Operational Integration the Trend in RCM automatization

There is no other way to describe 2020 but unprecedented, given the impact and changes each economic sector has suffered due to the COVID-19 pandemic. The healthcare industry, like many others, has had these grey areas where telehealth has sprouted, a high rate of patient admissions has been seen, and non-COVID hospital operations have crashed. One thing is clear for all healthcare providers, whether in the midst of survival or with the highest influx of patients: action to improve revenue generation and management is necessary.

When analyzing the potential changes and demands for this sector, it should be noted that insurers should not be the only ones adapting to these constant demands. Rather, providers should have the tools to stay in-sync and on top of their game. For instance, according to a recent analysis, there was a 23 percent increase in claim denials registered in the US in 2020 compared to 2017. Most of these rejections, according to the study, identify the reasons for denials as avoidable. Moreover, the unavailability of up-to-date information related to clinical coding, coverage and policy management represented not only a frustrating and chaotic working environment but potential revenue loss.

The transition toward the automatization of revenue cycle management (RCM) is not a recent idea. Still, a proper integration of operational processes and revenue control is pending, while still considering key transactions for a successful claim submission. I remember glancing at these possibilities at least five years ago, where improving the billing process in Mexico and Latin America through our HIS/ERP product at Ecaresoft was the potential outcome. Today, gratefully, it goes beyond that. Last year’s trends have proven that remote transactions and digital processing are here to stay.

At Ecaresoft, our RCM HIS-embedded module, with capabilities to interoperate with third-party platforms, is a promising solution. Focusing on those prior-to-claim transactions enables healthcare providers to prevent rejections and consequently reduce losses and delays in accounts receivable. A tool like this broadens the control of revenue processes from end-to-end; from pre-authorizations to reimbursement by integrating daily operations with data generation for submission. All this is done through a highly flexible and easy to use interface, which is our gold standard, empowering users to overcome the constant struggle of adapting to any crisis.

This is just the tip of the iceberg. The communication between third-party portals, such as insurance companies, is becoming compulsory worldwide. This will open possibilities not only for improving revenue management for providers or even fraud detection for insurance companies, but to improve the patient experience. This enhancement of efficiency and accuracy is optimal for protecting organizations, providing data analytics that inform strategy and actions. 2020 set the pace. It is now the duty of all parties involved in the process to find a way to keep that momentum going, and hopefully identify the best cost-benefit operations for each organization involved.