Overcoming challenges in healthcare revenue cycle management with generative AI

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If healthcare providers were race car drivers, revenue cycle management (RCM) teams would be the engine. You power everything.

But the current landscape presents various challenges that impact RCM’s teams’ ability to drive success.

(Too much with the racing metaphor? Okay, we’ll stop.)

RCM teams are wrestling with real issues, including staffing shortages, increased competition, errors, and negative customer experience, as well as constantly shrinking margins. 

The good news? You’ve got new options. Innovative solutions including AI-powered tools and process automation can address these challenges and improve RCM departments’ overall performance.

Let’s review what you’re dealing with and think about what can help.

Your Challenges

1. Staffing shortages

Just like everywhere else in healthcare - and everywhere else, period - staffing shortages are hitting hard.

The desire for experienced staff, combined with a limited talent pool, has resulted in understaffed teams, leading to overworked employees and a higher risk of errors. Ouch.

2. Increased competition and thin margins

Healthcare providers are increasingly seeking cost-effective RCM partners due to the rising costs of healthcare services and pressure to reduce expenses. 

It’s a vicious cycle. Heightened competition forces RCM companies to operate on thin profit margins, making it challenging to invest in staffing, technology, and infrastructure improvements that could enhance processes.

3. Billing errors due to overworking and understaffing

Overworked and understaffed revenue cycle departments can lead to increased billing errors. 

Fatigue and workload pressures contribute to mistakes that lead to delayed payments and revenue loss. 

Addressing this challenge requires a strategic approach that focuses on reducing staff workload and implementing quality control measures to minimize errors.

But who’s got time to be strategic when you’re always running behind?

4. Increased hold times

Extended hold times during patient inquiries frustrate patients and impact the efficiency of revenue cycle departments. RCM staff need to be able to handle patient inquiries efficiently and provide prompt responses, enhancing the overall patient experience.

5. Cash flow challenges

Timely and accurate documentation is crucial for revenue cycle management for both accuracy and delivering financial stability. Even in a challenging economic environment, faster revenue cycle turnaround improves cash flow.

6. Reduced investment and expansion

In an environment of reduced investment and constrained expansion, healthcare providers and RCM companies must focus on improving efficiency and productivity. 

Your Options

If solving any of these challenges were easy, you would have done it already, right?

You can’t magic new staff members out of thin air - and alas, we can’t either - but you do have options. You’re probably already using solutions for things like self-serve payments, chat, and automated billing.

Leading RCM teams have found solutions with generative AI that’s trained for financial conversations like the ones you have with patients every day.

They’re using:

  • Automated call notes (slashes AHT, reduces stress on staff, standardizes documentation for easy reference, redacts for HIPPA compliance and patient privacy)
  • Real-time representative assistance (dramatically reduces ramp time for new hires, includes guidance based on emotions and sentiment, supports representatives without relying on robotic scripts)
  • Fast and better-than-human accurate interaction review (automates scoring and review, delivers training opportunities, relieves managers of manual processes). 

By leveraging AI-powered tools and automation solutions, your RCM team can handle a higher volume of cases with existing resources.

With custom-built AI solutions, we’re seeing teams overcome the challenges posed by limited resources to move ahead.