Automation in the Revenue Cycle: It’s All About the Journey

By Colleen O. Hall and Matthew M. Szaflarski 
| 10/8/2019
Automation in the Revenue Cycle: It’s All About the Journey
There’s no doubt the time for automation in healthcare is now. Concepts such as machine learning, artificial intelligence (AI), and robotic process automation (RPA) are making the reduction of manual business-office tasks more feasible than ever before. Automation has the potential to improve several areas within the revenue cycle, including improving net revenue and reducing the overall cost to collect. As organizations begin implementing automation technology into their workflows, however, it is critical that they take a step back to make sure they approach implementation in the right way.

At the advent of any new technology, the temptation for an organization to jump in with both feet is strong. After all, the idea of a silver bullet to fix the complex operational problems today’s healthcare organizations face is appealing.

History warns, however, that while the market may be directing businesses toward the latest and greatest technology, an improperly planned implementation of that technology can lead to costly mistakes. One need only look to the aftereffects of the meaningful use era, when many organizations rushed to implement electronic health records (EHRs) without taking the time to put the right processes and frameworks in place first – often at great cost.1

How can healthcare organizations avoid making the same mistakes when implementing automation technologies into their revenue cycles?

Enter the journey to automation.

By approaching automation as a well-thought-out journey, an organization can make sure it is automating the processes that best help it meet its strategic objectives while mitigating potential financial risks. However, just because an organization deems that it could automate a process doesn’t mean that it should.

What should be automated? Avoiding garbage in, garbage out

Without a carefully mapped-out journey, organizations risk automating processes that don’t result in improved revenue cycle function or might have patient care implications. It’s the old “garbage in, garbage out” adage: If an organization automates a bad process, that process will continually yield poor results. Or, if an organization automates a function in an area where automation might not be well-received, it could result in a decline in patient volume or negatively affect the organization’s reputation.

How can an organization make sure it’s identifying the best automation opportunities within its operations?

The first step is assessing the revenue cycle and finding opportunities for automation. Typically, the revenue cycle processes that best lend themselves to automation are manual, repetitive tasks that don’t require much, if any, human touch. Working credit balances and denials are two examples of such tasks. Other examples include patient access-related tasks such as gathering patient information, verifying insurance eligibility, and conducting retrieval authorizations. Automating repetitive processes such as these that take up a lot of staff members’ time frees up staff to focus on more patient-related processes. This is a necessity for organizations today as the healthcare landscape evolves to be more patient-centric.

Each organization’s journey to automation will look different. Answering the following questions is a good starting point when considering which processes an organization might wish to automate within its revenue cycle:

  • How much workload is the team able to reduce through automating the process?
  • Does moving a process from being human controlled to being machine controlled change any related interactions with stakeholders, such as another department or patients?
  • Is the process the team wants to automate data driven?
  • Is a substantial amount of manual effort involved with the process?
  • Could the process be scaled across the organization?
  • Are all the data elements necessary to define the process and evaluate whether it is worthy of automation available?
  • Is there potential within the process to integrate an automated solution, such as RPA or machine learning?

5 steps to automating the revenue cycle

After assessing which processes to automate, an organization is ready to embark on the journey to automation. This journey can be achieved in the following five steps.

1. Craft
During this step, an organization reviews the processes selected via the initial assessment and determines which of those processes yield the best results. For example, if an organization decides to automate billing, leadership should review which team members’ billing processes are the most successful and seek to automate those processes versus automating less effective billing processes or methods.

In addition to using data from top performers within its own revenue cycle staff, the organization should look at data from top-performing peer organizations in the industry. Homing in on high-performing individuals or organizations helps an organization make sure it is standardizing only the best processes – not the garbage.

2. Standardize
During this step, an organization takes the best, most efficient practices identified in the craft step and implements them into process workflows. At this point in the journey, staff members should be trained in new processes, new monitoring structures should be implemented, and new processes should be aligned with performance management metrics.

3. Systematize
After the organization standardizes a process, the next step is systematizing it so that the work is performed consistently throughout the organization. Best-practice processes are applied across the appropriate functions of the revenue cycle, across departments, and even across other facilities within a health system, if applicable.

4. Automate
In this step, automation technologies are applied to the specific best processes identified within the revenue cycle in the previous steps. The selection of the appropriate framework and technology (for example, an in-house patient accounting system, a bolt-on solution, or an external vendor) is important to help ease maintenance and scalability. This step in the journey often helps to improve efficiency and reduce costs related to full-time equivalents (FTEs) associated with the specific automated function. This allows organizations to reallocate these FTEs to more important functions or eliminate the cost entirely.

5. Sustain
The final step on the journey to automation involves measuring the effect automation has on revenue cycle performance. Monitoring the performance of a digital workforce will require a different skill set geared toward ongoing analytic troubleshooting. In addition, the financial results of each process implemented should be tracked and monitored to assess how the automated processes have affected the revenue cycle from both workflow and financial perspectives.

Succeeding on the journey to automation

Automation in healthcare is here to stay. To succeed in the transition to automation, a healthcare organization must embark on a journey that is well-thought-out and automates the processes that best help the organization meet its strategic initiatives and capture the most value.

As with many organizational initiatives of this scale, the path to automation is an ongoing, evolving, and often complicated process. Organizations embarking on this journey should consider seeking help from qualified third-party specialists to help make the transition smoother and even more successful.

1 Rachel Z. Arndt, “No End in Sight: EHRs Hit Hospitals’ Bottom Lines With Uncertain Benefits,” Modern Healthcare, Oct. 13, 2018,

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Colleen Hall portrait
Colleen O. Hall
Managing Principal, Healthcare Consulting
Matt Szaflarski
Matt Szaflarski
Senior Manager, Healthcare Consulting