Revenue Cycle of the Future...something we have heard on several occasions. But what does it actually look like?
In a recent article, HealthLeaders highlights a roundtable discussion sponsored by our friends at Waystar, bringing together a group of leaders in revenue cycle management to gather their thoughts on what they believe is important for the revenue cycle of the future.
Let's take a look at what they said.
1. Strategic Partnerships
There continues to be a divide among healthcare payers, providers, and patients -- causing friction and at times, and distrust. While payers and providers are familiar with the nuisances of the industry, patients are sometimes unsure or do not know what is covered and what is not.
"I would like to partner with the payers to provide additional education to the patients around their benefits, what is or is not covered, what requires pre-certification, and what the patient's expected costs would be," says Jeannette Wood, vice president of revenue cycle management and credentialing at Privia Health in Arlington, Virginia.
She continues, "I would like to see payers, especially from a commercial side, really develop something that's patient-friendly and at a level that's understandable, similar to what is available from CMS."
Also looking for partnership opportunities is Denise Szalko, vice president of revenue cycle at Rush University Medical Center in Chicago. Szalko touches upon the issue that surrounds denials and audits from payers, even providing a bit of a compromise.
"I would like to partner with the payers regarding the denials and the audits that they perform. I would be willing to take a little bit less on the rates if payers would commit to not denying pour claim."
What can be surmised from the quotes is that rather than treating healthcare as a service or transaction, creating a stronger partnership among all the parties would be beneficial for the industry.
2. Automation of Processes
There is no surprise with this one. There are a plethora of tasks and processes that can be automated with the use of AI and Machine Learning technologies.
"Things such as claims, follow-up, anything that is normal routine business, are areas where significant automation is possible," says Jana Danielson, revenue cycle executive director at Nebraska Medicine in Omaha. "In those scenarios, the only things you touch are the exceptions."
She adds that she'd "really like to get to auto adjudication" and even greater automation for inpatient coding.
The key for automation is identifying the processes and tasks that can provide real results from automation, and finding the right technologies to implement or collaborate with the right technology partners.
3. Standardization Across the Industry
The roundtable identified lack of standardization across payers and contracts as a major barrier to achieving automation's full potential. Danielson defines standardization as the key to real success. Indeed, it is "the very foundation to make sure that you can just go back and forth in an automated way without having several tweaks or creating rules that are just a little bit different for everybody."
We can attest to the issue with the lack of standardization, especially in processing EOBs and remits. A challenge that exists in RCM is that many payers continue to use their proprietary codes, and it is up RCM to match standard ANSI codes to each payer’s proprietary adjustment explanatory verbiage. AI and Machine Learning technologies exist that can automate this process, but it is equally important for RCM professionals to ensure that they are able to make adjustments or "override" to the ANSI code that better meets the provider's custom output needs.
We agree with the article's viewpoint with regard to how important these three elements are for the future of RCM, and we highly recommend that you download the full report, Ushering in the Revenue Cycle of the Future, available for free on HealthLeader's website.