Optimized workflows in healthcare receivables management remain an elusive goal, one that has become more urgent to attain as hospitals, health systems and practices cope with the effects of the coronavirus crisis and the need to generate major cost savings. Process optimization is also central to readiness for managing the transition to value-based reimbursement.
This CommerceHealthcare® Solution Perspective briefly examines typical remittance automation barriers, defines the essential characteristics that comprise an automation “gold standard” and describes how Commerce’s solutions can help meet these challenges.
Cost containment is a healthcare imperative. Pandemic-induced total 2020 hospital and health system losses are projected to reach $300 billion.1 Through August 2020, hospital total expense per adjusted discharge was up 17% for the year.2
This environment mandates a high-performing revenue cycle, with automation of the core remittance management process an increasing necessity. Unfortunately, the receivables area continues to face several hindrances to optimized automation. Two of the most prominent:
- Labor intensive processes. Manual steps still burden the remittance process despite greater technology use. Many observers estimate that at least half the volume in the average community hospital remains paper-based. Multiple payment sources and workflows create inconsistency and complexity.
- Disparate systems. The revenue cycle also relies on multiple, often non-integrated financial, EHR and other systems, forcing manual splitting and posting of aggregated remittances. Reconciliation across the various systems is difficult.
To overcome these hurdles, health systems, hospitals and physician practices have pursued remittance automation with varying success in reducing manual workflows. For example, it is not uncommon for remittance staff to access twenty or more payer websites, only to download paper forms for completion. A Frost & Sullivan assessment underscored a major need to re-engineer workflows and implement technologies to deal with mounting reimbursement complexity.3
The CommerceHealthcare® Solution
To fully leverage automation, organizations must evaluate remittance automation investments through the lens of a “gold standard.” RemitConnect®, by CommerceHealthcare®, automates the entire posting and reconciliation process for insurance and patient receivables, reducing complexity caused by variable payment formats. It adheres to the essential gold standard requirements by offering:
- A single unified system. RemitConnect® is a unified technology and services platform that integrates with revenue systems and establishes one centralized hub for all payments processing.
- Automated handling of diverse payment types. The solution manages the full array of payer and patient payments, from checks and paper Explanation of Benefits Statements (EOBs) to Electronic Remittance Advice (ERAs) and Electronic Fund Transfers (EFTs).
- Comprehensive process automation. RemitConnect® goes “all in” to prevent automation leakage with end to end coverage, including (Figure 1):
- Proactively working toward 100% EFT for every remit claim.
- Automatic unbundling of commingled payments.
- Automatic reconciliation of payments and claims.
- Automatic posting to the appropriate financial system.
- System-generated management reporting and audit trails.
This feature set creates exception-based workflow, so staff can focus on non-routine cases.
Full Optimization Yields Major Benefits
Pursuing a “gold standard” rather than accepting partial automation unleashes significant benefits:
- Optimizes workflow. Delivers ROI and sustains long-term gains.
- Maximizes cost savings and cash flow.
- Heightens workforce productivity. Exception-based workflow boosts output and permits reallocation of staff to priority work.
- Strengthens organizational agility. Automation enhances adaptability to change.
- Promotes value-based care initiatives. Optimized, efficient processes are foundational to manage value-based reimbursement.
- American Hospital Association, Hospitals and Health Systems Continue to Face Unprecedented Financial Challenges Due to COVID-19, May 2020.
- J. LaPointe, “August Was a Setback for Hospital Financial Recovery, Report Shows,” RevCycle Intelligence, September 29, 2020.
- M.Haglund, “Revenue Cycle Management in the Value-Based Era: It’s a Whole New Ball Game,” Healthcare Innovation, September/October 2019.