How to Make True RCM Automation Work for You: Three Tools Every Organization Needs in Their Toolkit

If you’ve been in the healthcare space for any length of time, you know the buzz around artificial intelligence (AI) is nothing new. In fact, the act of automating processes to increase organizational efficiency and profitability has been in place for decades. Unfortunately, there is a murkiness that exists in the industry where too many companies are touting services and offerings as “AI,” when in reality they are using some offshoot of automation but lacking real intelligence. 

For those of us in the revenue cycle management (RCM) space, we know that tech-enabled services with humans in the loop are vital components to healthcare organizations’ overall prosperity. One cannot exist independently of the other. In this article, I will walk readers through three tools that every RCM leader needs in their toolkit when approaching automation. 

Tool #1: Education

One of the best tools you can have in your automation toolkit is education. Knowledge is power, and can be extremely timely in helping you and other leaders make good decisions. One of the areas I find important when educating teams that I work with is the distinction between Robotic Process Automation (RPA) and AI. 

While both are types of automation, they have different roles in increasing operational efficiencies for organizations. Think of a standard RCM process such as prior authorization (PA). RPA alone doesn’t cut it with end-to-end (E2E) automation in PAs. It can do a lot of things, like entering data into a patient portal or website. However, when it comes time to look at a patient’s clinical documentation or answer medical necessity questions like “Did the patient have conservative treatment done?” RPA isn’t able to do that. That’s where AI or generative AI comes into play.

If RPA is the doer, think of AI as the thinker. AI is able to help with reading, understanding, rationalizing, and answering clinical questions. By plugging AI into traditional RPA, you’re able to completely automate the entire RCM process from front to back, or E2E. 

Tool #2: Strategy 

What is it that you’re trying to achieve at your organization? Maybe it’s to limit the number of full time employees (FTEs) it takes to follow up on claims, or to reduce the number of denials you’re seeing from a certain payer, or (fill in the blank). Here is the good news – regardless of whatever your goal is, there’s a way to automate it. 

Strategy is important because it creates a roadmap that makes the most sense for your organization. As we discussed earlier, education on the types of automation out there is just the first tool in your toolkit. The next piece is strategy – how are you going to execute said goal?

If your organization is trying to alleviate your staff from the strain of redundant, non-complex reasoning-related tasks that could be automated, you’re not alone. A recent study of medical groups found that 62% of participants have roughly 40% of their revenue cycle operations automated. For hospitals and health systems, the percentage of organizations automating some portion of their RCM is even higher at 74%.

Use cases for these different types of automation in the revenue cycle space are strong – lower cost-to-collect, increased productivity, and less claim denials/errors are just some of the advantages that hospital executives are seeing. Unlike other areas of healthcare, the revenue cycle is a low-risk, high-reward area to experiment with automation. 

Tool #3: Change management

A final but important tool to consider for your tool kit is your team’s response and adaptability to experimenting with automation. As I tell executives often, automation will not replace human jobs. But humans who know how to use automation will replace those who don’t. 

Earlier in the piece I mentioned that tech-enabled services need humans in the loop. You might start out with only 10% automation and 90% people. As AI agents get stronger, the platform automatically delivers value and the number of people using the system gets reduced. Human intellect is an amazing thing, and brains are designed to do more than drudge work. By allowing automation tools to do what they do best, humans are freed up to do what they do best. 

For true change management to happen, it’s important to identify those team members in the organization who will be champions of the technology and its benefits. These people will be able to lead the charge with third party technology companies if applicable and communicate important status updates and enhancements with other team members internally. Think of this group as inhouse “power users.” They will enable the change to trickle down throughout the organization.  

Closing

Automation is a marathon, not a sprint. Start small. Even the smallest dollar claims add up, and over time the risk will be worth the reward.

Photo: zhuweiyi49, Getty Images

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