Health & Fitness
How Can Hospitals Boost Their Financial Performance?
Your hospital’s sales cycle management (RCM) group is in all likelihood, under greater stress than ever to preserve financial health in a swiftly changing industry. They’re no longer alone. Recent statistics indicate that many hospitals struggle to preserve a feasible backside line, with common denial charges coming near 10% and internet days in accounts receivable (AR) frequently exceeding forty-five days. These unique RCM metrics highlight why CFOs consider RCM optimization by athena medical billing critically; each day spent chasing denied or underpaid claims immediately results in misplaced sales and higher administrative payments.
Financial concerns remain the top concern for healthcare executives, as reflected in the American College of Healthcare Executives’ (ACHE) annual survey, in which financial challenges ranked second among the top issues facing hospitals. In this environment, suboptimal reimbursement from payers is a major obstacle to improved RCM performance.
Low insurance reimbursement and high reliance on government payers
Payments frequently fall properly short of real expenses: simply eighty-two cents according to dollars spent in 2022. This shortfall widens the distance your medical institution desires to fill simply to balance even, not to mention fund vital tasks like cybersecurity, group of workers development, and affected experience revel in improvements.
Although Medicare is scheduled to grow inpatient and outpatient Payments by 2.9% by 2025, many healthcare finance specialists argue that this adjustment is insufficient. With labor, supply, and generation expenses continuing to rise, incremental compensation will increase may look like a drop in the bucket in comparison to ongoing operational demands.
Commercial insurers and denials: the alternative aspect of the coin
While public payers have their own set of challenges, industrial coverage vendors are similarly complex. Routine denials, frequently generated automatically, can pressure your RCM crew to spend precious time and resources on appeals. According to a 2023 study, hospitals spend nearly $20 billion yearly disputing claims that must have been reimbursed at the time of preliminary submission.
For each denied claim, a qualified billing employee or RCM professional must:
- Interpret the refusal letter and compare it with clinical documentation.
- Gather supporting data: lab results, medical notes, images, etc.
- Comparison of Treatment Specialties
- Determine whether an appeal is justifiable.
- Write the appeal letter with detailed clinical and billing justifications.
Even a fairly green denial control expert can generate six attraction letters within a day. That slightly makes a distinction while massive healthcare structures address many unpaid claims every year. As a result, denied claims can take a seat in AR for weeks or months, negatively impacting your coins float and taking on personnel time that might be spent on proactive claims prevention and sales cycle optimization.
Healthcare costs and fees concept.Hand of smart doctor used a calculator and smartphone, tablet for medical costs at hospital
Monitor the evolution of provider requirements
The American Medical Association (AMA), Centers for Medicare & Medicaid Services (CMS), and different regulatory bodies often replace coding suggestions and care requirements. Any oversights can lead to increased denials, underpayments, or even fines, resulting in longer accounts receivable days and higher write-offs.
The cascade effect of RCM difficulties
In addition to denied claims and lower reimbursements, broader healthcare industry trends only add to the complexities of RCM:
Population aging
A greater number of patients with chronic conditions results in a higher volume of claims and potentially more denials due to complex coverage determinations.
Team burnout
Burdensome administrative tasks can lead to high turnover, further hampering hospitals’ ability to maintain efficient workflows.
These troubles additionally undermine the network to get admission to care. Nearly two hundred rural hospitals withinside the U.S. have closed in the past beyond decades, and more than 25 percent of modern-day rural centers are susceptible to closure. When hospitals cannot stay financially sustainable, whole groups lose admission to their neighborhood healthcare system.
The potential of agentic process automation
In the face of growing administrative fees and shrinking margins, agentic system automation (APA) is emerging as a transformative solution. APA advances past conventional robot system automation (RPA) by permitting smarter, context-conscious structures that can coordinate duties throughout complicated workflows and respond dynamically to changes in information or system requirements.
How Agentic Process Automation Transforms RCM
Denial management
AI marketers can quickly investigate whether or not a denied declaration is well worth attractive and generate an enchantment letter in minutes.
Automated coding and billing
By checking documentation in opposition to coding guidelines, AI marketers assist lessen mistakes and enhance first-time declaration acceptance.
Predictive evaluation
Advanced algorithms can flag claims with an excessive threat of denial, allowing RCM groups to address issues proactively.
Compliance monitoring
AI marketers can sign coding requirements and insurance guidelines from organizations like CMS, alerting the workforce to updates that would in any other case cause denials.
A latest evaluation with the aid of Deloitte discovered that AI and automation may want to unfasten up as much as 50% of sales cycle professionals’ time, permitting them to shift their attention from repetitive responsibilities to higher-cost tasks like complicated case evaluation and coding accuracy.
Creating long-term sustainability and sound governance
Selecting a PAC platform with robust governance and controls is critical. Tools that provide integrated compliance capabilities, sturdy information security, and obvious audit trails allow you to manipulate affected person information responsibly and hold the belief of regulators, payers, and patients. By automating coding exams and tracking payer rules, your sanatorium can lessen denial fees and get better reimbursement.
Automation Anywhere is a leader in agentic process automation, offering an ecosystem of AI-powered solutions that can be tailored to your specific RCM needs. From pre-claim processing to final adjudication, an integrated approach to agentic process automation supports every phase of the revenue cycle.
Flying to the future
If you are prepared to refocus your RCM crew on duties that honestly require their expertise, such as resolving complicated claims or enhancing payer relationships, while appreciably decreasing guide work, it is time to consider PAC.By leveraging agency automation, you can speed up payment, lower denial rates, reduce accounts receivable days, and cut administrative expenses, all while improving patient and staff satisfaction.
With the right technology partner and a clear strategy, you can reduce pressure on your RCM team and build long-term financial stability, even in today’s complex reimbursement landscape.
Learn more about how Automation Anywhere can help your hospital grow on our healthcare solutions page.