Hospitals and health systems face unprecedented RCM challenges as they try to optimize patient care while maintaining financial stability. The primary issue is that there’s more revenue cycle work than ever before and not enough skilled RCM workers available to do it.

The healthcare RCM labor market has remained flat since COVID-19, and competition is fierce for existing workers, both within healthcare and from other industries where wage inflation has made salaries more competitive. The lack of RCM labor is putting hospitals in a financial bind as they fight shorthanded to keep up with overflowing revenue cycle demands.

Of course, the emergence of AI and automated processes is helping to compensate for the lack of RCM workers. AI can automate repetitive tasks or tasks that don’t require critical thinking and execute them exponentially faster, leaving more complex issues to experienced RCM employees.

The flip side is that payers use AI to make successful insurance claim outcomes harder. Before AI, payers had a limited capacity to look at all the claims filed and often just automatically paid claims under a specific value. Now, with AI, payers can look at every single claim to find causes for denial. As a result, claim denials have risen 20% over the last five years (1) – with no repercussions. The worst case for payers that incorrectly deny a claim is that they’ll eventually have to pay, but in the meantime, they can hold on to more cash. The scenario is much more severe for providers who are denied the critical revenue they need to improve care and services and must also spend more on trying to get reimbursed. It’s a double-whammy for hospitals and health systems that, if not appropriately staffed from an RCM perspective, will likely never see most of their denials overturned.

Maintaining the Status Quo Won’t Work

Today’s RCM landscape is as perilous as it’s ever been for healthcare organizations. More work, fewer experienced workers, and payers employing AI to muddy the claims process are all significant obstacles to overcome. Adding more employees isn’t a viable avenue. Even if it was, adding people without technology doesn’t help overcome the AI being deployed by payers to subvert claims.

It's time for hospitals, healthcare systems, and physician practices to adapt and adopt a multi-pronged solution that combines tiered personnel with AI and automation to achieve RCM success.

Finding a (Combined) Solution 

Today’s RCM challenges require healthcare organizations to deploy a combined solution that addresses obstacles from multiple fronts. The three key elements of an effective RCM model include the following:

1. Artificial Intelligence and Automation

Implement advanced technology, analytics, and automation to perform simple, repetitive tasks that don’t require critical decision-making skills

A small, dedicated staff to handle the lower-level tasks that fall outside AI’s capabilities

Industry-savvy employees who handle complex tasks that require high-end critical thinking and expertise

For hospitals and healthcare systems, it’s not about doing one of these things, but about creating a model that successfully incorporates all three. Larger organizations might try to build their own models in-house, but it’s costly and complex and detracts from their core mission of delivering exceptional patient care.

A more viable and immediate avenue is collaborating with a proven RCM partner with a platform already in place. Joining forces with an RCM partner allows healthcare organizations to focus on allocating revenue instead of how to collect it, which is a much more natural fit.

Meduit’s tech-powered RCM solution seamlessly balances RCM expertise, AI, and automation to accelerate cash flow, minimize claim denials, and provide a more gratifying and productive patient experience.

Our solution lessens the impact of the RCM labor shortage while still addressing the most pressing RCM issues facing healthcare organizations today, including the following:

2. Reducing Claim Denials – Providers MUST utilize the same AI capabilities that payers use to increase denial rates. Meduit’s solution uses AI to preemptively identify claims that could be denied so they can be fixed ahead of the review process.

3. Enhancing the Patient Experience – Our solution combines self-service automation tools and compassionate customer specialists to give patients the freedom to create their own payment journey.

4. Back-office Staff – This is an area hit hard by the industry’s staffing shortage, and our solution provides the necessary support so providers can optimize their existing staff.

Meduit’s three-dimensional RCM solution empowers healthcare organizations to achieve revenue cycle success. By leveraging the strengths of AI, industry expertise, and tiered staffing, hospitals and health systems can minimize their exposure to workforce challenges, fortify their end-to-end RCM systems and processes, level the technology playing field against payers, and future-proof their revenue cycle for whatever industry challenges await.

1. Claims Denials: A Step-by-Step Approach to Resolution (ahima.org)