Automating revenue cycle on the back end improves patient engagement on the front

Revenue cycle directors are seeing a clear path for automation to increase revenue, decrease denials, speed up prior authorization and claims, and remove many of the repetitive clicks that hamper daily operations.

From an ROI perspective, automation saves money through fewer full-time equivalent positions.

Three rev cycle executives interviewed, who are at different stages of revenue cycle automation in their health systems, said the savings have not been achieved through layoffs, but through attrition and employees being trained for jobs machines and even smart AI processes, can't do.

"From a savings perspective, it's a moving target," said Lynn Ansley, senior director for revenue cycle at Moffitt Cancer Center headquartered in Tampa, Florida. "People get so dead set on FTEs. Our volume is growing. To me it's not the net reduction in FTEs. It's people we wouldn't have to hire to keep up with the volume."

Robotic process automation equates to about 27,000 hours in a month saved, which correlates to around $500,000, Ansley said. As the price tag on automation is pretty large, the savings make for a good argument for starting the process. 

However, the executives at Moffitt Cancer Center didn't need to be sold, she said. Automation has been embraced to the point that the revenue cycle team is now showcasing what it can do for other departments.

"We're proud of the seamless performance we have," Ansley said. "Through the automation we've done, we've been to absorb more and more volumes without having to increase FTE volumes."

Automation control stays within the revenue cycle department at Moffitt Cancer Center, not with the IT department.

"We like to have control over our automation," Ansley said. "We like to do that scripting and monitoring in-house. We've recruited talent that knows the system, but has that coding background to script. They're able to look at a problem and know what the right technology is."

But automation alone won't align the revenue cycle process.

"You don't want to automate a broken process," Ansley said. "First you fix your process."

Melisa Brereton-Esposito, director of systems training and development for corporate business services at Yale New Haven Health System, said the team has not yet attributed savings to automation, since the systems are new. 

"It will save FTEs," she said. "We didn't necessarily eliminate staff, we relocated them. People are afraid of automation. They see it as potential to take jobs, its resources being distributed to something else, as opposed to eliminating a position."

Sherri Liebl, executive director of revenue cycle for CentraCare said, "We look at its incremental value as four-and-a-half times the investment in technology. It will have a significant impact on our organization and our patients."

THE RIGHT TOOLS 

Moffitt Cancer Center has been using an EMUE tool from Databound since May 2011. The emulator operates in the system on claim scripts, which are monitored on a dashboard. As soon as an appointment gets scheduled, EMUE checks insurance eligibility and benefits and then secures any needed prior authorization from the payers.

EMUE gets the correct values on claims. Through the automation, Ansley's team can discharge bills faster and sort out the ones that need to be done by hand.

"A lot of that can be started by the emulators," Ansley said. In fact, so much work is being handled by EMUE that it's working around the clock to run "turbo EMUEs" on claim scripts, she said. "We're at the point now, there is no longer low-hanging fruit with EMUE. If there's a redundant task, we can have the emulator do that."

Another automation that came about a year-and-a-half ago is the Healthcare Extensibility Platform, or HEP, which, unlike an emulator, works behind the scenes in real time to get a claim paid. It's a Cerner product that fits with the health system's EHR Cerner system.

Still, neither system involves artificial intelligence. AI is next on the list for rev cycle improvements.

Brereton-Esposito at Yale New Haven helped to implement intelligent process automation (IPA) in 2019 to automate high-volume, mundane administrative tasks in the revenue cycle.

Yale New Haven has an Epic EHR system. "We brought Epic in and did a full review, instituted a number of changes in bills and systems," Brereton-Esposito said. "And then we looked at, what else could we do? We recognized what we could to automate within Epic. In addition to eliminating work, it improved the accuracy." 

The system also worked closely with CognitiveHealth Technologies in process-mapping such areas as cash-posting -process. That's been in place for over a year now. This past June, Yale New Haven started automation work with prior authorizations. And in September, they put in a correspondence automation workflow that cut down on the number of people needed to look at mail. CognitiveHealth uses AI tools to recogniz the key words and structure on a document, puts an indicator on it and routes it to the correct work queue. The team started with remits, overpayment letters, approval and denial letters from insurance companies and expanded it to include medical records requests, attorney letters and more.  

Despite the digital improvements, the fax machine is still in use. "We're waiting for insurance companies to have portals to accept digital information,"  Brereton-Esposito said.

ARTIFICIAL INTELLIGENCE

AI watches what your team does and then it learns what your team does, said Ansley, who sees this as the next logical step in automation. "I don't think it's way in the future," she said.

Liebl at CentraCare said the health system is in the process of implementing AI and automation in relation to the payers – and in taking some of the low-level work off staff that's tedious and expensive to do. Staff people are being moved to positions that can't be done by machine.

"For instance, using AI in regards to prior authorization: We're constantly getting notices from payers for prior authorization."

AI can tell payers, she said, "Yes, this is service that needs to be authorized."

If it's simple, AI can do it without human intervention. For claim status checks that have been denied, AI is going into the payer portals and into work queues.

AI is new, within the last year. It's been doing prior authorization for a couple of months. 

Leibl said she's seen a 20% decrease in denials. "Yes, that's a huge impact for us," she said.

AN IMPROVED PATIENT EXPERIENCE

Mindy McNamara, patient financial experience coordinator for  Yale New Haven said, "As far as engaging patients, these are more back-end workflows," which the patient doesn't see. But value is added through increased accuracy and a decrease in lag times. Claims are processed faster. 

Within the revenue cycle is a huge opportunity to leverage automation for better patient engagement, Liebl said.

MyChart from Epic engages the patients. Patients can schedule an appointment and get out-of-pocket cost estimates. 

"From that point, we can ask them to pay in advance," Leibl said. "If a patient says 'I can't afford this,' it moves into patient counseling for payment programs."

If patients still can't afford the payment, the health system can determine if they qualify for Medicaid.

"Our patients are asking, 'How much is this going to cost me?' This weighs on them as they go into procedures. We have better clinical outcomes in the end."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com