Optum Leaders on the New Revenue Cycle Management - and Its Challenges and Opportunities

Revenue cycle management (RCM), long a staple function of hospital and health system operations, has been undergoing a thorough transformation of late, evolving forward through advancing iterations of such methods as business process automation (BPA) also known as robotic process automation (RPA), which have been successfully incorporated into core RCM processes around managing all claims processes and into new territory. That new territory encompasses the emergence of the leveraging of machine learning- and artificial intelligence (AI)-based technologies to achieve what is being called predictive denials management. Essentially, this involves the development of algorithms based on data analytics, that can trigger interventions based on anticipated insurance claims denials.

That evolution was the subject of one of the Ten Transformative Trends that the editors at Healthcare Innovation examined in the publication’s March/April issue. In an article entitled “The New Revenue Cycle Management,” Healthcare Innovation Editor-in-Chief Mark Hagland interviewed a variety of industry leaders regarding the rapid advances taking place now in revenue cycle management, which has become an absolutely critical function for hospitals, medical groups, and health systems, as their leaders attempt to weather the financial storm that has come in the past year with the emergence of the COVID-19 pandemic in the United States, and its impact on patient care organizations nationwide.