Healthcare should always prioritize patient well-being. However, the undeniable reality is that medical services incur costs.

This undeniable fact has driven the development of a sophisticated IT infrastructure to manage the healthcare revenue cycle, from processing insurance claims to securing payments. The entire process is a series of interconnected steps, each critical to the overall function. Its complexity allows room for optimization but leaves little tolerance for errors.

Efficient Revenue Cycle Management (RCM) is essential for effective healthcare delivery and minimizing revenue loss, yet many industry leaders fail to recognize its significance. For instance, a 2020 report found that 87% of providers still relied on manual, paper-based methods for collections. The results? 78% of them struggled to collect payments exceeding $1000 within 30 days. Combine this with fluctuating healthcare spending, and the system becomes unstable and inefficient for both patients and providers.

Despite the pandemic accelerating digital transformation in healthcare, many organizations continue to rely on outdated, manual revenue management processes. Fortunately, there are solutions that are easy to implement, without requiring substantial investment in complex IT infrastructure or ongoing maintenance. This article will explore some of these solutions, focusing on RCM systems for medical services, and how automation in Revenue Cycle Management can benefit your healthcare organization.

Discover more about the application of Robotic Process Automation (RPA) in various sectors, such as RPA in insurance, logistics, and consultancy automation.

Revenue Cycle Management in Healthcare & Medical Billing

Revenue cycle management encompasses the administrative tasks related to financial transactions between patients and their healthcare providers, and how these are managed. The core processes of RCM include:

Understanding Revenue Cycle Management Systems and Their Benefits

Revenue Cycle Management (RCM) software is designed to digitize and replace traditional paper-based processes in revenue cycle workflows, much like how EHRs (Electronic Health Records) streamline medical billing and claims management.

A 2021 forecast predicted that the RCM software market would see a 10% annual growth rate from 2021 to 2025. This, along with other research, highlights the increasing demand for RCM solutions and their growing importance in the healthcare industry.

RCM systems support back-office teams with key tasks throughout the revenue cycle, such as:

Selecting the Best RCM Automation Tool

A variety of RCM processes, particularly medical billing, can be streamlined with advanced software. In addition, algorithms can fully automate certain simpler tasks. Below are some of the leading tools used for automating revenue cycle management.

Robotic Process Automation (RPA)

As the name suggests, Robotic Process Automation (RPA) uses pre-configured scripts to perform repetitive, rule-based, high-volume tasks.

Several stages of the healthcare revenue cycle are ideal for RPA, such as scheduling, claims management, invoice processing, and most medical billing tasks.

Explore more on how RPA can assist in medical coding automation and learn about the RPA development process.

Machine Learning (ML)

Machine learning (ML) thrives on vast datasets, which healthcare providers can leverage to enhance decision-making processes.

In RCM, ML can be used to identify claims that are likely to be denied before submission and suggest corrective actions. Additionally, it can help predict patient outcomes, allowing providers to make informed decisions for risk-based cases.

Optical Character Recognition (OCR)

OCR (Optical Character Recognition) is a cutting-edge technology designed to scan physical documents and images, converting the extracted text into a digital format. In healthcare, OCR is commonly used to streamline processes like prescription management, medical records, and other crucial documentation.

The speed of data entry through OCR results in significant time savings across various RCM tasks such as pre-registration, claims submission, and medical coding.

Advantages of RPA in Revenue Cycle Management

RPA plays a pivotal role in automating revenue cycle management. While its deployment varies in complexity, RPA remains one of the most accessible and cost-effective solutions, offering a quick return on investment.

However, RPA adoption is not without its challenges. A recent survey by Becker’s Hospital Review found that while 51% of healthcare providers have integrated some form of RPA, only 7% consider it “mature” and 33% deem it “robust.”

Despite these hurdles, partnering with a reliable team of automation experts can make deploying RPA for revenue cycle management a smooth first step towards enhancing your financial operations.

Final Thoughts

The healthcare industry faces constant challenges like regulatory changes, cost fluctuations, and unforeseen events such as the COVID-19 pandemic. In this environment, a robust financial infrastructure is crucial for delivering quality medical services. That's why healthcare leaders are increasingly turning to automation to streamline revenue cycle management.

If you're seeking a reliable partner to automate your organization’s RCM systems, look no further than Destan. With extensive experience in the healthcare sector and an ROI-first approach, we prioritize maximizing cost savings and generating profits for our clients.