Answering 3 RCM Questions Faced by Hospital CFOs Today

As hospital and healthcare industry finance leaders meet the challenges of continued consumerization in a post-COVID world, streamlining technology and maximizing patient collections has become increasingly important to future forecasting plans. With over 30% of health industry revenue now a patient responsibility, hospital CFOs responsible for the healthcare payment lifecycle are having to reevaluate priorities and shift established workflows to positively impact their bottom line.

While understanding RCM problems faced by hospital CFOs can be subject to variables related to payor and patient mix, location (i.e., urban vs. rural), and institutional mission or mandate (i.e., not-for-profit, charitable), there are some global similarities that can be addressed. Now and in the future, a hospital may record outstanding patient census and quality outcomes but struggle financially without the proper systems in place to manage electronic Accounts Receivable (AR).

Impacting the RCM Process

Healthcare has significantly lagged behind other industries in adopting digital technologies— whether due to cost, security/regulations, or the intricacies involved in implementation.

Now the entire sector is in a sprint to catch up—redesigning workflows and adopting and or launching aggressive automation plans. In a recent Black Book Survey, 86% of hospital CFOs surveyed recognize the positive ROI impact of digitization, but only 25% of their transactional work has actually been automated.

Implementing Comprehensive Automation That Effectively Supports RCM

Investment in non-clinical technology may often take a back seat, but it is imperative that today’s hospital CFO recognizes the strategic implications of neglecting modernization when technology is changing at hyper speed.

Consider these three questions:

How Can Hospital RCM be Improved Through Automation?

Holistically, Artificial Intelligence (AI), machine learning, and predictive analyses are all being utilized in ways that significantly support the healthcare payment lifecycle overall and the RCM process specifically. Through HL7/FHIR/API Integration, intelligent RCM systems provide the ability to accelerate A/R recovery through robotic process automation and payer/clearinghouse assimilation.

Currently, hospital denials (which have reached record levels in 2021) are followed up on a scant 50% of the time leaving millions on the table annually. Using AI-enhanced smart prioritization, denials can be weighed and ranked in a concentrated way that predicts revenue and focuses effort where most effective. This ensures the maximum dollar amount is collected as quickly as possible.

How Do CFOs Effectively Lead RCM Teams in Today’s Environment?

As the hospital CFO’s role continues to evolve with increased strategic involvement and high-level policy development, RCM technology is evolving to allow leaders real-time revenue insights that are available by dashboard or portal. With advanced digital processes and robotic process automation, CFO’s have a constant pulsepoint on RCM status where they can oversee the performance in aggregate or by account.

With visibility 24/7, everything from KPIs, to shortfalls, to denial intelligence is readily available.

What Can be Done Limit Final Write-Offs?

When all is said and done, hospitals currently have a large amount of uncollectible claims at the end of the RCM process – as high as 10% in some cases. Before that money is shifted to charitable care or sent to collections, undisclosed insurance coverage can now be located by leveraging AI-supported technology working with billing specialists to find, verify, and resubmit claims with coverage that was previously unknown, often even by the patient.

This not only improves the hospital bottom line, but carries no financial risk and reduces bad debt for self-pay or charity care.

In Summary

As healthcare delivery and reimbursement responsibility continue to evolve, hospital CFOs are acutely focused on understanding the collection problems they face. With value-based payment, razor thin margins, and insurance payers intent on shifting more and more of healthcare costs to consumers, digital automation will help provide the tools necessary to thrive in the coming years.

Contact us to schedule a demo and to learn more about how Infinx’s RCM Platform can help your hospital improve its RCM.

About the Author

Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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