Automating revenue cycle -The benefits and impact on costs & staff

 Erika Regulsky Billing & Collections, Most Popular, Most Recent

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The repetitive process of the revenue cycle is time consuming and prone to human error, be it registration, prior authorization, and claims management, they are stressful and demanding processes. No wonder, many providers in the U.S are looking at automation solutions to not only improve revenue capture, but also cut cost to collect, and unburden the revenue cycle staff, which is overworked.

Automating revenue cycle

Malinka Walaliyadde, co-founder and CEO of Alpha Health, speaking to Berkshire’s Healthcare correspondent Alia Paavola, explained that many existing revenue cycle solutions make it difficult to reach those improvement goals. The company offers a unified automation technology that fits the needs of the healthcare revenue cycle.

Mr.Walaliyadde observed that the COVID-19 pandemic has posed severe challenges to revenue cycle, and asserts that providers must evaluate automation solutions. Discussing with the correspondent, he shared his ideas on how Alpha health is helping providers reach automation goals.

The excerpts of an edited version of  the important points that he dwelt upon during his discussion with the correspondent are available below: 

An Excerpt That Sheds Light On The Aforementioned Topics

Question: What revenue cycle challenges did the COVID-19 pandemic expose? 

Malinka Walaliyadde: The first being the need for staffing flexibility. Health systems across the country are seeing significant decreases in volume due to the pandemic.

The second challenge is business continuity. During this crisis many staff shifted to working from home, which has been disruptive to a lot of folks. What some companies are seeing is a drop in productivity, which can result in the disruption of the entire revenue cycle.

The third challenge is that with this reduction in volume, we’re also seeing a drastic reduction in revenue. This will pick up when volumes return, but when the volumes come back it is going to have a significantly different payer makeup.

Q: Why should healthcare organizations prioritize revenue cycle optimization?

MW: An optimized revenue cycle can help healthcare organizations get through this challenging time filled with cost restructuring and payer mix changes. 

Revenue cycle leaders are incredibly ambitious and focused on optimization, we just believe they have been vastly underserved by the technology world, and people in the technology world really have

Q: How can automated revenue cycle processes benefit providers? 

MW: A clear benefit of automation is that it reduces the amount of time staff spends on routine administrative tasks. Automation can enable revenue cycle staff to work at the top of their license and spend their time on the tasks that return the greatest value to their organization. 

Q: How can providers find the right automation technologies for them?

MW: Providers should look for automation technologies that are flexible, meaning they can adapt to change and scale effectively. When evaluating automation technologies, providers should also understand the different parts of the process, the full cost and time involved in deploying the solution. Observing, which is mapping existing flows; learning, which is developing automation based on those workflows; and performing, autonomously performing those flows and maintaining through changing environments. Using solutions that have been purpose built for revenue cycle management in healthcare instead of trying to use horizontal technologies and force-fitting them into a specific vertical like healthcare.

Q: Can you describe how Alpha Health’s solution differs from others on the market?

MW: Alpha Health’s Unified Automation approach is entirely new. In our solution, instead of sending an army of consultants onsite to shadow staff and understand where automation could be delivered, we have proprietary technology that we’ve built that can capture a multimodal 360-degree view of current workflows. 

For the learn and perform pieces, our machine learning algorithms are trained using this data that we capture and then we can autonomously construct complex flows that would be extremely challenging to script by hand. With our solution, if something breaks, it is immediately triaged to one of our trained revenue cycle staff members. Then, our automation system is able to observe how our staff did that work and add it to the set of cases that it can do automatically in the future. 



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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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