Insurance eligibility verifications and benefit checks are one of the first steps in the healthcare revenue cycle, and unfortunately, are also one of the first places that inefficiencies occur — causing downstream revenue cycle problems. Patient insurance providers frequently change, and inaccuracies in verifying patient benefits lead to denied claims, scheduling problems and increased patient balances. Revenue cycle leaders need to look to artificial intelligence to automate their insurance eligibility verifications.
The healthcare revenue cycle is a clear candidate for intelligent automation through AI, since it consists of many repetitive, inefficient processes that add significantly to the administrative waste burdening our healthcare system. Employees are bored and burned out, claims are chronically backlogged, and ultimately, it ends up hurting the patient experience and a hospital’s bottom line. As the start of the healthcare revenue cycle, automating insurance eligibility verifications benefits the entire process. Here’s how:
1. Reduce claim denials
Denied claims and managing denials are a massive problem for the healthcare industry, costing hospitals $262 billion annually. They create significant work, often too much to even be addressed by employees, leading to increased patient balances and increased write offs. And while most denials are preventable, only about half are recoverable, meaning the best denials management strategy is reducing the denials in the first place. Luckily, 23.9% of claims are denied simply because of eligibility and registration issues. When you hand off insurance eligibility verifications to intelligent automation, benefit checks can be done more frequently and more accurately than humanly possible. At one health system, AI has been used to automate 100% of eligibility verifications, averaging 90,000 checks annually and at multiple points in the patient journey. By eliminating the upfront errors, denials due to these problems are also eliminated.
2. Save employee time
Another problem posed by today’s manual insurance eligibility checks is the employee time burden. It takes an employee an average of 10 minutes to manually check benefits. That already seems like a long time, but when you consider that benefits need to be checked more than once, it quickly becomes clear that it is impossible for humans to accurately and thoroughly complete insurance eligibility checks at the cadence needed to best support the revenue cycle.
When hospitals deploy artificial intelligence on their eligibility verifications, accuracy can be improved while simultaneously freeing employees to focus on other tasks. Not to mention that reducing downstream errors, such as denials, also saves time. Employees can then be shifted to other work that requires a human touch, ultimately helping the hospital and reducing employee burnout.
3. Improve the patient experience
The healthcare revenue cycle, although it may not seem like it, is directly tied to patient satisfaction: Even when patients are satisfied with their clinical care, negative experiences with the billing department may cause frustration and even anger. And since patients are taking on increasing amounts of financial responsibility, they need hospital staff to accurately check benefits and explain costs clearly.
When patients are informed last-minute that a procedure or test is not covered by insurance, or they are hit with an unexpected bill, their entire experience is tainted. On the other hand, accurate explanations of benefits and office staff that have time to educate patients on anticipated costs leads to higher patient satisfaction.
4. Accelerate and improve cash flow
When eligibility and benefits are completely accurate, three things happen to accelerate cash flow: claim denials, patient balances and manual touches are all reduced. Claim denials, even when resubmitted, slow down the time for reimbursement. Accurate benefits also ensure that patients pay the correct copay at the time of appointment and are not hit with unexpected, out-of-pocket charges that they are unable to pay (and which can be very difficult to collect on). Satisfied patients are more likely to pay on time and pay the full amount.
Plus, all of these manual processes take valuable time: time to check benefits in the first place, time to appeal denied claims, and time to chase down payments. Time is money, and this employee time can be redirected to other tasks that improve cash flow, such as actually working all the denied claims or following up on patient balances. Over time, health systems may even be able to scale back their administrative hiring even while growing as an organization.
5. Connect your eligibility checks to the Internet of Healthcare and use AI to transform your entire revenue cycle
Not all eligibility and benefit verification solutions are the same. Simple robotic process automation (RPA) technology will only take you so far. If you are considering automating this workflow, make sure you are looking at the big picture of your revenue cycle. Yes, automating eligibility and benefit verifications brings tangible ROI, but to truly reap the benefits that AI and automation can provide your organization and your revenue cycle, you need to think bigger. A simple point solution may help with this one step, but over time, piece meal automations and an accumulation of vendors and solutions will lead to disjointed processes, creating more problems than they solve. Real transformation happens when you scale AI throughout the enterprise. What you need is a full service, healthcare-only artificial intelligence company to partner with your health system. Then you can connect your processes into a network of intelligence running throughout your hospitals, delivering value today and setting you up for the future. Today, AI can already tackle your eligibility and benefit verification, your prior authorizations,, your denials management and more. Imagine the possibilities of a fully connected revenue cycle and even a fully connected hospital.
Optimize your revenue cycle and see real results with AI powered insurance eligibility verifications
Olive uses proven solutions to deliver meaningful ROI that propels AI’s success in your organization and provides the momentum you need to scale. As a single AI vendor for operational efficiencies, you can create an AI network in your health system that connects your processes and your existing systems, providing deeper visibility and insights that deliver ongoing improvements.
While AI has applications throughout the entire enterprise, for many, the revenue cycle is one of the best places to start. To learn more about getting started with AI in your health system, download our white paper, Building the Business Case for Operational AI in Healthcare, to help you build and prioritize a list of processes for automation that deliver meaningful ROI.
- Change Healthcare Healthy Hospital Revenue Cycle Index 3 2018 CAQH Index
- 2018 CAQH Index