It seems that often priorities in healthcare revolve around patient care and treatment, but equally important is effectively billing and collecting the revenue associated with that care. It allows the doors to stay open and quality staff to be retained. Unfortunately, the system often breaks down once the claims have left the office.
Revenue that is a little more challenging to acquire is then tied up in the aging A/R, and collecting it often requires hands-on follow up that can be postponed or ignored in favor of more urgent administrative tasks. As an example, the Centers for Medicare and Medicaid Services (CMS) denies 26 percent of all claims, and of those, 40 percent are never resubmitted even though over two-thirds are recoverable, and 90 percent are preventable.
What’s to be Gained
By focusing on an automated solution to tackle the outstanding 3rd party aging A/R and reduce days outstanding, revenue that is owed can be collected and claims resolved. The impact is three-fold:
- Increased Cash Flow and Overall Cash Position — it’s almost a certainty that the bottom line will improve when money is collected quickly and efficiently. With the additional revenue, day-to-day operations can be funded, expansion plans can be initiated, or capital equipment can be pursued.
- Reduced Administrative Costs — by automating the billing and A/R functions, the burdensome follow-up would be eliminated, and billing personnel could be redeployed to higher-level functions, including improving the patient experience.
- Analytics-Derived Operational Improvements — With knowledge comes the ability to make overall improvements in the operations functioning, including enhancing patient flow, improving patient portion collections, advancing cash controls, and preventing future errors in coding and billing.
The Groundbreaking Impact of AI-Driven AR Optimization
To make a major shift in A/R management often, real change is required. Today, an AI-driven process enhancement is the most effective way to achieve ongoing improvement. By leveraging AI, automation, and machine learning, outstanding aging A/R activities can be turned into actionable insights optimizing recovery and decreasing write-offs.
With AI, a curated knowledgebase using predictive rules can determine the “next best course of action” and prioritize the resolution effort to maximize dollar recovery. This concentrates workload, focusing on the most effective use of administrative time.
With a concentrated approach, denials management can be tracked, and each denial can be automatically appealed if necessary so that revenue isn’t lost in the system or abandoned prematurely. Denials that used to sit untouched can now be addressed and processed in real-time using state-of-the-art automated systems that give up-to-date progress updates 24/7 and detailed analytics reporting – overall, especially useful when negotiating third-party payer contracts.
To reach maximum operational efficiency in any healthcare system or group, expertly managed A/Rs is paramount to overall financial health. By using an expert third-party partner, armed with technology that includes AI-driven and machine learning capabilities, you can benefit from a scalable payment lifecycle solution that ensures increased revenue, timely resolution of accounts, and reduced administrative costs.
Contact us to schedule a demonstration and learn how optimizing your outstanding 3rd party aging A/R through automation can positively impact your bottom line.