Leading health systems optimize revenue cycle for cost savings

March 28, 2023

It is a critical time in healthcare. Most health systems ended 2022 in the red, and the average hospital is once again facing a year of losses. With financial pressures increasing at an unsustainable rate, administrative expenses have become a primary area of focus for managing costs.

Prior to the pandemic, the cost of healthcare administrative tasks and activities had already reached $950 billion. Of that cost, nearly a quarter was spent on managing claims, financial transactions and processing payments — and cost to collect has only continued to rise.

High administrative costs, inflation, workforce challenges and lost revenue from denials and patient leakage are major pressures on organizations to improve efficiency. To do so, leading health systems are turning to automation to enable healthcare professionals to work at the top of their license, improve financial outcomes and optimize revenue cycle management.

How should health systems optimize their revenue cycle?

95% of healthcare executives are increasing their investment in automation and AI. To address the rising costs in the revenue cycle, health systems need to invest in combining automation and intelligence to deliver data that proactively addresses revenue leakage.

However, many technologies in the market were not designed to deliver intelligent insights on data. Most vendors operate on decades-old technology, grown out of acquisitions and mergers. These systems work in silos, offering a collection of point solutions, and each addressing only one piece of the revenue cycle challenge. This results in healthcare professionals having to navigate multiple dashboards to manage processes and reporting across data silos. This places additional burdens on staff, which automation should never do.

Instead, health systems should invest in automation designed on a modern architecture with interconnected solutions.

Bar graph of statistic that 95% of healthcare executives are increasing investment in automation

95% of healthcare executives are increasing their investment in automation and AI

An optimized revenue cycle must be autonomous

Having automation solutions that are interconnected, operating in a single architecture, breaks down data silos. These solutions can then unlock previous inaccessible data and highlight intelligent insights and trends about an organization’s revenue cycle.

Olive’s Autonomous Revenue Cycle (ARC) solution is built on a modern technology stack where all products are aligned to one environment with a single version accessible to all customers. This enables organizations to gain critical insight into their data, while streamlining user flows for healthcare professionals

Though driving financial health is a leading automation effort, autonomous technologies should also improve the experience of healthcare staff. Olive’s ARC solution optimizes revenue cycle processes by integrating directly with a health system’s EHR for faster data processing and connecting other automations across the revenue cycle, enabling more processes to run concurrently and requiring less time from staff. This enables healthcare professionals to spend less time on data entry and rework, and only focus on the high-value workflows that drive their organization’s mission forward.

ARC is made up of three integrated suites: Olive’s Financial Clearance, Prior Authorization and Claims Management suites to address healthcare’s biggest challenges across the revenue cycle.

1. Olive’s Financial Clearance suite maximizes revenue capture in the registration process

Denied claims are a leading cause of write-offs, and with 27% of claims denied due to of eligibility and registration issues, optimizing front-end revenue cycle is critical. To aid patient access staff in consistently capturing accurate patient data at check in, Olive’s Financial Clearance suite automates eligibility verification and returns a complete view of coverage and benefits information for staff.

Reducing the burden placed on patient access staff helps avoid staff burnout and turnover, leading to a better patient experience and reducing patient leakage. And with fewer errors in patient data up front, health systems can avoid downstream impacts and cut down on the 86% of preventable denials stemming from administrative errors, while improving revenue capture.

2. Olive’s Prior Authorization suite streamlines the prior authorization process

Accurate front-end patient data also improves the prior authorization process for physicians and patients. Prior authorization is the No. 1 source of dissatisfaction among providers, a driver of patient leakage and a major cause of write-offs, costing the industry millions. It’s an area of revenue cycle where automation and intelligence has the greatest impact.

Revenue leakage from prior authorization stems from multiple places:

  • Patient leakage after a prior authorization is delayed or denied
  • Denied claims when procedures required prior authorization approval and didn’t receive them
  • Denials when the billing codes on claims don’t match services that originally received prior authorization approval

To address these causes of revenue leakage, Olive’s Prior Authorization suite determines patient eligibility and whether a prior authorization is needed. The technology then supports prior authorization teams in assembling the clinical documentation to meet medical necessity. These automations streamline the submission process for hospitals, reduce peer-to-peer reviews for physicians and decrease the time required for approval, accelerating patient throughput to drive revenue.

3. Olive’s Claims Management suite reduces downstream denials

Claim denials are continuing to rise across the country, with many health systems seeing denial rates of 11% or more. To get ahead of high denials from payers, optimizing back-end revenue cycle processes with cost-effective automation solutions is a key opportunity for healthcare organizations.

Olive’s Claims Management suite leverages modern clearinghouse technology that integrates with patient access automations to improve claims submission and remittance processing. Operating on Olive’s modern architecture, Olive’s Claims Management suite enables health systems to submit claims and receive remittance with claim denial rates lower than the industry average. Most importantly, Olive’s fee structure is unlike that of traditional clearinghouses: a single fee is charged per claim, aligning incentives with the health system to ensure the claim is submitted correctly the first time, without requiring rework from provider staff.

With each of Olive’s product suites designed to optimize revenue cycle process, Olive minimizes human touches and unlocks long-term value for healthcare organizations.

86% of preventable denials stem from administrative errors

Prior authorization is an area of revenue cycle where automation can have immediate impact

Olive delivers a 98.2% claim acceptance rate

An Autonomous Revenue Cycle minimizes revenue leakage, avoids preventable denials and accelerates claims processing for faster payments. In doing so, automation and intelligence frees up healthcare staff to focus on complex, high-value work — not just saving time and money, but ultimately improving quality of care and the patient experience.

Dive deeper into the benefits of Olive's Autonomous Revenue Cycle solution.