(scroll below for a video of our HIMSS panel discussion—"A.I. and Machine Learning in Revenue Cycle Management"—featuring Justin Adams (CEO. Digitize.AI), Valerie Barckhoff (Principal, Windham Brannon) and Brooke Moore (CFO, The Emory Clinic)
HEALTHCARE CFOS AND VPS OF REVENUE CYCLE FACE BIG CHALLENGES...
- Payers dictate the revenue cycle rules, and providers face day-to-day changes and gamesmanship.
- Disconnected systems force back office teams to work off “gut-instincts,” not scalable processes.
- Pressure is mounting to reach hard targets (<30 days in A/R) and soft goals (enable the patient care mission).
...BUT THEY OFTEN OVERLOOK A KEY REVENUE-IMPACTING ISSUE...
Every CFO knows the dollars their healthcare system loses due to wrongly denied claims (some studies put the average at $4.9MM, and rising). But one of the most overlooked areas of revenue leakage is the prior authorization cycle -- according to studies by the American Medical Association and the Journal of the American Board of Family Medicine, legacy prior authorization processes can consume 20+ hours each week per physician, and lead to a total annual cost of $600-700M in the US. And this analysis doesn't account for the negative ripple effect that broken pre-certs can have on the patient experience (scheduled/canceled procedures, murky billing expectations, etc). The current prior authorization can create enduring pain for patients, damage hospital reputations, and cost money.
... WHICH LEAVES THEM SWINGING AT "STATUS QUO CURVEBALL"...
In the past, CFOs helped solve systemic problems by installing 8-figure software and/or by adding more back office support personnel. But regulations, shifting care and payment trends, new competitor threats and technologies, and intensifying cost reduction targets mean that the old problem-solving playbook is obsolete.
... AFTER CURVEBALL.
Some CFOs have found cost savings by pooling resources as a result of health system M&A. But studies show that cost containment has remained flat in revenue cycle functions in recent years. CFOs cannot pool their way to prosperity, and need a new way to reduce prior authorization costs, minimize denials, and increase revenue.