Automation and Artificial Intelligence Transforming the Revenue Cycle Space

Revenue Cycle Management (RCM) models are gaining traction within the healthcare industry as it’s extensively recognized for its ability to reduce management complexities. The space is changing, and the operations behind healthcare compensation is changing with it. Healthcare organizations have been going through an unprecedented crisis for the duration of the pandemic, where entire service lines have closed down to focus completely on stopping the spread of a deadly virus. Meanwhile, healthcare agencies have been going through a virtual revolution. Organizations are focusing on streamlining the entire manual processes, switch from paper records to electronic databases, and send administrative personnel home to work. Revenue Cycle Management is critical for healthcare to hold monetary viability and offer higher care to their patients.

What are some of the significant challenges and trends that have been impacting the Revenue Cycle Management space?

Lets be honest, all hospitals and physican practices had major losses in revenue over the last year. Many don’t realize that when you shut down a country healthcare stops. Less ER Visits, less preventative care, less of everything. We are surely paying for some of that now as our patients are sicker having put off their preventative screenings, but that’s a different topic. For Revenue Cycle, transforming with new technological advancements and truly leaning on data to drive our decisions has blossomed. Automation is driving change in the healthcare space, and we are integrating and sharing information at every turn (whether we want to or not based on governmental regulations). Revenue Cycle teams across the country are pushing harder on our electronic health record vendors to use artificial intelligence and use robotic process automation to reduce the manual tasks and boost performance.

What to look for in a Revenue Cycle Management Partnership?

Before selecting the right vendor for your organization, you should know what problems your organization is facing. I think your question is around what to look for in a technology partnership and for that, you first have to understand what you are solving and ensure you are heavily investing in the RIGHT technologies. Here at Mercy, we were able to reduce our technology vendors due to duplication. Then, we looked at what we needed to get us through the backlog and the pandemic. This meant a full inventory of our current state and understanding what we needed from a technology partnership so we could solve the problem and automate tasks where possible. I used to believe organizations should hire proven and experiencedtechnology vendors over new vendors, but I was truly proven wrong here. Not only did our newest technology, VISPA, bring us high ROI, installed and live in forty-five days, and allowed us to send people home during a pandemic. The right partnership works with us instead of against us and understands that we know our business and they are here to enhance it.

What are some of the common misconceptions when it comes to RCM in today’s political situation?

The government wants healthcare systems, hospitals, and providers to be transparent.They are pressing rules and regulations to create ‘transparency’ not realizing that decades of software build have been in direct conflict with sharing reimbursement structures.

The lofty goal of publishing estimates or making healthcare like Amazon isn’t realistic unless there is a clear path to get there. The rules and regulations that govern our data sharing such as HIPAA were formed 20 years ago. Healthcare is so far behind other industries due to how these rules were formulated Even worse, the challenges in politics are that government is more concerned with the publich perception than actual reality. Give everyone free healthcare! The government needs to amend those guidelines, created two decades ago, to allow for modern healthcare requirements of data sharing between providers and payers; create a block chain of sorts health information system, provide resources to take the hospitals, anciallary systems and providers to that level. Provide support instead of punitive situations. We can then be concerned about the public perception of transparency. No one wins with the current political games being played other than the Payors. Patients and providers are certainly on the losing end.

 What would be the single piece of advice you could impart to your colleagues to excel in this space?

I would advise my co-workers to be curious and look at everything as an opportunity. With the adoption of Artifical Intelligence and automation technology, the revenue cycle management space will change tremendously. Look toward our youth, embrace technology and become innovative. The next generation will expect more technology in their healthcare and therefore, we have to ensure we are ready in the administrative side to use those ideas to their fullest.

What are some of the technological trends that excite you for the Revenue Cycle Management space’s future?

Artificial Intelligence (AI) and automation can change revenue cycle management, and medical leaders continue to believe that AI can yield high results. A survey conducted by Optum on AI in healthcare shows that 75 percent of healthcare leaders are looking to implement an AI strategy, with 43 percent saying automating the revenue cycle management process will be their first step. Experts believe AI will be beneficial as it maximizes the RCM system’s workflow and understands the core challenges. It can optimize RCM by reducing medical claims errors and helping organizations update and change to avoid human mistakes and save the company from huge loss. I get excited about this not because we can automate or use AI for so many human tasks – in my opinion, it is using the technology where we can allows us to fully utilize our strongest asset… our People! Freeing people to do high value tasks and continue to innovate where we can is what gets me excited.