Not all clearinghouses are created equal: Automate workflows, speed up payments and promote a unified revenue cycle

Clearinghouses are no longer a commodity. The demand for smarter automation, streamlined workflows and faster, fuller payments is the new norm and expectation for revenue cycle leaders. The payment process starts with the first patient interaction, so ensuring the front-end is set up correctly is key. Additionally, automated and efficient workflows not only boost staff morale and the patient experience, but also yield bottom line improvement for an industry with increasingly negative margin pressure. During a webinar on Dec. 15, John Jungbluth, solution strategist for Waystar, discussed how clearinghouses can use automation in innovative ways to improve health system efficiency and payments processing, while positioning for the future in a unified way.

1 Meeting peak revenue performance is an attainable goal

You might consider volume growth a success on its own terms, but a look at your cash flow could tell a different story. During a time when staffing shortages are putting major pressure on providers, one simply cannot ‘hire their way’ out of the administrative hurdles that plague the revenue cycle. Smart automation is critical to scale, reduce costs, and provide a better patient experience. With the right tools and clearinghouse partner, staff can work smarter, revenue leakage and denials can be mitigated, and payments can be realized fuller and faster, helping organizations reach peak performance.

2 Clearinghouses should have seamless data integration

Clearinghouses should be seen as more than a ‘transaction’ vendor. At a minimum, clearinghouses should process all payer claims, connect to all payers, and provide great service and partnership. A standout clearinghouse is fervently innovating, helping to upskill users with smart automation, providing key data insights that help inform business decisions, and connecting the entire revenue cycle from front-to-back.

3 Avoid automation fallacy with purpose-built automation

The healthcare market is exploding with new entrants claiming they can ‘automate’ the revenue cycle, only to leave providers dissatisfied and not realizing true ROI. There are two types of automation to watch for: general purpose and purpose-built automation. It can often be hard to tell the difference though. General purpose automation compromises of basic data movement and focuses on high-volume, low-value tasks.

Purpose-built automation, on the other hand, uses augmented intelligence and is designed for specific use cases like automating authorizations or statusing claims based on payer behavior. It focuses on high-volume, high-value tasks, with demonstrable ROI.

4 Purpose-built automation can improve efficiency and increase revenue

There are numerous use cases for how AI, RPA and machine learning are revolutionizing the way we think and operate within the revenue cycle. From curating rich eligibility details, to automating authorizations, to identifying missing charges, and predicting patient and payer payment behavior, purposebuilt automation is essential for empowering the human touch and increasing accuracy and efficiency. Although automation can vary across different parts of the revenue cycle, providers have been or plan to make investments in AI+RPA technology. But technology alone isn’t enough, integrating purpose-built automation within workflow is a key factor to user adoption and ROI realization. As a result, understand from your clearinghouse all the different ways they’re helping to automate and connect the entire revenue cycle – from eligibility to accurate cash reconciliation and beyond – the possibilities seem endless.

5 The importance of a single, unified platform

An increasing number of providers are looking to consolidate vendors, reduce their risk, and provide a seamless experience from front-toback. Bringing all healthcare claims, transactions and payers onto a single experience yields performance, operational and strategic benefits, while positioning providers to scale for the future in a unified way.