For years, the capacity question in healthcare RCM was pretty straightforward.
If the workload increased, you hired more people. And if that still wasn’t enough, you paid those people more overtime to close the gap.
Today, that model is becoming increasingly difficult to sustain. There simply aren’t enough trained RCM professionals to bring on every time the work starts piling up. And it is piling up. AI-powered denials are seeing to that.
The RCM game itself hasn’t changed much. Hospital business offices still need to work accounts, resolve denials, connect with patients, and ultimately collect what the hospital is owed. What has changed is the number of pieces on the board.
Healthcare organizations can now use generative AI tools, agentic AI, traditional automation, RCM professionals with different levels of experience, and outside partners to get the RCM work done. That gives decision-makers more options than ever to build the capacity they need.
It also gives them a lot more to figure out.
At Meduit, we’ve long believed that the best RCM results come from finding the right balance of AI and human expertise. I still believe that. But even that formula is getting more complicated.
That’s because not all AI is the same anymore. The AI we’ve grown accustomed to can analyze data, recognize patterns, summarize, and assist with high-volume tasks. Agentic AI goes even further by taking action and moving work through multiple steps without needing a person at every juncture.
The human side has its own levels, too. Not every account requires expert insight or oversight, but many do, which means a modern business office must offer a full range of knowledge and judgment.
The capacity question is changing before our eyes from “How many people do we need to get everything done?” to “What combination of resources will get everything done most effectively?”
A cohesive business office has to bring all those pieces together. Technology, people, process, and compliance all have a role, with the mix changing with demand. Creating this model may mean building internally, working with outside partners, or a combination of the two.
Headcount alone won’t tell you much about the true capacity of a business office. What matters is how much work gets done, how well, and whether the model can adjust when the work changes.
There are more pieces on the board now. The next challenge for RCM leaders is figuring out how they fit together.
That idea runs through this edition of Cycle Up, beginning with an article about a Meduit platform that helps match RCM work with the people and technology best equipped to handle it.
Enjoy Cycle Up.
Jeff Nieman
CEO