As profit margins stay slim and budget allocations remain tight, healthcare RCM organizations will continue to explore ways to do more with less. Heading into 2025, this means using your limited resources to invest in technology. And these technology investments will focus on improving many aspects of the revenue cycle process.

Let’s look at what areas healthcare RCM organizations will be investing in this year and how they can boost RCM operations.

Technology investment

According to a report from Deloitte, 43% of health system executives are planning to invest in core business technology solutions in 2025, with 30% of them planning to invest in digital technology platforms to strengthen their core operations.

Organizations that rely on their Electronic Health Records (EHR) system to manage RCM are also looking at technology solutions – either RCM-specific solutions to bundle with their EHR to improve performance or RCM-specific platforms to migrate completely. That is due, in part, to the struggles of integrating digital health records with billing processes. In fact, about 62 percent of those healthcare organizations that use their EHR for RCM report that EHR adoption struggles have been “equal to or outweighed” benefits specific to the provider’s RCM.

Focus on remote staff

Speaking of technology, some of this investment is in tools designed to help RCM organizations attract and retain remote workers. The focus on remote staff is important as, according to one report, approximately 75% of RCM employees report higher productivity when working from home.

For healthcare RCM leaders, this means turning to Cloud-based systems, which allow remote workers to access necessary data and applications from anywhere, ensuring they can work efficiently and securely.

This also requires RCM leaders to invest in performance monitoring tools with advanced analytics to help managers track productivity and provide feedback, ensuring remote workers stay engaged and aligned with organizational goals.

Automation and AI

Much of the tech investment will be around AI and automation, which is only in its infancy. Reports indicate that only 46% of hospitals and health systems already utilize AI in their RCM operations. And this is yielding positive results. According to the same report, AI has helped increase the productivity of RCM operations by 15% to 30%.

However, RCM organizations exploring the adoption of AI solutions must be cautious. A phenomenon known as “AI washing” is becoming more pervasive. Basically, products being touted and sold as AI-powered don’t fully utilize AI.

But, healthcare RCM organizations that are looking for automation need to know that they don’t necessarily need AI. Automation that doesn’t rely on AI can help with many critical areas of RCM operations, including:

• Denial management
• Insurance follow-up
• Complex claims
• Program enrollment
• And more

The adoption of AI and automation will continue to grow as more healthcare RCM organizations discover how beneficial this move can be for their employees, patients, and RCM operations.

Build vs. buy

With a focus on adding automation to RCM operations, the next issue facing RCM leaders is whether to rely on a vendor to help with your automation. The notion of building your automation in house may seem like a cost-effective approach. However, it is better to leave it to the vendors whose core focus is building technology. This is due to several reasons, including:

• Industry standards: Technology vendors take on the burden of ensuring their solutions remain up to date with the latest integration and security standards, ensuring high levels of interoperability and security.
• Innovation: Technology vendors continue to iterate and innovate their products, ensuring their solutions don’t turn stale and are keeping up with market needs
• Expertise: The vendor’s core competencies lie in building technology, allowing your organization to focus on its areas of expertise and deliverables.
• Time and resourcing: Building and maintaining technology takes time and resources. By relying on a vendor, organizations benefit from speed of implementation as well as external support instead of investing heavy amounts of development and support staff in house to build a solution from scratch and then maintain it.

However, RCM organizations must do their due diligence when researching a vendor to partner with. Be sure the vendor not only has  tech expertise, but RCM workflow expertise as well to ensure that the automation being built brings added productivity results, and is not just automating for the sake of automation.

Denials, denials, denials

Revenue cycle leaders are just beginning to recognize how robotic process automation (RPA) may speed up parts of the denials process. And early applications of RPA have provided much-needed relief to busy revenue cycle workflows and teams. While revenue cycle leaders are in the preliminary stages of automation adoption, there remains substantial room for growth.

Since a claim can be denied for any number of reasons, automating the process of gathering the necessary information to analyze why the claim was denied would be a critical time-saver.

Healthcare RCM organizations that have begun automating revenue cycle tasks have discovered how beneficial this move can be for their employees, patients, and RCM operations. When it comes to denial management, automation can lead to increased efficiency, reduced operational costs, improved accuracy, and better utilization of human resources for tasks that require critical thinking and decision-making. Staff can focus on those tasks that require a human touch, specifically when connecting with and reaching out to patients.

Data analytics

The digital world revolves around data – lots and lots of data! This includes healthcare RCM organizations. The data housed inside your systems is a treasure trove of information. However, that much data isn’t easy to cull through. It is imperative that RCM organizations properly analyze this data to improve operations. Along with denial management, data analytics are critical for:

• Revenue optimization: By analyzing financial and operational data, organizations can uncover inefficiencies and revenue leakage points. This helps in optimizing billing processes, improving collection rates, and enhancing overall financial performance.
• Patient payment behavior: Analytics can provide insights into patient payment patterns, helping organizations tailor their collection strategies. This might include offering payment plans or financial assistance to patients who are likely to face difficulties in paying.
• Resource allocation: Data analytics can identify areas of over or underutilization of resources, enabling more efficient allocation. This can reduce costs and improve operational efficiency.
• Compliance and risk management: Analytics helps ensure compliance with regulatory requirements by monitoring coding, billing, and privacy practices. This reduces the risk of penalties and enhances overall compliance.
• Performance monitoring: Continuous monitoring of KPIs through data analytics allows organizations to track their financial health and make informed decisions. This includes metrics like claim denial rates, days in accounts receivable, and collection efficiency.

All in one?

As healthcare RCM organizations investigate their investment options, they will look for a single solution that incorporates all the key areas mentioned above. But does one exist? Well, yes!

Artiva HCx is a market-proven solution that encompasses all the tools your staff needs to accelerate the path to recovery. It has been built by technology and RCM experts, ensuring that it works with the features and functionalities that help drive outsourcing organizations forward.

And since its built for medical revenue collection, it includes various tools that allow you to improve both the agent, hospital, and patient experience – identifying payment discrepancies, uncovering patient funding options, accelerating the claims follow up process, and therefore getting to final claim resolution faster.