Revenue Cycle Management Automation: 5 Use Cases in Medical Billing

The revenue cycle has become more complex. With so many steps in the process from patient access through charge capture and submission, manual work slows down the process. It can also make errors more prevalent. Applying advanced technology to the financial aspect of care can alleviate this, namely with revenue cycle management automation.

Automation capabilities improve processes and provide efficiency. Learn how it works and how it impacts medical billing.

What is Revenue Cycle Management Automation?

Automation in the revenue cycle describes employing technology to streamline workflows. It does so by taking over mundane, repetitive tasks necessary in RCM operations. That’s the first level of automation, typically carried out by robotic process automation (RPA).

In RPA, digital robots automate rules-based tasks, removing the need for human intervention. The second level is intelligent automation. This combines RPA with artificial intelligence (AI) to enable technology to make decisions or complete activities beyond the repetitive.

The Key Benefits of Revenue Cycle Management Automation

Adopting automation in the revenue cycle has experienced increased adoption. The technology has become cost-effective and easier to implement. According to a healthcare finance survey, 74% of healthcare organizations are using it to some degree. Nearly half (46%) are also using AI.

The reason for the rising adoption has much to do with the benefits. Those include:

• Streamlining tasks, which saves time and reduces strain on staff
• Cost savings as a result of less labor and fewer denials
• Optimized operations that no longer have blockers involved in the billing cycle
• Improved cash flow with faster claim submissions
• Enhanced patient experiences due to more convenient information collection, accuracy in eligibility, and easier ways to make payments

Automation in the revenue cycle is highly versatile and can create improvements across the process. It’s something that any size practice or facility can leverage. There’s also the opportunity to benefit from automation without a technology investment. Should you choose to outsource medical billing, those specializing in the service have deeply rooted automation into their solutions.

So, how can automation in RCM be useful?

5 Use Cases for RCM Automation

What does RCM automation look like in practice? These examples showcase how it delivers on the benefits.

Eligibility Verification

An important initial step in RCM is eligibility. You need to have accurate information on the patient’s coverage. Manually doing this is time-intensive. It slows down patient access activities.

By applying automation, the technology uses the information the patient provides to check on benefits automatically. With this verification, you can then determine what insurance will cover and patient responsibility.

When patients have this information up front, they’re aware of their financial liability. It can reduce issues with patient collections. Validation also minimizes the chance of denied claims.

Claim Scrubbing

Automation offers relief from the manual entry involved in claim scrubbing. As a result, claims submission is much more accurate and faster. A provider in the industry has reported that automated claims scrubbing reduces time spent on these efforts by up to 95%.

One example involves modifiers, which are a complicated area and source of many denials. Automation can manage attaching these to claims accurately. You can see fewer denials and faster reimbursements.

Patient Collections

Following up on payments due from patients is cumbersome. You may not have the time or staff to devote to this. Yet, it’s necessary to realize this earned revenue. Automation can assist here, too.

A few ways it supports patient collections include:

• Identifying patient balances due after insurance payments
• Generating invoices for patients
• Reconciling patient accounts when payment occurs
• Prioritizing which patients have the highest propensity to pay with machine learning algorithms

Claim Management

Every mistake on a claim costs you time and/or money. Avoiding these isn’t always possible with disjointed manual processes. Using both RPA and intelligent automation, technology can scrutinize every component of the claim for accuracy and completeness.

Automation can find inaccuracies or alert that the claim doesn’t have proper documentation through scripts trained to find these. It can find what the human eye may not, and these tools always have the most current information regarding codes and modifiers.

Healthcare can also use automation in claims management to track the life cycle of the claim. Your technology platform could trigger alerts when payments are late or under the original claim value. These notifications ensure you always know the state of your claims.

Denial Management

Revenue cycle automation for denial management may be one of its most valuable abilities. Denials disrupt the revenue cycle. They delay reimbursements and require time to address and fix.

RPA and intelligent automation can define the root causes of denials based on historical information. Uncovering this can help you avoid it in the future. Review of claims before submission via automation can also find errors before submission.

This very advanced approach to denial management ensures you see fewer of these. Automation can also assist with reworking claims by advising you on correcting the error and resubmitting. This technology can significantly contribute to a healthier bottom line.

RCM Automation Drives Better Financial Performance

There are numerous opportunities to infuse automation into the revenue cycle to support medical billing. When it’s part of your platform or in use by a billing provider, you reap substantial advantages that improve financial performance.

If you’re interested in finding medical billing partners, check out these reviews for top companies.