Most medical practices admit to struggling with revenue cycle management. We all know the reasons: reimbursements are shrinking, staffing issues are worsening, and burnout is taking a toll on productivity. The environment’s far from ideal, but keeping your practice sustainable isn’t optional — it’s the baseline.

While inflation may be easing, staffing remains a critical concern for 37% of medical leaders.

Do we have a way out?

Yes, through automation!

It’s time to turn to Revenue Cycle Management (RCM) automation — a smart way to tackle the various challenges of practice management and keep your practice running efficiently. Join us as we unwrap the challenges of traditional RCM and discover how automation can mitigate these hurdles, simplify RCM, and improve efficiency and productivity.

Operational Challenges Associated with Traditional RCM

The healthcare revenue cycle is a complex ecosystem where every step, from patient scheduling to accurate reimbursement, is interconnected. Unfortunately, most medical practices still rely on traditional or manual processes. The problem? This approach comes with its own set of challenges, like:

• Time-Intensive — Tasks like verifying patient eligibility, documentation, medical coding, tracking denials, and processing payments are time-consuming.
• Human Errors — Inaccurate patient information, incorrect billing codes, or missed charges lead to claim denials.
• Regulatory Compliance —Complex and constantly changing regulatory guidelines make it challenging to stay compliant.
• Limited Scalability — Managing high-claim volume demands more staff, leading to rising operational costs without improving efficiency.
• Denial Management — Inefficient manual claim tracking and follow-up often lead to revenue leakage.

5 Ways Automation Can Reshape and Optimize Your Revenue Management

What do you expect from an efficient RCM system?

Improved productivity?

A more streamlined process?

Enhanced patient satisfaction?

Reduced manual work?

The truth is that achieving all these goals is nearly impossible without RCM automation. In fact, according to an MGMA poll, 4 in 10 medical groups (43%) added or expanded the use of AI in 2024. 

Why? AI, machine learning (ML), and robotic process automation (RFA) have tremendous potential to transform RCM, making processes faster, smarter, and more efficient.

Here's how automation can help reshape your revenue cycle management and take your practice to the next level.

1. Claim Submission

A streamlined revenue cycle begins with simplified claims management. A lot goes into generating a clean claim, like code assignment and claim scrubbing, which involves meticulous proofreading for errors and inconsistencies before submission.

AI-driven claim scrubbing tools can automatically detect and correct common errors, such as coding discrepancies, missing information, or incorrect patient details, much more efficiently than manual processes and in a fraction of the time. They can analyze past claim data to predict and flag potential issues that might lead to claim denials, allowing for proactive corrections.

A staff member can process one claim at a time, but automation redefines this process through batch processing, enabling multiple claims to be submitted simultaneously. This significantly speeds up the claim submission process. Additionally, automated systems operate 24/7, ensuring claims are submitted promptly without delays associated with human working hours.

2. Regulatory Compliance

Medical codes (CPT, ICD, and HCPCS codes) and payer guidelines are regularly updated to reflect new treatments, procedures, and regulations. Manually tracking these evolving regulations and staying current is tedious, increasing the likelihood of errors and resulting in potential revenue leakage.

Automated RCM systems use AI that can integrate with coding and regulatory databases to automatically reflect real-time updates in coding rules and payer guidelines, enabling effortless compliance. Moreover, RCM automation systems include built-in compliance checks that automatically review the assigned codes and send regular alerts and notifications, preventing audits or penalties due to non-compliance.

GlaceScribe — Glenwood's AI scribe — alleviates the complex coding burden by automatically suggesting CPT, ICD, and HCPCS codes based on patient-provider conversation transcripts. This automation speeds up the coding process, improves coding accuracy, and keeps your practice audit-ready.

3. Patient Collection

Managing patient collections is often a pain point for practices. With more patients on high-deductible plans, outdated collection processes can mean revenue slipping through the cracks. Traditionally, patient collection involves staff sending paper statements, making reminder calls, and following up on overdue payments. This manual process consumes a lot of time and increases the administrative workload.

Automating your patient collections alleviates the workload while ensuring maximum revenue capture. These systems can send out e-statements and timely reminders, provide online payment options, and set up payment plans to make it easier for patients to settle their balances. Automating patient collections enables healthcare providers to continuously track outstanding payments, follow up on overdue accounts, and keep their collections consistent. Moreover, your team spends less time chasing payments, and patients appreciate the convenience of flexible, user-friendly payment options. 

Glenwood's GlacePhoneSmart offers 24/7 phone support for patient billing queries, ensuring patients get assistance and resolve their billing issues any time, day or night. Furthermore, it provides patient account balances and accepts credit card payments, accelerating the collection process and boosting practice revenue without increasing staff workload.

4. Predictive Analysis

Let’s face it — mistakes in claim submission are bound to happen and are admissible. What’s inadmissible is letting those errors slip through and submitting claims without fixing them.

Human oversight can often miss these errors, but a robust system powered by AI and machine learning can efficiently detect errors in coding or billing and improve your clean claim rate. With machine learning ability, these systems analyze past claim data and learn from common mistakes, flagging errors before the claim goes out.

In addition, AI can analyze past denials, identify patterns in denials, and flag high-risk claims before they are even submitted. They can also analyze payer-specific patterns and identify payers who tend to delay payments or deny specific claims, allowing providers to tailor claim submissions to meet their requirements.

5. Denial Management

Denial management is one of the most challenging aspects of Revenue Cycle Management (RCM). Interestingly, over 50% of claims are initially denied but can be overturned with a successful appeal. Ignoring denials out of fear of the lengthy and tedious appeal process equates to missing valuable reimbursement opportunities and increasing AR (accounts receivable).

Automating denial management is a win-win solution: it alleviates staff workload while boosting your practice's revenue. You can also monitor and track each claim in real time, ensuring timely resubmissions after rectifying the errors. Moreover, with automation, you can streamline the denial appeal process by organizing documentation and generating templates for appeal letters, improving the chances of successful appeals and reducing your AR days.

You're One Click Closer to RCM Automation

Traditional revenue cycle management has gaps that result in inefficiencies, increased workload, higher denial rates, and lost revenue opportunities. Nevertheless, embracing AI, machine learning, and automation guarantees improved productivity and alleviates staff burnout. Transitioning to RCM automation enhances operational efficiency and elevates patient satisfaction through better support and streamlined processes.

Glenwood's suite of practice management tools — GlaceEMR, GlaceRCM, GlaceScribe, and GlacePhoneSmart — integrates advanced AI and machine learning technology to automate revenue cycle management, boosting practice productivity while alleviating workload. Generative AI is evolving, and so are we. We ensure you stay ahead of the curve by continuously incorporating the latest advancements in AI technology into our solutions.

Still on the fence? Don’t be! Tap into the power of RCM automation with just a click.