Using healthcare workflow automation to streamline RCM processes
Tight profit margins are nothing new to healthcare providers. But over the last few years, the margins have grown increasingly small. Before the start of the COVID-19 pandemic, the average profit margin was around 2%. Now, up to half of providers report that they are operating in negative margins.1 Amidst these tight margins, providers also are dealing with challenges such as retaining staff and improving the patient experience to meet customer expectations or regulatory requirements.
Today’s modern healthcare organizations are leveraging technology to automate and streamline redundant tasks and utilizing data to identify risk and opportunity for workflow improvements to prevent revenue leakage.
Maximizing revenue with workflow automation
Traditionally, when providers analyze their revenue cycle, the focus is on the clean claims rate. While improving clean claims can result in higher revenues, focusing on clean claims alone doesn’t provide insights that allow providers to secure payments faster and more reliably. That’s why providers looking to improve their margins are now focusing on monitoring and evaluating their first pass yield rate.
First pass yield determines how many claims are paid on first submission. Using workflow automation to pull denial data allows providers to identify problem areas in their RCM process, take proactive corrective measures to improve first pass yield, and capture earned revenue faster.
Improving staff workflows
Using first pass yield as an organization-wide KPI also allows leaders to get ahead of productivity issues or payer changes that could disrupt the organization’s cash flow. With the right data, leaders can proactively spot problems and work with staff to provide clear guidance on measures they can take to improve performance. The data also enables organizations to clearly see and celebrate successes.
Monitoring first pass yield is also an effective benchmark to identify and address problems with:
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- Eligibility workflow
- Coding and documentation errors or delays
- Payer rule changes that require new business rules
Addressing organizational challenges with healthcare workflow automation
Inovalon is committed to understanding and improving the everyday workflow of all RCM staff. With the right technology, such as RCM Intelligence and Claims Management Pro, providers can grow margins and ease the burden on staff so they can focus on creating positive patient experiences and optimizing healthcare outcomes.
Discover the ways Inovalon can help you automate your healthcare workflows.
Sources:
- “Simplifying the New Frontier of Payer Reimbursements,” Karly Rowe, Inovalon Customer Congress 2022
