Why is workflow management essential in the RCM process? Why can’t each department of RCM function separately without any communication? What is the role of automation in workflow management? We ask ourselves these questions every time when the whole RCM process is on the verge of collapsing. Worry not fellow RCM specialist BillingParadise provides a hybrid model of workflow management combined with automation.
What is Workflow?
A good definition of workflow is a logical sequence of operations which are carried out in order to obtain a pre-defined result
Here’s an example of how a model workflow management should function:
Claim submission: Submitting claims of billable fees to insurance companies.
Charge capture: Rendering medical services into billable charges.
Coding: Properly coding diagnoses and procedures.
Patient collections: Determining patient balances and collecting payments.
Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements.
Remittance processing: Applying or rejecting payments through remittance processing.
Third-party follow up: Collecting payments from third-party insurers.
Utilization review: Examining the necessity of medical services.
Automation in workflow:
Intelligent Process Automation (IPA) is emerging as one of the most transformational technologies that can help healthcare providers by automating many of their labor intensive, costly, and error prone tasks. IPA has the potential to free up resources from mundane administrative tasks and unlock data that is buried in fragmented applications. Utilizing IPA in Revenue Cycle Management also helps healthcare providers maintain compliance and increase collections rates. This, in turn, accelerates their cash flow, reduces their accounts receivables, and minimizes write-offs.
Simple process automation tools are becoming more mainstream for simple, rule-based, repeatable processes. But more complex processes, such as RCM, require smarter tools which can understand the complexities and high level of variation that is found in the end-to-end process of getting paid. IPA is currently being applied to processes like:
Applying IPA enables healthcare providers to realize additional revenues, capture information for claims disputes, and gain insights into the efficiency and effectiveness of their revenue cycle. IPA has amazing potential to make revenue cycle management a strategic strength versus a cost and administrative burden.
