Revenue Cycle Automation: Not hot, still bought

May 28, 2024

Workflow automation in healthcare has gotten a bad rap, but automating administrative tasks can help cut costs and get patients care faster. Where most existing systems of record have limited capabilities enabling automation, revenue cycle automation products can focus on both integrating with these systems and creating automated agents to run through common workflows.

Enter revenue cycle automation

Instead of replacing key systems, these vendors integrate into them and use a combination of rules and AI to automate common workflows within them. Key use cases here include:

  • Claims processing

  • Eligibility verification

  • Prior authorization

  • Patient payment collection

  • Denials management

Tradeoffs and possibly Hegelian synthesis?

Vendors in this category use one or more core approaches to enable integration:

  • UI automation – can be brittle, but is fast to implement and requires no API support.

  • API integrations – these generally work well but require substantial engineering investment.

  • AI-enabled UI navigation – technically challenging and potentially prone to unexplained behavior, but promising as the future of process automation.

Similarly, vendors’ strategies for programming automation include recording clicks and keystrokes, coding and rules engines, natural language, and combinations thereof. The most robust automations tend to come from coded implementations, but LLMs are a potential wonder-tool for generating robust automations more quickly.

Vertical-native versus horizontal products

The category can be broken down into RCM-focused products (Element5, Infinx, Jorie AI, and Thoughtful AI) and EHR systems, and vertical-agnostic products like Luminai (AI-Enabled UI Automation) and UiPath (both connectors and UI Automation).

RCM-focused products have specific, built-out workflows at which they excel, whereas the open-ended products tend to be applicable across a wider range of use cases. If you’re looking for general purpose automation across many workflows, you should consider the vertical-agnostic products, but if you have tightly defined workflows with integrated systems, perhaps an RCM-focused vendor makes sense.

Looking forward, we’re interested in how revenue cycle automation tools evolve as platforms incorporate more native AI. There’s a lot of promise here for rapid improvement.