Revenue Cycle Management Challenges and Landscape
As leadership continues to look for revenue cycle management teams to make improvements, there are continued pressures in healthcare to identify cost efficiency opportunities and generate stronger cash flows. Between ICD-10, accountable care and other regulations it is in the hospital’s best interests to have effective revenue cycle management systems to meet financial pressures and regulations.
Challenges revenue cycle management teams face in healthcare include:
- Billings and collections errors. Patients are becoming increasingly responsible for out of pocket costs, and providers need to ensure they are not leaving uncollectable revenue on the table. It’s important to start the conversations early with patients at or before point of service. Medical billing processes need to be understood and clearly documented.
- Health information technology challenges. Some organizations struggle with information technology and billing infrastructure. Revenue cycle management teams are investing in technology advancements for more efficient consumer facing billing and payments procedures.
- Lack of staff training. It’s become important to get the most accurate information up front in patient scheduling and patient registration.
- Monitoring entire process. Evaluation and monitoring of the entire claims process is critical.
- Lack of financial policy. Financial policies need to be clearly articulated.
Element Blue is partnered with a major healthcare provider based in Texas that has significant objectives to generate stronger cash flows and drive cost efficiencies. Given revenue cycle challenges this provider faces, the client is looking to transform revenue cycle management and drive cost takeout initiatives using robotics process automation technologies.
Opportunities for improvement and cost savings include:
- Vendor Placement reconciliation process. Current process is a week long and requires multiple interactions between the client and external vendors. There are different vendor systems, a lack of systems integration in some cases, and time consuming visual reconciliation processes that are currently occurring.
- Pre-qualification payer submittal process. The current pre-qualification payer submittal process is manual, taking 4-6 minutes per submittal and there are 800 submittals processed daily.
Solution and Approach:
Having led successful business process management solutions, delivered software technology integration projects for 18 years, and developed a successful healthcare vertical, Element Blue was selected to deliver this Robotics Process Automation “RPA” based project and help this client embrace these new technologies.
Element Blue is providing technology recommendations and an approach that includes:
- Meetings and reviews with operational leads and Information Systems to audit current revenue cycle management processes
- Identification of opportunities that are the best fit for leveraging robotics process automation and digital business automation technologies
- Application of robotics process automation will enable automation of mundane, repetitive tasks in order to free up workers for higher value work including patient experience and satisfaction
- A pilot project that provides sample of diverse routines and will minimize redundant tasks and improve FTE efficiencies so employees can work on higher value tasks
Benefits of Solution:
The longer accounts receivables age, the greater the burden of carrying them becomes. Submitting claims and re-submitting them, has drained time and money from the client. With robotics process automation, this provider is reducing operating costs. RPA is executing rules-based tasks at increased speeds offering:
- Accelerated time to value with the ability to create, test and deliver new automations in days or weeks
- Reduced human error, and elimination of copy/paste mistakes introduced by swivel chair integration
- Increased throughput, having the opportunity to fulfill automated tasks in seconds or minutes, round the clock