Improve the Health of Your Revenue Cycle – With Workflow Automation

Hospitals and health systems depend on the lifeblood of the revenue cycle to stay afloat. Both success and failure depend upon how well health system administrators manage billing, coding, prior authorizations, payment processing, claims, denial management, and collections. Optimizing the revenue cycle can be a challenge in the best of times. The financial and operational impact of COVID-19 is affecting every hospital and health system, and financial leaders are now, more than ever, considering ways to mitigate losses and evolve from this pandemic with new strategies.

Denial Management Costs Hospitals Roughly $262 Billion a Year

Claim denials represent an operational speed bump for hospitals and health systems. To minimize delays, hospitals and provider organizations can improve the process and #bridgethegaps that exist between system vendors, billing systems, and other data silos, areas that should work easily (but don’t), giving human workers back their time, and providing relief for some of the mind-numbing tasks in the revenue cycle. This shift allows staff to focus on higher priority items that require communication or a personal touch, improving productivity and satisfaction.

Before submission, automation can handle the tedious tasks of claims management that should just work (but don’t) such as:

  • Eligibility verification
  • Prior authorizations
  • Analyzing or identifying missing information
  • Accessing other applications or 3rd-party sites for information

After submission, automation can handle additional tasks such as:

  • Denial routing, resolution, and re-submission
  • Collections management
  • Payment processing
  • Crossover claims
  • Contractual allowables and analysis
  • Write-offs and adjustments

90% of Denied Claims are Preventable

Automation sifts through volumes of claims, managing, optimizing, and correcting the issues that need attention, without the need for human interaction. This makes it a pivotal resource in today’s challenging times. It supports the challenges faced by shorter staffing and increased responsibilities, improving cash flow, reducing days in A/R, and powers higher clean claims rates.

65% of Denials are Never Corrected and Resubmitted for Reimbursement

Many times you hear revenue cycle managers say, “don’t worry about that” when it comes to the claims resubmission process. Paying people to spend inordinate amounts of time re-working claims for an extra few dollars may not seem like the best use of time or people. But, that $4.00 adjustment on thousands of claims can translate to millions of dollars in lost revenue. And when it’s corrected as part of an automation, human workers aren’t burdened by the extra time analyzing, clicking, typing, and re-submitting.

Bogged Down by a Manual Process

Checking eligibility can mean applying more than 250 complex business rules to data found in 30+ fields about co-pays, co-insurance, deductible amounts, etc. Automating the process saves over 80% of the processing time, sifting through volumes of data and applying rules-based processes to claims so that humans can spend time working on higher-priority tasks. Automation relieves the burden of accuracy and increases efficiency in revenue cycle management. A return on investment can be anywhere from from 30% to 300% in the first year. Here’s what just some of our clients achieved:

  • Saved 180 hours per month and $20 million automating failed claims re-submissions
  • Recovered $2 million per year automating Emergency Department billing
  • Saved 10 hours per day and $1.2 million per year by automating crossover claims processing
  • Saved 15 FTEs and $450,000 per year by automating claims submissions

Automation is a pivotal resource in today’s healthcare landscape to relieve cost and resource burdens. The best revenue cycle tasks to automate are high-volume, tedious, and repetitive. In the revenue cycle, these tasks are both time-consuming and copy-paste-click intensive. By automating revenue cycle tasks, a hospital can accomplish more work with fewer resources and maximize collections to get paid faster.

See what our customers are saying:

“CAMC was able to eliminate a very time consuming and costly process of manually entering data from and to disparate sources. Our workflow automation processes do exactly what we need them to do and with the added bonus of proper error checking.” David Dickens, CAMC

“A process that could take six people up to eight hours of data entry. The Boston WorkStation completes that daily task in around 90 minutes, saving up to 48 hours of staff time and performs it error free.” Mitch Lawrence, Christus Health

Why Boston Software Systems?
Give us 30 minutes to explore your most time-consuming workflows and learn how we can provide a great return on investment (ROI) with automation. With over 95% of our projects completed in under 30 days, savings are right around the corner.

We can get the process started quickly so you can get back to caring for patients: 866-653-5105. We’re also available to connect via Twitter, @bossoft.

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