At a Glance:

• Begin 2025 by thoroughly analyzing your 2024 revenue cycle, including payer reimbursement rates, collection cycles, and key performance indicators suited to your setup.
• This is a great time to get acquainted with and get clarity on what AI can or cannot do for your healthcare revenue cycle. It is also a good time to re-visit patient touchpoints within your business and evaluate improvements that affect staff efficiency and price transparency.
• Alignment with the latest RevOps best-practices improve cash flow, enhances patient satisfaction, and fosters long-term financial sustainability for your practice.

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"The art and science of asking questions is the source of all knowledge." – Thomas Berger, American Novelist.

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The start of the year is NOT the time for reflection and planning, especially for healthcare operations managers and owners. In fact, this is the time of the year when see a flurry of changes in benefits for the patients, an insane rush for verifications, and inevitable scheduling delays.

Navigating this time of the year is challenging, but.. taking the time now to assess internal processes and plan your revenue operations for the coming year can significantly ease the burden for your patient facing team members in the long run.

A bit of time set aside for planning ahead also prepares you and your team for a smoother transition to the new set of regulations next year.

To begin, the first question to ask yourself is -'What does revenue operations (RevOps) mean to me in the context of my healthcare setup?' Answering this would give you a clear idea of where you stand- is this an area of operations that you actively engage with and have clear frameworks that work for your business or are you looking to improve in these aspects?

Next, consider your resources at hand and consider moving parts that go beyond patient care, such as communications, billing, insurance, and documentation.

Remember, RevOps is more than just billing and cash flow. It’s about aligning your entire practice or platform– people, processes, and technology – to drive predictable revenue and enhance the patient’s experience.

A Thorough Assessment of Front-End RCM for Healthcare
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As an example, and for the purpose of this blog- we shall focus on one of the most important areas of the revenue cycle in healthcare—the front end.

The pre-appointment phase of the healthcare revenue cycle establishes the tone for patient experience and influences everything from the subsequent treatment and trust-building that follows. From patient registration to insurance verification, each step is critical, creating a domino effect that impacts not only financial performance but also the overall patient experience.

Conversely, any missteps at this stage can lead to claim denials and delayed reimbursements, creating a ripple effect that impacts the entire organization.

Thus, a crucial component of this review of front-end revenue cycle management is not only to review the KPI's of the previous year, but to understanding the current trends in technology which ultimately helps in decision-making while strategically investing in the right technology.

The healthcare landscape is undergoing a rapid transformation as we approach 2025, driven by the rapid emergence of staff and patient-facing AI- solutions.

These AI -agents are not just enhancing the way patients interact with healthcare providers; they are fundamentally reshaping the patient's experience. With the increasing demand for convenience and transparency, patients now expect seamless access to their health information and services at their fingertips.

Another key area practice owners should focus on is implementing price transparency for their patients. Patients increasingly expect clear, upfront pricing for healthcare services, and practices that can deliver on this will gain a competitive edge.

Healthcare practices can follow the checklist below to begin planning their 2025 Front-end RevOps Strategy:

☑️ Benchmark against 2024's RevOps Performance

☑️ Solidify a Basic Understanding of AI

☑️ Review Patient Touchpoints

☑️ Evaluate Staff Efficiency Needs

1. Benchmark against 2024's RevOps Performance
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Begin by thoroughly analyzing your 2024 revenue cycle, including payer reimbursement rates, collection cycles, and key performance indicators suited to your practice setup.

Without relevant metrics to measure performance, it’s nearly impossible to plan for growth or adapt to change. Measuring performance will help you reach goals, make improvements, and benchmark your practice against standards.

This will provide a clear picture of your current state and areas that require improvement. Look for trends in payer reimbursement, collection timeframes, and denials.

Armed with this data, you can identify opportunities for improvement, such as automating manual processes, optimizing patient communication, or renegotiating payer contracts.

Examples of metrics your medical practice should be tracking:

• Number of patient visits
• Average length of time taken from first contact to appointment scheduling
• Patient satisfaction ratings
• Average time from visit to payment by patients and insurance
• Billing and collection efficiency

You may also explore:

• Payer Reimbursement Rates: Did you experience the ~3% CMS reimbursement reduction for neurology services in 2024?Did other payers follow suit? Understanding this trend is key for financial forecasting.

• Revenue Collection Lifecycle: Analyze your cash flow. Short cycles, like upfront collections, improve immediate cash flow. Long cycles, common with complex claims or denials, carry the risk of bad debt. Assess your current cycle and identify areas for improvement.

• Net Revenue and Cost Per Acquisition: These standard metrics are crucial for gauging overall financial health. Calculate your cost to acquire a new patient. What's your net revenue per patient? Track these figures to pinpoint areas for optimization.

Use these 2024 insights to set realistic financial goals for 2025.

This might include targets for increased net revenue, reduced bad debt, or a shorter revenue collection cycle. Implement practices to monitor these goals. For example, track upfront collection rates, denial rates, and average time to payment.

2. Solidify a Basic Understanding of AI and AI-Integrations
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“The first thing we ought to recognize is that AI agents are now part of the healthcare operations fabric — every day in everybody’s life. So, if you’re not looking at AI solutions, then you’re not really looking at all solutions.”

AI agents are becoming increasingly integrated into healthcare operations, impacting everyday processes. Healthcare practices are actively exploring AI applications beyond clinical settings, delving into its potential for operational areas like voice transcription and benefits verification.

Undoubtedly, Artificial intelligence (AI) is revolutionizing healthcare, including revenue operations (RevOps).

AI's ability to automate routine tasks, provide data-driven insights, and personalize patient interactions is undeniable. However, to effectively integrate AI tools, healthcare professionals need to develop a fundamental understanding of AI principles.

This can be achieved through various avenues.

Staying informed about the latest AI updates and best practices through relevant newsletters (Check out The Efficient Provider Newsletter for fundamentals of AI in healthcare pieces), articles, podcasts, and discussions with peers who are evaluating new technologies for their practices.

The 8th edition of 'The Efficient Care Podcast' titled 'Integrating Price Estimation Automations at Independent Practices' is one such sample resource that features Mike Ball, VP of Clinical Services for a neurology practice sharing his approach for evaluating AI products for his healthcare group.

Here are some further noteworthy AI use-cases in healthcare that merit exploration:

• Automated Insurance Verification: Tools like Aarogram's SmartVerify can retrieve patient eligibility and benefits information from over 1,300 insurance plans. This automation eliminates manual data entry, reducing errors, and allowing staff to focus on tasks that require human expertise.

• Real-time Patient Estimates: AI-powered systems like these cost estimators can generate precise patient cost estimates based on insurance coverage and the specific services required. Providing upfront estimates empowers patients and can lead to improved collection rates.

• Prior Authorization Support: AI can streamline the often complicated prior authorization process, helping to minimize claim denials and ensure timely reimbursement.‍

• AI-powered voice transcription: Explore AI-powered voice transcription tools that can capture clinical conversations, document it, improve accuracy, and save valuable clinician time.

3. Review Patient Touchpoints: Digitalization and Automation
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The patient journey is a series of interactions, from initial contact to post-treatment follow-up. Each touchpoint presents an opportunity to enhance the patient experience and optimize revenue flow. From scheduling appointments to paying bills, every interaction a patient has with your practice is a touchpoint. In the age of digital health, patients expect seamless, convenient experiences.

Take time to evaluate your current patient journey and aim to introduce small but significant improvements to the existing workflow. Some patient touchpoints that you may consider enhancing are:

• Embrace patient-centricity in all you do. This includes implementing regulations like the No Surprises Act, which protects patients from unexpected medical bills. Transparent communication and proactive financial guidance build trust and improve cash flow.

• Online cost estimation: Provide online cost estimation to your patient before their first visit. Offer a user-friendly website estimator tool like Aarogram’s to allow patients to easily estimate their out-of-pocket costs for specific services.

• Online Scheduling and Appointment Reminders: Reduce no-shows and improve patient satisfaction by allowing patients to schedule appointments online and receive automated reminders.

• Automatically generate patient estimation sheets: Offer patient price estimates that are accessible to patient-facing staff and patients quickly.

4. Evaluate Staff Efficiency Needs: Technology and Optimization
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In today's fast-paced healthcare environment, maximizing staff efficiency is crucial for both patient satisfaction and practice profitability. By streamlining workflows and empowering your team, you can create a more productive and fulfilling work environment.

• Identify Bottlenecks:
  • Observe staff interactions: Identify repetitive tasks, delays, and areas where staff may be waiting for information or approvals.
  • Gather employee feedback: Conduct surveys or hold team meetings to gather input from staff members on their biggest challenges and frustrations.
• Cross-Training:
  • Develop a comprehensive training program: Equip staff with the skills and knowledge necessary to perform a variety of tasks, such as scheduling, insurance verification, and patient check-in.
  • Implement a flexible scheduling system: Allow staff to adjust their schedules to accommodate personal and professional needs, while ensuring adequate coverage for patient care.  
• Invest in Technology:
  • Explore automation tools: Implement technologies that can automate repetitive tasks, such as appointment reminders, insurance verification( for example, Aarogram), and data entry.
  • Provide staff with the necessary tools and resources: Ensure staff have access to the technology and equipment they need to perform their jobs efficiently and effectively.  

By proactively addressing the above front-end RCM areas, you can create a more efficient and productive work environment for your staff.

Need help implementing automations at your medical practice or digital product quickly? Book a meeting with an Aarogram expert today.

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