How Healthcare Executives Can Increase Revenue and Improve the Patient Experience
Updated: Mar 20
As the founder of an intelligent automation-as-a-service company, my day is spent studying, analyzing, improving, and automating manual, repetitive processes to drive business outcomes.
Stealth Scaling is focused on solving major healthcare challenges specifically within revenue cycle management workflows and processes.
Biggest Operational Pain-points for Hospitals and Healthcare Systems
The healthcare industry is facing a shortage of qualified professionals, which can lead to overworked and stressed staff, leading to burnout and decreased productivity. Automation can help by taking on tasks that don't require a human touch, such as scheduling appointments, managing patient records, and processing insurance claims. This can free up staff to focus on more critical tasks, such as patient care.
Healthcare organizations often have complex and cumbersome processes that can be time-consuming and prone to errors. Automation can streamline these processes by eliminating manual steps and reducing the potential for errors. For example, automated document intake forms can reduce the time and effort required to gather patient information, and automated claims adjudication can help reduce the time and effort required to process insurance claims.
Healthcare organizations generate vast amounts of data, and managing this data can be a significant challenge. Automation can help by automating data entry and analysis, allowing staff to focus on more critical tasks. For example, automated data analysis can help identify trends and patterns that can be used to improve patient care and reduce costs.
Insurance companies often deny or partially cover healthcare claims, which can be frustrating and time-consuming for healthcare organizations. Automation can help by identifying and flagging denied claims, allowing staff to focus on resolving these issues more efficiently.
Revenue Cycle Management
The revenue cycle is a critical process for healthcare organizations, but it can be time-consuming and prone to errors. Automation can help by automating tasks such as billing and coding, reducing the potential for errors and improving the speed and accuracy of the revenue cycle.
Revenue cycle management (RCM) is the process of managing the financial aspects of healthcare, including patient billing and payment. It is a critical process for hospitals and health systems, as it directly impacts their revenue and profitability.
Effective RCM can help hospitals and health systems increase revenue in several ways. First, it can help ensure that hospitals are accurately billing for the services they provide. This includes accurately coding diagnoses and procedures, submitting claims in a timely manner, and following up on denied claims. Accurate billing can help hospitals maximize their reimbursement from insurance companies and other payers.
Overall, effective RCM is important for hospitals and health systems because it can help maximize revenue, reduce costs, and improve efficiency. By optimizing RCM processes, hospitals and health systems can potentially increase their revenue and profits, which can help them better serve their patients and communities.
High-value Revenue Cycle Management Use Cases / Automatable Processes
Billing and Coding
Automating the billing and coding process can help reduce errors and improve the accuracy and speed of billing. This can be done through the use of automated coding systems that can quickly and accurately assign codes to diagnoses and procedures.
Claims Submission and Denial Management
Automating the claims submission process can help reduce the time and effort required to submit claims, as well as reduce the potential for errors. Automated denial management systems can also help hospitals identify and resolve denied claims more efficiently.
Pre-authorization is the process of obtaining approval from insurance companies for certain procedures or treatments. Automating this process can help hospitals reduce the time and effort required to obtain pre-authorization, allowing staff to focus on more critical tasks.
Medical coding involves assigning codes to diagnoses and procedures to facilitate billing and claims processing. Automated medical coding systems can help hospitals reduce the time and effort required for coding, as well as improve accuracy.
Forms and Documents
Documents that can be digitized and automated, some common examples include patient intake forms, medical records, and insurance claims. Digitizing and automating these forms and documents can help hospitals reduce the time and effort required to process and manage them, as well as improve accuracy and security.
Helpful Tips for a Health System / Hospital That Wants to Possibly Adopt Automation
Assess Current Processes
Before implementing any changes, it is important to understand your current RCM processes and identify areas where improvements can be made. This can be done through a process mapping exercise, which involves documenting each step in the RCM process and identifying areas that are time-consuming, error-prone, or otherwise inefficient.
Identify Automation Opportunities
Once you have a clear understanding of your current processes, you can start looking for opportunities to automate. Some common areas where automation can be helpful include billing and coding, claims submission, and denial management.
Choose Automation Tools
There are many different automation tools available, and it is important to choose the ones that are right for your organization. Consider factors such as cost, ease of use, integration with your existing systems, and the level of support available.
A Human in the Loop
An outsourced human expert can review and validate automated coding or claims submission to ensure accuracy. Additionally, having a human backstop can help ensure that automation is being used effectively and efficiently and that any issues or errors are promptly addressed
Choose to automate workflows that are the easiest and least risky to automate to get a quick win. From there expand and begin automating more complex workflows.
Overall, automation can help healthcare organizations address many of their operational pain points by streamlining processes, improving data management, and reducing the potential for errors. Automation can be most effective when it is used to augment rather than replace human efforts, allowing staff to focus on more critical tasks and increasing efficiencies.
If you would like to get a free automation evaluation please fill out our contact form and our automation specialists will get in touch with you right away!