Amy Raymond
December 18, 2023

The Gist

Claim status automation is a great way to test out RCM automation. You have the opportunity to see how the new technology and processes interact with your team, your organization, and your automation vendor. It's an easier, lighter lift that carries a lower security risk, can result in faster buy-in and quicker wins, and is often a more affort. Plus, relying on advanced, AI-powered claim status automation can solve many of your revenue cycle's workflow challenges.

When I talk about revenue cycle automation with any healthcare leader, it’s not uncommon for their eyes to light up. Automation is innovation. It’s the future of RCM, as it can help improve metrics and provide much-needed relief for staff.

What is uncommon during these conversations: Anyone getting excited about the idea of automating claim status.

No one jumps at claim status automation. It’s not flashy. It’s just something RCM teams do — if they have time.

The words “automation” and “revenue cycle” conjure up visions of streamlined workflows from the front desk to the back office. Prior auth. Denials. Those are the biggest pain points for revenue cycle teams and the first areas organizations want to jump to for automation.

I suggest they don’t.

Claim status is the perfect place to start your RCM automation journey. Why? Numerous reasons.

Claim status automation isn’t scary

Revenue cycle automation isn’t new anymore, but there’s still a lot of resistance to it. Dated technology, like robotic process automation (RPA), has left a bad taste in people’s mouths. Maybe you tried automation, but it didn’t give you the results you were promised.

Trusting vendors is scary. Giving someone else access to patient data is scary. Figuring out where to start is scary. Knowing where to expand is scary.

In short, automation is scary for a lot of organizations.

But claim status isn’t scary, nor is claim status automation.

It’s an easier, lighter lift for an organization, with a lower security risk. When you automate claim status, the data you’re pulling from the portal is static. You’re not having a vendor come in and change any information — no one is updating payers or altering claim details. Claims simply move to new queues and notes get added.

Claim status automation is the perfect way to dip your toes into RCM automation and see how it clicks with your team, your organization, and whichever vendor you choose.

Claim status automation helps your workflows

Think of it as creating a queue with superpowers.

The automation tells your team what to touch and when. Why should they waste valuable minutes looking into each claim to determine if it has been paid and then going to the next claim?

Automation sections off that work, so your team is now hyper-focusing where you need them to be. It will decrease that time from sending a claim out to getting payment in the door.

The quicker you see a status of No Claim on File (NCOF), the quicker you’re addressing that problem and getting the correct claim out the door to the payer. The quicker you’re seeing that it’s pending or needs additional documentation. The quicker you’re allowing another automation product or your staff to intercede. You’re avoiding claims going into a black hole and getting written off.

Automating claim status helps your entire claims process move faster and potentially reduces timely filing limits.

Want to speed up your processes? Check out these ten ways to accelerate your claims.

Claim status automation improves your data

No matter how good your reporting and analytics are, it’s still hard to know details, like what percentage of your claims are NCOF.

When you spend time to check on it, you’re likely not getting that information in a consistent way from all of your team. You might be hearing, “Of the claims I checked today, this many were no claim on file.” Or “it feels like X” or “it looks like Y.” And you’re gathering that from five to fifty to a hundred people. Conclusive details are challenging to pull together without putting more work on your team and taking away from their productivity.

When you implement something like claim status, the right AI-powered automation solution can provide that extra layer of data and insight. Anything we touch, we’re telling you what the status is. This helps you understand where you should focus your efforts.

Claim status automation is a great way to vet a vendor

Starting with claim status gives you a chance to see how a vendor works. What’s their onboarding process like? How is their communication? Are they asking a lot of your team or handling the bulk of the burden? Are they living up to their promises? Is their technology working?

Trying to vet an automation vendor with something complex, like eligibility or denials, is difficult. There are simply too many variables and approaches to that level of automation. But claim status? It doesn’t get any simpler.

If they can’t handle claim status, do you really want to try expanding into other, more complicated areas?

Claim status automation generates buy-in and quick wins

Automation isn’t the new kid on the block anymore, but some people are still resistant to change. Getting leaders and teams on board with a new technology or process can be a political challenge. (Especially if you’ve been burned in the past.)

Fortunately, claim status is so straightforward that it’s easy to pitch the benefits:

  • Speeds up claim resolution
  • Prevents reimbursement delays
  • Improves cash flow
  • Allows your team to tackle more complex, rewarding tasks

Another perk of claim status automation is that it delivers quick wins. This can help you maintain positive momentum once you’ve implemented automation and help you make a case for additional workflows.

On top of this, claim status automation is typically the most affordable automation solution offered by vendors — making it an easier sell to leadership.

Claim status automation helps you get your sea legs

When you bring in automation, think of it as adding a new team member. It’s not simple, and you don’t want to overload the onboarding process. To help increase chances of success, automate the smaller, simpler tasks first. Like claim status.

Starting small with claim status gives you a lower-risk start with your vendor. It also gives your team time to adjust to the automation and learn from trial and error before the automation scales to other workflows.

As with any other new process, change management is crucial here. Claim status automation presents a great chance to test out your own change management approach and get a feel for what’s working and not working internally.

Automation exists to make our lives easier. If you start with a complex workflow, you risk overwhelming your team, fumbling the change management ball, and discouraging your team from wanting to utilize automation and experience the benefits.

Read more about why I think change management is so crucial to the revenue cycle.

Claim status automation powered by AI is pretty amazing

Not all claim status automation is the same. Different vendors approach claim status differently.

At AKASA, we use advanced AI-powered automation to solve claim status. Our AI simultaneously works on a batch of accounts at a time and cascades through various search options to find a matching claim. Status check results are interpreted by our machine learning or RCM experts-in-the-loop and returned to your EHR. While some vendors may just write a note about the status in the account, we can take the next action and move problematic claims to the next queue for your staff or AKASA to prioritize follow-up, helping prevent reimbursement delays.

Start your revenue cycle automation with claim status

When you’re starting an automation journey, it can be hard knowing where to begin. I’ve heard countless leaders say: “We have all these big problems. Do I risk starting with a big problem? Will it actually get solved?”

Start with claim status automation, make a quick difference, and fulfill the big promises of RCM automation as a whole. Then, you can move on to solving the rest of your revenue cycle pain points with automation and a stronger, more focused team.

Want to learn more about how AI-powered automation — including claim status automation — can help your organization? Let’s chat.

WRITTEN BY
Amy Raymond

Amy Raymond serves as the senior vice president of revenue cycle operations and deployments at AKASA, where she maintains operational responsibility for the production and performance of the firm’s AI-driven automation platform. Across her 25-year career in revenue cycle, Raymond has held several leadership, consulting, and implementation roles. Her industry experience includes tenures at national and regional health systems, as well as numerous care settings and specialties. Most recently, Raymond served as a senior leader in the revenue cycle technology vertical at Advisory Board. Her extensive professional expertise includes: end-to-end revenue cycle operations, process redesign/optimization, patient financial experience improvement, technology deployment/adoption, change management, and employee engagement. As a military spouse, Raymond is a passionate advocate for mil-spouse hiring and community support.

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