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RCM Optimization
Intelligent Automation in Healthcare
Optimize the Revenue Cycle Management (RCM) Value Equation with Intelligent Automation
Generate Savings & Realize Revenue Faster
Revenue Cycle Management processes within healthcare environments are critical to an organization’s financial viability. Yet, revenue cycle leaders struggle to control costs while keeping up with demand and reducing errors that can lead to lost revenue and lower patient satisfaction.
pureIntegration partners with healthcare organizations to tackle these challenges through a combination of process and technology. With large numbers of disconnected tools driving manual, repetitive, and error prone tasks, it’s estimated that 60% of revenue cycle management functions can be automated entirely, and 95% can be augmented with automation. Our revenue cycle management Intelligent Automation solutions focus on optimizing workflow first, then applying automation at key points to drive improved outcomes across the value chain.
Realize Revenue Faster
We partner with your team to deliver accelerated cash flow. We help you achieve this through automation that focuses on improving claim follow-up timeliness, reducing uncompensated care, improving claims submission accuracy, and more!
Decrease Operational Costs
Our Intelligent Automation solutions allow your staff to work on complex case processing while relieving them from repetitive activity such as payer status checks and simple denials handling. By increasing the accuracy of claims that are submitted, and ensuring necessary information is collected in the scheduling of a registration process, your staff spends less time making downstream corrections when claims are processed.
Ensure Regulatory Compliance
There are many aspects to compliance in a healthcare environment, further complicated by frequently changing regulations. Our automation solutions help in identifying false claims, identifying fraudulent claims or unnecessary services, executing external reporting of audit data, as well as in automating compliance with new rules such as CMS Price Transparency.
Improve Patient Experience
Healthcare organizations are under greater pressure than ever to improve patient experience through digital transformation initiatives that increase retention of current patients while fostering new patient acquisition. pureIntegration’s Intelligent Automation solutions, combined with our Customer Experience Expertise, optimizes the end-to-end journey a patient takes with their provider and payer.
Intelligent Revenue Cycle Management Automation Service Offerings
Payer Status Checks
Revenue cycle management staff in many provider environments spend one to two hours a day checking outstanding claim status on payer websites. This allows for earlier detection and correction of claims issues, reduces overall time in A/R, and leads to potential improvements in cash flow. Performing these status checks manually though can cost a provider with 40 staff engaged in the activity almost $500,000/yr.
Our automation solutions relieve your staff from this repetitive activity, freeing them to perform more complex work while delivering accelerated cash flow!
Prior Authorization
Prior authorizations processing places an increasingly heavy burden on healthcare providers, while also detracting from patient experience and having the potential to negatively impact clinical outcomes. Our Intelligent Automation solutions can be applied throughout the prior authorization process, such as in determining the authorization requirement for an order, keeping an EMR up to date with new rules, submitting for authorization via the web or EDI, and checking for authorization status.
Automating prior authorization shortens the length of time patients wait to schedule follow-up as well as to reduce the burden on clinical and administration staff, improving both patient and employee experience!
Claims Edits, Submissions, and Denials Processing
Claims staff frequently struggle to respond back to all claims denials due to the sheer volume of work placed on them. In fact, 1 in 4 claim denials are due to technical detail errors in the submission process. Our Intelligent Automation solutions work throughout the claims process, ensuring accuracy of information submitted on the front end, and automatically responding to simple denials to free up staff time to work on complex cases.
Automating denials processing has been shown to cut administration time spent on this process by > 50%!
Scheduling and Registration
In the US, between 5% and 30% of patients miss their appointments, costing the US healthcare system $150 billion per year! Besides the financial implications, missed appointments drive gaps in the continuity of care, which negatively impact patients’ health as well as driving up the cost of healthcare as preventative medicine turns into reactive care.
Our Intelligent Automation solutions are used to send appointment reminders; automate scheduling or rescheduling through channels like web, chat, and SMS; coordinate transport; send pre-appointment patient instruction; perform registrations; drive no-show analytics; and much more!
Cost Estimation
Providing accurate cost estimates helps eliminate surprise out-of-pocket expenses, in turn increasing the likelihood of on-time payment. With as much as 30% of hospital revenue coming from out-of-pocket expenses, it’s more important than ever to maximize the chances of realizing this revenue!
Our Intelligent Automation solutions drive real-time, accurate price estimates for patients through self-service. In addition, new CMS rules dictate that providers must provide transparent payer-negotiated rates and lists of “shoppable” services. Intelligent Automation helps you comply with this and other regulatory rules by driving the back-end information collection and presentation required to comply without placing additional administrative burden on teams.
