In this white paper, Randall Davis, Senior Director of Client Operations, explains how automation technologies may significantly enhance workflow and how talent and system integration can contribute to success.
Please click on the video to the right to learn more about the author, hear his insights on this white paper, and learn what motivated him to write about this topic.
To discuss this white paper in detail, please contact Randall using the information provided at the bottom of the page.
Health systems can thrive only when revenues are collected accurately and economically.
But complex payer rules and systems bog down recoveries for patient services. This drives up staffing and software costs meant to improve results. Revenue cycle executives spend their careers steering the cost tradeoffs of staff process optimization and technology.1
We see innovative clients thriving in this environment. They use expert agents––humans and software––to simplify workflow with disciplined process engineering, talented staff, and automation.
Process errors leak revenue, staying hidden until denied for payment.2 Extraordinary efforts late in the cycle might fix a problem or still result in a write off. If tolerated, this produces devasting operating losses.3
Write offs for care reimbursement originate in mismatches between payer rules for service authorization and provider documentation. Alignment demands focused attention and can still delay patient care. Workloads pyramid as yesterday’s problem accounts get buried under today’s new encounters. While physicians deliver high quality care, their overwhelmed administrative staff struggles with the paper trail.
Automation technology can promise dramatic improvements. But merely automating the complex paths of existing workflow generates errors without mercy. Frustrated administrators have to clean up automated mistakes, and software alone can’t solve the problem, inevitably failing to deliver promised ROI.
Talent retention is the controlling factor for success. Experienced staff know intuitively how to solve account problems.4 But the daily grind of repetitive clicking through low-value steps toward uncertain outcome discourages high performers and trainees alike. We must create rewarding jobs where thinking assures success.
Mundane work of navigating payer systems, researching rules, matching checklists, copying, pasting, and choosing the high-probability next step for a great outcome should be delegated to software agents. Experienced staff can then address problems of judgement that depend on their creativity.
But before automation, the process must be re-engineered to seamlessly integrate talent and systems.
Executives are anxious to focus and prioritize performance goals. With a dashboard of Healthcare Financial Management Association Map Key metrics, they can manage progress against performance baselines.
To dodge denials, root causes must be distilled through operations engineering. Messy cases with denied reimbursements pose lessons for improvement. Those lessons will prevent future error conditions, driving the cost of quality to the front of the revenue cycle. Eliminating a problem early on burns much less time than fixing the fallout later.
By clustering cases into related scenarios with common causes, they can be addressed with policies for preventative action. Disciplined eligibility, coverage, and authorization scenarios can be defined, based on payer and treatment procedure. The Electronic Health Record (EHR) documentation must be kept up-to-date to prove closure.
Process maps that are candidates for automation should be tested manually by human agents in live production. This ensures improvement against the MAP Key baseline before investing in technology.
Next, we can tally the many scenarios by volume and effort, sorting them onto a Pareto curve to prioritize automation that tackles performance goals. Prevalent payers, procedures, and denial events present as likely targets.
Target scenarios are split into two parts: system functions that can be satisfied by automation tools and creative functions to which human judgment must be applied. Steps in the decision tree provide a reference system design. The automated part of the design grinds through details across applications, escalating to a managing human for creative judgment.
This Scenario Map details a workflow solution in Vee Healthtek’ Sona Promise system. The Workflow Automation Engine assigns a software agent to retrieve and analyze data for an authorization, passes control to a human agent for quality assessment and decisions, then sends control back to the software agent to finalize documentation in payer systems and the EHR.
Workflow Scenario Map
Using our automation solution, clients routinely achieve 95% net collection rates,5 while capturing these coveted results:
Vee Healthtek runs this playbook with clients to authorize patient care, assure correct recoveries, and dramatically improve both productivity and job satisfaction for revenue cycle employees.
By equipping clients with automation to thrive in the revenue cycle, we deliver Extraordinary Outcomes.
1. 3 Strategies for Revenue Cycle Management Optimization, Revenue Cycle Intelligence 2021, https://tinyurl.com/2p8pk3yd
2. Top 10 Revenue Leakages, Effy Healthcare 2020, https://tinyurl.com/mr4eyj3k
3. The Hospital: Life, Death, and Dollars in a Small American Town, St. Martin’s Press, New York 2021, p.56
4. Ibid, p.119
5. Internal, aggregated dashboard data, Vee Healthtek 2022
