Evaluating intelligent automation as a front-end revenue cycle solution

Pursuing intelligent automation as a front-end revenue cycle solution, which requires due diligence to sort through hype versus reality, is a decision with the potential for significant impact. With the number of full-time revenue cycle employees on the decline and staffing shortages a top challenge in healthcare overall, intelligent automation has emerged as a viable solution that enables organizations to do more with less. 

The following six-point checklist can be a starting point for finding an intelligent automation partner that can address your organization’s unique challenges.

A comprehensive platform that is customizable based on needs.

Research firm Kaufman Hall estimates the health system revenue cycle market to now exceed $30 billion, which represents 3.5% growth over the previous 12 months through September 2022. As a result, point solutions that aim to bring the power of intelligent automation to the revenue cycle abound.

While point solution vendors claim to provide a quick path to return on investment (ROI), they often create additional data silos and compound downstream work for already overburdened administrators. Rather than opt for a solution that can address a single portion of the front-end revenue cycle, look for a partner that can support revenue cycle automation in all areas: patient registration, check-in, scheduling, authorizations, and claim statusing for follow-up or denials.

Taking things a couple of steps further, be sure to ask for an automation assessment to help identify both qualitative and quantitative operational metrics. Then, use those metrics in combination with the defined solution and scope to develop a highly personalized ROI model to drive value and outcomes.

Scalable to account for organizational growth.

Broadly speaking, healthcare continues to undergo rapid and widespread change driven by a combination of digital transformation, new and complex legislation, staffing shortages, and ever-changing patient expectations. In the revenue cycle many of the same factors are at play while leaders grapple with how to best reduce the overall cost to collect.

It’s a given that every organization's revenue cycle needs will change over time. Therefore,  leaders should look for tools that can scale as practices expand or change. For example, a scalable solution should allow practices to customize automation to align with claim rules in order to reduce inaccurate registration data. Why? Notable data indicate about half of denials are sourced at the patient access or preauthorization stage:

• 27% of denials result from registration and eligibility errors
• 22% of denials stem from pre-authorization or coverage issues

Consumer-grade patient intake and registration technology that gathers patient information accurately.

Denial reduction is a goal of every revenue cycle team, but few are able to truly make an impact on this important metric. Our data indicates that 30% of claims submitted the first time are denied or rejected, highlighting the critical need to accurately gather and code patient information on the front-end.

The evaluation of any intelligent automation solution should include a critical examination of its patient intake technology. Seek a tool that uses optical character recognition (OCR) and machine visual technologies to extract data from an insurance card, understand its contents and accurately and automatically select the patient’s insurance plan in the system every time–all without staff intervention. Additionally, the best solutions will provide an intake agent that enables patients to complete a fully digital pre-visit registration as well as allow patients to self-report clinical information. Solutions with advanced features like these can cut wait times, reduce errors and ensure patients are ready to go when they arrive for care.

Fast, accurate authorization that identifies, submits, and tracks authorizations without staff intervention.

Authorizations are a critical, yet very costly and time consuming aspect of getting patients the critical care they deserve. According to an American Medical Association survey, physicians complete an average of 41 prior authorizations per week, with physicians and their staff spending almost two entire business days (13 hours) per week completing those prior authorizations. 

When it comes to intelligently automating authorizations, be sure to search out a tool that can determine whether authorizations are required, manage instant approval submissions, and conduct statusing, all without staff having to click a button. A sophisticated system will have the ability to drive authorizations all the way to completion without requiring staff intervention.

An ongoing commitment to safety, security and accessibility for patients and caregivers.

As hospitals and health systems continue their journey toward digital transformation the topics of safety, security and accessibility cannot be ignored. Intelligent automation solutions are increasingly utilizing patients’ personal and private information in order to deliver personalized and efficient care experiences.

A vendor short-list should only include those who make data safety and security a non-negotiable. Safeguarding patient information must be a core tenet of any platform. Seek out solutions that not only encrypt data in transit and at rest, but also maintain HITRUST CSF certification and compliance with the standards from sources including the HIPAA Security Rule and NIST SP 800-171, among others.

Ongoing measurement and reporting that drives value creation and mutual accountability.

The old adage that you can’t improve what you don’t measure holds true in revenue cycle automation just as it does in the world of business. Identify a tool that can instill a loop of continuous feedback to improve overall outcomes. Ask potential partners how they capture and report on the three core components that allow for a true assessment of the value of automation: efficiency, staff capacity and revenue.

Any significant intelligent automation solution will be set up to drive alignment on goals and surface progress against key performance indicators (KPIs). Ensure the tools in your consideration set offer a robust reporting interface that provides insights to inform data-driven solutions.