Many healthcare providers struggle to get fully reimbursed for the care they provide. Hospitals are writing off 49% of the patient’s financial responsibility as bad debt. Only 32% of patients pay their full medical bills, and that number is expected to drop to 5%, an effect often attributed to the growth in high deductible insurance plans and increasing co-pay amounts. Federal and private payers, meanwhile, expect providers to follow increasingly strict reimbursement rules as they move toward value-based payment contracts. Yet on the provider side, tedious manual processes, from patient registration through revenue reconciliation, lead to errors, underpaid or denied claims and, ultimately, revenue shortfalls that cannot be overcome.
It’s time for providers to deal with these issues head on by treating RCM operations as a profit center, making the function as efficient and subject to the same financial controls as any other part of their operation. Every RCM operation must become digital, incorporating automation, artificial intelligence (AI) and blockchain solutions to accomplish business goals. In today’s healthcare landscape, digital RCM (dRCM) solutions augment human expertise and experience, tackling routine, manual processes and provide insight while humans perform complex, value-add activities. Automating even one task, such as verifying eligibility using robotic process automation (RPA), can generate substantial time and cost savings to reinvest in additional technology solutions in the dRCM journey.
Providers may use dRCM based tools to estimate their costs of collection and quantify benefits, demonstrating dRCM’s value and profitability. Providers can deploy dRCM solutions relatively quickly to optimize and increasingly automate RCM operations, following a path that eventually will lead to no-touch claims processing. Along the way, providers can generate millions in annual savings by streamlining processes, using skilled RCM personnel more effectively and achieving optimal claims-submission accuracy with AI-based predictions about payer reimbursement behavior.