Guest Column | December 30, 2020

Setting The Facts Straight: 3 Common Misconceptions When Applying Automation To The Revenue Cycle

By Sean Barrett, SVP of project and digital transformation at R1 RCM

After an extremely difficult year – one where health systems now face losses projected to exceed $323 billion due to COVID-19 and as much as $200 billion in administrative waste as a result of revenue cycle inefficiencies – providers, now more than ever, are feeling enormous pressure to reduce costs and effectively manage finances. Many organizations are turning to automation technologies to navigate healthcare’s operational challenges and improve outcomes at a lower cost – however, many may be taking a misguided approach that is preventing them from reaching widespread efficacy and justifying the initial cost of investment.

With numerous automation solutions on the market and an abundance of companies that offer services to deploy these solutions– it’s important to ‘look before you leap’ and watch out for common pitfalls that prevent full realization of anticipated value. This article will uncover three general misconceptions and describe why a multi-layered automation approach and aligned partnership are key to delivering major organizational improvements, healthier profit margins and a better patient experience.

Misconception #1: Standalone Or Bolt-On Technology Will Deliver Quick Revenue Cycle Improvements

Reality: Purchasing standalone automation components or bolt-on technology that expedites production, such as installing a few bots to complete a series of daunting tasks, will not fully satisfy an organization’s revenue cycle needs. Automation can be a powerful problem-solving tool but can also unintentionally hide operational problems. Knowing what NOT to automate is an important as knowing what TO automate to maximize ROI. If an organization uses automation to accelerate a process that was flawed from the start, bottlenecks will occur and staff members will need to identify workarounds, leading to workplace dissatisfaction and an increase in overall operating expenses.

Misconception #2: Automation Can Be Implemented Effortlessly And Quickly

Reality: Implementing, managing and maintaining automation technology is a laborious undertaking. If an organization attempts to handle automation in-house, they will need to invest significant funds into new employees for engineering, infrastructure adjustments, technology support and production management to build and create the technology needed to realize lasting change. Furthermore, if deciding to work with a partner, be wary of those who advertise a quick deployment period -or those without healthcare specific expertise. These types of organizations are likely using the same standard approach or solution for all deployments, and may not know how to integrate this technology with key internal systems like your EMR or patient accounting system, or be able to holistically transform your revenue cycle.

Misconception #3: A “One Size Fits All” Automation Approach Is Most Effective

Reality: There are many different automation technology levers available to consumers, and each one can deliver its own unique enhancements. However, in order to be truly successful, organizations need to strategically apply a mixture of these technology levers to their revenue cycle processes based on the task being performed and the information being utilized. For example, if dealing with structured data, machine learning (ML) can be utilized to decipher trends and determine how best to complete a transaction. However, if working with unstructured data, such as a medical records or clinical charts, natural language processing (NLP) or optical character recognition (OCR) is needed to pre-process data and then subsequently feed it into another automation workflow.

How To Course Correct: Look For An Operationally Driven, Symbiotic Automation Platform

Organizations need to move away from standalone technology, quick win advertisements and rudimentary partnerships and work with proven experts who can deploy an automation platform that generates more capacity from an operational standpoint. A platform approach that encompasses a combination of powerful technology levers such as: ML, NLP, OCR or robotic process automation (RPA) and workflow orchestration will expand the number of revenue cycle challenges your health system can tackle through automation.

The claims management workflow is a key use case that demonstrates the value of applying a series of technologies to a revenue cycle process. NLP technology can extract clinical terms from an EMR note, and then provide key data elements to a ML model that will assess the data, apply historical reimbursement trends and predict the likelihood of a potential write-off. After evaluating the data, the workflow orchestration tool can escalate high priority items to operators for direct handling or route the low dollar write offs to RPA digital workers to be processed and completed.

A multi-layered automation platform enables organizations to take on more revenue cycle use cases by giving health systems access to better decision-making tools, as well as the ability to create unified hand-offs between digital workers and humans. In addition, since automation isn’t meant to replace all revenue cycle work, it’s important to have a platform that allows digital workers to carry out routine tasks while human staff members handle the complex work that requires additional skill sets. There can be significant increases in employee engagement by utilizing automation to remove administrative or repetitive tasks from a teams’ responsibilities and empowering them with more meaningful daily work. Overall, a platform approach can remove many common errors or interoperability issues across a health system’s enterprise allowing revenue cycle work to be completed in a way that is faster, more standardized and allows an organization to operate at scale.

The truth is that automating revenue cycle processes is a complex endeavor that requires significant technical and operational skill. Deploying technology in a vacuum, even with a single tool such as RPA, will limit an organization’s ability to realize the benefits that automation at scale advertises. Maximizing this potential requires careful analysis of which technology levers should be applied to various sub-processes and how solutioning will complement or re-engineer existing, human-based workflows.

Healthcare providers that are going to invest the time and money into deploying automation technologies should conduct the appropriate due diligence to find a revenue cycle partner who can address your RCM challenges head on. Selecting a partner who has already invested in digital capabilities at scale can help your organization avoid many of these common misconceptions.