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Managing revenue cycle in consumer-based healthcare

by John R. Fischer, Senior Reporter | July 18, 2022
Business Affairs
From the July 2022 issue of HealthCare Business News magazine


Artificial intelligence and machine learning are also helping providers facilitate patient preferences, such as how they would like to communicate, whether it be by phone, text or in person, so as to improve their experience. Cavanaugh says that as machine learning becomes smarter and analyzes more data, it will find new ways to cut costs, save on time and help with filing accurate claims.

Coffta says automation is also helping to check eligibility and direct claims, denials and other tasks to people best equipped to take care of them. Meanwhile, Williams is seeing AI and machine learning help patients and doctors come up with effective payment plans. “I can look at their actual ability to make payments and know if they should pay in full versus, on a prescribed payment plan, versus if they qualify under a financial assistance policy. AI and machine learning allow empathy to be infused in those interactions. It goes back to value-based care in interactions and ensuring the patient comes back through our doors.”

Prepping for the future
Today, RCM is influenced by hundreds of variables that will only grow in number as care continues to become more value-based, with factors like price transparency, shorter staffing and higher expenses weighing in. Whether an RCM team is in-house or outsourced, it should have the most up-to-date expertise to properly account for these factors, says Coffta. “The biggest challenge is making sure you're staying aware and educated about the changes that are coming. Make sure that whether you use an outsourcing company or in-house staff, that they are up to speed with the latest regulations.”

In addition to AI and automation, Fee says that providers also should look for solutions that expand interoperability, as hospitals seek out data both in and outside their walls to personalize care. “It's a siloed approach as we move towards value-based care. We need to invest in technology that looks beyond the hospital setting and infrastructure. That’s a sort of a larger, longer term investment as we look at the longer term horizon in revenue health.”

Cavanaugh says conversations with patients must be clear and concise and give them a thorough understanding of what to expect regarding care and payment. “With patients as payers, providers will need to meet them where they are at by listening to feedback and implementing enhancements quickly before referrals decrease and negative reviews increase.”

Additionally, the future of RCM is just as important as the present, says Williams. "It's important to choose a partner that is solving today's challenges and innovating for the challenges of tomorrow. It's paramount to constantly evolve how we engage with patients."

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