No one needs to tell a healthcare CFO that revenue streams are shifting. It is getting tougher than ever to navigate the nuances of chasing down payments. Money is leaking from the bottom line on a regular basis, but it is often difficult to pinpoint why. The healthcare sector is still reeling from the effects of COVID on the industry. Physician burnout and changes in the marketplace make staffing an ever-present concern.
The Healthcare Financial Management Association (HFMA) says it is becoming increasingly difficult to find replacements for tenured coders and billers in today’s hospitals. In an HFMA article titled, "CFO of the Future,” Dennis Dahlen, CFO of the Mayo Clinic says, "The pace of change has become more accelerated during the pandemic, increasing the need for quick but informed decisions."
Having a team that knows the ins and outs of revenue cycle management (RCM) is a priceless asset in and of itself, but even that is getting increasingly difficult to come by. Healthcare organizations are competing with other industries for precious staff to fill this need. This loss of seasoned RCM professionals is creating a knowledge gap or “brain drain” that affects financial performance.
Add to that, the increasing number of patients with high deductible health plans. These unpredictable and difficult-to-collect patient payments make up about 25% of collections. According to the Kaiser Family Foundation, about one-third of insured adults worry about affording their monthly health insurance premium, and 44% worry about affording their deductible before health insurance kicks in.
In addition, payers are moving to value-based care, adding a whole host of pressures to reimbursement and many places for errors in the billing workflow. In an RCM world based on these obstacles to payment, any healthcare organization without a clear, overall, end-to-end daily picture of its entire billing process will have a hard time collecting what is due, preventing truly lost revenue, or hunting down revenue that may only appear to be lost.
The answer is an influx of fresh insights, the kind provided by WhiteSpace’s Platform a cloud hosted, ever learning artificial intelligence (AI) solution. The platform’s AI-powered digital consultant monitors daily activities such as patient encounters, reimbursement, and financial transactions and more. AI can rapidly identify underperforming RCM workstreams and recommend the best course corrections. The solution also reveals ill-advised workflow patterns and show ways to collect money efficiently.
Inside the platform, AI culls through thousands of records and analyzes the data specific to each RCM workstream. As data is refreshed daily, AI supplies updated organization-specific intelligence, by identifying complex patterns in data and the insights on how to resolve them that humans cannot decipher. The WhiteSpace Health Platform shows what claims should be priority re-works, where there are leakages due to missed steps, and where the most impact can be gained. It also surfaces specific steps to resolve claims with ever learning technology.
The platform’s Resolution Insights module creates advice so RCM professionals can take the highest probability steps to resolve the issue. These insights are a playbook based on data, not just from the present moment but evolving into the future as the circumstances constantly change. It is ever learning.
The Resolution Insight module shows, what can be quickly worked, what can be sent back to the coding team and what could be best managed by bots.
It answers billing efficiency questions without guesswork. Revenue increases when hidden opportunities in the data are revealed and resolved. Intelligence in the platform recommends actions to resolve claims on historical evidence based on successful resolutions rather than “how things have always been done.”
AI generated advice in the platform, called RevIntel, transforms the collections process from reactive and time-consuming to streamlined and proactive. The prescriptive list of tasks and a precise estimation of the probability to collect with each course of action vastly improves financial performance and brings in cash fast.
Designed by healthcare industry experts with direct experience managing revenue cycle and operations, RevIntel stipulates robust collections workflows that tell employees what to do, when to do it, and how to do it, based on predictive analytics mined from the data. It suggests actions that successfully have solved the same issues in the past at other organizations, including those found in scheduling, billing, coding, denials, and patient engagement.
Resolution Insight is designed to be a digital clone of your staff. It virtually executes actions and performs data-related investigation by applying logical reasoning. It helps your RCM team decide what claims should be appealed by A/R, sent to coding, and automated by bots. Additionally, it researches details missed by the human staff members and follows guidelines so steps are not missed.
In the revenue cycle world, this means curating and combing through all the data elements in the system, as well as information that are coming from third-party systems like payer remits, providing guidance on how to get the claim reimbursed. When AI generated resolutions are processed each week, each month, or over a year of claims, it adds up to significant revenue.
Once opportunities to improve financial performance are identified, RevEnhance shows your management team how to upgrade processes to keep them performing at this higher level. Depending on the challenges, the average healthcare organization can expect an uptick in revenue anywhere from 2-5% by using RevEnhance.
- Zero balance recovery
- Coding gaps-based revenue loss
- Patient payment accelerator
- Patient volume and utilization
- Pre-visit optimization
- Pre-auth tracking
- Pre-bill denial prevention
- Payer performance scoring
- Patient pay enhancement
Back in 1954, business legend Peter Drucker, author of The Practice of Management, famously said, “What gets measured, gets improved.” It is possible that today he would say, what gets measured analyzed by AI, gets improved. Adding AI capabilities to RCM has tremendous promise to revolutionize healthcare billing. A new Hyro trends report says emerging healthcare technology will play “an especially critical role” in alleviating labor shortages that increased in the healthcare sector due to the pandemic.
About Gautam Char