No Margin, No Mission: Why & How Technology Leaders Must Lean Into Revenue Cycle Management
For decades, healthcare technology leaders have often viewed revenue cycle management (RCM) as a necessary, but often frustrating, back-office function. That perspective is rapidly changing. Today, a robust and intelligently managed revenue cycle isn’t just about financial health – it’s fundamentally linked to patient care.Without a solid financial foundation, innovation stalls, clinical programs suffer, and ultimately, your association’s mission is jeopardized.
This article explores why IT leaders must proactively embrace RCM, how to navigate the evolving landscape – particularly with the rise of AI – and actionable steps you can take to drive meaningful improvement.
The Shifting Landscape: From Cost Center to strategic Imperative
Historically, RCM focused on basic billing and collections. “We’ve been automating revenue cycle processes for 20 years,” said Sunil Patel, Senior Vice President of Analytics at Change Healthcare. “but now AI is taking it to the next level.”
This isn’t simply about automating tasks; it’s about unlocking insights and optimizing performance.The key is identifying areas where AI can deliver tangible results, like streamlining claim submissions and identifying previously missed coverage opportunities for your patients.
consider this: organizations are already leveraging AI to audit 100% of charts, resulting in millions of dollars in increased monthly revenue. As noted by Brian Cragun,CEO of rhapsody,”That’s the power of augmenting humans with smart systems.”
AI: Augmentation, Not Replacement
AI’s potential in RCM is significant, but it’s crucial to approach implementation strategically. the goal isn’t to replace human expertise, but to enhance it. Focus on using AI to:
Automate repetitive tasks: Free up staff for more complex issues.
Improve accuracy: Reduce errors in coding and claims processing. Identify patterns: Uncover hidden revenue opportunities and potential compliance risks.
Enhance chart audits: Ensure comprehensive review and accurate billing.However, simply deploying AI isn’t enough.
The Integration Imperative: Vendor Partnerships & Strategic Alignment
Successfully integrating AI and other RCM technologies requires careful consideration of vendor relationships.Brian Cragun emphasizes aligning these partnerships with your long-term strategic goals. The most effective platforms offer more than just technology; they provide proactive service and strategic guidance.
Don’t settle for vendors who simply deliver a product.You need partners who are invested in your success – especially given the revenue cycle’s critical role. Under no circumstances should a vendor leave you to struggle with implementation or optimization.
Benchmarking & Rationalization: Knowing Where You Stand
Before investing in new technology, understand your current state. The Healthcare Financial Management Association’s (HFMA) Revenue Cycle Management Technology Adoption Model provides a valuable framework for benchmarking.
This model helps you:
Identify gaps in your current processes.
Prioritize areas for improvement. Rationalize existing technology investments.
Remember,it’s not always about acquiring more technology. Frequently enough,it’s about maximizing the value of what you already have.
Core Operations First: avoiding Shiny Object Syndrome
IT leaders are constantly bombarded with new trends and technologies. Though, it’s vital to resist the temptation to chase the latest “shiny object” at the expense of core operations.
as David Polikaitis,former CIO of Sharp healthcare,cautions,”Revenue cycle may not be the ‘sexy’ part of the job,but it’s essential.” Without a healthy revenue cycle, you can’t fund innovation, support clinical programs, or ultimately, fulfill your organization’s mission.
Actionable Steps for IT Leaders
Here’s a roadmap for proactively leading revenue cycle change:
Elevate RCM: Treat it as a core CIO obligation, not a back-office function. Foster Collaboration: Embed revenue leaders in IT governance and involve IT in front-end financial workflows.
Gain Deep Understanding: Invest in understanding revenue cycle processes by shadowing frontline teams and asking questions.
*Benchmark & Prioritize
