As health systems navigate revenue cycle complexities, tapping into the potential of the much-sought-after technologies like artificial intelligence (AI), business intelligence (BI), and robotic process automation (RPA) is no more a choice for them, but a necessity for survival. These technologies have become critical to revenue cycle management (RCM) to maintain financial integrity, adapt to changing payer policies, keep up with industry regulations, and uphold the commitment to patient care, all while following practices, starting from the front-end itself, that could keep denials at bay.
Optimize to thrive
The need for revenue cycle optimization is more than ever, as evidenced by the climbing rate of claim denials that are costing hospitals around $20 billion every year. The Healthcare Financial Management Association (HFMA) insights have revealed that process improvements can help prevent 90% of the denials, and 65% of the denials are never given a second chance through resubmission. This clearly highlights the growing burden of denials and the need for proactive measures to reduce them. Moreover, the Medical Group Management Association (MGMA) cannot emphasize enough on the need to understand denials to prevent them.
While it is encouraging to see providers intensifying their focus on mid-cycle and back-end functions of medical coding & billing and claims, AR, & denial management, it is also important for them to know that most of the denials are caused by front-end errors and that they can be prevented with strategic improvements.
Strengthen the front-end: The first line of defense
Since a lot happens before a patient’s clinical encounter and before the final claim reaches the payer for approval, front-end operations can have a huge role in preventing potential denials. Front-end functions like registration, eligibility verification, and prior authorization play a critical role in verifying coverage and patient details, estimating costs, streamlining claims, facilitating care delivery, and preventing denials that happen due to documentation errors and inaccurate verification. For instance, inaccurate patient details filled manually during registration may result in a denied claim, further impacting the cash flow of the health system. Thus, it is important for providers to focus on improving front-end efficiency to boost their clean claim rate and financial performance.
Strategize your way to RCM success
Needless to say, a big share of back-end denials is attributed to front-end inefficiencies, and optimizing functions at the front-end can well prevent these denials from happening in the first place. Here are the ways that can help providers up their front-end game.
Dive into technology fearlessly
For providers to ensure a seamless cash flow with a reduced denial rate, embracing a forward-looking approach to RCM is a must. This is particularly important when they are dealing with staff shortages and burnout and system inefficiencies due to heavy reliance on manual processes for their front-end operations. Pivoting toward technologies like AI and automation is thus not optional but the means to survive in the competitive healthcare landscape. Integrating advanced technology solutions into their workflows or outsourcing rcm services to a company with the right expertise and technology can be a game-changer for them.
From patient registration and appointment scheduling to insurance verification and prior authorization, each step should ensure accurate documentation and approvals before the patient intake and care delivery. Thus, providers who have been long dependent on manual operations should not shy away from leveraging AI and automation that can ease the burden on their staff or outsourcing tech-enabled RCM services for accurate and timely insurance verification and payer approvals before rendering services. This will help prevent not only claim denials but also provider-patient disputes over financial settlements at a later stage, which may be upsetting for both.
Improve patient access and experience
These front-end services along with financial counseling of patients, all fall under the umbrella term “patient access,” ensuring efficiency of which is critical for all providers to maintain revenue integrity from the outset and avoid error-driven denials. Thus, healthcare providers lacking the expertise but looking to mitigate claim denials and improve patient access should contemplate outsourcing services to and RCM company for improved patient financial and care experience.
Educate and train your staff
For starters, providers can educate and train their front-end staff to ensure accuracy in their patient registration, verification, and prior authorization tasks to avoid documentation and verification errors that result in denials. They also need to ensure their staff members stay up to date with changing payer policies and industry regulations and follow strict compliance while accessing patient information on payer databases and securing updated information. Besides, they should be proficient in their functions and maintain complete transparency with the patients on their financial responsibility.
Moreover, front-end standard operating procedures (SOPs) can help providers fine-tune and streamline their tasks to minimize any inconvenience. This will not only help save time and effort on training but also help reduce staff burnout and improve patient experience.
Automate to alleviate
Providers can automate repetitive administrative front-end tasks wherever feasible and take some load off their staff while making the process more efficient and faster. Automating eligibility verification using bots can help optimize the process with improved prospects of the clean claim rate. With automated bots efficiently verifying patient coverage details and benefits from vast payer databases in a matter of seconds and in real time, providers can ensure seamless documentation to avoid related denials. Since manual data entry is not only time-consuming but also more prone to errors, RPA can come in as a great optimization technology for providers wanting to minimize errors, expedite patient intake for care delivery, and reduce their claim denial rate.
Say “yes” to digitization and process governance
Healthcare providers can also digitize patient registration and other front-end tasks to minimize manual errors during the process, which may lead to claim denials. Besides, they can harness the transformative potential of AI and BI as part of their process governance strategy to assess their KPIs (clinical, administrative, and financial) and denial root causes to target revenue leakage with corrective measures to drive front-end efficiency. Additionally, they can leverage technology to streamline cross-department communication to eliminate siloes and facilitate smooth front-end operations to minimize denials.
Find the right RCM partner to drive your success
Providers who have pivoted to technology to complement their RCM capabilities to overturn denials hold a bright chance of long-term financial sustenance, while those still contemplating the move due to high costs and resource viability need to think outsourcing RCM services that offer the right blend of technology and expertise with complete process transparency.
For those seeking professional expertise to boost their RCM, Jindal Healthcare can be the right partner for your revenue cycle optimization. Its AI-powered suite of holistic RCM solutions helps providers streamline their revenue cycle operations for better financial outcomes and patient experience. Jindal Healthcare’s AI-powered patient access solution simplifies eligibility verification through RPA bots that verify insurance coverage and benefits from payer databases in real time, eliminating the scope of errors that result in denials.
Besides, prompt and efficient prior authorization by experts ensures healthcare services rendered are pre-approved by the payer, confirming the coverage and related limitations to reduce potential denials and revenue loss. The foolproof amalgamation of RPA and AI along with human intelligence not only empowers providers to achieve a streamlined revenue cycle, minimize back-end denials caused by front-end errors, and improve their financial performance but also encourages better resource allocation to support patient care.
With staff burnout and process inefficiencies leaving substantial revenue on the table, it’s imperative for providers to execute a tailored front-end optimization strategy that works best for them to plug the revenue leaks before they escalate into costly denials.