HFMA 2024 Recap: Revolutionizing Revenue Cycles From Prior Authorizations to Peak Productivity

HFMA 2024 offered enlightening perspectives on some of today's most pressing topics in revenue cycle management. As we listened to conference speakers and interacted with attendees, a few key themes emerged:

• Overcoming prior authorization challenges that contribute to denials and disrupt cash flow
• Accelerating the adoption of AI to improve operational and financial efficiency
• Engaging patients in a way that supports both high-quality care and financial solvency

Inovalon is here to help providers address these common challenges and more.

Overcoming prior authorization challenges

Lack of prior authorization is a major driver of revenue-slowing denials, and 90% of physicians say strict pre-authorization requirements have a negative impact on patient care.¹ Despite technological advancements, many providers still complete prior authorization processes manually. This leads to slow turnarounds and a higher opportunity for error, not to mention creating a stressful situation for patients.

Providers can expedite patient registration and eliminate time-consuming tasks by automating the process of verifying patient information, finding all available coverage, and checking eligibility. With Inovalon's registration workflow software, all of this can be completed before a patient walks in the door.

Streamlining these labor-intensive activities simplifies patient intake and contributes to a more seamless care experience. Accurate up-front information prevents claim denials on the back end, which further reduces the administrative burden on staff and helps providers get paid faster.

Leveraging AI to enhance financial and operational efficiency

AI seemed to be the buzzword of HFMA 2024, with healthcare leaders recognizing the need to swiftly harness AI-powered tools to alleviate cumbersome tasks and combat soaring claims denials.

In a recent Inovalon survey of more than 400 healthcare industry professionals, 41% of respondents cited claims denials as the top challenge their organization is facing.² Providers were optimistic about AI's ability to turn the tide on this challenge via capabilities like intelligent denial prediction, pre-submission denial flagging, mass denial appeals, and auto-generated appeal letters.

Denials aren't the only area where providers see the potential to drive efficiency and enhance processes with the help of AI. Survey respondents said intelligent tools could improve the revenue cycle by:

• Minimizing revenue cycle friction
• Accessing deep revenue cycle insights
• Conducting AI-based pre-reviews to speed up conventional review processes
• Automating expensive human-based tasks
• Responding to patient collection inquiries
• Assessing risk
• Diagnosing and solving for problems in the revenue cycle

Overall, leaders are hopeful about the opportunity to leverage AI for positive business outcomes in the months and years ahead.

Inovalon's Claims Management software helps providers enhance revenue cycle management by simplifying every step of the claim life cycle. An advanced rules engine proactively catches mistakes and flags claims at risk of being denied, while predictive analytics pinpoint opportunities to improve accuracy and identify when a specific payer is likely to reject a particular claim. By using our technology to identify claims errors before they're submitted, providers reduce their denial rates by an average of 40%.³

Hospitals and practices can further overcome the surge in denials by adopting time-saving workflows to address rejected claims. Claims Management's click-to-fix claim corrections coupled with automated audit responses and appeal submissions ensure complete reimbursements are captured rather than turning into bad debt.

Engaging patients clinically and financially

Today's providers face the delicate challenge of providing high-quality, compassionate care while being vigilant of financial outcomes. Activities that address payment at the start of the care journey can reduce back-end collection efforts while providing a better patient experience.

Inovalon's Registration Workflow software speeds up critical patient intake tasks like authenticating patient identity and benefits details so the appropriate payer can be billed on the first pass and patients spend less time in waiting rooms. Simple, easy-to-understand billing promotes cost transparency while alleviating stress on patients. With the right technology, providers can offer a hassle-free experience from a patient's first interaction, which sets the tone for a positive path forward.

We are thrilled to have engaged with many forward-thinking healthcare organizations at HFMA. Now, we invite you to join us at Empower, Inovalon's annual data-driven healthcare summit, in Washington, D.C. from October 27-29. Alongside our customers and industry experts, we will explore how our solutions enhance cash flow, expedite the operational adoption of AI, and improve the patient experience.

Sources:

1. "Prior Authorizations Beat COVID Workplace as Top Regulatory Burden," Jacqueline LaPointe, RevCycle Intelligence, October 27, 2021, https://revcycleintelligence.com/news/prior-authorizations-beat-covid-workplace-as-top-regulatory-burden
2. "Exploring AI's Role in Revenue Cycle Management: A Data-Driven Study of Adoption and Sentiment," Inovalon, July 9, 2024, https://www.inovalon.com/resource/exploring-ais-role-in-revenue-cycle-management/
3. Inovalon internal reporting. Average of customer results, February 2023

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