21 Oct 2019
2 mins read
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?
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.
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.
Read more on how we quadrupled collections for a leading healthcare system with Intelligent Automation in North America
About the Author
Business Process Services
23 Sep 2020
21 Sep 2020
15 Sep 2020
09 Sep 2020
07 Sep 2020
20 Aug 2020
10 Jul 2020
19 May 2020
06 May 2020
20 Apr 2020
30 Jul 2019
31 May 2019
25 Dec 2018
Business Process Services, Insurance
01 Nov 2018
24 Oct 2018
11 Oct 2018
03 Oct 2018
25 Sep 2018
07 Sep 2018
29 Aug 2018
28 Aug 2018
18 Jun 2018
22 Mar 2018
25 Jan 2018
25 Apr 2017
BI & Analytics
19 Mar 2009
26 Nov 2010
Digital Assurance
02 Jan 2012
17 Feb 2012
Infrastructure Mgmt. Services
02 Mar 2012
03 Jan 2013
04 Feb 2013
06 Feb 2013
Digital Assurance, Enterprise Solutions
14 Feb 2013
18 Feb 2013
21 Feb 2013
27 Feb 2013
Others
01 Mar 2013
04 Mar 2013
Enterprise Solutions
05 Mar 2013
18 Mar 2013
Digital Assurance, Enterprise Solutions, Others
22 Mar 2013
12 Apr 2013
26 Apr 2013
29 Apr 2013
13 May 2013
11 Jun 2013
17 Jun 2013
25 Jun 2013
19 Aug 2013
26 Aug 2013
27 Aug 2013
03 Sep 2013
10 Sep 2013
19 Sep 2013
24 Sep 2013
26 Sep 2013
30 Sep 2013
01 Oct 2013
03 Oct 2013
01 Nov 2013
19 Nov 2013
Enterprise Solutions, Manufacturing and Consumer
28 Nov 2013
03 Dec 2013
20 Dec 2013
03 Jan 2014
22 Jan 2014
27 Jan 2014
31 Jan 2014
12 Feb 2014
13 Feb 2014
20 Mar 2014
24 Mar 2014
17 Apr 2014
11 Jun 2014
Manufacturing and Consumer
26 Jun 2014
30 Jun 2014
10 Jul 2014
15 Jul 2014
16 Jul 2014
18 Jul 2014
28 Oct 2014
13 Jul 2015
06 Aug 2015
26 Aug 2015
28 Sep 2015
07 Oct 2015
26 Oct 2015
07 Mar 2016
22 Mar 2016
13 May 2016
23 May 2016
Application Transformation Mgmt.
11 Jul 2016
25 Aug 2016
03 Sep 2016
14 Sep 2016
15 Nov 2016
22 Nov 2016
25 Nov 2016
Banking and Financial Services
18 May 2017
30 May 2017
23 Jun 2017
27 Jun 2017
18 Jul 2017
26 Oct 2017
Healthcare, Insurance
28 Nov 2017
11 Dec 2017
21 Feb 2018
14 Mar 2018
( Mandatory field * )
The information you provide will be used in accordance with our terms ofPrivacy Policy
Please Check on "I Agree" to register for the blog.