Healthcare revenue cycles impending productivity revolution

Challenges in the healthcare industries have put providers in a place where they need to improve productivity and find ways to increase cash recoveries sooner rather than later.

Efficient revenue collection management has become essential, and providers have been forced to get creative with ways to improve efficiency.

The stage has been set: Medicaid cuts seem to be imminent. Medicare reductions have started to materialise. The rise of high-deductible health plans continues to push more responsibility to patients, who demand a more convenient experience.

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Together, these factors will pressure margins in the future. As the sun begins to set on the Affordable Care Act’s repeal, providers are all asking the same question: “How do I do more with less?”

Plenty of solutions tout methods that increase productivity, but these returns are only incremental at best, offering one to four percent increases in efficiency. Only a few solutions in the last several decades have generated improvements in the 15-20% range, despite 30 years of automation and progress in the revenue cycle process.

However, there is one area where a lot of manual work remains, with a great opportunity for the right innovation: insurance follow-up working claims.

During the insurance follow-up process, representatives work a queue of accounts that are X days from being billed. They review the notes, then usually must check the payer’s website to see if a status has been determined.

If it has not, then they pick up the phone, navigate the interactive voice response (IVR), and wait on hold for a payer rep to answer. This entire manual process takes up a significant amount of the representative’s time.

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If you could eliminate the majority of this manual effort, returning significant amounts of time to work more accounts, or reallocate resources to other areas, the opportunity to improve your operations would be tremendous.

Today, a technology solution exists that can address this need. With website bot technology, you can check the claim status with the payer. The detailed information obtained is then returned to a software system to route accounts to the appropriate areas for resolution, or to move them to a status indicating a phone call needs to be made.

When a phone call is needed, the technology launches a call to the payer, navigating the IVR, and waiting on hold until a few minutes before the payer picks up. The system then passes the call to an agent, estimates the average talk time, and launches another call, navigating the IVR, and waiting on hold so another call is ready for the agent soon after they hang up.

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This technology eliminates a significant amount of manual work for providers and increases productivity by 25-30%. This presents the opportunity to work more accounts or reallocate resources to other areas to help providers increase cash recoveries.

It’s a great opportunity for a big, important healthcare revenue cycle lift in the next couple of years as cuts to reimbursement materialise. It’s the answer to the most pressing question facing healthcare providers today: “How do I do more with less?” Providers will be forced to adopt creative solutions such as this — and fast — if they hope to survive these challenging times.


Sourced by Shawn Yates, director of Product Management at Ontario Systems


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Nick Ismail

Nick Ismail is a former editor for Information Age (from 2018 to 2022) before moving on to become Global Head of Brand Journalism at HCLTech. He has a particular interest in smart technologies, AI and...