Revenue cycle management (RCM) has long been considered one of the top use cases for artificial intelligence (AI) and automation in healthcare.
For those familiar with healthcare finance, the potential benefits of artificial intelligence and automation for RCM are obvious. RCM is filled with repeatable, frequent processes that can be standardized, such as prior authorization, referrals, claims management, and admission notification, making it uniquely suited to the efficiencies that automation can provide.
The American Hospital Association says that by streamlining these common RCM tasks, automation can reduce administrative burden and expense while increasing efficiency and productivity.
According to Deloitte, 74% of hospital CFOs and revenue cycle leaders say they already use automation or are implementing automation in their revenue cycle operations.
Deloitte says that with today's technologies like automation and artificial intelligence, revenue cycle professionals can free up up to 50% of their time to take on more strategic and relationship-building responsibilities.
For hospitals, successful automation starts with strategic preparation.
Here are five essential tips to help hospitals prepare for automation and drive new levels of efficiency, productivity and performance in RCM.
Map current workflow pain points: Before automation can come into play, hospitals must have a clear understanding of what inefficiencies exist in their current revenue cycle processes. RCM is complex by nature, with large teams spanning multiple functions and work processes. This complexity often creates bottlenecks, redundant steps, or inconsistent processes that lead to longer reimbursement times, higher levels of employee burnout, and weakened cash flow.
Identifying these workflow pain points lays the foundation for a targeted automation strategy. Identifying which steps are highly manual, error-prone, or repetitive allows leaders to prioritize the processes that need automation the most. By visualizing each stage of a claims or authorization workflow, organizations can discover where delays occur, such as handoffs between departments or payer-specific slowdowns. With this knowledge, automation becomes a tool of precision rather than guesswork, resulting in significant improvements in speed, accuracy, and efficiency.
Assess technical infrastructure and interoperability: A common pitfall in automation initiatives is underestimating the importance of technology infrastructure. Even the most sophisticated automation solutions can run into problems if they fail to integrate with a hospital’s existing systems. Seamless interoperability with electronic health records (EHRs), payment portals and other core technologies is critical to avoid costly outages or workarounds.
Hospitals preparing for automation should first evaluate whether their IT environment can support the new tools without creating friction. This means evaluating system compatibility, data sharing capabilities, and scalability. The goal is to ensure that automation can plug into existing workflows rather than forcing employees to adopt parallel processes. Investing in robust infrastructure up front reduces risk, accelerates deployment, and sets the stage for sustainable automation growth.
Key performance indicator benchmarks: Automation is not a blanket solution; it is most effective when aligned with an organization’s specific performance goals. Benchmarking key metrics before implementation can provide the baseline needed to measure progress and determine where automation will yield the greatest returns. Typical benchmarks might include collection costs, denial rates, days authorized, time spent per claim, and charge-off amounts.
By establishing these benchmarks, hospitals can clearly understand the pain points and potential value of automation. Tracking improvements over time also holds teams accountable and ensures automation is tied to tangible results. Ultimately, benchmarking enables leaders to demonstrate value to stakeholders and refine their automation strategies based on actual results rather than assumptions.
Assess team readiness and change preferences: Technology alone does not guarantee success: People are at the heart of any automation initiative. Hospitals must assess whether employees are ready for change and develop a plan to win buy-in throughout the organization. Resistance is natural, especially in healthcare, where employees are accustomed to established workflows and wary of disruptions.
Preparing the workforce includes transparent communication about automation goals, training for employees on required skills, and opportunities for teams to provide feedback. Hospitals that engage employees early in the process are more likely to see smoother adoption and stronger long-term results. By viewing automation as a tool that reduces administrative burdens and frees employees to focus on higher-value activities, leaders can help shift the mindset from worry to enthusiasm.
Continue to iterate and discover new opportunities: Automation should be viewed as a journey, not a one-time project. Once a hospital begins to see the benefits of automation in certain areas of the revenue cycle, it must continually evaluate new expansion opportunities. This iterative approach enables organizations to build on success and adapt to changing challenges, payer requirements or regulatory changes.
Regularly reassessing workflows ensures hospitals remain proactive rather than reactive. As technology advances and organizational needs change, new use cases for automation will emerge—from denial management to patient financial engagement. A culture of continuous improvement ensures that automation is not only implemented but becomes a core driver of efficiency, economic sustainability and patient satisfaction.
Preparation drives results
The promise of RCM automation is undeniable, but achieving it will require more than just adopting new tools. Hospitals must take prudent steps to prepare their people, processes and systems for change.
Mapping workflow pain points ensures automation targets the right problems. Assessing infrastructure and interoperability can prevent costly implementation challenges. Benchmarking metrics provide clarity and accountability. An engaged team drives adoption, while continuous iteration scales the value of automation over time.
Taken together, these steps create a roadmap for hospitals to not only successfully implement automation but also maintain its benefits into the future.
Image: erhui1979, Getty
Jamie Hill-Walters, CRCR, serves as chief customer officer at Janus Health and has nearly 20 years of healthcare revenue experience. As CCO, Jamie leads Janus Health's customer-centric strategy, overseeing the delivery of an exceptional customer experience and ensuring our products, services and operations align with customer needs and expectations. Prior to joining Janus Health, Jamie served as Chief Revenue Officer at Alpha II, serving on the leadership team through two acquisitions and strategic investments from TA Associates and Westview Capital Partners. Prior to joining Alpha II, she held various leadership positions at Ensemble Health Partners and Healthcare Payment Specialists (acquired by TransUnion). Jamie is the past president of the HFMA Lone Star Chapter and has worked with the largest healthcare systems in the United States, many of which have been recognized as “America's Best Hospitals” by U.S. News & World Report.
This article appeared in Medical City Influencers program. Anyone can share their thoughts on healthcare business and innovation on MedCity News through MedCity Influencers. Click here to learn how.
