Revenue cycle management is more difficult than ever, as hospitals and health systems try to deliver a positive financial experience for patients, bring in much-needed revenue and deal with ongoing labor shortages.
Becker's Hospital Review recently spoke with Raj Sethuraman, chief product and technology officer at Finvi, about how organizations are using technology to address their RCM workforce challenges.
Question: How have the changing work environment (e.g., the shift to remote/hybrid teams) and RCM workforce struggles influenced the advancement of RCM technologies?
Raj Sethuraman: When the pandemic emerged, most healthcare organizations witnessed significant drops in patient volume. Hospitals had to suspend elective procedures, like hip replacements, that generate significant revenues and profit. It became critically important to chase after every dollar owed by both patients and payers. In addition, hospitals and health systems had to understand their contractual obligations with payers, as well as different modalities for reaching patients.
To maximize the revenue cycle, technology came into play. Organizations have recognized how essential it is to automate and streamline workflows for RCM employees who work continuously with payers and patients. A classic example is automating follow-up on high-value denials and claims to avoid missed timely filing deadlines and to generate higher margins and revenues.
Additionally, the pandemic has shaped how everyone works. Many organizations have adopted hybrid work environments and some are 100 percent remote. In this new world, managers can lose the personal touch with team members. They need technology to maintain and improve visibility into employee performance and behaviors. Tools that enable supervisors to track the number of calls made to payers or patients as well as QA and coaching tools to continue improving performance from flexible work environments are critical to a successful remote team. Technology has also been deployed to address compliance requirements for standards like HIPAA and PCI.
Q: What is the impact of not having enough staff to work accounts on a hospital or health system's revenue stream? How does that trickle down to the patient experience?
RS: When employee turnover is high, organizations lose institutional knowledge and subject matter expertise. Without that expertise, it takes existing employees longer to work on high-value claims and denials. Opportunities to appeal denied claims may be missed. That impacts revenue and margin.
From the patient standpoint, people want to get their bills promptly so they can plan for their payments. Staff shortages often mean that it takes longer to work through the claims follow-up process and for patients to get their bills, creating a sub-optimal patient experience.
Q: How are hospitals and health systems leveraging technology to offset the impact of RCM talent shortages?
RS: Revenue cycle management has many workflows, so automation is essential to improve productivity. Thanks to technology, it's possible to automate low-value tasks and enable staff members to focus on high-value work.
For example, if revenue cycle team members have to call an insurance company, can they address a group of accounts with commonalities with a single call? Or do they need to make one call per account? Process automation can group accounts with similar attributes and drive efficiency, which directly increases revenues and reduces cost to collect.
Technology can also enhance the patient experience. Many patients now pay for some portion of their healthcare out of pocket. As a result, organizations must empower patients with digital payment channels. Digital tools can also be leveraged for patient communication and alerts.
Q: Where are hospitals and health systems prioritizing their budgets for RCM technology investments?
RS: Finvi recently partnered with Porter Research to survey top healthcare RCM decision-makers and we have published the results in a white paper. Automation came out as a clear winner. However, a lot of investments are also being made in system integration. Mergers and acquisitions are commonplace in the healthcare sector and each hospital has its own EHR, patient engagement solution and billing system. When mergers are completed, there are a lot of moving pieces to evaluate and make the merger successful. In many instances, rip and replace of tech solutions is not the top priority, since that is time-consuming and costly. To ensure that systems can integrate together in real time and in batch mode, organizations are investing heavily in application programming interfaces including solutions that simplify that ongoing effort.
From the end user perspective, ease of use is critically important. That means providing an intuitive user experience and seamless navigation of workflows. RCM staff need the best dialing and caller experience possible, since they spend most of the day calling patients or payers. Systems must be configurable, so nontechnical users can configure emails, alerts, reports and more. Ease of use for the patient in self-service options is also critical, as ease of use increases adoption and likeliness to pay.
Q: Where do you see RCM technology continuing to impact and support the RCM workforce of today and tomorrow?
RS: It's critically important to understand the use cases where you can apply artificial intelligence and machine learning to drive efficiency and productivity, while reducing costs. One example is predicting a patient's propensity to pay past the use of a credit based, static propensity to pay score. Another is predicting a payer's propensity to deny to proactively avoid that scenario from occurring.
It's also important to use data to drive insights and specific actions. This requires a solid foundation of predictive analytics and reporting that is tailored to specific users. Finally, enabling API-based integration will be vital for seamlessly connecting systems into a platform.