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

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.