Part 3: RCM Automation Use Cases

This is the final part of our 3-part series on how healthcare organizations can improve revenue cycle management (RCM) processes by leveraging automation. Part 1 reviews the many challenges of RCM and explains why automation is the ideal solution. Part 2 explores the benefits of automated RCM, and this final part offers RCM automation examples and use cases.

In part 2, we discussed all of the benefits healthcare organizations experience with RCM automation. However, there are numerous ways this technology can be implemented to drive those benefits. 

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Driving Efficiency within Revenue Cycle Management through Automation.

RCM Automation in Action

There are four types of RCM automation:

Across these, a spectrum of tasks can be automated to increase efficiencies. For example, more basic levels of automation typically handle data input, while more advanced types can conduct decision-making tasks driven by algorithms and decision tree processing.

Regardless of the type implemented, automation helps healthcare organizations streamline workflows, optimize processes, and improve the patient and employee experience.

Leverage Automatic Verification

The best way to speed up the RCM process, save employees time, and improve the patient experience is to ensure all billing and coding is entered correctly, initially. When a patient’s insurance information changes between visits, figuring out what insurance companies will and won’t cover is challenging. In addition, matching every visit and procedure to the appropriate billing code can be confusing.

A 2021 report by Healthcare Financial Management Association highlighted that 90% of claim denials are preventable. Automation can make the process more efficient and accurate by fixing front-end processes and developing a robust method for collecting, confirming, and entering patient details.

Ensure Up-to-Date Eligibility

Revenue cycle software can automate coding and insurance verification, reducing the time needed to track down insurance eligibility details. The right automation technology rechecks the patient’s eligibility a few days before their appointment, ensuring coverage hasn’t changed since scheduling.

Automate Claims Denials

Incorporating automation into the initial steps of the RCM process can significantly reduce denials, simplifying the claims denial process and easing one area where employees struggle most.

Reduce Manual Research 

Manual claims research is another daunting task for employees. Using technology that automatically pulls together pertinent coverage details and updates correct codes for each claim reduces the time employees spend on manual research. Then, employees simply verify that the automated data is accurate, avoiding the possibility of manual errors altogether.

Gain New Insights

Not only can automation elevate accuracy, but it can also deliver insights around the RCM process for continuous quality improvement. Healthcare organizations can use analytics and reporting tracked through automation software to uncover additional opportunity areas that would benefit from automation and parts of the process requiring further efficiency measures.

Streamline Workflows

Automation technology helps teams stay organized. For example, developing a standard claims denial workflow allows employees to monitor which claims are open, the workstream status for each, and outstanding activity. A clear, repeatable RCM workflow also reveals process improvement opportunities and bottlenecks.

Finding the Right Partner for RCM Automation

When a healthcare organization is new to automation or considering more advanced technology like artificial intelligence or intelligent automation, there are a few common pitfalls to avoid:

  • Challenges with employee buy-in and automation adoption
  • Neglecting to ensure RCM processes are ready for automation
  • Failing to set up efficient workflows with selected automation solutions
  • Struggling to integrate various technology products

Despite being aware of these and other pitfalls, it can still be challenging to determine how to improve revenue cycle management. We recommend working with a partner that knows the road ahead. Partner with a team that has all three competence areas — automation, healthcare, and lean process management. Look for those who have specialized knowledge and proven experience in RCM automation.

Right Partner

We might be biased, but we think you should work with us.

SDLC Partners has over 15 years of healthcare case studies, demonstrating how we’ve helped healthcare organizations improve operations, consumer and employee experiences, processes, and care with technology.

By joining our automation acuity with the deep analytics and interoperability expertise of CitiusTech, our parent company, we create a frictionless experience within and across healthcare organizations.

Read the complete eBook on how to improve revenue cycle management.


Or, if you are interested in learning how SDLC Partners would help you implement RCM automation, get in touch.

Schedule a free one-hour session with a healthcare automation expert.


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