6 Ways To Automate Revenue Cycle Workflow

 Erika Regulsky RCM
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Automate Revenue Cycle Workflow Using These 6 Ways

In today’s healthcare landscape, technology plays a crucial role in optimizing operations and improving financial performance. One area where technology has made significant strides is in healthcare revenue cycle management (RCM). By embracing rcm workflow automation, healthcare organizations can streamline their RCM processes, reduce costs, and enhance efficiency. In this article, we will explore the benefits and implementation of rcm automation workflow in healthcare.

Understanding RCM Workflow Automation in Healthcare RCM

RCM workflow automation in healthcare involves the use of software solutions that improve the efficiency and effectiveness of internal revenue cycle and billing operations. By automating tasks, documents, and information flow, healthcare organizations can ensure adherence to defined rules and significantly enhance their financial performance.

Benefits of Workflow Healthcare RCM Automation for Healthcare Organizations

It is widely recognized that a significant portion of healthcare spending is allocated to administrative and RCM expenses. The Centers for Medicare and Medicaid Services (CMS) estimates that a staggering $372 billion is spent on administrative complexity in the United States, with $39 billion dedicated to administrative and RCM tasks. By embracing RPA revenue cycle automation in healthcare administration, costs can be reduced, and the burden on staffing can be alleviated. The Council for Affordable Quality Healthcare suggests that a partial transition to healthcare revenue cycle automation could reduce spending on administrative transactions by 42%.

Processes Suitable for Automation in Healthcare RCM

Workflow automation encompasses various aspects of healthcare RCM. Let’s explore some of the key processes that can be automated:

Project Management

Efficient project management is crucial in healthcare RCM. With RCM process workflow automation software, tasks such as raised tickets, scheduled events, queries, task assignments, feedback, and document uploads can be effectively managed, ensuring streamlined collaboration.


Generating comprehensive reports is vital for monitoring financial performance. With workflow automation, healthcare organizations can generate reports with a single click. These reports cover diverse areas such as demo, charge, insurance payments, patient payments, AR caller summary, AR analyst summary, rejections, patient eligibility, coding, denials, audits, and appeal reports.

Accounts Receivables

Workflow automation software offers a dedicated section for accounts receivable processes. This includes monitoring AR benchmark standard aging, prioritizing payer, patient, and provider claims for follow-up, and tracking amounts pended in AR buckets.


Key Performance Indicators (KPIs) provide detailed insights into the entire RCM process. Workflow automation allows customization of KPI metrics, enabling healthcare organizations to track and optimize their performance based on their unique workflow requirements.

Production Tracking

Monitoring the different stages of the RCM process is essential for identifying bottlenecks and optimizing productivity. Workflow automation in RCM enables tracking of production metrics, including charge entry, coding, eligibility verification, AR, and denial management. This granular visibility enhances performance management.

Productivity Comparison

To ensure quality and training, it is essential to assess individual productivity. Workflow automation provides production metrics that offer clear information on productivity rates per person, reducing errors and fostering a culture of continuous improvement.

Why should your third party billing service company use workflow automation?

RCM workflow

It is important to assess the provider’s utilization of workflow automation technologies to streamline processes, reduce manual errors, and enhance productivity. Here are some key workflow automation solutions that an ideal third-party billing service company should offer:

SLA Alerts:

Ensure that the provider offers Service Level Agreement (SLA) alerts to monitor performance, promptly address bottlenecks, and maintain efficient revenue cycle operations. SLA alerts help maintain accountability and ensure adherence to established benchmarks.

AR Management Software:

Look for a comprehensive AR management solution that can effectively handle claims follow-up and collections, ultimately improving revenue recovery. This software should streamline the accounts receivable process, facilitating efficient tracking and resolution of outstanding claims.

Denial Management Software:

Evaluate the provider’s approach to denial management, including their use of denial management software. The software should incorporate strategies for reducing denials and efficiently appealing denied claims. This ensures effective resolution of claim denials, minimizing revenue loss.

Eligibility Verification Software:

The ability to verify patient information such as address, plan limitations, exclusions, and covered and non-covered services is crucial. Seek a provider that offers eligibility verification software, allowing easy access to the verification status and detailed information with just a click. A customizable dashboard that utilizes patient appointment data can help calculate the number of eligibility checks needed within specific timeframes.

Project Management Software:

A reliable project management software enables transparency in productivity tracking for billers, coders, accounts receivable professionals, and denial management experts. It should allow tracking of quality, live tickets, work assignments, and other relevant metrics. Examples of such software include TeamBillingBridge, which streamlines workflows and enhances collaboration.

By considering a third-party billing service company that offers these workflow automation solutions, healthcare organizations can achieve improved efficiency, reduced errors, and enhanced productivity in their revenue cycle management processes.

In the face of increasing administrative complexity and rising costs, healthcare organizations are turning to workflow automation to streamline their revenue cycle management processes. The benefits of automation, including reduced costs, improved efficiency, and enhanced financial performance, make it a valuable tool in healthcare RCM. By embracing revenue cycle automation, organizations can expect high-quality data, transparency, and the ability to focus on the growth of their business. As the healthcare industry continues to evolve, workflow automation will play a pivotal role in driving positive change and ensuring financial success.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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