Jim Bohnsack, chief strategy officer at Aspirion, moderates a panel discussion featuring Edna Buffington, vice president of revenue cycle at Community Health Services, and Spencer Allee, director of artificial intelligence at Aspirion. Bradley Tinnermon, senior vice president of shared financial services at Kaiser Permanente, and Ted Syverson, vice president of revenue cycle at King’s Daughters Medical Center.
LAS VEGAS – A panel of revenue cycle experts shared their biggest challenges during the annual HFMA conference in Las Vegas on Tuesday.
The massive three are employment, denials, and prior authorization. No one probably surprised the standing-room-only audience at the Mandalay Bay Conference Center. More than 3,500 people attend the Healthcare Financial Management Association’s annual conference.
Hospital CFOs have been grappling with these issues for some time, with claims denials and prior authorizations becoming such a growing threat to providers’ finances that some have stopped accepting Medicare Advantage reimbursements, although denials are reported to be widespread.
A bipartisan group of more than 50 representatives and senators sent letter of June 25 asking Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure for increased oversight of Medicare Advantage coverage decisions. Plans are using artificial intelligence to wrongly deny care, lawmakers say.
Panelists said they exploit AI and automation in all problem areas where practical.
“A Practical Approach to Leveraging Artificial Intelligence, Machine Learning and Automation in the Revenue Cycle,” moderated by Jim Bohnsack, chief strategy officer at Aspirion, included panelists Edna Buffington, vice president of revenue cycle at Community Health Services; Spencer Allee, chief artificial intelligence officer at Aspirion, Bradley Tinnermon, senior vice president of shared financial services at Kaiser Permanente, and Ted Syverson, vice president of revenue cycle at King’s Daughters Medical Center.
It is tough for hospitals to remain competitive in attracting workers to the lowest-wage occupations in the health care system, such as registration. Buffington said workers can earn $25 at a car wash, compared to $14 an hour when a hospital employee works at the registration desk.
Due to staff turnover, hospitals also have difficulties with customer service, where registration may be the first point of contact.
CHS uses AI to automate areas such as the telephone system and redeploy staff to other positions.
Denials are a top priority for CHS, Buffington said. The health system is becoming very proactive in getting preauthorizations. For example, colonoscopies are being denied if there is no preauthorization before a biopsy.
“These are the main challenges for all of us to improve our reimbursements,” Buffington said.
The CHS system automatically corrects differences in the amount paid if the insurance amount differs from that stated in the system.
CHS receives a weekly denial report. It considers how to implement systems for more convoluted denials and whether this is something that needs to be built in-house or purchased.
Tinnermon said all revenue cycle departments are considering building, purchasing or collaborating.
Many people have tried to automate the pre-authorization space, but it has proven to be a bigger challenge than many people realize, Tinnermon said.
However, Kaiser does a lot of analysis on denial codes and what it takes to fix them.
“That’s something we’re really looking into,” Tinnerman said, “to see what we can automate.”
Denials mean money is being spent on legal resources. More legal expenses have been spent on convoluted claims and contract issues over the past seven years, said Syverson of King’s Daughters Medical Center.
Tinnermon said Kaiser Permanente is taking an in-depth look at automation to eliminate differences between systems. Some ideas for artificial intelligence and technological improvements die on the drawing board due to lack of connection to existing systems.
Kaiser is an integrated system that operates a risk-adjusted health plan that will likely continue to grow, Tinnermon said. And it runs three revenue cycles: a value-based revenue cycle, a revenue cycle for self-funded plans, and a typical fee-for-service revenue cycle.
When it comes to AI and automation, the first thing Kaiser looks for is the stability of the underlying technology. The second is the cost of collection, and the next step is whether the systems should perform real-time automation or an overnight approach.
“I would say there aren’t many places we aren’t looking,” Tinnermon said.