Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

Key to RCM Success

A survey conducted by leading healthcare technology company, revealed the top revenue cycle tasks like denials management, coding, and prior authorizations requiring the most subject matter expertise. Out of 15 tasks listed, over 550 healthcares financial and revenue cycle leaders identified denials management, coding, and prior authorizations as the top choices.

  • Denials management was chosen by 78.7%
  • 50.1% identified coding
  • 49.7% identified prior authorization

According to the survey, denials management is not only the revenue cycle task that requires the most subject matter expertise, but it is also the most time-consuming. This is followed by prior authorization and insurance follow-up. With healthcare systems and hospitals facing significant staffing gaps, advanced automation powered by AI and ML can help simplify these complex tasks, save time, and increase revenue for providers.

As a  VP of revenue cycle of the surveyed company, noted that revenue cycle leaders are facing challenges of higher volumes of claims and limited resources. To improve yields and meet revenue goals, automation and AI-driven solutions can help reduce burnout for existing employees and ensure reliable workflows. Health systems and hospitals can automate repetitive work, such as claim status checks, to allow teams to focus on tasks that require human judgment and revenue cycle expertise. An ideal automation tool can handle both mundane and nuanced tasks, streamlining processes and increasing efficiency.

According to survey, deploying automation for repetitive work can be a retention strategy by providing opportunities for junior staff to build expertise while allowing experienced staff to focus on more challenging claims that return more value to the organization. This creates an environment where individuals feel invested in their career development and success while improving the bottom line.

The survey, commissioned by healthcare tech company, received responses from 556 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States between July 8, 2022, and August 2, 2022. The national survey aimed to assess revenue cycle challenges at hospitals and health systems across the U.S. through the Healthcare Financial Management Association’s Pulse Survey program.


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