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The New Age RCM:

Even without a GPS, everyone knows the shortest distance between two points is a straight line. In health care, however, we rarely travel in a straight line to get to the destination. This scenario is prevalent in our businesses processes and revenue cycle management is no exception. By no means is the journey between patient visit and settlement of claims a straight line. Technology and predictive insights can help to make this journey effortless, safe and predictable.

COVID-19 (a detour) has forced the healthcare industry to shift to digital more than ever before. This pandemic has presented providers and hospitals with opportunities to embrace new technologies to re imagine care delivery, innovate communication with all stakeholders, and optimize revenue cycle processes. These digital enablers, advanced analytics, and predictive insights will not only help to get to the other side of this pandemic but also position organizations to thrive in the new normal.

In the context of revenue cycle management, optimizing the performance isn’t possible without an end-to-end perspective. This, coupled with meaningful interventions made feasible through predictive insights, will help deliver timely and better outcomes.

In addition to re imagining workflows and deploying bots, predictive analytics and AI can help integrate clinical and financial data to drive solutions in areas such as:

  • Payments at Point of Service: Utilize enhanced capabilities to determine patient financial responsibility prior to care and increase point-of-service payments.
  • Revenue Integrity: Leverage predictive analytics to build a sustainable revenue integrity infrastructure that is agile enough to flex with changing reimbursement models.
  • Hyperautomation: Employ models driven by artificial intelligence (AI) and machine learning (ML) models to predict propensity to pay, manage denials, appeals and, variance management and automate collections.
  • Interoperability: Bring together clinical and financial datasets to help infuse intelligence into eligibility, prior authorization and much needed transparency for patients.
  • Shift to Value: Transition from fee-for-service to value-based service using real-time reporting and dashboards that provide actionable insights to monitor/manage/accelerate cashflow and improve financial performance.

This shift is here to stay and will help providers to get ahead and stay ahead of future challenges and deliver exceptional patient experiences from health and financial outcomes perspectives.

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