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."

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.

"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