In the ever-evolving healthcare landscape, RCM stands as a critical aspect that ensures financial stability for healthcare providers. However, the journey of optimizing revenue cycles is fraught with challenges, and one of the most pressing concerns is the need for automation. 

The Need for Automation in RCM

The healthcare industry has recognized the urgency of embracing automation to enhance efficiency, reduce errors and address other day-to-day challenges. However, the path to automation is often obscured by a lack of clarity on where to start. The myriad of options, from optimizing EMR to implementing third-party vendor solutions, can be overwhelming. Additionally, the definition of automation varies depending on who you speak with, adding to the confusion.

Value of Automation

Automation, in the context of RCM, employs technology to streamline and optimize financial processes, minimize manual intervention, reduce errors, and enhance overall operational efficiency. This transformative force in RCM delivers benefits, enhancing efficiency by streamlining workflows, reducing processing time, and optimizing resource utilization.

Additionally, it significantly minimizes billing, coding, and claims processing errors, ensuring precision and reliability in financial processes. Cost savings are a notable advantage as automation eliminates manual handling of repetitive tasks, freeing up resources that can be redirected to critical areas within healthcare. Moreover, automation plays a vital role in ensuring compliance with industry regulations and mitigating the risk of non-compliance and associated financial penalties.

The positive impact of automation extends further, expediting claims processing and billing for faster reimbursement, making it a multifaceted solution that improves efficiency, accuracy, cost-effectiveness, regulatory adherence, and overall patient satisfaction in RCM.

By integrating automation, we embark on a transformative journey that optimizes processes, empowers our people, and enhances the overall quality of care for our patients.

Key Questions Before Approaching Automation

Before venturing into the realm of automation in healthcare RCM, it’s imperative to delve into the existing processes. Understanding the nuances of the current revenue cycle procedures is the foundational step. This involves thoroughly assessing how automation can strategically optimize these existing processes. By identifying bottlenecks and areas for improvement, organizations ensure that automation is applied judiciously for maximum impact.

Moving beyond mere budget considerations, evaluating the ROI becomes paramount. How automation will influence the broader business landscape, encompassing efficiency, cost-effectiveness, and overall performance, forms a critical facet of the pre-implementation assessment. This holistic understanding ensures that the introduction of automation aligns seamlessly with the organization’s overarching business objectives.

Integration with existing systems and scalability are intertwined considerations. Organizations need to evaluate whether automation can effortlessly integrate into the current system or if there’s a necessity for integration with a new system. This assessment encompasses both scalability and the potential impact on existing workflows. Deciding whether to add automation within an existing system or integrate a new one becomes pivotal to ensure a smooth transition without disruption.

Furthermore, it’s essential to consider the impact on end-users. Will automation simplify their tasks or make their jobs more complex? Striking the right balance is key to ensuring that automation enhances the user experience rather than causing unnecessary complications. This user-centric perspective is crucial for the successful implementation and acceptance of automation within the healthcare revenue cycle.

Some Lessons Learned when Implementing Automation

Learning from the lessons of organizations that have successfully implemented automation in Healthcare RCM reveals valuable insights for those considering a similar path. These lessons underscore key considerations. 

Automation does not have to be an all-or-nothing scenario. Starting small and gradually scaling has proven to be a successful approach. Many organizations initiate their automation endeavors with pilot projects targeting specific processes. This allows them to cautiously test the waters, identify challenges, and refine their approach before expanding the scope.

Collaboration with stakeholders, especially frontline staff, is paramount. Involving key personnel in the decision-making process fosters a sense of ownership and ensures that the chosen automation solution aligns seamlessly with organizational goals and day-to-day workflows. Input from those directly involved in operations is instrumental for a smooth transition.

Know that automation is not a one-and-done solution. Successful organizations emphasize continuous monitoring and optimization because automation is not a one-time fix. Regular reassessment of the effectiveness of automation ensures adaptability to evolving challenges, maintaining agility in response to dynamic healthcare landscapes.

Flexibility and adaptability are cornerstones of effective automation strategies. Acknowledging the dynamic nature of the healthcare industry, organizations that thrive in automation embrace solutions capable of evolving with changes in regulations, technology, and organizational growth.

Contrary to common assumptions, the impact on staffing, measured in Full-Time Equivalents (FTEs), is nuanced. While automation can free up staff from mundane tasks, its implementation does not always equate to reducing FTEs. Acknowledging this, organizations recognize that automating a broken process may expose a need for more FTEs if underlying issues are not addressed. Automating a flawed system is akin to masking a problem rather than solving it, highlighting the importance of thorough evaluation before implementation.

Lastly, the overarching lesson emphasizes the necessity to evaluate existing processes before introducing automation. Adding automation to a broken or inefficient process is not a panacea. A critical evaluation of workflows is essential, identifying areas that need improvement. Automation should strategically enhance well-defined and optimized processes, contributing positively to the overall efficiency and effectiveness of healthcare RCM.

Taking steps toward implementing automation in RCM is marked by challenges, uncertainties, and the need for careful consideration. By defining automation, understanding its value, asking critical questions, and drawing insights from successful implementations in other organizations, healthcare providers can navigate this complex landscape with confidence.

As the healthcare industry continues to embrace automation, there is hope for a future where revenue cycle processes are more efficient, accurate, and the evolving needs of patients and providers alike. Embracing these challenges of automation as opportunities for growth and improvement will undoubtedly pave the way for a more streamlined and resilient healthcare system. By integrating automation, we embark on a transformative journey that optimizes processes, empowers our people, and enhances the overall quality of care for our patients.

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After the 2022 financial healthcare struggle, many healthcare systems have faced the challenge of creating a profitable revenue cycle. According to Becker’s Healthcare, expenses increased while revenue growth fell to 5.1 percent last year from 11.3 percent in 2021. With this new challenge, healthcare systems are identifying ways to not only provide the best quality of healthcare to each of their patients but also how to optimize the current revenue cash flow. 

The COVID-19 economic crisis played a key role in accelerating many of the current RCM healthcare trends we are experiencing today. Some of those trends include the automation process and the use of artificial intelligence (AI). We also see a shift towards outpatient services as payers have been requesting extended observation stays.

With the use of automation, healthcare systems are finding ways to lower the cost of care, assist in reducing administrative backlog, and empower staff to treat their patients in a faster time frame.  Automation is transforming the revenue cycle industry as it aims to increase effectiveness, save time, and reduce errors. We also see AI starting to play a significant role in the RCM process with the creation of algorithms that assist in gathering information from data sets to predict future outcomes such as patient behavior, billing patterns, and denial trends.

 As we advance forward, we can see the patient experience has been at the forefront of all healthcare systems. Improving the patient experience plays an imperative role in the future of healthcare as we see Medicare move towards a more value-based care model.

Provider payments will be constructed from certain metrics, which include cost, quality, effectiveness, efficiency, equity, patient-centeredness, safety, and timeliness.

Patient experience and patient satisfaction play two separate roles in healthcare. Patient experience focuses on what should have happened and how often it happened, whereas patient satisfaction focuses on whether the patient’s expectations were met. Some of the ways healthcare systems have aimed to streamline the patient experience is by improving and creating more accessible payment options for patients, optimizing the diagnostic experience, decreasing wait times, and involving the patient in their own care. Healthcare systems are seeing the importance of moving towards an improved patient experience. By doing so, it will improve the healthcare system as well as the providers’ business success by creating higher profit margins and increasing patient retention. According to a report published by Press Ganey in 2021, “patients’ likelihood to recommend their healthcare experience to others has decreased nationally since the onset of the pandemic. The greatest decreases in scores were largely influenced by patients’ ability to access timely care, including phone response, ability to book an appointment when needed, and seeing a doctor as quickly as possible”. According to Sage Growth Partners research, only 39 percent of health system C-suite executives report using a text messaging feature to improve the patient experience which presents a possible opportunity for healthcare systems to improve the patient experience.

Centers for Medicare and Medicaid Services (CMS) have begun to transition to the value-based care program with the intention of improving patient health outcomes. The ultimate goal is to have healthcare providers focus on the value of care they are providing to their patients rather than the volume of services they are rendering. This program will tier the amount of payment a healthcare provider receives based on the results from the care that was delivered to the patient, such as quality. Provider payments will be constructed from certain metrics, which include cost, quality, effectiveness, efficiency, equity, patient-centeredness, safety, and timeliness. The program is designed to hold providers accountable for their patient’s outcomes and aims to create a larger care team of physicians for the treatment of the patient. With the extension of the Medicare Advantage Value-Based Insurance Design Model extending into the calendar years 2025 through 2030, according to Centers for Medicare and Medicaid Services, “we can expect changes to be introduced that will address the health-related social needs of patients, advance health equity, and improve the care coordination for patients with severe diseases and illnesses. Fifty-two Medicare Advantage organizations representing over 9.3 million enrollees are participating in this year’s model”. By the year 2023, the Centers for Medicare and Medicaid Services aim to have all Medicare and most Medicaid beneficiaries enrolled in the value-based care program. Medicare and Medicaid Innovation expects to share more information on model updates once it becomes available.

The RCM has seen many changes over the past decade. As we move forward, we can see there will be many changes still to come. As we approach 2024, healthcare systems hope to find ways to increase operating cash flows that will improve revenue growth.

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Having worked in many different environments over the years, from remote, critical access, Indian health, and large suburban hospitals, I have seen how technology has evolved in the past two decades. These technological changes have advanced the usage of remote workers and services. While progress towards improved technology has facilitated an ever-increasing trend of using remote resources both locally and globally, this year the Coronavirus has dramatically accelerated adoption of this practice, bringing this business model out of extended infancy and into a mainstream method of managing business processes and human resources almost overnight.     

There have been many reasons to use remote workers for the past decade and more, including limited availability of local talent in rural communities, and the cost and time savings of not having to provide office space for certain types of workers such as Medical Billers, Coders, Collectors, and Registration personnel. The key qualifying factor in determining if an employee would qualify for as a remote worker was, “do they need to be onsite to perform their job functions.”  Historically, in rural areas until recently, one of the big obstacles to moving forward in this trend has been limited technology, primarily limitations in high-speed internet. This shortcoming has been even more challenging for the hospitals that wanted to leverage a work from home strategy as hospitals and vendors have had higher speed internet for multiple years now, but rural employees have not. However, the onset of Covid-19 and the strong desire to social distance, combined with the maturation of increased rural high-speed internet services, has driven the Remote worker trend to blossom and even explode in rural hospitals across the country. 

A big decision for hospitals now is whether to leverage vendor relationships or to expand their own local staff understanding; the information technology (IT) lift and additional resources to set them up as a remote worker can be significant. Whether your facility chooses to hire remote workers directly or to use outside vendors, you are likely to be using more remote workers than you have in the past. There are some of the pros and cons associated with either of these choices.

Vendors can provide remote workers that might be 2,000 miles or more away from the facility. These workers are often able to perform requested functions as well as if they were working on site. A key operational component when determining success for remote workers is the training a client partner is willing to provide. An organization’s ability to communicate facility guidelines, workflows, policies, and procedures can drastically impact a vendor’s level of success. Using vendors can provide cost savings, ease of resource management, and speed when providing new hires or replacing workers. In addition, ramping up staff levels for initiatives such as computer or system conversions can offer opportunities for vendors to add resources and positively impact an organization. Vendors can often supply a well-qualified employee in as little as a few hours when the Human Resources (HR) department might need a few weeks or even longer to find the same caliber candidate in the local market. Often, the Vendor contractors have years of experience and need little to no training on their proprietary systems and are adept at learning new systems quickly. Quality vendors are also versed in background checking and credential verification of the types of employees that they specialize in, and are better networked to source talent and identify potential employee red flags in the job market.  

Using outside vendors makes sense for many, especially when talking about small teams of specialized types of workers, such as medical coders, billers, and accounts follow-up representatives.

In-house control of hiring standards and personnel is certainly a strong reason to keep the HR department directly involved in the remote hiring processes, but that also includes the costs associated with hiring W2 employees and liabilities that go with that. In many locations, it can be difficult for a hospital’s HR department to find local talent, and equally challenging to figure out where and how to reach workers with job opportunities on a more regional or national level. While vendors have their benefits, some can be unscrupulous with poor performance, so keep an eye on their performance, invoicing, and KPI. Some vendors have been found to be using unapproved and uncredentialed offshore resources, instead of saving the organization money; this has the potential of causing millions in losses.

Some executives see vendor usage as being more expensive than direct hiring. Still, when looking at the whole picture, vendors can have a dramatic improvement on the bottom line and in the aggregate, be much more cost-effective for the facility. If an organization looks at the HR cost of an employee (the hourly plus cost to employ, plus an average of 25-30% for fringe benefits), vendors can seem expensive. But especially in remote areas, the higher caliber of talent available on a national level, and the better results in KPI performance that comes with a quality vendor, combined with the other issues already mentioned (access to talent, ease of replacement, time to fill, etc.), in the grand scheme using vendors to manage remote workers can be a cost-effective option.   

In closing, there are options and decisions that we all need to explore in this “new normal” work environment. One of those is the choice between direct hiring and then managing the remote working staff or contracting with outside firms to provide those services.  

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Take a step back for a moment if you will…and let’s briefly evaluate your patient’s financial experience at your hospital: Do you have a single statement where you can see the hospital and medical group combined providing one comprehensive view for your patients and their bills? Do you have a world-class payment portal where patients can seamlessly view all their balances and set up a payment arrangement in just a few clicks? Do you have digital-first billing where you can reduce paper statements sent to your patients and increase the propensity of payment? If your answer to any of these is, “No,” then you might not know what you’re missing out in partnering with a patient payment vendor to provide world-class financial care to your patients.

At BJC, we took that step back in 2019 to evaluate how we could further deliver a world-class patient experience. Through a due diligence process, we ultimately selected Patientco to help us lead some of our transformational efforts of our patient’s financial experience.  Throughout the evaluation period, we realized that there are very few solutions in healthcare that give the trifecta in revenue cycle; (1) increased patient satisfaction through self-service, (2) increased patient yield, (3) decreased bad debt. In partnering with Patientco, we are able to put our best foot forward to further achieving the organizational objectives supported by the trifecta. Most importantly, BJC was able to meet the patient where they wanted to be met, and enhance organizationally how we executed on that.  

BJC is known for world-class clinical care and we expect the highest standards on financial care as well.

It is our goal to make the patients’ financial experience as seamless as possible. Having a financial burden of a healthcare expense can be hard enough; the last thing we want is the make it harder by not providing the best financial experience as possible. BJC is known for world-class clinical care and we expect the highest standards on financial care as well. Below are several functionalities that we enabled to enhance the patient financial experience through our Patientco partnership:

Digital First Billing: Gone are the days where we just send out patient statements via paper. Many industries outside of healthcare interact with us via email and text alerts, whether it be Amazon, Southwest or Verizon, to name a few. Why should healthcare be any different? As consumers, we have adapted to communicating electronically and that is what BJC was able to enable with Patientco. By sending the statements to our patients electronically, we increase the propensity of payment by getting it to them front and center sooner.

Single Statement: Having a hospital bill can be overwhelming for many, especially if you are getting a service done that will create multiple bills. Being able to have a comprehensive view of not only the hospital bill but the physician bill helps the patient see the entirety of their service, as well as those bills that are still outstanding. Look at it as a one-stop-shop of statements.

Patient Payment Portal: With the introduction of the PatientWallet© through Patientco, we were able to drive more self-service and integrate all the hospital facilities that we serve as well as the  Medical Group bills into one comprehensive view that interfaces seamlessly onto all electronic mobile devices. When the patient setup their PatientWallet©, they are able to set up their own payment arrangements and pay their bills online.

Chatbot: Meeting where the patients want to be met has been the mantra of BJC and Chatbot is one of the functionalities that we are implementing in order to deliver how we interact with our patients. One good thing about Chatbot is there is an Automated Intelligence component that helps answer repetitive questions and can learn over time.

Interactive Voice Response: Many of your bills outside of healthcare allow you to pay your bills over the phone. The IVR functionality is enabled through the patient’s interaction with a computer operated phone system that allows patients’ to engage via their phones keypad. We are excited about being able to enable the IVR functionality to allow for 24/7 payment from our Patients via IVR to further drive self-service.

Enhanced Reporting: Data is key in being able to bring further exposure to adoption rates for various solutions and strategies that have been deployed. With that exposure in the data, it allows BJC to further identify opportunities to interact with our patients as well as an opportunity to create remediation plans on adoption strategies for items like digital-first billing and ensure the electronic patient consents are obtained and key data point such as email and cell phone numbers are procured at check-in and registration.

Net Promoter Scoring: Net Promoter Score is nothing new to many companies outside of healthcare to evaluate the customers’ experience with a company. With the introduction to Patientco, we are able to obtain feedback from every patient that makes a payment through the PatientWallet© that allows us to bring exposure to our Net Promoter Score around the patients’ financial experience. We also have the opportunity to gain insight on free-text responses from patients where they can talk about their financial experience as well as their other experiences that are received throughout the care continuum. Being able to obtain that type of information is extremely invaluable. It allows us to put a data point to the patients’ financial experience as well as engage with the patient further if the opportunity permits to do so.

There are few solutions in the revenue cycle where you can get impact so many different areas, most importantly your patients. Overhauling our patient payment strategy has been a incredible journey of discovery of not only our opportunities to further engage our patients holistically, but also knowing we are putting our best foot forward to enhancing our delivery of world-class financial care with our Patientco partnership. In healthcare and revenue cycle, one thing is certain, and that is change.

We look forward to embracing the change and continuously evolving to ensure delivery of meeting our patient’s needs not only clinically but financially.

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The healthcare industry is constantly changing in ways that healthcare providers cannot control.  Changes in payor billing requirements and payment models, along with fluctuations in patient demographics and health conditions can cause struggles for organizations with poor processes. Successful organizations must optimize their controllable procedures and create the bandwidth to address industry changes they simply cannot control. The use of technology to maintain financial stability is essential in this ever-changing industry.

Front end revenue cycle begins with patient registration and ends once payments are collected. Obtaining the correct insurance information and patient health profile upfront allows a company to develop the appropriate plan of care tailored for that specific individual. Many patients need health care right now and time is of the essence when verifying benefits and communicating patient financial responsibilities. Utilizing technology to verify eligibility automatically decreases the chance of human error, while providing faster results. Some insurance providers only authorize a certain level of care or visit count, depending on the patient’s health condition. Setting up system holds in the EMR will ensure that the company won’t provide unauthorized services that most likely will be uncollectible. A correct patient profile at the start of care sets the groundwork for the most efficient claim submission and collection process. Using online payment systems to collect known balances prior to the start of service significantly decreases the amount of uncollectible dollars at the end of care.

The automation of processes not only saves time, it reduces the chances of errors to allow for a steady stream of revenue and cash collections.

Healthcare revenue cycle can be challenging due to the length of time it may take to submit a claim for services provided. Many insurance providers require a significant amount of documentation to be completed before a claim can be submitted. In these instances, the provider must rely on the physician overseeing the care to complete and sign documentation. Since the remainder of the patient balance is contingent on the final claim submission, the lag in billing makes it difficult to collect a patient balance for a service that was provided long ago. Technology can play a key role in this process.  By selecting a robust EMR that allows an agency to properly setup billing holds, eligible claims can be easily identified and sent out immediately when ready. Partnering with a vendor that assists with electronic document management is also essential in reducing the time it takes to receive these required documents.   Creating this streamlined workflow to receive incoming documentation allows for a quicker review and attach process. From optical character recognition to utilizing a barcoding system, each document can be uniquely identified and attached to the correct patient record with a simple touch of a button. The time savings this creates from both a workload and claim submission perspective is vital.

Typewritten claims, paper billing, and mailing documents are something of the past.  To maintain the optimal level of success, companies now utilize clearinghouses to submit claims electronically. A clearinghouse allows an agency to monitor the life of the claim from submission to payment. Receiving an automatic alert for a problem claim has now replaced the need for manual inquiries on payment status.  This allows an agency to redistribute their resources from claim follow-up to claim submission.  Denial management services are also key to success in an industry of varying payor requirements. These systems allow visibility into denied claims and suggestions on how to properly appeal the denial.  Not only does this automation save time, but it also increases cash flow and collectability. To further complicate the billing process, many payors have different timely filing limits, so it is essential to automate submission reminders based on timely filing. This automation allows the billing team to prioritize time sensitive payors to ensure claims are sent before the deadline has passed. Without technology, it would be impossible to keep track of these different protocols and securing payment for services would be even more challenging.

Reporting and monitoring key performance indicators are an essential part of maintaining the integrity of the entire revenue cycle system. Many EMRS offer automated reporting that can be measured monthly to determine opportunities for improvement.  These reports highlight anything from days to collect A/R, problem payors, and operational deficiencies that lead to collection issues. Investing in an EMR which presents these metrics at a glance allows an agency to proactively fix an issue before it becomes a financial loss. Agencies should continuously review the services offerings of vendor partnerships to ensure they are keeping up with the latest advances to address changes in the fast-paced health industry.

There is no doubt that technology has transformed the world of revenue cycle. Technology is no longer a choice within the health care industry; it’s a requirement. The automation of processes not only saves time, it reduces the chances of errors to allow for a steady stream of revenue and cash collections. Shorten the revenue cycle, decrease costs and increase revenue by transforming your revenue cycle through technology.

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When I joined Providence St. Joseph Health, one of the country’s largest health systems, I understood health care to be a sector ripe for innovation. My expertise is not on the clinical side, so I have left that to others. My focus has been on a topic that is decidedly less flashy, but no less critical: revenue cycle management.

While it may not make headlines, innovation in revenue cycle management is imperative for the type of transformation that health care needs. In 2018, revenue cycle inefficiencies were responsible for more than $500 billion in U.S. healthcare costs, primarily due to an overreliance on manual, outmoded processes built on physical correspondence, legacy data systems, and employees who spend hours calling insurers on the status of claims. Compounding the impact of these inefficiencies, health care providers today are confronted with headwinds that threaten to worsen their revenue cycle yields on multiple fronts: rapid growth in patient liability at a rate of up to five times that of overall reimbursement, payers challenging and denying a significant number of claims (with 20 – 25% of claims rejected, up from 10 – 15% just 3 years ago), and an increasingly complex environment of regulatory reform and new payment models that will exacerbate these challenges for health systems. Given the crucial importance of a health system’s revenue yield to its ability to re-invest in the health of its community, addressing these frictions in the revenue cycle must be a top priority.

In a simpler time, revenue cycle management was a straightforward process that could be left to the individual talents of billers capable of eking a margin from the billing cycle. As health systems have scaled and payment methodologies have increased in complexity, however, more and more providers are searching for ways to standardize processes, automate workflows, and unlock economies of scale.

Providence St. Joseph Health is turning to technology, commonly used in banking, to transform its revenue cycle. In addition to our pursuit of continuous improvement in core legacy revenue functions and patient-facing activities, we’re building a hub for insights and innovations that will serve as a common base for the entire revenue cycle. To this end, we recently acquired Lumedic, a next-generation blockchain-based revenue cycle platform. With our new partner, we are advancing shared ledger technology, smart contracts, and machine learning for an efficient, secure, and trusted end-to-end platform. Moreover, we are identifying opportunities to drive efficiencies and modernize our revenue cycle – for instance, by streamlining the underlying business processes unique to referrals and prior authorizations. While these prior authorizations typically require manual, time-consuming processes where hospital employees track down information on a payer’s website and hope that it is up to date, blockchain-enabled technology can update a decentralized ledger in real time rather than individually validating or updating files or data systems.

As health systems have scaled and payment methodologies have increased in complexity, however, more and more providers are searching for ways to standardize processes, automate workflows, and unlock economies of scale.

A blockchain-enabled approach also has the added benefit of enhanced security, given that it leverages modern cryptography, public-key infrastructure (PKI), decentralization and consensus protocols that render it resistant to hacking. Many people ask: Why go to the trouble of making dramatic changes to the revenue cycle process when we might do just as well by merely improving on the current model? In our view, while incremental improvements through increased standardization and automation can be beneficial in the short-term, these efforts do not make the fundamental changes necessary for transformation. Approaching a process differently can work. Uber, for example, didn’t just fix the taxi dispatcher model. Instead, it changed the model, using a systematic approach to applying rules for the user experience. It took the inefficiencies of dispatching out of the system, increased ease-of-use and transparency, ultimately resulting in a better, more hassle-free ride.

I realize this may sound futuristic. However, if you’re not convinced about blockchain, consider that a whole country is adopting it for medical care. Estonia uses blockchain technology to control their health records and facilitate the proper use of the records by the medical community. The system is touted for providing a collaborative ecosystem and a single immutable data source for health care professionals and patients.

As we see it at Providence St. Joseph Health, there is a strong case for building out a blockchain platform and applying it to the revenue cycle. There is a multitude of benefits beyond the uses we are currently working on, but, for now, our focus is on unlocking the efficiencies that blockchain technology enables. Imagine a world that runs by standardized, enforced rules instead of passing paper back and forth. Imagine an innovative network that will facilitate seamless sharing of trusted information and collaboration on integrated business processes, reducing inefficiencies in the health care system, and improving the patient experience. Our investments in blockchain technology aim to help make our vision of a frictionless revenue cycle a reality.

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As healthcare continues to transform into a consumer-driven marketplace, it’s incumbent on every employee of every provider organization to understand how they can positively impact the patient experience at their facility. We have marketing teams dedicated to attracting patients to the health system. Once they’re here, we have clinicians who take tremendous pride in providing the best health care to improve patients’ lives. So when it comes time for the patient to interact with the revenue cycle, why should it be any different?

At Cooper University Health Care, our focus is creating a best-in-class patient experience by leveraging technology in a way that allows our employees to focus more on the patient and less on the trivial headaches that historically come with revenue cycle work. Over the past twenty-odd years, technology in the revenue cycle has transformed a notoriously labor-intensive line of business into one that is much more automated. Perhaps the changes are moving too fast for many of us to keep a handle on. If you have ever been through a revenue cycle system conversion or implementation, you know that automating age-old manual processes creates challenges that make you question whether you know your own name at times.

As an industry, we’ve come a long way. We can now automate insurance eligibility. Patients can schedule their own appointments and pay their bills online. Medical records can be shared across multiple health systems to avoid mistakes and delays in care. We can code simple visits with computers alone. We can predict denied claims before they ever get adjudicated. The vast majority of our transactions with payers are now electronic. We can receive massive electronic remits, reconcile, and post them without even the click of a button. All of this has put our industry in a position to transform the way we think about the revenue cycle and its role in patient satisfaction.

At Cooper University Health Care, we implemented a new revenue cycle platform to integrate with our EHR in 2016. Over the past three years, we’ve experienced all of the benefits (and stress) that come with implementing these technological advances. Three years later, we have a stronger cash position, cleaner claims, and a more efficient business processing system. Through the pursuit of operational excellence in our business practices, we have been able to turn our attention where it should be: the Patient.

Not surprisingly, patient complaints to our billing office have reduced nearly 50% year-over-year.

As leaders in any healthcare organization, I believe it is our top priority to make our employees’ work as efficient, effective, and enjoyable as we can. By pursuing technology that will enhance employee engagement and satisfaction, we believe that it ultimately leads to a better experience for our patients. By engaging our employees in the design process of technology, you can mitigate their fear in what efficiency and automation will mean to them. Employees get to see what having more time allows them to do, and how it impacts the lives of real people each and every day. We take great pride in finding ways to impact patient satisfaction in each area of our Revenue Cycle.

Here are some of the ways that technological advances will allow us to focus on customer service:

In Healthcare Access, streamlining eligibility allows our team to spend less time on the payer portals and allows them more time the phone with our patients. Triangulating this data with contract management and CPT-driven orders will allow us to automate patient estimates. Our Financial Navigation Team is working to contact every patient before their scheduled procedure and explain their out-of-pocket cost and answer any questions they may have about their benefits or payment options.  This allows patients to make informed decisions and to avoid the “sticker shock” bills after they receive their care. Not surprisingly, patient complaints to our billing office have reduced nearly 50% year-over-year.

In Transitional Care Navigation (Social Work/Case Mgmt.), our teams have worked with our IT partners to implement real-time avoidable day tracking within the EHR. This allows our Transitional Care professionals to strategically drive improvements in length-of-stay, resulting in more efficient patient throughput and reduced delays in discharge.

In Health Information Management (HIM), we are implementing A.I. technology that will help us to prioritize charts for Clinical Documentation Improvement, Coding Quality, and Accuracy. This will ensure that the patient’s care is captured and documented completely with the patient’s insurance company, ultimately avoiding unnecessary denials. Many times, disagreements in coding can lead to denials or unexpected claim adjudication behavior which can affect the patient’s bill.

In our Business Office, our systems are working to identify incorrect patient balances, incorrect denials, and comply with regulatory requirements much more seamlessly than ever before. When processing over a million claims each year, being able to highlight the exceptions and work them timely has allowed us to actively handle what would have been a dissatisfying situation for our patients.

Seems simple, right? Well-deployed technology creates happy employees, which results in satisfied patients. It is simple, until the technology or the names on the badges change. If you want to deliver a consistent patient experience, you must deliver consistent training and education to your team.  That is why, at Cooper, we have created a Revenue Cycle Training and Education department.  This group is focused on hard-wiring the progress we’ve made operationally so that our teams can continue to focus on service to our patients. With the ever-changing landscape of payer rules, government regulations, and system upgrades, training and education is the grease that keeps the wheel turning.

Pursue operational excellence, install technology smartly to let your people shine, and hardwire the process with training and education. Your patients will see the difference. After all, isn’t that why we’re all here in the first place?

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