The lifeblood of any healthcare organization is a smooth-flowing revenue cycle process. Yet, revenue cycle leaders are increasingly burdened by administrative tasks that threaten to drown them in a sea of paperwork. This “administrative burden” acts as a barrier, hindering their ability to focus on core strategic initiatives and ultimately impacting the financial health of the organization.

This article dives deep into the specific administrative burdens weighing down revenue cycle leaders.

We’ll delve into the challenges that revenue cycle leaders are currently facing and explore strategies to address these issues. These challenges include denial management, prior authorization, and medical coding, all of which contribute to the growing mountain of medical records. Additionally, we’ll examine the increasing pressure to provide accurate cost estimates and the pivotal role that artificial intelligence (AI) plays in easing these administrative burdens.

Drowning in Claim Denials: The Administrative Burden of Appeals

Denials are a constant thorn in the side of revenue cycle leaders. Nearly 50% of providers have experienced an increase in their denial rates compared to the previous year, as per a recent survey commissioned by AKASA. Another 27% said they saw no change, and 26% reported a decrease from 2022 to 2023.  Dealing with these denials becomes a time-consuming administrative burden. Researching the reason for denial, gathering supporting documentation, and crafting a compelling appeal all take away from focusing on core revenue cycle functions.

This “administrative burden for revenue cycle leaders” surrounding denials is further compounded by the complex and ever-changing landscape of payer policies. Staying up-to-date on these policies requires constant monitoring and training, further adding to the administrative load.

Common reasons for Claim denials:

• • Errors in patient access/registration

• • Lack of documentation to support medical necessity

• • Missing or incorrect patient information

• • Physician documentation issues

• • Medical coding errors

Other reasons mentioned included duplicate claims, and untimely filing of claims.

Prior Authorization: A Paperwork Labyrinth

Prior authorization is another culprit in the realm of administrative burden. Obtaining prior authorization for necessary procedures can be a labyrinthine process, requiring gathering and submitting copious amounts of documentation. A 2021 survey by the American Hospital Association (AHA) revealed that hospitals spend an average of $8,346 per physician per year managing prior authorization requirements [2]. This translates to a significant administrative burden for revenue cycle leaders, diverting resources and staff time away from core revenue cycle activities.

Medical Coding: Accuracy Under Pressure

Accurate medical coding is paramount for ensuring proper reimbursement. However, the complexity of medical coding systems and the constant updates to coding guidelines create a significant administrative burden. Revenue cycle leaders are tasked with ensuring their coding staff is properly trained and compliant with these updates. This ongoing training process adds another layer of administrative burden.

Further complicating matters is the ever-growing volume of medical records that need to be coded. The Electronic Health Record (EHR) implementation has led to a surge in the amount of data that coders need to navigate, increasing the potential for errors and further administrative burden for revenue cycle leaders.

Cost Estimates: The Crystal Ball Conundrum

Providing accurate cost estimates for healthcare services is another administrative burden for revenue cycle leaders. Patients are increasingly demanding upfront pricing information, but with the complexity of healthcare billing and the variations in insurance coverage, providing accurate estimates can be challenging. This pressure to generate accurate cost estimates adds another layer of administrative burden.

Why AI is a Must for Revenue Cycle Leaders

Given the ever-increasing volume and complexity of administrative tasks, AI is no longer a luxury for revenue cycle leaders; it’s a necessity. AI-powered solutions can automate many of the time-consuming tasks that weigh down revenue cycle teams, freeing them to focus on more strategic initiatives.

For example, AI can be used to automate prior authorization processes, reducing the need for manual data entry and streamlining approvals. Additionally, AI-powered coding tools can assist coders in identifying the most accurate codes for specific procedures, improving coding accuracy and efficiency.

MediCodio: Transforming RCM with AI

MediCodio is a company at the forefront of AI-powered RCM solutions. Their flagship product, CODIO, is an AI-powered medical coding tool that utilizes natural language processing (NLP) to analyze medical records and suggest the most accurate codes. This not only reduces coding errors but also streamlines the coding process, significantly reducing the administrative burden for revenue cycle leaders.

Overcome Administrative Burden for Revenue Cycle Leaders

The administrative burden for revenue cycle leaders is a real and growing threat to the financial health of healthcare organizations. However, with the advent of AI-powered solutions like CODIO from MediCodio, there is a light at the end of the tunnel. By embracing AI, revenue cycle leaders can free their teams from the shackles of administrative tasks and focus on strategic initiatives that will improve the organization’s bottom line.

Ready to learn more about how CODIO can transform your RCM processes? Schedule a demo today!