Hospital leaders are increasingly turning to automation to streamline revenue cycle operations, but should some processes be left behind? By striking the right balance between automation and human touch, organizations can effectively optimize their revenue cycle operations and position themselves for success.
JUNE 2024
Does your organization currently use any form of automation or are you currently in the process of implementing automation, in your revenue cycle operations?
SOURCE: Akasa. The survey fielded responses from nearly 400 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States through the Healthcare Financial Management association's (HFMA) Pulse Survey program between May 27, 2021 and June 28, 2021.
Where to pull back
“Our primary focus was initially eligibility checks, authorizations, scanning documents within the EHR, [and] claims statusing,” says Savanah Arceneaux, the health system’s director of pre-service and financial clearance.
According to Arceneaux, there’s no area in the revenue cycle she doesn’t think some form of automation can exist. However, there are some that are more difficult. For example, the system recently went live with a solution to automate emergency department coding, but inpatient coding has proven to be more complex.
“We use computer assisted coding, but we haven’t seen an example where a human coder would not have to be involved,” Arceneaux said.
Another area of automation difficulty is prior authorizations, particularly those for chemotherapy and other oncology-related services.
“Those are really complicated prior authorizations, and clinical background is needed to be able to understand the treatment plans and know what needs to be submitted to get approval,” Arceneaux said.
TAKEAWAYS
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While automation offers numerous benefits, there are areas that require a human touch for optimal outcomes.
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Developing in-house automated solutions can help organizations save money and ensure compliance, but justifying the expense and managing staff upskilling are important considerations.
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Automation allows staff to work on more complex tasks, leading to job description revisions and opportunities for upskilling.
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While automation simplifies processes like registration and check-in, maintaining patient communication and personalization in healthcare settings is essential.
Savanah Arceneaux
Director of Pre-Service and Financial Clearance, Ochsner Health
Moffitt Cancer Center in Florida has also had difficulty automating their coding process, along with extracting clinical information from their EMR.
The health system develops its own automated solutions with in-house developers. Lynn Ansley, Moffitt’s vice president of revenue cycle, says this strategy is cheaper and allows them to manage it themselves.
Ideally, Ansley said, Moffitt would like to automate everything that can be done.; If a task is too complex or there’s too much of a compliance risk for the organization, that’s where revenue cycle staff will step in.
“I’d say in the spectrum of revenue cycle, we have a lot of automation [in the] front end and back end,” she explained. “In the middle, most of the automation is around the revenue integrity charge function and less around the actual medical record coding function.”
There are some vendors who offer solutions to automate coding which provide an audit trail. With Moffitt managing their own solutions, those audit trails include output logs with additional controls in place to review the accuracy of the automation.
“Your automation should be as traceable as if you were a human, if not more so,” Ansley said.
Similar to Arceneaux, Ansley doesn’t think you should avoid automating certain areas of the revenue cycle, only that some are too complex.
“If you are trying to automate something that’s going to risk the integrity of the data you’re submitting on your claim, that’s where you need to stop and say, ‘OK, we need a human in the loop on this one,’” Ansley said.
Arceneaux shares this sentiment, adding that when working with complicated prior authorizations, for example, a clinical background is needed to understand treatment plans and what needs to be submitted to get approval.
“There are some parts of the revenue cycle that are further along with automation, like eligibility and coverage discovery tools,” Arceneaux said. “And these cases where the tools are more mature, you have to invest in that human capital to design what will work best for your workflows. With automation, there is no plug-n-play.”
Lynn Ansley
Vice President of Revenue Cycle
Moffitt Cancer Center
“Technology is one of those things where a lot of vendors will sell you the moon, and then you go through implementation, and it’s not the reality.”
—Lynn Ashley, Vice President of Revenue Cycle, Moffitt Cancer Center
Where to push forward
Ansley hopes that, eventually, Moffitt will be able to automate the codes for large volumes of consistent treatment.
By including the facility’s compliance partners in the development from the beginning, she said, they’re able to help them mitigate any risks.
“That’s been a really effective method for us, because your organization’s compliance team is already going to be auditing this,” she explained. “So it’s better for them to understand what you’re trying to accomplish and the considerations that you’ve made from a risk perspective up front.”
Developing and managing automated solutions in-house enable Moffitt to grow and maintain staff, with volume increases supplemented by automation. The organization is conservative in how it scales and develops additional resources, looking to suggestions or requests from operational teams to determine what’s needed.
While developing their own tools saves the organization money, there’s still the matter of justifying the expense.
During the HealthLeaders 2023 RevTech Exchange, a survey found that executive satisfaction with the solutions they’d implemented within their organization’s processes were largely varied. However, despite their frustration, many were still interested in exploring other solutions by different vendors.
Many health systems are struggling to maintain financial stability due to the increasing cost of resources, operating expenses, low reimbursement rates, and persistent workforce shortages. This includes revenue cycle staff, whose roles require a specific level of training and expertise.
“Technology is one of those things where a lot of vendors will sell you the moon, and then you go through implantation, and it’s not the reality,” Ansley said. “So, we on the provider side get a bad taste in our mouth where we’re like ‘we want an ROI right out of the gate,’ and that’s just not realistic with automation because you have to develop and refine, and then it compounds over years.”
Jacqueline Samuel
Director of Revenue Cycle Quality, Strategy, and Analytics, Grady Health System
Atlanta’s Grady Health System, and its physician billing arm One Grady, use automated solutions developed in-house in both clinical and nonclinical settings. They have a process similar to Moffitt’s for gauging the ROI for a new solution, monitoring the revenue impact monthly once it’s been deployed.
Monica Richey
Vice President of Physician
Revenue Cycle, One Grady
According to Jacqueline Samuel, Grady’s director of revenue cycle quality, strategy, and analytics, they’ll continue to use it until the process is no longer needed because of an operational change or the specific process is added to their EMR functionality.
“Within One Grady, we are not averse to using any technology and automation that increases efficiency in our processes,” says Monica Richey, vice president of physician revenue cycle at One Grady. “Because of this I would say we are able to explore those automation opportunities more freely.”
Grady is looking to further its automation efforts in PB coding and denials management, credit balance management, and underpayment review.
Richey and Samuels also think there’s no area of the revenue cycle that shouldn’t be automated, with Samuels saying all repeatable processes are good candidates.
Examining the benefits
“I think with the margin challenges that all the healthcare organizations are facing, revenue cycle leaders are looking at how to do things as efficiently as possible,” she says.
A common misconception when an organization announces they’re looking to invest in a new solution is that staff are being replaced, when the solution is intended to make their jobs easier.
According to Ansley, by developing their own solutions and being receptive to staff recommendations , Moffitt has created an organic, buy-in culture . They’ve gone from a culture of not wanting any automation, she says, to saying they can’t automate some tasks soon enough.
“We’re at the point at Moffitt where even my team will tell you we will never have enough people to be able to do and keep up with the volume,” she said. “So, what we do is try to help and be transparent around where that automation is helping them do their job smarter.”
Another benefit is the opportunity for staff to upskill.
The more tasks that get automated, the more complex tasks staff are able to work on, she says, which leads to job descriptions getting revised. Staff can upskill, earn certifications in other areas, and then be compensated for a more complex role.
Ochsner has built a similar culture, giving revenue cycle staff a seat at the table and allowing them to speak on issues they’re seeing with workflows in real time.
“What’s really helped is making sure that they’re a part of the process the whole way,” Arceneaux said. “They know that we still need them to help kick this off.”
Outside of the more meticulous and complex tasks within the revenue cycle, tasks like registration and check-in are now automated or completed online.
More than 66% of Health Systems and Hospitals Use Automation Tools for Revenue Cycle Operations, According to Survey.
Healthcare CFOs and Revenue Cycle Leaders were asked, “Does yourorganization currently use any form of automation, or are you currently in the process of implementing automation in your revenue cycle operations?”
SOURCE: The survey was commissioned by Akasa and conducted through the Healthcare Financial Management association's (HFMA) Pulse Survey program. The survey was fielded between May 19, 2020, and June 22, 2020, among 587 responses from nearly 400 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States. The survey has a confidence level of 95 percent with a margin of error of plus or minus 5 percent.
While accessibility is a benefit, it comes at the cost of the face time revenue cycle staff would typically have with patients—an important part of patient communications that helped nurture patient-provider relationships. Because of this it’s important to still give patients the option to choose their preferred communication method.
“Recognizing that there are patients that don’t want that human interaction and making those options available, making them seamless, is easy,” Arceneaux said. “But we are in healthcare, and this is sensitive [information]; so we should also focus on how can we make a person available when requested to make that more personalized for patients?”
Jasmyne Ray, Editor, HealthLeaders
Savanah Arceneaux (the director of pre-service and financial clearance at Ochsner Health), Lynn Ansley (the vice president of revenue cycle at Moffitt Cancer Center), Jacqueline Samuel (the director of revenue cycle quality, strategy, and analytics at Grady Health System), and Monica Richey (the vice president of physician revenue cycle at One Grady) are all HealthLeaders Exchange members.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights. Our exchange program hosts two revenue cycle events a year, one that specifically focuses on revenue cycle technology.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.