Ever feel like your revenue cycle system is less like a finely tuned engine and more like a rusty contraption of grinding gears and squealing cogs?
The lack of oil — or lack of care and attention — brings everything to a screeching, frustrating halt. I’ve seen it happen. It’s not pretty and it’s not just inefficient. This is a disservice to the healthcare organizations, members, and patients.
That’s where RCM comes in. There’s lots of room for improvement in this administrative process that tracks a patient’s journey from the initial medical appointment scheduling to the final payment for services rendered. It’s the lifeblood of a healthcare business, and when it’s not flowing smoothly, everyone feels the pinch.
So, how do you know if your RCM engine is purring or sputtering? Here are three questions I believe every payer and provider should ask:
- Are our claims denial rates consistently high, indicating underlying issues in our billing process?
- How long does it typically take us to get paid after a service, and where are the biggest bottlenecks?
- Do our patients and members frequently express confusion or frustration about their bills, suggesting a lack of clarity and ease in our payment systems?
From my perspective, the best new opportunity to truly improve RCM lies in a smart blend of AI, automation, and crucially, human oversight. The handoffs from one step of the revenue cycle to another become seamless with minimal human interaction. This empowers healthcare advocates in the contact center to focus on complex cases. Meanwhile, technology handles the repetitive tasks and provides information advocates need to complete their tasks.
All too often, it’s the inherent friction and inefficiency of billing and payments systems themselves that lead accounts to fall into arrears. When systems are siloed, talking to each other like strangers, the problem just snowballs, creating unnecessary headaches for everyone.
When AI and automation — with human oversight — enters the picture, everything changes. Here are a few examples:
Eligibility verification, which takes 3-5 minutes on the phone or online, can be performed in 20 seconds using AI. That’s 80% faster.
Prior authorization (PA), that unavoidable step for some healthcare plans, can eat up 15-20 minutes with a healthcare advocate in the contact center. That’s understandable as members often have questions — or remarks they want to express and have documented on a call. Using AI and automation to pre-fill certain data fields will reduce the probability of errors and PA rejections.
Coding and claim creation, a manual process that typically takes 5-7 minutes, takes only 1-2 minutes with AI-enhanced auto coding and validation.
Appeals, the most time-consuming process that takes two hours or more and most likely multiple calls into a contact center, can be whittled down to 8 minutes or fewer when advocates are assisted by AI for generating appeals letters.
Talk to me about TTEC’s cloud-based, AI-enhanced revenue cycle management solution. Let’s do a demo and see what happy numbers we can create for you.
