AI-powered healthcare automation startup Olive is partnering with Cincinnati-based health system TriHealth to increase automation of revenue cycle management (RCM) processes like insurance claims status checks, as well as tasks on the clinical side, like pharmacy operations.
So, what’s RCM? The RCM process involves all payments-related tasks from the start of a patient encounter all the way through to payment on the provider end. This includes patient insurance eligibility, copays, claims submission and management, and billing.
Most hospitals implemented some type of RCM tech during the pandemic, and we think penetration will inch even closer to 100% of hospitals in the year ahead:
- Nearly 75% of hospitals deployed RCM tech to automate revenue cycle operations within the past year to keep admin projects on track remotely, according to a February 2021 Akasa survey of 350 US hospital CFOs.
- We expect even more to turn to the tech due to its ability to help hospitals avoid expensive claim denials. More than 10% of hospital claims are denied by payers, and more than 25% of those denials could have been avoided if patient data or documentation wasn’t missing, per Olive. Denied claims cost the US healthcare system billions of dollars annually—but tech can lower the chances a claim gets rejected: For example, Olive’s AI tech quickly retrieves and corrects the reasons a payer rejected or denied a claim (like a name misspelling, for instance).
Beyond claim denials, hospitals miss out on payments when patients delay or avoid them—RCM firms are adding digital billing options to their toolkits to help tackle this problem, too.
- Patients avoid paying their healthcare bills if they don’t understand how or where to pay. Over 10% of consumers say they simply won’t pay their bill if the administrative process for doing so is too complicated, per Cedar’s 2020 Healthcare Consumer Experience Survey.
- RCM vendors are adding digital payment options to their tools to boost their health system clients’ revenues. Earlier this month, R1 RCM announced it’s acquiring cloud-based financial engagement platform VisitPay for $300 million in cash to consolidate patients’ billing statements across different visits and locations. This move should help its health system partners (including large organizations like Intermountain Health and Geisinger) keep patients engaged so they’re fulfilling their out-of-pocket costs: Over 24% of health consumers say their financial experience could be improved with one comprehensive bill for their care rather than multiple bills.