Denials management software packages and newly available analytics solutions offer hospitals insightful means to identify the root causes of rejected and underpaid claims. However, can this information be used to accelerate collections and reduce costs?
Here is a 3-fold solution
First, analytics and the resulting insights alone cannot reduce the cost to collect or the cycle time required to get cash in the door. While analytics solutions offer powerful ways to understand important questions such as what is causing denials, which payers are more likely to deny and for what reason, or how certain procedures map to denial rates, the insights that can be gleaned from this exercise are certainly not enough to help get cash in the door sooner.
One key to unlocking the value of analytics lies in how the information is translated into the day to day work of the collections staff who do the follow up. While workflow systems have used queueing mechanisms and other techniques to route work to individuals with the proper training and capacity to follow up in a timely manner, these traditional approaches cannot significantly improve the overall efficiency or productivity of the team. This due to every step required to clear a claim, or look up missing information, or correct bad data consumes time and energy that could be better spent by staff on core activities.
The key is to eliminate tasks and steps in the process so that cycle time is dramatically reduced without sacrificing quality or individual collection volumes.
This brings us to the second element – which requires us to combine the results of analytics with intelligent automation. Hexaware’s Intelligent automation takes several forms, including robotic process automation (RPA), machine learning (ML) and artificial intelligence (AI). Each of these technologies has a sweet spot in affecting overall productivity and cost reduction in the revenue cycle. We propose RPA as it is extremely well suited for driving improvements in accounts receivable (A/R) and payer follow up within the back-end of a typical revenue cycle.
Finally, it is important to note that RPA is not an invasive technology with respect to workflow systems or electronic health record (EHR) systems. RPA technology mimics human actions in the process, thus, taking data directly from these systems and eliminating potentially repetitive and mundane steps from the A/R process.
Bots in action to boost staff morale
The elimination of repetitive human tasks like checking payer web sites and databases for information means can be automated with Bots. This can redeploy to be redeployed to focus on work appropriate for their skill levels and experience, rather than who is available at the moment to process a task.
Second, the RPA takes care of the mundane repetitive tasks, allowing staff to work on higher value activities. This leads to higher morale and lower staff attrition, which reduces a significant cost burden given the amount of training and effort needed to bring new staff up to the same level of productivity as tenured staff.
And last but not least, quality goes up since the ‘bots’ are doing only what they are asked to do and doing it exactly the same way every time. This cannot be overstated, given the amount of waste effort that goes into reworking claims, especially when the details of why they were denied can be understood in detail by using analytics to drive the automation.
