Denials Management is Ripe for Automation Investment

CFOs and revenue cycle leaders can save on costs and optimize workflows by addressing the problem area.

If your healthcare organization isn't already automating denials management, it should consider moving away from manual processes to alleviate expenses.

Denials management is one area of revenue cycle management that is especially susceptible to inefficiencies, which is why hospital leaders need to explore investment in AI, whether that's a standalone or an end-to-end solution.

Currently, only 38% of hospitals and health systems are automating any component of denials management, according to a survey of more than 350 CFOs and revenue cycle leaders by AKASA. However, many of the respondents said they plan to automate some component of denials management in the future, with 44% indicating they would by the end of the year and another 32% saying they plan to in 2024.

Denials management continues to keep healthcare executives up at night, due to the resources, time, and costs it incurs.

A previous survey commissioned by AKASA found that, based on the answers of 550 financial and revenue cycle leaders, denials management required the most subject matter expertise (78.7%) of all revenue cycle tasks.

Another survey by Plutus Health revealed that denials management is the greatest challenge for healthcare providers when it comes to revenue cycle management, cited by 59% of respondents. More than 40% of the providers surveyed also said they lose more than half a million dollars in annual revenue each year because of denied claims, with 18% reporting losing more than a million annually.

Of the respondents who use AI and robotic process automation (RPA), nearly 20% said the greatest improvement since implementing the technology was improved efficiency in filing claims, while 30% said it resulted in faster cash flow and collections.

Due to tight margins, providers are cautious right now when it comes to investing outside of their organization, but technologies like AI and RPA have proven to be beneficial in cutting down on costs in the long term.

Nicole Clawson, VP of finance and revenue cycle at Pennsylvania Mountains Healthcare Alliance, recently shared with HealthLeaders how her organization implemented an end-to-end solution to streamline revenue cycle process, including denials management.

"The integration of data, the ability to loop the front end, data quality, and eligibility to the back end in payments, denials, collections, and everything in between made the difference," Clawson said. "Being able to analyze that data and find the root cause for denials or payment issues and correct it going forward to eliminate the issue. I prioritize and focus on prevention."