Connecting the Dots in Revenue Cycle Management

Healthcare revenue cycle is the heartbeat of hospitals, provider organizations, and health systems. The revenue cycle processes, tracks, and collects for services rendered to patients. As medical billing becomes more complex, and rules and regulations keep constantly shifting, it is no longer just a simple business office transaction. The revenue cycle touches everything from schedules and registrations to patient responsibility, claims status, denial management, and collections. The COVID-19 pandemic has only made it more difficult as providers and payers continue to face unique value-based care challenges. For providers, COVID-19 caused a shift from volume to outcomes. For patients, telehealth caused a shift in how care was delivered and how the value of a telehealth visit was assessed.

When there are issues in the revenue cycle, the trickle down effect causes issues with providers, staff, and patients. Upwards of 14% of the estimated $3 trillion in claims submitted by hospitals last year were initially denied, according to a new analysis by Change Healthcare. Denial rework costs providers roughly $118.00 per claim, according to an article in Becker’s Hospital Review. The following are the most common reasons for denials:

• 25% of denied claims are missing documentation.
• 3.5% of claims are denied due to untimely filing.
• 48% of rejections and denials go un-appealed or unworked, mainly because the cost to re-work a claim is not worth the remittance.

Automation is a Game Changer in the Revenue Cycle

There are a lot of fancy words and phrases floating around right now about the benefits of AI in the revenue cycle. It’s not AI that improves revenue cycle queues and reduces the time spent on tedious tasks. It’s Robotic Process Automation (RPA). Boston WorkStation is the only healthcare specific RPA solution that runs successfully in hundreds of applications, hospitals, and partner technologies every day, addressing processes like claims status checks, missing information and errors, or the need for additional documentation. As hospitals and provider organizations continue to improve financial stability in the wake of the COVID-19 pandemic, automating the revenue cycle is truly a game changer.

The Balance Between Time and Resources

About 90% of claim denials are preventable, and effective prevention of claim denial can result in more than $5 million in additional revenue for an average hospital, according to Becker’s Hospital Review. Becker’s analysis found registration and eligibility to be the leading causes (one in four) for denied claims, followed by missing or invalid documentation (14.6 percent). These areas are perfect examples of where to use RPA bots. RPA enables the healthcare industry to better balance time and resources, by shifting the focus from an operational emphasis to a business emphasis. RPA does the job of human employees in a fraction of the time, eliminating the risk of errors. RPA can reduce the administrative burden by as much as 85%. It can work around the clock, with no days off, and can easily be scaled up or down as needed. When we pass these tasks to a robot team, it empowers people. It’s a win/win for everyone involved.

Claims Management Tasks

Revenue cycle departments can have as many as 20 disparate data silos to navigate depending on the task. They still rely on manual data input from human workers, who navigate through the steps in payment processing. Automation removes this manual data burden, adding flexibility and adaptability. A recent example revolves around HRSA uninsured patient claims for COVID-19. The manual, lengthy process of researching coverage and entering data in multiple portals is replaced with automation, freeing up your most valuable resource (people) and recovering millions of dollars in claims in a matter of weeks. Leveraging RPA ensures that claims can be filed and payments posted, updating patient accounts with no administrative burden on people, which allows them to focus on higher priority tasks like ensuring claims are collected and paid at the highest reimbursable amount. This reduces days in AR and provides a stronger financial standing for any healthcare organization.

By reducing the number of days that claims remain unresolved, RPA helps providers and health systems improve clean claims rates and ensure faster settlement and “dollars in the door.”

Choose the Right Partner

There are a lot of companies out there who profess to help streamline revenue cycle tasks. With a solid “A” ranking in the “Best of KLAS 2021” RPA category, Boston Software Systems has a demonstrated history of positive revenue cycle performance, and a 30-year track record of successful partnerships in the healthcare technology space. Boost revenue, increase productivity, and eliminate an administrative burden on your human staff, with Boston Software Systems’ revenue cycle management solution. Boston WorkStation can be implemented quickly, usually in < 30 days, and can bring a well-documented (average 350%) ROI to the revenue cycle, within the 1st year. Give us a call. Spend 30 minutes to find out what can “go live” in < 30 days.