Revenue Cycle Management Summit 2023
Moving toward Meaningful Automation & Defining Autonomous Coding

Survey Respondents Most Often Cite ROI from Automating Claims Processes; Majority Plan to Invest in Autonomous Coding in Coming Years

Demonstrating ROI can be critical for revenue cycle leaders who need to make a compelling case for automation, especially when ROI can at times be difficult to assess. Most survey respondents realized ROI from saving employees time around claim statusing; these respondents used bot technology to reduce tedious manual workflows and eliminate wait times on the phone, which allowed them to allocate staff to new, more challenging and detailed work that requires human oversight. Due to pressures from limited staff bandwidth and limited coding expertise, more than half of respondents want to invest in autonomous coding (see Question 2 and Question 3 Discussion Insights on how users define autonomous coding and their reasons for investing in it). Although automation technology is anticipated to greatly impact the coding market in the coming years, many respondents want more information before investing, as they don’t know the initial costs or ROI.

Summit Discussion Insights: Lessons Learned with Automation

The pre-summit survey was used to provide context for the small group discussions at the summit. Attendees in these small groups discussed four different questions (outlined in the following sections) as well as lessons learned and best practices for achieving success with automation.

Summary

• Autonomous coding, claims statusing, and prior authorization are key revenue cycle areas in which provider attendees have used automation to relieve pain points:
• Autonomous coding reduces administrative burden and increases coding efficiency.
• Automating claims statusing helps organizations make necessary workflow adjustments, significantly save time, and boost efficiency around handling claims.
• Automating prior authorizations helps save time when validating whether an authorization is required per the procedure codes and when submitting authorizations.

Key Lessons Learned

• Healthcare organizations should start small when utilizing automation—there are many opportunities but also many challenges. Organizations need to look beyond a siloed approach to healthcare technology and think in terms of end-to-end solutions. When first starting out, organizations should also focus on collaboration between departments and quick wins.
• To help overcome unknown ROI, healthcare organizations need vendors to better provide both hard and soft ROIs and demonstrate how automation can improve accuracy, efficiency, and financial outcomes. Some customers may need their vendor to go at risk to prove ROI.
• There are many challenges with payer-provider relationships that complicate automation opportunities, emphasizing the need for stronger alignment and collaboration that can be achieved through dialogue.

Summary

• The definition of autonomous coding varies among healthcare organizations and vendors but generally involves automating coding processes to ensure high accuracy, reduce costs, and improve efficiency by minimizing or eliminating human intervention.

Key Lessons Learned

• Autonomous coding is required to have at least a 95% accuracy rate, which is the standard expectation for human coders.
• Autonomous coding is intended to alleviate staffing burdens and reduce the need for human coders. It entails the ability to code and submit claims directly from clinical notes with minimal involvement from human coders.
• Customization and learning capabilities are important aspects of autonomous coding, allowing the technology to adapt to the guidelines and requirements of different organizations.

Summary

• Staffing shortages are a top driver of revenue cycle leaders looking at autonomous coding solutions. Healthcare organizations are not looking to replace employees with automation solutions; instead, they want to bridge staffing gaps with automation.
• Healthcare organizations want to automate repetitive, high-volume coding tasks; this would allow coding staff to focus specifically on critical coding needs that require a deeper level of expertise.

Key Lessons Learned

• To automate tasks, healthcare organizations will need to implement training and employee development programs. Autonomous coding vendors should work closely with customers to develop a more holistic coding approach that considers both the upstream and downstream pieces that are ancillary to the coding process (e.g., refining the ambient speech technology used during physician documentation to streamline coding processes later on). As vendors do this, healthcare organizations will better understand existing gaps and what training programs should be implemented.
• Cost is an important consideration factor for organizations looking at autonomous coding solutions; many organizations do not want to adopt a solution if it will cost more than using human coders. Ideally, coding solutions will ultimately decrease costs for organizations once they are implemented.

Summary

• Healthcare organizations don’t expect their workflows to go away due to automation but rather anticipate seeing manual workflows minimized. Revenue cycle leaders believe automation will lead to an evolved revenue cycle workforce where staff are repurposed and workflows are more efficient and consolidated, enabling staff to tackle more challenging assignments. Ultimately, automation will be used to enhance not only the provider experience but also the patient experience.

Key Lessons Learned

• Before implementing automation, organizational processes need to be optimized, as that will lead to healthcare organizations achieving better outcomes and improved value.
• Employees are often the best resources for identifying inefficient workflows and automation opportunities.
• To achieve better outcomes in the future and move toward more meaningful automation, healthcare organizations need to address data assimilation and implementation challenges, since existing methods aren’t fully meeting their needs.
• Effective change management is critical as automation becomes more widely adopted and employees shift to more complex roles. Organizations should implement effective communication, management, and training.
• Actionable analytics regarding ROI are crucial for revenue cycle management automation.

Next Steps

• Due to market energy and provider interest in autonomous coding, KLAS is currently expanding research in this area via Emerging Insights reports as well as an autonomous coding market segment to monitor vendor performance.
• KLAS plans to host another revenue cycle management summit in 2024.

Summit Attendees