Long gone are the days when healthcare organizations could afford to rely on traditional, manual practices for front-end revenue cycle management (RCM) operations of eligibility verification and prior authorization. Given the sheer volume and the pace at which patient data is being generated and exchanged today, providers have no choice but to trade inefficiencies for innovation or risk falling behind and missing revenue opportunities. Today’s fast-paced healthcare landscape demands them to embrace technologies like artificial intelligence (AI) and automation to mitigate revenue leaks, thrive financially, and stay true to their cause of patient care.
AI-Driven Automation: More Than Just Robots
While automation in front-end RCM primarily involves deploying robotic process automation (RPA) or rule-based bots for repetitive tasks like eligibility checks for expediting patient access, emerging AI-driven automation focuses more on intelligent systems ingesting and processing high volumes of data and making decisions on their own to facilitate smooth front-end operations, paving the way for more advanced form of revenue cycle optimization.
Both forms of RCM automation, though, have laid out a path for providers to speed up patient access management. This has significantly reduced the time and efforts that would otherwise strain their resources, eating up their time from patient care and coordination, and result in errors causing rejections and denials, which would eventually hurt their bottom line and impact their patient experience across the care continuum.
With RPA bots working around the clock and verifying patient insurance and benefits from payer portals in real time and AI workflows ensuring accurate and complete documentation for timely prior authorizations, health systems now have a much better and faster way of managing front-end operations today, improving the scope for care and collections.
A Wake-Up Call to Act, not React!
It would be an understatement to say that the pandemic served as a wake-up call for health systems to adapt and adopt. The healthcare burden, which peaked during this time, gives testimony to how ill-prepared the system was and how badly technology was needed to unburden the overwhelmed healthcare staff given the sheer volume of patients they were handling during the pandemic. And there’s been no stopping ever since.
Given the projected increase in public healthcare needs, rising claim denials, increasing costs ($19.7 billion spent in overturning denials in 2022 alone), growing staff shortages, and shifting payer behavior are only underlining the need for health systems to act (adapt to evolving needs and adopt technology-driven solutions), and not react or defend traditional practices.
With health systems losing hundreds and millions of dollars every year to uncompensated care and claim denials, they need to view automation as a strategic tool for optimizing operations, reducing costs, and improving care and margins.
Why Manual Workflows No Longer Make Sense
The time and efforts spent manually on verifying eligibility, seeking prior authorizations, estimating patient costs, and coordinating patient access take a significant toll on providers and their staff. This has been highlighted by the American Medical Association (AMA) in its study, stressing the administrative burden these systems have in acquiring prior authorizations, with over 95% reporting an increase in staff time spent on the process and 84% emphasizing the high costs involved in maintaining compliance with payer policies. Despite putting all their valuable time and resources, they have reported over 60% prior authorization denials and 50% overturned appealed denials due to manual errors and delays.
This clearly indicates that the seemingly simple front-end functions of eligibility verification and prior authorization, if plagued by inefficiencies, can not only disrupt the cash flow of any health system but also significantly challenge its care commitment, resulting in impacted patient access and bottom line.
This is where automation shines. By confronting these front-end inefficiencies with AI and RPA, providers can turn the tide in the favor.
The Untapped Potential of Automation in Patient Access
Given the vast amount of data that flows through the revenue cycle from the front-end, patient access makes for the prime candidate for automation and AI. While RPA-assisted automation is more specific for functions that are repetitive in nature and demand little human intervention like eligibility checks, AI-powered automation is important for insight-driven workflow optimization.
A recent study by McKinsey suggests that automation and analytics if deployed effectively can save US healthcare $200 billion to $360 billion, from administrative functions, including RCM and nonclinical parts of healthcare provisioning (including scheduling, coordinating care with insurers, documentation, and claim or bill adjudication.
By leveraging RPA for administrative tasks of eligibility verification and AI-powered workflows for prior authorization, providers can significantly boost operational efficiency, improve productivity and compliance, and reduce front-errors errors that result in delays, rejections, or denials by payers, long patient wait times, underutilization of clinical staff, and affected cash flow. In fact, a recent survey by the AMA suggests that over 74% of hospitals have implemented some form of RCM automation, including AI and RPA, and have demonstrated significant improvements in their productivity.
From a cost perspective too, providers automating patient access functions can not only save on overheads but can also increase their prospects of revenue generation and recovery through improved clean claim rate, point-of-service collections, and reimbursements. Moreover, thousands of hours saved from automation can equate to thousands of dollars saved for a practice.
Overcoming Internal Barriers to Streamline Patient Access
Despite a multitude of benefits of automation, many providers remain in a dilemma as to how they should evaluate their needs and prepare themselves for automation owing to the lack of awareness or expertise to optimally use the technology for best results. To navigate internal barriers, providers must first:
Assess Organizational Needs to Streamline Patient Access: Automating eligibility verification with RPA bots can help providers minimize the time and cost spent on this task, with bots performing the checks with higher accuracy and efficiency in real time and in a fraction of seconds. However, it’s important for providers to keep in mind that they leverage RPA bots only for well-defined, rule-based, repetitive tasks and not for functions that are more nuanced, or context based, as they will not be able to optimize the process in the desired way if not aligned with the objectives. Thus, it is imperative for providers to deploy automation as per the organizational needs.
Gain Technology Acceptance from All Stakeholders: The benefits of automation in simplifying front-end tasks should be communicated to the front-end staff whose job will be complemented and eased with this technology. It’s important to not only have their acceptance but also their willingness to learn, adopt, and work with this technology and understand the fact that automation won’t take up their jobs but will only augment their efforts in streamlining patient care.
Run a Pilot Program to Measure Success: Organizations can implement the technology on a small scale first before expanding it to other areas of implementation. They can focus on one or two key aspects of patient access initially (for instance, automating eligibility verification before expanding the technology to other areas like prior authorization) and measure its success through KPIs like reduced denial rate and faster approvals. This would help ascertain its impact on the process performance and build confidence across the board.
With these measures, providers can optimally leverage automation (RPA bots to perform eligibility checks with high-precision and speed and AI-led workflows for prior authorization) to realize seamless patient access. This in turn will help them improve accuracy and timeliness of eligibility verification and payer approvals, reducing their reschedule rate, patient wait time, no-shows, and denials, thus improving patient care outcomes and collections.
Learn how Pain Management Group Revenue Leaps by 30% with Streamlined Claims Filing.
Automation: Embrace the Future of RCM with Confidence
As healthcare organizations deliberate the implementation of technology to transform their RCM, automation is key to driving efficiency in their mundane, repetitive processes. Moreover, the technology holds a strong potential in combating day-to-day challenges of payer rejections and denials by reducing front-end errors, paving the way for better patient and revenue cycle outcomes.
From automating eligibility checks and prior authorizations for reduced manual workload to making cost estimates and improving financial transparency for patients, automation not also helps providers address staff burnout but also allows them to focus on high-value tasks and patient care, thereby increasing employee satisfaction.
For practices with limited experience in technology implementation, partnering with a professional RCM solutions provider can help address their challenges with a tailored patient access solution to optimize their front-end processes for long-term growth.
To understand how Jindal Healthcare leverages automation and AI to help healthcare providers achieve seamless patient access and embrace the future of RCM with confidence, connect with our experts today.