How to make the best use of automation in revenue integrity

Wednesday, November 16, 2022

Automation and similar technologies are increasingly prevalent in revenue integrity but understanding best practices and long-term implications is still a major challenge. While organizations are learning how to best leverage technology as they adopt it, it’s just as important that revenue integrity leaders understand what these technologies can and can’t do.

Tackling misconceptions about automation is critical, Seth Katz, vice president of HIM and revenue cycle at University Health KC in Kansas City, Missouri, told HealthLeaders.

Automation isn’t a plug-and-play solution, Katz cautioned. Automation and related technologies are still computer systems—and that means if data provided to the system is bad the system won’t yield a solution or improvement.

These technologies also require dedicated, on-going maintenance—which includes regular training for users. Users, and the organization as a whole, need to actually learn about the technology, Katz said.

“If you don't do those things and support it then you're going to fall short of your expectations. It adds efficiency, it adds improvement, but it also comes with other things you have to do,” he said. “It's not a plug-and-play and it's also not one-size-fits-all.”

It’s not unusual for organizations to work with several vendors that provide automation technologies, Katz adds. One vendor may help automate prior authorizations, but an organization will likely have to turn to a completely different vendor to implement AI-enhanced coding.

University Health started implementing automation in prior authorization processes and has branched out from there, Katz said. They’re currently expanding into inpatient notifications, eligibility, claim status checks, and more. Generally, go-live in a step-by-step process that involves a little more than two months of allowing the automation to run in the background so that it can learn. Then, once the system has collected enough data, it should be ready to begin executing tasks such as logging requests for prior authorizations.

So far, University Health’s experience with automation has been positive, according to Katz. Although prior authorization is a common place to start with automation because it’s a repetitive task, but Katz sees opportunities in a variety of revenue integrity and revenue cycle functions.

“On the revenue cycle site, the biggest one is the medical coding. I think there's a number of players growing in that space doing AI coding. It's very early. It is still a job that there are oftentimes shortages, that it relies on contract coders which are very expensive,” he said. “So, I think this is a really interesting opportunity there in the next couple of years.”

However, organizations should look at automation as a way to reduce the need for staff, Katz said. Although these technologies reduce the burden of repetitive tasks they simply shift where and how staff are deployed.

“Amazon has more automation than everybody and they keep adding more. But at the same time they're on pace this decade to pass Walmart as the world's largest employer. So that's the way to look at this,” he said. “Now they might not need as many people in the warehouse. But that doesn't mean you need fewer people just because you've automated. In some ways you need more. You have different, new roles that you never would have thought of before.”