Ambient Listening on the Front End; AI & Automation on the Back End Poised to Improve RCM, KLAS Finds

RCM is increasingly recognized as the backbone of financial stability and operational efficiency in healthcare systems. The 2024 KLAS Revenue Cycle Management Summit, held in October, gathered 117 industry leaders  to address pressing challenges and explore emerging solutions. The summit’s findings, documented in a recently released report, offer strategies and insights for healthcare IT executives tasked with enhancing RCM performance.

Tackling Persistent Challenges in Revenue Cycle Management

According to the report, RCM faces mounting pressures due to increased denial volumes, staff shortages, and payer-related complexities. The survey preceding the summit revealed that denial management and automation were among the most pressing and addressable challenges.

The report stated that “more than 90% of denials stem from front-end problems such as eligibility verification, prior authorizations, and documentation errors.” Addressing these issues requires a proactive approach, including the use of real-time insurance discovery tools and employee education programs.

Staff recruitment and retention are also critical pain points, as many organizations struggle to maintain an engaged workforce amid increasing workloads. Strategies discussed during the summit include offering competitive pay, remote work options, and targeted training to address both technical and soft skills. These approaches create a supportive work environment where employees feel valued and connected to their organization’s mission.

Emerging Technologies Reshape RCM

The summit highlighted the transformative potential of emerging technologies in addressing RCM inefficiencies. Automation, AI, and advanced data analytics already demonstrate promise in streamlining denials management and claims processing.

The report stated “AI can increase efficiency in denial resolutions, particularly for repetitive and rules-based tasks.” Beyond denials, predictive analytics can help organizations identify trends and implement preventive measures, thereby reducing overall claim rejections.

Another promising area is the integration of ambient speech recognition technology. This innovation reduces the documentation burden on clinicians while enhancing the accuracy of medical records. The downstream effects include improved coding and billing accuracy, ultimately benefiting the entire revenue cycle. The report cautioned that technology must be carefully selected and integrated to align with organizational goals and existing systems.

Building Resilience with Cybersecurity and Vendor Partnerships

Cybersecurity in RCM emerged as a critical focus during the summit, particularly in the wake of high-profile breaches. According to the report, over 90% of respondents indicated they were negatively impacted by a recent Change Healthcare cybersecurity incident. To mitigate such risks, the report recommends robust preventive measures, including real-time alerts, restricted access during administrative changes, and comprehensive audits of technology vendors.

Effective vendor partnerships were also emphasized as essential for achieving RCM success. The summit underscored the importance of treating vendors as extensions of the internal RCM team, fostering transparency, and aligning goals to build mutually beneficial relationships. As one attendee noted, “Strong partnerships can significantly reduce inefficiencies and improve outcomes.”

The report concludes: “Healthcare organizations must embrace change and innovation to thrive in an increasingly complex landscape. By prioritizing collaboration and transparency, we can achieve a more sustainable and patient-centric revenue cycle.”