Over the last 20-plus years that I’ve personally been in this industry trying to solve revenue cycle problems through software development, there’s been a huge shift in a few key areas.
First, the cost to deliver care has continuously gone up. Second, the cost to administer claims adjudication for that care has increased. So, your labor costs keep climbing—exponentially in some cases. At the same time, many people are now working remotely, thanks to COVID, which adds another layer of complexity in determining whether someone is actually effective at their job or not.
Third, reimbursements continue to decline and we’ve seen a significant shift in how much of the dollar is now owed by the consumer – especially with the rise of high-deductible health plans. We’ve also seen substantial reductions in reimbursements, particularly from Medicare and Medicaid, and now the commercial payers are following suit.
This raises the question: what can providers actually control? What can we really influence to claw back profit margins for provider organizations? The answer: not much!
Until now. Healthcare organizations that use a workforce automation solution, such as the MedEvolve Effective Intelligence® (EI) Suite, can actually begin to see how many human touches it takes to get a claim adjudicated and fully resolved to a zero balance (ideally you want the claim to be paid without a human touch, which we call “zero touch rate”).
By capturing this additional data, these organizations are creating a new dataset beyond their PM/EHR platforms which empowers them to pinpoint – with laser accuracy – exactly where breakdowns occur in the revenue cycle that require human intervention on the A/R side to resolve. The result: 35% less dependency on labor, and a 3 to 5% net revenue lift out of the gate.
Most healthcare organizations rely on traditional metrics, such as “clean claim pass rate,” or “days in AR” but these metrics only provide part of the picture. You might have the highest clean claim pass rate and lowest days in AR, but how much manual work is being done to get there? This is where providers are losing margin. Their cost to collect is too high because there is too much wasted work in the revenue cycle and they are almost certain to be overstaffed because of it.
Some organizations are at least tracking staff productivity, which is a step in the right direction when determining the amount of work that is being done, but daily productivity doesn’t tell the full story either. I can be highly productive and still be ineffective at my job.
This is why we ask our clients to spend 20 seconds or less tagging a little additional information on the claims as they work to understand details such as why a human is working an unpaid or partially paid claim, and what action they’re taking. This allows us to truly understand human performance and effectiveness on the back end.
Another reason this human effectiveness data is so important is the industry is being flooded with AI automations and solutions. But here’s the truth: all of these AI companies are sitting on the same, commonly available data—claims data, EHR data, clearinghouse data. There’s nothing novel, nothing unique, and most of it is too vague to get to the root of the problem, let alone solve it. This is why this new human dataset is so powerful.
Here’s an example of how we track employee effectiveness. How many claims touches did it take the RCM employee to get the claim paid and how many got paid on the first pass? Each quadrant represents the best action to take for each employee.
The new data created in the MedEvolve EI suite—captured in 20 seconds or less—combined with the commodity data, gives you a powerhouse of structured information. When applied to AI principles, this drives real automation, actionable insights, accurate predictions, meaningful correlations—everything a healthcare provider group needs to preserve margin, minimize avoidable write-offs, and reduce the labor costs associated with claims management.
Repairing today’s broken revenue cycle isn’t just adding more people or patching old workflows—it’s generating better data. By capturing human effectiveness at scale and combining it with traditional RCM data, we empower practices to take control of what they can influence: operational efficiency and workforce optimization. The MedEvolve Effective Intelligence® Suite creates a new standard for visibility and action in revenue cycle management—one that significantly reduces labor costs and finally gives some control back to the provider organizations. The future of healthcare finance isn’t about working harder—it’s about working smarter, and it starts with data that tells the whole story.
Matt Seefeld, Chief Executive Officer at MedEvolve, brings over 24 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence solution and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014. Matt ran global sales for NantHealth and provided consulting services for healthcare technology and service businesses nationwide, prior to joining MedEvolve full-time.
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The creator of the Effective Intelligence® suite for revenue cycle optimization will lead the next phase of innovation & growth at MedEvolve.
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