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RCM Budget Shuffle: Shift Dollars to Technology

Amanda Parada
October 11, 2023
RCM: AI vs. Labor

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Stop me if you’ve heard this before – RCM organizations in the healthcare sector are facing workforce shortages.

This is why news articles and industry reports have been providing a host of ideas to try to help RCM organizations attract and retain new talent. But maybe it’s time for a different approach.

Instead of holding onto the precious dollars that have been budgeted for hiring more employees, RCM organizations should instead spend that money on… technology. Let me explain.

Numbers don’t lie

Do a Google search on the breadth of the workforce shortage, and you get bombarded with numbers. Survey after survey touts the depth of the problem, and it’s almost overwhelming.

I’m sure you’ve seen these numbers before.

One 2022 survey of healthcare leaders reported that 83% of respondents felt labor shortages across the revenue cycle. In addition, 44% of respondents indicated their RCM staff was between 10% to 20% below steady-state levels.

Want more? A different 2022 survey of chief financial officers and RCM vice presidents from large health systems and physician groups in the U.S. showed that:

  • 90% are experiencing a labor shortage in their RCM department.
  • 50% of their RCM roles are vacant.
  • 48% are experiencing a severe shortage in their organization’s RCM or billing department.
  • 8% had adequate staffing for its RCM or billing department.

Another survey in 2023 found that 63% of healthcare providers were dealing with staffing shortages in their revenue cycle departments.

Solving this workforce shortage isn’t easy. But since a swath of employees aren’t going to suddenly show up at your office door, it’s time for a different strategy. RCM organizations should consider taking some of those budget dollars set aside for hiring and using it to invest in technology.

People or automation?

When executives broach the idea of using technology instead of people, employees begin to worry. And with the stories about AI all over the news, it’s not surprising that people are concerned about technology taking their jobs away. But that isn’t likely to happen, at least not in the grand fashion most people are predicting.

According to the World Economic Forum, some jobs are in danger of becoming automated. But the use of automation and AI will also help boost the economy and create jobs. Just because a job has the technical potential to be automated does not mean it will happen. A variety of economic, political, regulatory and organizational factors could block or at least significantly delay automation.

For example, based on its probabilistic risk analysis, the World Economic Forum’s best estimate is that only around 20% of existing jobs in the United Kingdom may be displaced by AI and related technologies during the next 20 years. That number is expected to be slightly higher for China. It is expected to rise to around 26%. This is due to the higher potential for automation there particularly in manufacturing and agriculture.

Despite the fear of job loss, AI, automation, and related technologies are actually predicted to boost economic growth and create additional job opportunities. This has happened after other waves of technological innovation in the past.

Automation, RCM, and healthcare

The fact is…AI and automation cannot replace every job. These technologies are best at handling mundane, repetitive tasks. For RCM organizations in the healthcare sector, some of the areas where automation can be effective include:

  • Patient scheduling: Enable patients to schedule appointments without intervention from hospital employees.
  • Compliance: Tracking and documenting each process step in structured logs files so that the company can maintain regulatory compliance, comply with external audits, and improve data confidentiality.
  • Handling data: Extracting data from legacy systems and entering it into digital systems. When there is a need for the migration of data for a different purpose, such as medical research, another RPA bot can handle this migration process.

In addition, the denials management process can certainly benefit from automation. Since a claim can be denied for several reasons, automating the process of gathering the necessary information to resubmit the claim and further analyzing why the claim was denied would be a critical time-saver. Automation can help with:

  • Data: Automatically scour various systems to find incorrect and missing demographic, insurance, or other data points, and automatically update the account.
  • Eligibility checks: Conduct automated eligibility checks through various systems to search for coverage options. If any additional coverage options are found, the bot automatically updates the account.
  • Documentation: Gather all necessary material as directed by the insurance company, such as medical records, pre-authorization details, clinical notes, and more, then create a PDF of the required documentation and submit it to the insurer.
  • Adjustments: Remove the manual efforts associated with adjustment posting by logging into the system of record, then creating an adjustment transaction. Once the balance is updated, the platform is automatically updated once the balance is updated.

A personal touch

Moving budget dollars from hiring employees to investing in technology – while “radical” to some – is quite practical. And, despite outward appearances, this strategy isn’t looking to replace people. In fact, people are highly valuable throughout the patient journey. Spending budget on technology can lead to increased efficiency, reduced operational costs, improved accuracy, and better utilization of human resources. Employees no longer have to look for documents or manually enter patient information. Instead, they can focus on tasks that require critical thinking or personal interaction with patients.

And in an era when trust in healthcare providers and organizations has diminished, having employees available for patient interaction can boost public confidence and perception.

Insanity or ingenuity?

We’ve all heard the axiom: “The definition of insanity is doing the same thing over and over again and expecting a different result.”

This has defined many RCM organizations in the healthcare industry, which are continually searching for employees to fill their plethora of openings. Instead of doing the same thing, it’s time for RCM leaders to do something different.

Turning to technology to boost your RCM operations might seem a bit unorthodox. But, in actuality, it’s quite genius.

Want to learn more? Check out this white paper on automation in the healthcare industry.

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