Understanding the pain points and the issues that are keeping revenue cycle managers at healthcare facilities up at night are opportunities for companies in the accounts receivable management industry to enhance partnerships and strengthen relationships with their healthcare clients. A panel of revenue cycle managers who spoke during HFMA’s annual conference this week in Las Vegas shared their three biggest challenges — staffing, denials, and prior authorization, according to a published report.
The Big Picture: More than 3,500 attendees at the conference learned that hospitals are under increasing financial strain. Staffing shortages, high turnover rates, and the burdensome process of claims denials and prior authorizations are creating significant hurdles. Notably, some hospitals have stopped accepting Medicare Advantage due to rampant denials, drawing attention from lawmakers who are calling for more oversight on AI-driven coverage decisions.
- Staffing woes: Hospitals struggle to attract and retain employees for low-paying positions such as registration. Edna Buffington of Community Health Services (CHS) pointed out the stark wage disparities, where hospital registration workers earn significantly less than comparable jobs in other sectors.
- AI and automation: Panelists emphasized the role of AI and automation in addressing these challenges. AI is being leveraged to automate phone systems, process pre-authorizations, and manage denial corrections. CHS, for instance, uses automated systems to ensure reimbursement accuracy and generate weekly denial reports.
- Denial management: Denials are a critical focus area. Hospitals like CHS and Kaiser Permanente are investing in analytical tools to understand and address denial codes and trends. However, the complexity of automating pre-authorization remains a significant challenge.
What they’re saying:
- “We get very proactive to get pre-authorization. For instance, colonoscopies are being denied if there is no pre-authorization before a biopsy,” Buffington explained.
- “A lot of people have tried to automate the pre-authorization space, and that has proved to be more challenging than people think,” said Bradley Tinnermon of Kaiser Permanente.
Opportunities for Strengthening Relationships
- Leverage AI and Automation
- Strategic Partnerships
- Focus on Patient Engagement
