Revolutionizing Healthcare with Revenue Cycle Automation
Building on the unlimited possibilities of AI integration and digital solutions, automation in revenue cycle management is significantly transforming the healthcare finance landscape. The deployment of analytical tools and automation frameworks is expected to reduce US healthcare administrative spending by $360 billion. From driving operational efficiencies to enabling accurate billing and finance processes, technology is advancing the routine functions into more streamlined and profitable segments for healthcare providers. A recent report by Gartner predicts that almost 90% financial analytics will be completely automated by the year 2027, forecasting an opportune path for AI-driven technologies.
Adopting AI-based advanced technologies to streamline operational processes and optimize financial systems for accuracy and enhanced service quality defines automation in RCM. Data-intensive and repetitive tasks are regulated through automation to reduce human intervention and increase the bandwidth for critical aspects and high-value activities. By transforming multi-step, complex workflows into transparent and highly effective processes, AI is redefining payment cycles and patient experience.
Some notable features for RCM automation are:
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Deployment of real-time dashboards
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Predictive analysis for data-based decisions
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Billing frameworks and processes
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Monitoring and reporting dashboards
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AI-powered alerts
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AI-enhanced visual tools
With enhanced efficiency and seamless payment cycles, AI enables real-time tracking for budgets and encourages better financial control for improved ROI .
Understanding the Benefits of Healthcare Revenue Cycle Automation
Supporting the critical functionalities for healthcare holistically, automation is changing the way providers operate with Artificial Intelligence and Natural Language Processing (NLP). Cloud and other advanced technologies are changing in the following ways:
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Better claims processing output
With access to automated workflows, verifications, deal scrubbing, and quick submissions, insurance claims can be swiftly verified and processed while minimizing the occurrence of false claims or any scrupulous activities
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Improvement through claim denials
Scrutinizing and verifying claims and billing documents through AI-driven audits enables providers to track missing information and enhance the first-pass acceptance rate for claims, minimizing rework
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Better processes for appeals and denial management
Using automation, providers can track and analyze insurance claim denials, predict denial trends using historic data, and speed up appeal processes with automated steps for faster results
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Access to insights and analyticse
One of the most significant benefits of AI adoption is access to critical analytics that it generates using a wide range of data. With continuous and real-time monitoring, workflow optimization helps maximize the revenue cycle
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Minimal revenue leakage
By ensuring payment postings and timely reconciliations, AI enables accuracy and clear financial details with consistent reporting, thereby minimizing the leakage of revenue
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Enhanced administration
Automation enables human-free workflows and standard practices, performed with utmost precision, allowing the workforce to focus on other relevant areas such as patient care and service improvisation
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Timely pre-authorization and credentialing
Using automated credential verification and follow-ups for authorization enables quick processing and minimal errors, resulting in more satisfactory outcomes
Download our whitepaper on AI-driven Revenue Cycle Automation
Deep Diving into the Challenges with Automated RCM Adoption
While a structured approach and a long-term strategy are crucial to successfully adapting to revenue cycle management automation, many providers still encounter various challenges when embracing advanced technologies. Some of the key challenges faced are:
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Integration with legacy systems
Most healthcare providers need to undergo a complete IT overhaul to enable any automation for their existing processes, given the archaic nature of legacy systems and the complexity of integration
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Heavy investments and slow ROI
Extensive costs for deploying automation solutions and integration often deter healthcare organizations from investing, as the return on investment is slow to come by
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Technical complexity and processes
As part of the revenue cycle management automation, a lot of complex processes and workflows, such as pre-authorizations, claims processing, etc, need to be accurately and effectively automated, which can prove challenging and time-consuming
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Compliance and data security
Healthcare organizations need to comply with safety regulations and compliance such as HIPAA. The mammoth patient data and other sensitive information need to be safely integrated while embracing automation
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Data availability
Many times, healthcare organizations have access to only incomplete or fragmented data, which poses a challenge during integration, as it limits the efficacy of results due to incomplete workflows
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Adoption of change
Introducing change to employees often faces resistance due to an underlying fear of losing their jobs. Many organizations also suffer from a shortage of skilled employees to work on advanced technological solutions, marring the results of a technological overhaul
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Human intervention
The complexities of clinical judgements and processes are hard to combat with complete automation, requiring a certain degree of human intervention at different stages.
Driving Future Value with Revenue Cycle Management Automation
The accelerating trends for intelligent automation governing all critical aspects of revenue cycle management will define the future of healthcare. AI-driven frameworks and solutions are reshaping the revenue cycles, adding real-time insights and precision at every step.
Getting ahead of isolated tasks, the following automation trends will dominate the RCM section for healthcare:
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Enterprise-wide integration
Replacing manual tasks, AI is permeating the entire RCM spectrum, with integrated tools from the patient admission stage to the billing and reconciliation stages
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Hyperautomation
Driving hyperautomation through the areas of claims processing, charge captures, billing processes, the integration of Machine Learning (ML), and Robotic Process Automation (RPA) is orchestrating seamless financial operations, accurately and more effectively
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Focused investments and RCM evolution
Evolving RCM roles are designed to emphasize exception management, look for data oversight, and provide strategic decision support. More and more healthcare organizations are increasing investments in AI to streamline the financial cycles
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Optimized revenue and cost gains
With reduced operational burdens through revenue cycle automation, operational costs also go down due to fewer denials and minimal rework.
Transforming Healthcare Revenue Cycle Automation with WNS
Leveraging advanced analytics, AI with clinical expertise, and process optimization, WNS has been catalyzing revenue cycles and operations for leading names in the healthcare industry. With AI-driven proprietary and partnered tools and frameworks such as RCMplify and healthcare analytics, WNS has been helping clients with:
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Automating the coding, billing, payments, and claims processing processes through our AI-powered platform WNS WNS Skense
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Deploying certified medical coders to maintain compliance
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Seamless transitions by integrating the upload solutions into client systems
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Streamlining operational tasks through automation and error reduction
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Enhancing business continuity with remote process migration
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Facilitating quality control through audits and upskilling with in-house training sessions
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Ensuring patient data safety with strict regulatory compliance
Harmonizing digital precision with human expertise, WNS emphasizes a holistic approach towards automation, combining people, processes, and technology to achieve tangible gains. From helping clients achieve a 30% cost reduction to a productivity increase of 40%, the comprehensive digital-first approach addresses the complexities of manual, fragmented workflows and delivers value with cost-effective and patient engagement-intensive solutions.
Learn more about how to efficiently deliver care and future-proof your revenue cycles by connecting with our experts today.