HBI Panel: Front-End Improvement as a Foundation for Back-End Efficiency

HBI Panel: Front-End Improvement as a Foundation for Back-End Efficiency

Key Panel Takeaways: Asante, MetroHealth, Olive Share Ways to Reduce Denials

Every healthcare organization has to combat denials in their revenue cycle – but not everyone does it the same way. And because 90% of denials are preventable, but only two-thirds are recoverable1, leading healthcare experts agree: the best strategy is a proactive strategy.

HBI recently hosted a panel as part of their Fall Member Retreat on this exact issue. In the panel, titled “Front-End Improvement as a Foundation for Back-End Efficiency”, Olive participated in a discussion with leaders from Asante and The MetroHealth System that focused on what these organizations are doing, especially with technology, to help streamline their front-end revenue cycle processes.

Watch the full panel to hear what Dominic Foscato, Executive Director at Olive, Erin Coffey, Director of Revenue Cycle and Patient Access at Asante, and Donna Graham, Executive Director for Revenue Cycle at The MetroHealth System had to say.

Take a Multi-Faceted Approach to Reducing Denials and Write-Offs

From the moment a patient registers, their journey with the healthcare organization’s revenue cycle begins. It’s a long and complex journey, each step posing potential problems and potential opportunities for improvement. The behind-the-scenes administrative work in the revenue cycle may not be top-of-mind for a patient seeking care, but it greatly impacts their overall experience, satisfaction and the hospital’s bottom line.

Targeting the beginning of this journey can reduce denials and write-offs down the line, instead of trying to manage them once they occur. By approaching the problems – denials, write-offs, patient satisfaction – from more than one angle, these organizations have been able to get better results.

For example, Asante is identifying patients at financial risk and connecting them with resources earlier on. They’re also leveraging Epic’s financial assistance modules, so patients will be able to apply for financial assistance from their own home. MetroHealth optimized their patient scheduling to reduce no-shows and cancellations. They also added natural language analytics to their call center to better resolve billing and cost questions.

Although many strategies were discussed, one theme was common throughout: technology. Through targeted deployment of technology and comprehensive internal education, Asante and MetroHealth have both been able to successfully improve many of their front-end processes.

Technology has huge potential to improve the patient journey within the revenue cycle because many of those processes still rely heavily on manual, repetitive data entry and retrieval. Not only are these processes mundane and time-consuming, they are also extremely error prone and costly to health systems. These errors cause delays and patient frustration. Donna Graham may have said it best: “Patient satisfaction depends on getting everything right – the first time”.

One quickly-growing type of technology in particular is perfectly suited to the revenue cycle: healthcare AI and RPA.

RPA and AI are Transforming the Revenue Cycle, Reducing Denials Every Step of the Way

Artificial intelligence and robotic process automation can tackle many of these repetitive, error-prone processes, reducing mistakes while saving valuable employee time. At Olive, we’ve charted the revenue cycle management process and identified which workflows are best for full or partial automation.

For example, with eligibility verification for MetroHealth, Olive checks insurance eligibility status the day an appointment is made and records that status. Then, each month, the entire patient workqueue is rechecked. For surgeries, insurance eligibility is checked each and every day of the month of the appointment. These rules are not only customizable to your organization’s needs, but Olive’s machine learning capabilities can actually recommend rule sets for your organization to use to optimize the process.

Such regular checking is beyond the capacity of a human workforce, but by assigning it to an AI workforce, hospitals can get notified and address eligibility problems before an appointment takes place.

Dominic also discussed the process for automating prior authorizations. Olive auto-populates pre-authorization forms and gathers clinical bundles. After review by staff, Olive then submits the authorization and regularly checks its status, alerting staff to any denials or long pending statuses. She can even file a first-level appeal in some cases. By automating the authorization submission process and regularly checking the status, hospitals see major benefits in reduced write-offs, reduced review, and reduced turnaround time.

MetroHealth has begun implementing Olive throughout their revenue cycle, with great results thus far:

“We’re getting registrations accurate, so scheduling technology, authorization, and registration, we actually were able to avoid rejections by about 29%” – Donna Graham, Executive Director for Revenue Cycle at The MetroHealth System

Improving the Revenue Cycle Improves the Patient Experience

Improving and automating processes within the revenue cycle isn’t just about cutting costs and reducing write-offs, it’s also about improving the patient experience. Patients today expect their interaction with a healthcare system to be seamless. They just want things to be right. They’re going in for care, and they don’t want to have to worry about insurance problems or denials.

Automation addresses this challenge two-fold: One, it reduces errors that detract from the patient experience and makes the processes faster, finding potential problems sooner. Two, it frees up staff to focus on patients and to handle more complex issues. By reducing the administrative burden on employees, they can then turn their attention to the patients’ needs and questions, with more time and energy.

“What we need to do is take the robot out of the humans and upskill our staff to really focus on tasks that require more of a human touch.” – Dominic Foscato, Executive Director at Olive

Listen to the Full Recording to Learn How to Improve Front-End Processes

Olive is working with healthcare organizations around the country to improve their revenue cycle and reduce the trillion dollars of administrative spend that plagues the industry. Do you want to be part of the solution? Click here to download the full panel discussion to learn how Asante, MetroHealth, and Olive are improving revenue cycle management here.

 

Sources:

  1. https://www.advisory.com/research/Revenue-Cycle-Advancement-Center/at-the-margins/2014/12/denials-management


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