The $470 billion problem in Revenue Cycle Management
Providers get into medicine to help patients, but getting paid for the work they do is vital for sustaining their practices and delivering great care. They may not like dealing with the complexities of Revenue Cycle Management, but keeping a close eye on the books is a part of the cost of doing business.
But does that cost have to be so high?
In April 2024, researchers at a conference at Marshall University presented research showing that the annual cost of operating RCM systems in American healthcare was an astounding $470 billion.
While no one expects the costs of collecting healthcare payments to be zero, $470 billion is the equivalent of about 10 percent of the U.S.’s annual budget. In an age of artificial intelligence tools and supercomputers, there must be a better way to collect payments.
Putting AI to work on the financial frontier
We call that better way eClinicalWorks AI-powered RCM, a comprehensive approach that brings together a suite of solutions that combine the power of artificial intelligence with the clinical expertise and judgment only medical professionals possess.
Using autonomous agents for RCM reduces burdens on a practice’s staff, particularly billing and back-office personnel, leading to better cash flow and fewer errors.
Among the advantages in the detailed, day-to-day RCM operations that practices enjoy with an AI-powered solution:
Appeals are handled quickly and efficiently, with all required documents supplied to insurance payers and submissions generated with a single click.
Coding is precise, with the software analyzing providers’ Progress Notes to generate coding recommendation
Eligibility insights are achieved with optimal accuracy, including the interpretation of ANSI 271 data.
Billing is a breeze, with the software able to handle questions claims, payments, account lookups, refunds, or alert dashboards, eliminating manual searches.
Bank Reconciliation credits insurance payments to the practice’s account and automatically posts ERAs based on verified, credited transactions in that account.
Translating efficiency into big savings
Improving the efficiency of any one of the areas listed above can save practices time and money. When all of them are handled effectively by AI, the impact can be dramatic.
“Successful implementation of AI within RCM,” the findings presented at Marshall University conclude, “has showcased remarkable results, slashing the payment realization period from an average of 90 days to a significantly expedited 40 days, thus substantially enhancing revenue cycle efficiency.”
Many practices — of all sizes and specialties and in every corner of the nation — have embraced the RCM solutions eClinicalWorks offers.
“We are excited to implement eClinicalWorks AI-powered RCM to enhance our billing efficiency,” notes Carol Garrison, administrator at Main Street Medical Clinic, with locations in Spring and Huntsville, Texas. “With its automated features, we believe it will streamline our billing process, ensuring proper documentation and tracking, especially regarding appeals. We anticipate this tool will greatly assist our team in managing reconciliation.”
Overall intelligence for RCM operations
eClinicalWorks solutions can mean streamlined workflows, helping minimized denials and improve first-pass acceptance rates. That means collecting more money faster, reducing the time staff must spend resubmitting claims and managing them throughout the revenue cycle.
But the impact of an effective, AI-powered RCM solution is not limited to the back office. Having complete control over the RCM process means greater efficiency and savings in many other areas of a practice. After all, every dollar saved on collecting revenue is a dollar available for use elsewhere.
eClinicalWorks addresses not only the day-to-day, granular functions related to managing finances, but gives practices tools that provide maximum visibility into overall operations, including:
Alerts Dashboard that prioritizes claims to avoid missing filing windows
Work Queue Dashboards that handle inventory and process claims for larger organizations with a Central Billing Office model
Performance Evaluation Tools that include a variety of analytics and measures to assess over practice financial health and performance
AI’s impact beyond the bottom line
The Marshall University research cited above offers some additional advantages — beyond the obvious and strictly financial ones — that practices may realize with the integration of AI products.
Workforce well-being can be improved as organizations free up time for health professionals to focus on higher-value responsibilities and engage in “more meaningful, patient-centric roles.”
AI solutions personalize the financial experience for patients, helping improve transparency and trust for patients, leading to higher satisfaction and greater patient retention and loyalty.
The integration of AI fosters “a culture of collaboration and innovation” within healthcare organizations, promoting sharing of insights and best practices that help an organization unite around common goals.
It’s easy to put off change or to think that the savings that might come with AI solutions aren’t that significant. But the $470 billion or more that America’s healthcare organizations are spending each year just to collect the money they’re owed represents a serious drain on precious resources that could instead go to direct patient care.
Is your practice ready to learn more? Check out the full range of eClinicalWorks AI-powered solutions for RCM here. Let our experts show you how you can pay less to collect more while improving patients’ access to the quality healthcare services you offer.
Overall intelligence for RCM operations
AI’s impact beyond the bottom line
