Steps toward revenue cycle automation vary across medical groups

Whether recognizing opportunity or confronting necessity, medical group practice leaders are looking at their revenue cycle operations as a key area to automate for better efficiency, savings and accuracy.

But even as AI and other technological advances present new methods to confront existing challenges in healthcare provider organizations, the extent to which practices have enjoyed success is a mixed bag. Some medical groups simply were overwhelmed by the dual crises of the COVID-19 pandemic and staffing shortages and could not take a closer look at making improvements in this area; for others, those challenges were the reason to do just that.

As RevCycleIntelligence recently heard from Jaren Day, insights director at KLAS Research, there are “mixed signals” — healthcare organizations want to adopt new technologies yet “are waiting to see if they can get the ROI before jumping in.”

A Feb. 27, 2024, MGMA Stat poll sought to assess how advanced medical group practices are today in their efforts to eliminate manual RCM work, and the responses from healthcare leaders showed significant variance:

• Almost half (45%) of practice leaders noted that their automation efforts were in the 21% to 40% range (25%) or the 41% to 60% range (20%).
• More than one in three (36%) respondents noted their organizations had automated less than 20% of revenue cycle operations.
• About 17% of respondents noted that more than 60% of their revenue cycle operations were automated.
• Another 1% responded “other.”

The poll had 226 applicable responses.

• Learn more about this topic by watching our on-demand webinar, “Future-Proof Your Practice with Advanced Techniques to Navigate RCM Challenges in 2024.”

Defining what’s possible

Many practice leaders can divide their RCM operations into three segments: Front end, middle cycle and back end. Within each of these areas, there are opportunities for automation of previously manual tasks. Just a few examples, as noted recently in HealthLeaders:

• Front-end RCM: Patient registration chatbots, appointment scheduling, prior authorization, eligibility/enrollment tools, price estimators, contact center automation
• Middle-cycle: Autonomous coding, direct-to-bill, claims status checks, automated case finding
• Back-end RCM: Automated appeals, contract management tools, utilization review.

RCM improvement remains a focus among many medical group leaders: One in five (20%) cited revenue cycle as an area they will outsource or automate in 2024, per a Feb. 20, 2024, MGMA Stat poll, and another 18% noted they would do similarly with their contact centers, which play a significant role in front-end RCM.

Healthcare leaders said they were especially interested in automating:

• Claim scrubbing and submissions
• Denials management and appeals
• Eligibility checks and prior authorization work
• Medical coding, self-pay collections and credentialing.

Don’t see an automation option you’re using listed above? Reach out to connection@mgma.com to tell us your success story.

Leveraging technology to streamline your RCM

On a recent episode of the MGMA Business Solutions podcast, Matt Seefeld, executive vice president at MedEvolve, explored the state of play for boosting RCM automation in medical groups, noting that the wealth of data available in healthcare organizations is starting to translate into effective solutions via AI.

“The cool thing about AI today is looking at all the structured data that's being generated between the EHR and the practice management (PM) system. … Imagine a provider being able to come in and just read their insights,” Seefeld said. “This engine just told you where your problems are and then went further and told you what to do about it.”

Seefeld suggested going beyond the level of data capture for claims that exists in most current PM systems. One example is claims data: “Just telling me that a claim is in this status isn't enough. What I did with that claim, what was the outcome of the action and did it yield anything — now you're getting much more sophisticated,” Seefeld added.

Most medical practices track and understand the value of a clean claim pass rate, Seefeld said, but he sees the industry shifting to embrace new metrics as data analytics and AI improve robotic/automated processes in the revenue cycle, such as a “zero touch rate” — processes that require no human being involved after delivering a service.

Join MGMA Stat

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat — by texting “STAT” to 33550 or visiting mgma.com/stat — and make your voice heard in our weekly polls. Polls will be sent to your phone via text message.

Additional resources

• “Top trends in automation, AI adoption in revenue cycle” (RevCycleIntelligence)
• “2024: The year of smarter automation and AI in healthcare revenue cycle” (HIT Consultant)
• “How robotic process automation optimizes revenue cycle management” (RevCycleIntelligence)
• “3 questions with rev cycle execs on front end automation” (HealthLeaders)
• “Setting the revenue cycle up for success in automation and AI” (McKinsey)