anywhere from their digital devices without making phone calls or completing extensive paperwork. Patients can save time, receive direct access to financial information, and enjoy a more convenient and consistent financial experience from their physician practice. In turn, practices can standardize and increase overall accuracy for the patient registration process, as well as decrease administrative burdens allowing registration staff to answer patient questions and provide the best possible service.
For digital self-service platforms to be truly effective, they must utilize intelligent automation and have data-driven algorithms/AI capabilities that give practices access to existing patient databases so they can customize experiences based on the patient’s background. Data algorithms can be used to predict a patient’s likelihood of showing up to an appointment as well as paying the final healthcare bill. The self-service platform can then present the best appointment times or payment options available to the patient. AI-enabled chat bots can also be used to answer the patient’s basic questions during the registration/payment process, which again allows registration staff to focus on more strategic activities.
Through intelligent automation, digital self-service platforms integrate key RCM touchpoints—such as scheduling, registration and account resolution—and deliver the kind of seamless and transparent experience patients are yearning for. Digital self-service enables practices to optimize the revenue cycle and align it with patient experience, while also fostering substantial financial benefits such as higher collection rates and a lower number of missed appointments.
Because patients are taking on more of a consumer role in healthcare, physicians are taking on a new role as well—the “service provider.” In addition to being experts on healthcare, patients need physicians to have better knowledge of their cost of care and the financial benefits/risks associated with a certain treatment plan.
Rather than turning physicians into full-time financial advisors, practices need to provide patients with more price transparency up front and implement revenue cycle technologies that can accurately generate price estimates prior to care delivery. An analysis from R1 RCM found that patient collections increased from 40 to 60 per cent when potential out-of-pocket costs were clearly articulated prior to service.
The data algorithms referenced earlier can also produce estimates on the patient’s total out-of-pocket cost and recommendations on financial assistance options to pay the final bill. Through automated workflows, practices can electronically request insurance information for each patient and utilize digital reimbursement modeling. Through this modeling, practices can offer personalized payment plan options and financial counseling, thus helping each patient better understand the cost of care, what to expect and how the practice can support them.
Once patients are equipped with this financial knowledge, practices need to go the extra step and make the final post-visit payment process just as candid. Patients are accustomed to receiving numerous confusing bills and benefits statements from both practices and insurance companies before they receive their final bill. Through technology that allows patients to view all invoices in one online application and set up automated payments, practices can offer a consumer-friendly, easy-to-understand experience.
In terms of the back-end billing process, automation technology reduce errors and accelerate denials processes. Automation tools help practices glean actionable insights such as why denials are occurring, which denials have the most financial impact, and which processes are not working. This information helps drive front-end corrections and improve key areas such as patient registration by ensuring payer identification is accurately captured.
In today’s healthcare market where patient satisfaction is a key driver and operational costs are only increasing, practices need the right digital resources in place to create a stronger revenue cycle. Patients’ clinical and financial experiences can no longer be siloed—the financial aspect must be prioritized and become part of the overall care experience. By applying intelligent automation and utilizing digital self-service platforms and price transparency tools, practices can remove repetitive or unnecessary processes, increase accuracy and service quality, and give patients the financial support they truly need.
Rather than continuing to invest in quick-fix technologies, practices must find RCM partners who have extensive automation expertise and know the right implementation approach. Adding intelligent automation without evaluating your practice’s long-term needs will only kick problems down the road and steer your practice further away from meeting its financial goals. Practices that are equipped with the right partner and strategy will be able to address revenue cycle complexities head on, use automation to scale up operations, and always put the patient’s satisfaction first. Organizations that take this approach will succeed in today’s environment. Now the only question is: Are you ready and willing to get started?
Dan Pope is a Senior Vice President for Hospital-Based Physicians at R1.