Automation is a natural for front-end revenue cycle tasks like co-payment collection and bill processing. So, why haven’t more organizations embraced automation where it matters most: in the middle of their revenue cycle?
It’s a fair question. After all, most of today’s pressing revenue cycle management (RCM) troubles live smack dab in the center—specifically, with medical coding and audit. As denial rates soar and staffing shortages persist, organizations that take a fresh look at automating parts of their medical coding processes stand to gain the biggest benefits.
Let’s take a look at 5 common mid-revenue cycle pain points and explore how automation can help to solve them.
5 mid-revenue cycle challenges
1. Labor shortages
Recently, a Chief Financial Officer told me that medical coding and RCM is the most human-capital intense part of their organization’s entire revenue cycle. And that’s a serious problem at a time when patient volumes are rising and medical coding teams are shrinking.
Historically, facilities looking to overcome medical coder shortages have turned two sources: contract coders and RCM outsourcing providers. But each is fraught with additional peril. Contract coders can cost up to three times as much as in-house staff. And while the RCM outsourcing market is expected to grow to a record $23 billion by the end of 2023, most outsourcing companies have grown too large too fast and can’t keep up. This is creating quality issues.
With merger and acquisition activity continuing to run high, organizations are experiencing a myriad of interoperability roadblocks. Connecting systems remains difficult for even the
savviest of hospital IT teams, and when an organization’s technologies can’t properly communicate and exchange data, it creates problems for medical coders, HIM leaders, and clinicians. One of the biggest challenges is that healthcare organizations must process huge amounts of unstructured data—images, notes, text files, and narrative interpretations. Believe it or not, we still typically see an 80%/20% split industry-wide between unstructured and structured data.
The average denial rate was up almost 12% in the first half of 2022, outpacing the rate of growth in both 2020 and 2019, according to Change Healthcare’s 2022 Revenue Cycle Denials Index. At the same time, rules from payers continue to get increasingly complicated. This puts a huge administrative burden on healthcare facilities and medical coding teams. Matter of fact, someone in the HIM field told me recently that their team didn’t even have time to address 90% of their denials.
The reality is that denials are preventable. But HIM staff must have the time to review the denials, find the root cause and stop the cycle.
4. Claim edits
On the surface, claim edits appear to help the mid-revenue cycle. When done correctly, they allow coding teams to generate cleaner claims before a bill is submitted. The downside: Custom edits are complex. They take tons of experience and lots of time to do them the right way, creating a potential burden on already overworked coding teams. And when edits are rushed or done improperly, they may cause more problems than they solve.
5. Lack of analytics
Electronic health records were supposed to solve this problem, right? Yet RCM leaders I talk to say they still experience a serious lack of visibility. That means they don’t have the data they need to drive effective change management across the mid-revenue cycle.
But wait.. there’s more. At physician-owned practices, sometimes providers end up coding their own cases. The problem: Most don’t have the time, knowledge or experience to handle professional-fee coding. This pain point is exacerbated further by the fact that CMS has reduced the physician fee schedule conversion factor by 4.48% for 2023.
Mid-revenue cycle pain points: How to solve them
Most organizations don’t think twice about automating data collection, co-payment collection, and bill processing. But too many are ignoring the potential benefit of automating the middle revenue cycle.
The reason: many facilities got stuck on computer-assisted coding (CAC), which never delivered on the promise of automation. There are still a lot of HIM leaders who don’t even know that anything better exists beyond CAC. And while some new CAC models have integrated more advanced technologies like Natural Language Processing (NLP) into their solutions, most are glorified PDF word searches that don’t make a medical coder’s job easier at all.
To truly solve their mid-revenue cycle pain points, facilities must embrace both automation and analytics. This is where autonomous coding come into play. Today’s top solutions use sophisticated, next-generation algorithms to code charts within seconds, with zero human intervention and proven high accuracy rates. Because these algorithms understand context and relevancy, autonomous coding engines know when it’s proper for a machine to handle coding, and when human intervention is necessary.
And while some HIM leaders worry that autonomous coding will raise their error rates, we’ve found that the opposite is true. Autonomous coding on DeliverHealth’s PerformPlatform delivers 95% accuracy.
Tech-enabled coding is a perfect fit for areas with high-volume, repetitive coding tasks, including radiology, emergency departments, urgent care, hospitalist medicine, and laboratory.
When fully implemented, autonomous coding helps providers and facilities end their reliance on contract coders and focus their in-house staff on higher-value work. Autonomous coding also solves interoperability issues through its ability to code from both structured and unstructured data. It identifies patterns to help HIM teams find the root cause of denials. It reduces the need for complex claim edits.
Plus, with the DeliverHealth PerformPlatform, facilities get quality analytics—such as percent automated, percent human coded, and time to bill—that they can use to drive real change.
Start to ease your toughest coding pain points
If you’re interested in embedding automation into your mid-revenue cycle, start from the top. Outline your needs, goals, and objectives. Vet all technology and vendors well. And choose a partner who will understand your pain points and craft a solution that works for you.
Have questions about autonomous coding? Email us today.
Monica discussed autonomous coding and more on a recent episode of the “Payment Matters” podcast. Listen in.