What Percentage Of Your Claims Get Paid Without A Human Action?

Driving cash acceleration and higher zero-touch rates with financial clearance automation

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It’s well established that today’s healthcare financial executives face unprecedented challenges maintaining a healthy operating margin. And, given that labor shortfalls in the majority of healthcare revenue cycle departments are here to stay for the foreseeable future, the traditional knee jerk response of “throwing more bodies” at reimbursement problems is simply unsustainable and a less than strategic approach.

All revenue cycle leaders are striving to reduce the cost to collect dollars owed from patients and insurance companies, which means healthcare organizations are wise to embrace workflow models that capitalize on existing staff resources and create greater capacity within teams. That’s precisely why one key metric all healthcare organizations should be focusing on is zero-touch rate—the percentage of claims that require no human intervention after the service is rendered.

Phoenix-based Atlas Healthcare Partners, one of the nation’s fastest growing ambulatory surgery center (ASC) management companies, is reaping the benefits of improved zero-touch rates and decreased denials ultimately putting the organization in a position to increase capacity for existing staff and reduce the need to hire more. The organization elevated its financial health by laying the groundwork for more effective financial clearance processes through automation, minimizing the potential for downstream claim payment bottlenecks.

The Financial Clearance Challenge and Opportunity

Atlas experienced rapid growth in recent years, landing the organization on the Fortune 5000 Fastest Growing Private Companies in 2022 and 2023. In response to pent up demand following the pandemic years, Atlas’ ASC clients saw patient volumes soar in 2022. In tandem with this phenomenon, the opening of nine new centers inundated revenue cycle staff and systems, compounding the challenge of managing a remote workforce without automation and intelligent analytics. Meanwhile, breakdowns in financial clearance processes were driving up denial rates and creating reimbursement delays.

Financial clearance, also referred to as pre-registration, encompasses all the steps a healthcare organization should take prior to a patient encounter. The purpose is twofold: to ensure the patients are aware and accountable for any balance owed (past, present or future), and that all the necessary information is collected and verified to ensure claims flow smoothly, and reimbursement is timely.

Overcoming downstream challenges that start with front-end financial clearance is a significant and ongoing challenge for most healthcare organizations. However, the challenge can be remedied with the right combination of automation and AI. And when financial clearance runs smoothly, the opportunities for creating capacity within revenue cycle teams to generate greater ROI are significant because claims that require little to no human intervention naturally accelerate cash flow, improve net revenue and increase labor capacity.

The Power of Zero-Touch Claims and Better Workflows

Recognizing there was room for improvement of revenue cycle processes, the organization identified the need to get ahead of converging process issues to help position for future growth. Atlas determined top priorities would be to create capacity for staff by arming them with tools to work smarter and increase zero-touch rate. Financial clearance automation was put into place to address:

Insurance eligibility and benefits verification prior to every case
Demographic verification
Prior authorization
Payment estimation and past-due balance checks
Collection of estimated balances
Specialty MD referrals

In addition to financial clearance automation, Atlas implemented MedEvolve’s RCM workflow automation to holistically address the full lifecycle of revenue cycle processes and communication from the point of scheduling to payment. Workflow automation then provides the guidance needed to ensure back-office billing and collections staff are not only productive, but also effective, in their work. The technology creates worklists based on the claims and activities that have potential to produce the most ROI, rather than having staff focusing on claims do not require action.

Since implementing the automation and accountability solutions from MedEvolve, the organization achieved its goals of creating greater capacity and accountability for existing staff, improving coordination and communication across all teams and departments, and eliminating role redundancies. In addition, Atlas has improved a number of key performance indicators (KPIs) including:

97.5% NCR for closed claims
97.5% Pre-service patient collection
48% reduction in denials
31% increase in labor capacity
12% cash acceleration

Looking ahead, Atlas is evaluating solutions to automate additional processes, such as coding, prior authorizations and robotic process automation (RPA) which completes repetitive manual tasks to free up staff to do more important work.

Atlas Healthcare Partners has demonstrated the transformative power of automation in optimizing revenue cycle processes. By leveraging financial clearance and holistic RCM workflow automation, the organization has significantly improved KPIs, increased staff capacity, and reduced denials. Their strategic approach has not only enhanced operational efficiency but also positioned the organization for sustainable growth and better financial health. Other healthcare organizations should look to their success as a blueprint for leveraging technology to overcome financial and operational challenges in a dynamic healthcare landscape.