Automating Billing Processes To Increase Revenue

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

I just read that automation of revenue cycle management has increased by 12% from 2020 to 2021. Now, 78% of health systems and hospitals are using automation to decrease the cost of billing and increase earned revenues. And 37% of organizations currently not using automation plan to do so this year or sometime in 2022. These were the findings of a recent national survey conducted through the Healthcare Financial Management Association’s Pulse Survey program by Akasa.

This is no small issue as the revenue to specialty provider organizations from health plan billing continues to increase. In our recent webinar, Stop Leaving Revenue on the Table: Simplifying Behavioral Health Insurance Billing, Jonathan King, Director of Revenue Cycle Management for TenEleven Group, gave an overview of the top issues with health plan billing—from the grueling credentialing process, to the complexities of claims submissions that vary by insurer and state, and the challenge of tracking denials and resubmission. In addition, the shift to value-based reimbursement is adding another layer of complexity to reimbursement management.

He outlined the most common problems in managing reimbursement, including failure to verify coverage, insufficient documentation, duplicate billing, coding errors, and missed deadlines—and recommended automating the steps with repetitive tasks to improve accuracy and free up staff to focus on complex cases.

What are the options for automating the revenue cycle management (RCM) process? The key is to take a broad view of all the processes starting with pre-registration (or collecting basic information about insurance coverage, etc. from consumers) to communicating with health plans and culminating in the final payment from payers and consumers (if any balance is billed to them). In this process overview, managers should assess what tasks are transactional, repetitive, error-prone, or time consuming—and therefore have potential for automation. This will differ for each provider organization based on payers, consumer demographics, and business models. But the most common tasks that health care organizations automate are data capture during registration, coding, billing, claims submissions, status checks and follow-ups, posting payments, and tracking/analyzing denials.

Automation can be implemented through robotic process automation (RPA) or the use of artificial intelligence (AI). With RPA, rules-based “bots” mimic staff interactions with digital systems and integrate discrete data systems to perform the same tasks as staff but much faster and with minimal errors. AI imitates intelligent human behavior through algorithms that find patterns and plan future actions to produce desired outcomes.

Moving forward, analysts expect that automation in RCM will be most in demand for claims management (eligibility, prior authorizations, claims status); denials management (how to better predict, work/appeal denials and reduction of initial denials and write-offs to improve overall revenue capture); and clinical RCM (coding, clinical documentation, case management or utilization review to reduce unnecessary utilization, and charge capture for overall billing improvements). Automation solutions that can rapidly integrated into workflows, that can deploy remotely with limited or no need for staff interventions, and that extend across all revenue cycle functions will be most popular.

Is automation yielding the desired results in terms of optimizing RCM? Yes, according to some use cases. One health care provider organization that uses automation to see where consumers are in the financial clearance process in real-time, and what needs to happen next, has realized multiple benefits – an 18% increase in gross revenue, 85% fewer claims to work on at any given time, and a 50% reduction in anticipated staffing requirements for its newly centralized billing department. Another large specialty provider organization reported savings of about 27,000 hours a month in staff time, which equates to around $500,000.

In addition to automating parts of the RCM process, Mr. King recommended that organizations also consider educating consumers up front to help them understand their payment commitment and enable them to have a seamless experience from first appointment to billing. Other best practices are closely tracking, managing, and keeping up with credentialing; focusing on the most current receivables before tackling any backlog; and building a good flow of communication between billing and clinical professionals.

Optimizing RCM is an integral part of improving organizational efficiency, and the organizational value proposition. This is a critical element in building the base for future sustainability and being prepared for a changing (and more complicated) reimbursement landscape.