Administrative operations are the backbone of any successful organization, including hospitals and healthcare institutions. However, manual Provider back-office operations overload employees with tedious, time-consuming, and never-ending processes. Operational processes such as scheduling appointments, processing insurance claims or submitting a prior authorization, are not only physically straining the hospital administrative staff across the US, but also financially taxing the healthcare system while shifting the focus of Providers – from patient care to handling administrative tasks.
With the rising number of patient visits to hospitals, this burden is only increasing, resulting in staggering administrative costs which represent a significant portion of Healthcare Providers’ overall annual expense. A recent study published in the Annals of Internal Medicine reveals that administrative costs contribute to 34.2% of all U.S. healthcare spending.1 Denial management, one of the critical elements of successful revenue cycle management is a major contributor to this expense. US hospitals spend $262 billion annually on denial management alone.2
What is causing these high levels of expenditure? Well! On average, Health Plans deny 9% of hospital claims,3 causing the administrative staff to be constantly engaged in denial management and appeals. If we calculate the average cost spent per claim and the time the administrative staff spends on denial appeal, it leaves the hospitals with a vicious cycle of claim denials, a workforce steeped in managing denials, and patients exasperated due to delayed or denied claims.
How can Providers optimize denial management with Intelligent Automation?
Did you know 90% of insurance claim denials are avoidable?4 And yet they continue to occur on a massive scale costing the average hospital $4.9 million.2
The reason – manual processes.
Nevertheless, 31% of Healthcare Providers in the US continue to use manual processes for denial management.5 This causes errors at several levels and across workflows, delaying the entire process and leading to more time and money spent per claim.
To reduce administrative costs and improve patient experience, Providers need to leverage Intelligent Automation– a combination of Robotic Process Automation (RPA), and Artificial Intelligence (AI) to streamline and accelerate the claim resolution process. Intelligent Automation can help accomplish basic tasks across applications by replicating manual human activity and accentuating it further by incorporating machine learning and decision-making logic into the process.
By utilizing Intelligent Automation at each level of claims management, Providers can benefit through:
- Accelerated performance – By automating repetitive tasks such as collecting and sorting claims, Intelligent Automation aids in faster resolution, providing administrative staff the time and energy to focus on higher-value work like patient care.