Revenue cycle processes have had to continuously evolve over the years to keep pace with the rapid changes occurring in the healthcare industry. As a result, RCM vendor partners are now utilizing technology that hospitals do not have access to on their own. To be successful in this new climate of increasingly complex payment models, providers need to focus more on how to streamline their processes to optimize reimbursement rather than on insurance denial management.
Leveraging the technology available through end-to-end partners is one way to achieve this. Automation tools address some of the most pervasive issues in today’s revenue cycle landscape and allow healthcare facilities to spend less time focusing on payments, and more on patients.
In a survey of 1,000 practicing physicians conducted by the American Medical Association (AMA), 86% of doctors described the burden of prior authorizations as extremely high. Nearly an equal amount (88 %) also said the burden has increased over the last five years.
Prior authorization is one of the best use cases for artificial intelligence in healthcare right now. The transactional nature of prior authorizations makes it an ideal candidate for AI technology, which can leverage real-time analytics and machine learning to identify cases needing prior authorization, submit requests to payers, and check statuses.
Electronic prior authorization adoption continues to lag, according to the latest Council for Affordable Quality Healthcare, Inc. (CAQH) Index.
AI can do this by imitating intelligent human behavior through algorithms that find patterns and plan future actions to produce a positive outcome. This differs from other emerging technologies like machine learning or robotic process automation, which can identify patterns like AI but focus on improving accuracy rather than achieving positive outcomes. These other technologies also have no or limited ability to plan a future action beyond the task at hand.
Therefore, AI’s “intelligence” can effectively address the most pressing revenue cycle management issues, such as prior authorizations, claim status checks, and out-of-pocket cost estimates, all while getting the information that needs human intervention to the right person at the right time.
The answer is technology
The good news is that innovative payment solutions are coming to help healthcare organizations get the most out of their patient payment stream. These solutions enable hospitals and health systems to capture a bigger slice of the patient payment pie and to help patients better understand their healthcare bills. These solutions work across multiple different practice-management and health information systems, promoting greater efficiency and effectiveness.
Indeed, with these technology solutions, both the patient and provider can get, for the first time, a complete financial picture of the patient encounter.
Multiple benefits for provider and patients
Because both sides enjoy a clearer picture of what to expect financially from a given episode of care, providers and patients can openly discuss payment concerns and options that are good for both parties. The enterprise realizes more satisfied patients who are more likely to settle their financial obligations promptly and gets a clearer, more comprehensive and accurate picture of patient payment status. This institutional knowledge, in turn, leads to better revenue management and results.
Enterprises get greater reliability on the payment collection side (technology never "calls in sick") and the billing office comes to know and understand their patients' entire financial obligations for a given episode of care across all providers.