The healthcare industry is undergoing a significant transformation in revenue cycle management (RCM), with emerging technologies like robotic process automation (RPA) and artificial intelligence (AI) playing crucial roles. Traditionally, outsourcing RCM operations focused on cost efficiency by leveraging offshore teams. However, the integration of advanced technology is reshaping this approach, offering not only cost benefits but also improved efficiency, accuracy, and adaptability. As healthcare organisations embrace these changes, the challenge lies in balancing human expertise with the capabilities of cutting-edge technology.
The Rise of Outsourced RCM Solutions
Outsourcing RCM operations has become an increasingly popular strategy among healthcare providers, with organisations such as Mary Washington Healthcare, Hancock Health and Brookwood Baptist Health taking significant steps in this direction. According to Kaufman Hall’s 2023 State of Healthcare Performance Improvement Report, nearly one-third of healthcare organisations are exploring outsourced RCM solutions, a notable increase from the previous year. This trend highlights a growing recognition of the benefits external vendors can bring in terms of cost savings and operational efficiency.
Traditionally, outsourcing relied heavily on offshore teams to reduce labour costs. However, advancements in RPA and AI are challenging this model. Automated tools can now perform repetitive and time-consuming tasks, such as medical coding and claims processing, faster and more accurately. This has prompted a re-evaluation of outsourcing strategies, shifting the focus from purely cost-driven decisions to a more nuanced approach that combines human and technological strengths. The ability of automation to optimise workflows and improve overall performance is becoming a compelling factor for healthcare providers when selecting outsourcing partners.
The Hybrid Approach: Blending Human and Machine Expertise
In response to these technological advancements, many healthcare organisations are adopting a hybrid approach to RCM. This strategy combines traditional outsourcing with in-house integration of advanced automation tools, offering flexibility to address specific cultural, operational and financial needs. For example, Mass General Brigham has implemented a hybrid model that blends offshore staffing with automated solutions. Currently, 40% of their RCM full-time equivalents (FTEs) are offshore, but automation is progressively taking over routine tasks. A single RPA bot, for instance, has replaced the workload of 10 offshore employees, demonstrating the efficiency gains possible through this approach.
Beyond cost savings, automation offers significant improvements in quality and accuracy. Automated coding processes have reduced denial rates and associated costs, enabling healthcare organisations to reinvest savings into critical areas. At the same time, integrating professional and hospital billing teams fosters a unified culture, maximising the value of existing partnerships and ensuring organisations are agile enough to adapt to future technological advancements.
Healthcare leaders are also exploring ways to expand the use cases of existing tools. By fully leveraging the capabilities of their current technologies, they can achieve greater efficiencies and unlock opportunities for innovation. For example, while radiology-related coding has been successfully automated, there is potential to extend these capabilities to other areas, such as pathology and surgery.
Preparing for the Future of RCM
The integration of automation and AI is expected to profoundly impact the RCM landscape, potentially rendering up to 40% of current roles obsolete within the next five years. While this shift may seem frightening, it underscores the need for RCM professionals to adapt and refine their skill sets. Human capabilities such as critical thinking, problem-solving and workflow analysis remain irreplaceable, as these skills are essential for navigating the complexities of healthcare systems and their interactions with insurers and technology.
Organisations should focus on fostering a workforce equipped to complement technological tools rather than compete with them. Employees who can interpret data, identify inefficiencies and propose innovative solutions will be indispensable in a tech-driven environment. This human-centred approach ensures that organisations remain competitive while benefiting from the efficiencies brought by automation.
Additionally, healthcare providers must approach the integration of new technologies strategically. By closely collaborating with existing vendors and exploring additional functionalities within their current solutions, organisations can optimise performance without the need for frequent transitions to new platforms. This approach minimises disruption and maximises the return on investment in technology.
Emerging technologies such as RPA and AI are profoundly transforming revenue cycle management, reshaping the traditional outsourcing model and offering new pathways for efficiency and cost reduction. The rise of hybrid approaches demonstrates the value of blending human expertise with automation to address the complex needs of healthcare organisations. While these changes present challenges, they also open the door to innovation and growth. By embracing technological advancements and nurturing human ingenuity, healthcare providers can successfully navigate this transformation, ensuring sustainable improvements in operational performance and patient care.
Source: HealthLeaders
Image Credit: iStock
