Introduction

Billing cycle automation, even now, is considered a single solution to all your revenue cycle-related problems. How often have you heard people offering this solution when you talk about increasing competition, payers and care providers gap, and lost revenue?

As a healthcare service provider, you must have considered automating some or most of your RCM processes in the recent past. Automation is absolutely the need for the day. It is the future. It has a lot of advantages to the company and the clients. However, it is definitely not your holy grail!

It cannot solve every single problem that arises. Along with automation, experts suggest concentrating on the below three approaches to create effective revenue cycle solutions.

Understand the AR receivable environment 

One area where there may be contradictions and problems, even after automation, is the Accounts Receivable. Start focusing on the AR management function and notice leaks and delays that may be causing you dollars, despite all your efforts into automation.

Build processes that can collect hard-to-get dollars

Automation definitely helps improve collections and revenue. However, there will always be a part of receivables that is challenging and is often written off by the organization. Start building processes that tap these difficult dollars, and as a healthcare service provider, you will see your revenues increasing gradually.

Create a Global Delivery Model (GDM) 

A GDM will optimize the existing processes and make your efforts more efficient and cost-effective. You can create a GDM based on predictive workflow processes to achieve effectiveness along with automation.

Why is just automation not enough?

The payer-provider gap 

Now, the payer-provider gap is such an exciting topic that all healthcare service provider and RCM service providers need to study in detail.

Over the years, there have been a lot of upgrades in the provider industry. Technology has taken over, and payment posting time has been reduced considerably. The providers are doing as much as they can to quickly post payments, so they can collect bills. However, is the payer category equally motivated to pay up quickly? No, say the experts in the industry.

There is no logical motivation for the payers to pay quickly, and as a result, the providers are constantly spending money and time on upgrading processes, wanting to reduce the AR cycle but are not seeing the right results as the payers are not buying into this.

This is the payer-provider gap!

Unless the providers address the gap, all their efforts are going to go down the drain.

Making paper the villain

People who talk about automation constantly talk about the need for eliminating paper and making everything digital. This may work. However, assuming doing this is going to automatically eliminate bad AR is not accurate.

According to experts, manual errors in the AR process are very meager parts (less than 1%) of the total error rate. You can’t keep blaming manual processes for everything anymore.

Depending solely on analytics

Analytics provide great insights to correct past errors and automate claim decisions. Many healthcare service providers have been using this to their benefit. However, it is also to be noted that analytics tools suffer due to the highly volatile nature of the industry. In a place where rules and demands keep changing, unless you have a flexible and pliant tool, analytics may not be enough by itself.

Invest in the right tools

Experts say that healthcare service providers must start by analyzing their payers and their habits. Invest in tools that can intelligently understand denial trends and give you ways to handle the problem.

Quintessence’s Reimburssence has been our backbone to prioritize claims, analyze them based on past data, improve visibility in the AR process, and push claims towards closure. Unlike most others in the market, this tool is designed for flexibility and can be quickly altered with changing demands and requirements.

Implement a Global Delivery Model

A global delivery model seamlessly combines different resources, combining best-in-class technology, resources, and processes, to make a holistic difference. So a GDM, along with other process changes you do like automation, can actually help create a significant difference in your RCM processes and revenues.

Focus on the right areas

There is so much discussed on why automation alone may not help you get the required competitive advantage. Here is a crux of all the other changes you may have to focus on.

  1. Identify your provider-payer gap and try to fix that. When this conflict is handled right, achieving a competitive advantage will become easier.
  2. Completely eliminating manual processes may require a lot of time and money. However, this may not bring the required results unless the external climate changes. Therefore, while automating, also focus on uplifting your insurance partners.
  3. Payer payment processes and policies are highly dynamic and will continue to remain so. You will only survive if you learn to wade through such insecurities quickly and with confidence. You will need to train your team for this.
  4. Analytics are great, but need to be backed up by a flexible and mouldable tool.
  5. Do not ignore the difficult dollars. These may be the difference between struggling or getting the slight edge to race forward. Deduce strategies to collect the difficult dollars.
  6. Approach claims with a Global Delivery Model, which can target multiple issues all at once. A well-defined GDM can also help handle workforce problems like high labor costs and labor shortages.

Conclusion

Is automation ineffective? Absolutely not. Is it the single solution to all your RCM process challenges? Unfortunately, no!

By investing in automation and turning your back to other equally important changes will not help you gain the desired competitive advantage.

As a Healthcare service provider, start focusing on multiple small changes that can make a considerable difference to your process flow and your revenue-generating ability.

There is no doubt that the reimbursement system in today’s healthcare is complex and dynamic. However, it is not something that a properly designed RCM process cannot beat.

Quintessence is a brand that is constantly on the lookout for enhancements that help us grow into one of the best RCM partners. Our team of exceptional talents, smartly designed AR tools and technology, and our well-designed and structured workflow all make us an instrumental offshore partner to rely on.

We understand the industry in-depth and know that there is no one solution for our client’s challenges. Get in touch with us to know how better you can improve your RCM processes and workflow, and Quintessence can support you to become the best medical RCM company that there is!