Category: HealthTech

By Edward Maule, CIO and CISO, Advocare Bad things happen. While we can work hard to minimize the chances of bad things happening, we cannot completely eliminate them. The best option is to transfer some of that risk, which we do by purchasing insurance. Cyber insurance is becoming an increasingly necessary, but increasingly challenging proposition. In the past, virtually any company could buy cyber insurance, regardless of the state of their cyber defenses. The only variable would be the cost. This is no longer the case. Due to losses across nearly the entire insurance industry, insurance companies are no longer willing to sell insurance to organizations that don’t have a healthy cybersecurity program. At our organization’s last renewal, our insurance broker presented us with a long list of tools that needed to be in place, or they would be unable to obtain bids for us. These included a SIEM, Immutable Backups, Privileged Access Control, Network Segmentation, and an EDR, among other things. Interestingly, our broker made it clear that due to the spectrum of capabilities with EDR products, we should be conservative and choose a product in the Gartner magic quadrant. If you haven’t invested enough in cybersecurity, you had better invest more heavily in cyber insurance. This was particularly challenging, as the news came after the recent budget cycle had begun. We had no choice but to commit unbudgeted funds to meet these requirements. Not having cyber insurance was not an option. In the end, we were able to keep the costs under control by lucky timing with expiring contracts, and vendors willing to get creative with the timing of invoices. The lesson here is that when it comes to cyber security budgeting, assume that surprises may come; when they do, they will be big ones. The story does have a happy ending, however. Due to the hard work of our Infrastructure and Cybersecurity teams, we could get everything in place within the limited time we had. When we moved on to renew our insurance, we were surveyed to determine if we had met all the requirements. We did so well that not only did we have no trouble obtaining new cyber insurance, but our rates stayed flat, with our deductibles actually going down. Obtaining cyber insurance was a challenge in and of itself, but not the last challenge related to cyber insurance. As with any insurance, you need to make sure that your coverage matches your specific needs. A cybersecurity incident can cost wildly different amounts, making it difficult to estimate. And generally speaking, you have probably underestimated them. There are people costs, hardware costs, lost revenue, and possible regulatory penalties. These costs are likely inversely proportional to the investment you’ve made and the maturity of your cybersecurity program. If you haven’t invested enough in cybersecurity, you had better invest more heavily in cyber insurance. The real challenge is in being honest with the sophistication of your cybersecurity posture and reasonable, if not flat-out pessimistic about the costs of a cybersecurity incident. One area often overlooked is how your cyber insurance provider and/or your broker can help with your cybersecurity program. They often provide free tools and surveys to measure your cybersecurity program’s maturity and compare and contrast it to other, similar organizations. You answer a series of questions and are given a rating. While this is no replacement for a 3rd party assessment, it does provide a free view into your status any time you need it with much less effort. Another useful service they often provide is downtime tools. One area that cybersecurity sometimes struggles with is business continuity, particularly inside their own department. We all depend on our computers and phones and the data on them. I’m betting that of the hundreds of phone numbers in your phone, you only actually know three of them: yours, your significant other’s, and the one from the house you grew up in. However, in a cybersecurity incident, you might not have access to your contacts. The insurance company and brokers often provide tools to store key data such as contact information, standard forms, and policies. Though I would advise having hard copies of all of this, as in a geographic cyber security event, even that might not be available. The final, and possibly most important tool they provide is cybersecurity tabletop incident exercises. Cybersecurity programs can rarely be better than they are funded. Tools and people cost money. For this reason, it is critical that executive leadership and the board understand the risks and possible negative eventualities. As we all say in cybersecurity, “It is not if, but when.” To this end, running tabletop exercises can help the people that run and govern your organization to accurately understand just how impactful and challenging a cybersecurity incident will be for your specific organization. It makes the general specific and very personal (from a professional perspective). I know that at the beginning of my career in cybersecurity, I focused more on the technical aspects of the job. But as time has passed (and I do less and less actual technical work), I have learned to focus on the things that don’t come naturally to IT people, and cyber insurance is surely one of these things. We are all well served by taking a pause and evaluating our own cyber insurance situation. The post Modern Challenges Around Cyber Insurance appeared first on HealthTech Magazines.

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By Beth Carlson, CRCO, WVU Medicine As healthcare organizations navigate the complex landscape of digital transformation, revenue cycle technology has emerged as a critical component for driving operational efficiency and financial sustainability. Yet today, every department seems to be in motion—implementing new tools and chasing solutions all in the name of efficiency and survival. It’s an industry-wide pressure cooker. While others are moving fast, your revenue cycle team feels paralyzed by overwhelming options and the fear of making the wrong move. The result? Overwhelm morphs into inaction, and organizations find themselves in a constant state of assessment, trapped in a decision gridlock. The Crossroads: Promises and Pitfalls of Revenue Cycle Technology From automating coding to leveraging AI for denials management, we’re promised significant value. Yet many leaders remain desperate for clearly defined capabilities, compelling proof of concept, and transparent ROI. The promises often clash with internal skepticism, preventing strategic adoption. Lack of Proof of Concept: Vendors often present idealized scenarios, but real-world results remain elusive. Pilot projects may be too narrow or lack measurable outcomes, leaving decision-makers unsure about scalability. Analysis Paralysis: The proliferation of tools, platforms, and buzzwords overwhelms leadership teams, hindering their ability to make informed decisions. The sheer volume of options—each promising transformative results—makes it difficult to confidently chart a path forward, and persistent vendor pressure only adds urgency without clarity. ROI Uncertainty: Without solid benchmarks or historical data, calculating a realistic ROI is challenging. Financial leaders hesitate to invest without a clear understanding of cost recovery timelines or long-term value. Revenue cycles are often anchored in short-term financial metrics—but to innovate meaningfully, they must adopt a new mindset: one that embraces iterative learning, tolerates uncertainty, and prioritizes long-term transformation. Revenue cycle technology should be scalable, but it may be best to start small and expand based on success. Check, But Not Checkmate: Exposing the Blind Spots Data Unfit for Duty Most revenue cycle tools were designed for structured data—standard fields in defined formats—but real healthcare data is messy. EHRs contain mostly fragmented, incomplete, or inconsistent data across clinical notes, scanned PDFs, and various payer correspondence. If your solution can’t effectively process this unstructured data, it will limit your automation potential and create blind spots that can undermine your outcomes and ROI. Also, integration isn’t “plug-and-play.” Even with APIs, technical debt and customized workflows create expensive roadblocks that can derail implementation. Talent isn’t Turnkey Your tech may be up to date, but you can’t just upgrade your workforce with a software patch install. Revenue cycle teams are experts in operations—but they’re increasingly being asked to manage initiatives involving APIs, automation, machine learning, and data pipelines. These systems have complex dependencies and maintenance needs that most RCM leaders don’t possess the technical backgrounds to support. It’s crucial to be clear about what to expect from the technology, how it will integrate with existing systems, and who is responsible for fixing it when it breaks. When technical workflows are treated like traditional operations—without proper technical oversight or governance—ROI evaporates, and trust erodes. Organizations must build cross-functional teams that combine operational and technical expertise, providing leaders with a pathway to manage the new landscape. Suspected Diagnosis: Institutional Amnesia, Unable to Rule Out When executed correctly, technology serves as the team’s knowledge partner, not a replacement—a hybrid model where systems handle scale and speed, and humans contribute insight and adaptability. However, as AI applies more advanced deep-learning methods, there’s a growing risk that organizations may lose critical organizational memory that experienced revenue cycle professionals possess. Over time, employees may become less engaged with the “why” behind processes, relying on AI output without understanding context or leveraging opportunities for reinforcement. This passive reliance can lead to a fragile operational environment where key institutional knowledge—such as discernment of payer behaviors, workaround needs, and regulatory gray areas—is lost. Breaking the Gridlock: The Next Move is Yours Revenue cycle initiatives must be strategically integrated into the organization’s broader AI roadmap. A cross-functional governance model, including IT, finance, HR, and compliance, ensures that decisions align with enterprise risk frameworks and helps organizations move past the paralysis to fully harness AI’s potential. Demand Proof of Concept with Scalable, Modular Architecture AI maturity varies across organizations. Revenue cycle technology should be scalable, but it may be best to start small and expand based on success. Modular solutions allow organizations to adopt key functionalities without committing to full-scale transformations immediately. This approach builds confidence in a focused scope while cultivating stakeholder trust over time. Reframe your ROI Mindset Break down ROI projections into phases: efficiency today, sustainability tomorrow, strategic advantage over time. Also, rather than merely treating AI as a cost-cutting mechanism, leaders should view it as a strategic asset: one that unlocks new ways to engage patients, negotiate with payers, and stabilize institutional knowledge. Create Cross-Functional AI Literacy and Talent Development Successful technology adoption isn’t a project; it’s a capability built on people and process. To drive sustainable solutions that foster smarter adoption and faster iteration, organizations must build AI fluency across business units, extending expertise beyond IT so revenue cycle teams understand how it works, where it helps, and its limitations. This requires intentional and strategic workforce development: creating competency models, data-adjacent career paths, and upskilling staff through structured training and hands-on experience. Strategy, Talent, and Technology Must Evolve Together Winning a chess match isn’t about a single bold move; it’s about strategic alignment, foresight, and the ability to adapt with precision. In the face of market pressures and internal indecision, these are the antidotes. The pace of change isn’t slowing, and standing still is falling behind. It’s time to cut through the noise, regain clarity, and move forward with intention. The post Overcoming the Stalemate: Making Your Next Move on Revenue Cycle Technology appeared first on HealthTech Magazines.

Source: https://www.healthtechmagazines.com/promises-and-pitfalls-of-revenue-cycle-technology/

By Brian Sterud, CIO and CISO, Faith Regional Health Services In today’s digital age, hospitals are increasingly reliant on technology to manage patient care, records, billing, and communications. While these innovations improve efficiency and outcomes, they also expose hospitals to significant cyber risks. Healthcare institutions are among the top targets for cybercriminals due to the sensitive and high-value nature of medical data. As a result, cyber liability insurance has become an essential part of risk management for hospitals. What is Cyber Liability Insurance? Cyber liability insurance provides financial protection against losses arising from data breaches, ransomware attacks, and other cyber incidents. For hospitals, a policy may cover: Data breach response costs: Including notification of affected individuals, credit monitoring, legal fees, and public relations. Regulatory fines and penalties: Coverage for HIPAA violations and other compliance-related fines. Business interruption: Compensation for lost revenue due to system downtime from a cyberattack. Cyber extortion: Assistance and payments related to ransomware demands. Liability coverage: Protection against lawsuits from patients or third parties affected by a breach. Cyber liability insurance is no longer optional for hospitals—it’s a necessity in the face of rising cyber threats. Why Hospitals Need Cyber Liability Insurance Hospitals face unique cyber risks due to: High-value data: Electronic health records (EHRs) are lucrative on the black market. Complex networks: Multiple integrated systems increase vulnerability. Compliance obligations: Strict regulations like HIPAA require robust data protection. Life-critical systems: Downtime from attacks can jeopardize patient care. Cyber insurance has been a moving target within the healthcare industry over the last decade. As an industry, we’ve gone from not needing a policy to not being able to afford one. In fact, many organizations have chosen to self-insure to mitigate the rising premiums. This is not an option for mid to small organizations that may not have the buffer in their reserves to cover losses and stay afloat. In those situations, the organization is left to decipher the best path forward as a policyholder. One significant change has been the process of applying for coverage. Typically, there is an initial questionnaire that outlines the cybersecurity practices that are being followed by the hospital. There was a time when the questionnaire was around one page long, and no verification was performed on the answers. This has changed tremendously and is now a multi-page process with verification measures to determine the actual risk to the cyber liability provider. Given the increasing number of breaches in the last ten years, who could blame the insurance providers for validating their risk? In the past, they collected premiums, with claims being few and far between. The increasing number of breaches changed this landscape and ultimately, the frequency of claims submitted by healthcare providers. How to Reduce Cyber Liability Insurance Premiums Premiums for cyber liability insurance can be substantial, especially for large or high-risk institutions. However, hospitals can take strategic steps to reduce costs while maintaining robust coverage. The insurance providers assess the risk of the healthcare provider when they are writing the policy. The higher the risk, the higher the premium. In fact, there can be instances where coverage won’t be offered if their risk is deemed too high. As such, a more secure environment can reduce the risk and the associated premium.  Following are the ways to reduce risk and premiums 1. Strengthen Cybersecurity Infrastructure Implement advanced firewalls and intrusion detection systems. Regularly patch software and update systems. Conduct third-party security audits. 2. Conduct Regular Risk Assessments Routine risk assessments demonstrate proactive management of vulnerabilities. Documenting and mitigating findings can improve insurability and reduce rates. 3. Develop a Comprehensive Incident Response Plan A well-documented and tested response plan can reduce downtime and damages in the event of a breach—minimizing claims and enhancing insurer confidence. 4. Train Employees in Cyber Hygiene Human error is a leading cause of breaches. Regular training on phishing, password security, and device usage can significantly reduce risk. 5. Use Data Encryption and Multi-Factor Authentication Encrypting data at rest and in transit, and requiring multi-factor authentication (MFA) for access to sensitive systems, are key best practices that insurers reward. 6. Limit Access to Sensitive Data Implement role-based access controls and regularly review user permissions to ensure only authorized personnel can view or modify patient data. 7. Obtain Cybersecurity Certifications Certifications like HITRUST or ISO/IEC 27001 signal to insurers that a hospital follows industry best practices, which can lead to discounted premiums. 8. Work with a Cyber Insurance Broker Specialized brokers understand the cyber insurance market and can help hospitals negotiate better terms and identify underwriters that offer favorable rates for healthcare organizations. Conclusion Cyber liability insurance is no longer optional for hospitals—it’s a necessity in the face of rising cyber threats. However, hospitals can take proactive steps to enhance their cybersecurity posture, reduce risks, and ultimately lower insurance premiums. By combining sound IT practices with strategic risk management, hospitals can protect their operations, patients, and bottom line. The post Cyber Liability Insurance for Hospitals: Understanding Coverage and Reducing Premiums appeared first on HealthTech Magazines.

Source: https://www.healthtechmagazines.com/cyber-liability-insurance-for-hospitals-understanding-coverage-and-reducing-premiums/

By Anna Lee Jones, CNO, Claiborne Memorial Medical Center You would have to be far removed from the world of healthcare today to not scroll through your favorite social media platform and see countless reels where healthcare workers discuss being mistreated, making fun of management and hospital administration. If you are a CNO, DON, CEO, CFO, or Unit Manager, the first inclination is to pull back and immediately say, “That’s not me.” I often cringe when I realize mistakes made as a younger manager, and I take note of skits relating to healthcare management and staffing. Being very self-aware and connected to what the staff is being fed is vital. We cannot continue to ignore the realities that have led to our current staffing crisis. I do not pretend to know everything about healthcare staffing or managing healthcare staff, but I do know a thing or two about people. Some characteristics bring warmth, and others lend themselves to coldness. As much as nurses like to eat, I assure you that pizza for the night shift is not the type of appreciation they seek. The extra shift diff is not enough for the time they spend away from their family, or they are sacrificing their sleep to spend more waking moments with their children and family. As a manager, do you know what motivates your employees? It is a key point to ponder, especially when addressing healthcare staffing in retention. Yes, there are healthcare shortages from doctors, nurses, respiratory therapists, laboratory technologists, and every other patient-facing clinician in healthcare today. With staffing shortages, larger institutions have deepened their pockets, which is terrific in the post-COVID economy. Still, if you are not fulfilling the non-monetary needs of your employees, you will not retain them long term. There are core needs that must be met in healthcare workers for them to stay five years, and other than being paid fair wages, none of them has anything to do with money or pizza. Leaning in is not new, cutting-edge, or a new think tank theory. It is the basis of human connection, the foundational cornerstone of every relationship. If you have heard the old saying that no one appreciates anything more than being appreciated, you understand what I mean. I have found that the most beneficial means of employee retention is to practice what I call “leaning in.” Leaning in is simply being present and stepping in from time to time. Leaning in allows you to experience the happenings from the employee’s perspective. It also lets the employee see you climbing into “the trenches” with them. This time sharing fosters trust, and with trust comes an open relationship. With an open relationship, communication improves bi-directionally, showing the employees that their voice matters. As a CNO in a small rural hospital, I am afforded opportunities that my counterparts in larger institutions are not. I do not ever take that for granted. I still occasionally staff both the medical-surgical unit and work alongside my incredible ICU staff, where I quickly remind them that I am a solid second, but not a first. When I am alongside my staff, I relate to them on a different level; the bond, trust, and respect are different. Our relationships become different, deeper, and more mutually satisfying, and I can lean in and say the things they need to hear, like “Wow, great catch” and “You called that one, good job.” These small but personal interactions set the stage for genuine appreciation. Another core need for healthcare workers is respect. Every healthcare worker I have ever met had a very real and reasonable desire to be respected, and they should be. Even the most mediocre staff members have been tasked with saving lives, assisting with personal needs, and being present when life is at its worst. That is respectworthy, but you can only do that by leaning in. I hear so much about nurse retention bonuses, and while that is an excellent method to attract high performers, it is not the best method to retain them. As healthcare professionals, we prioritize the care for our patients. As healthcare managers, we need to prioritize the care and well-being of our staff. People who care for others need, deserve, and want to be cared for. Leaning in is not new, cutting-edge, or a new think tank theory. It is the basis of human connection, the foundational cornerstone of every relationship. Most importantly, it is not something that they should have to ask for. “Leaning In” is a way for managers to relate to their employees on a deeper level, work alongside them, and show appreciation directly. Retention of the best nurses in any organization solely lies in the hands of the nurses wanting to be retained. There is no single finding on a culture assessment at the smallest or largest healthcare facility, magic program, or employee recognition events that will keep an employee who feels undervalued, unappreciated, unchallenged, and unheard daily. “Leaning In” is about returning to the basics of healthcare staffing. It is about sharing experiences with nurses and other allied health professionals outside the supervisor-subordinate realm. Asking for opinions is leaning in. Hanging an antibiotic piggyback is leaning in. Answering call lights for 15 minutes while the ward clerk walks off the unit is leaning in. Offering to sit with a confused patient for 15 minutes is leaning in. Telling a nurse that you are proud of their work is leaning in. Utilizing all the compassion and grace we would have given our patients and now sharing that with our staff is “leaning in”. “Leaning In” works because it is meaningful and personal. It will cost you some time but also increase your joy as a manager to just “lean in”. The post Leaning In appeared first on HealthTech Magazines.

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By Victor Bycroft, Chief Nurse Executive, Humboldt County Memorial Hospital This may be a controversial opinion, but nurses are the backbone of any healthcare organization. While ancillary services are vital and provide invaluable portions of care, nurses are at the top of the food chain when it comes to direct, hands-on patient care. This is why the current and worsening shortage of nurses in this country is so concerning for all aspects of healthcare. Nursing shortages are not a new concept. They have existed to some extent as long as nurses have been utilized, typically running in cycles with an ebb and flow of approximately eight to ten years. Each decline brings about mild panic for a short time, then the available pool increases, and everyone breathes a collective sigh of relief. However, since 2020, the nursing profession has seen a steady decline in available numbers, and the future appears grim. The COVID-19 pandemic briefly highlighted nurses as heroes, but the fanfare quickly dulled, leaving nurses feeling disenfranchised and unappreciated. This led to an unprecedented exodus of nurses from the profession. This presents numerous challenges for any organization relying on a stable pool of nurses to provide care. Still, these challenges can vary based on the organization’s size, geographic location, and other factors. The nursing shortage will not go away any time soon. We must continue to adapt to this new paradigm as we seek to provide high-quality care. All organizations must be acutely aware of the challenges posed by competition in recruiting nurses. Urban areas tend to attract a larger number of candidates but also have more facilities nearby competing for those candidates. Rural areas struggle to draw many candidates but typically have a greater distance between facilities. This does not necessarily reduce geographic concerns, as nurses who migrate to rural areas tend to be more willing to travel a greater distance for the right job and environment. Wages have always been a concern for nurses, with many feeling that their compensation is not commensurate with the expectations set on them. This leaves healthcare facilities chasing a mark that is often difficult to pinpoint, let alone nail down. Available jobs far exceed the number of nurses to fill those positions. Nurses can shop around for the best wages and benefits, causing hospitals to compete more than ever. To remain viable in the recruitment process, facilities continue to increase the starting salaries for new nurses as well as for seasoned nurses switching to new roles. This can lead to tenured staff nurses feeling undervalued and unappreciated as they see individuals starting with wages at or about what they have taken years to achieve. This can also lead to increased healthcare costs as facilities raise prices to offset the salary increase. This leads to higher turnover rates in facilities and areas that are unable to keep pace with the market. Imagine being a hospital in northern Iowa. Iowa ranks 48th out of 50 states and the District of Columbia for average nurse salary, while Minnesota ranks 14th. A short drive and a little paperwork between nurse license compact states can allow a nurse to earn $20,000 more per year. Mobility can lead to even higher wages, with California offering double the average annual salary compared to Iowa. With exceedingly tight margins, the ability to compete and attract nursing staff is low, especially in smaller markets. Another challenge is the change in expectations among nurses. While this is often attributed to younger generations, recent trends show that nurses are looking for improved work-life balance across the continuum. This means fewer nurses are willing to work the shifts required in a hospital setting, specifically evenings, weekends, and holidays. In a workplace that never closes, this leads to frustration among all nurses; those willing to work those shifts are asked to do more, and those who don’t want them are pushed to work shifts that do not fit their ideal schedule. With fewer nurses available, the remaining staff must take on an increased workload. Nurses frequently complain about being required to do more with less. This can lead to an increase in the number of shifts per week, more hours during those shifts, fewer breaks, and increased stress. All of these factors can lead to increased dissatisfaction and disengagement among nurses, commonly described as nurse burnout. Regardless of what one may think about burnout and its causes, the effects are no less devastating than PTSD in combat veterans. A shortage of nurses can compromise the quality of care each patient receives. While nurses will do everything within their power to provide high-quality care, a reduction in the workforce will inevitably lead to less time spent with each patient, resulting in delayed treatments, decreased patient satisfaction, and, in the worst-case scenarios, actual harm to the patient. The nursing shortage will not go away any time soon. We must continue to adapt to this new paradigm as we seek to provide high-quality care. Most importantly, we must support our nurses and make them feel appreciated for their critical work. The “pizza party” has gotten a bad rap recently. Instead, if you are in a leadership role, get out and talk to your nursing staff. Help them to see you as a friend and supporter, not someone to be feared. There is nothing more important in your work than making your nursing staff feel appreciated. Be sure to thank your nurses when you see them. The post Challenges of the Nursing Shortage appeared first on HealthTech Magazines.

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By Candice Hoshi, VP of Revenue Cycle, UCHealth In today’s rapidly evolving health care landscape, sustainability depends on quickly addressing key areas within revenue cycle management. The pressure to deliver value and reduce costs is constant. At UCHealth, we’re leaning on data analytics and artificial intelligence (AI) to help uncover problems, streamline operations and improve patient experience and financial performance. At UCHealth, our mission is to improve lives. Staying congruent with our mission was key to adopting the tools rapidly and proficiently. Leading with data to improve processes and performance The revenue cycle often starts with patient registration and ends with patient billing, but there are many steps along the way. Each step presents potential for delays or errors, which can have a variety of negative impacts. In 2023, we developed an analytics tool to investigate the mismatch between the authorized and billed CPT codes. The tool revealed that CPT mismatches were the cause of many prior authorization denials – in other words, what we told the insurers we were performing was not what was billed. On the surface, it may appear to be an administrative issue; however, in the example of colonoscopies, up to 50% of screening exams result in some level of diagnostic intervention like a polyp removal. We implemented a retro authorization process to notify insurers of CPT changes within 48 hours of service, and the result is quicker payment and less rework in appealing for services based on medical necessity.  We also launched “DPCs” – denial prevention committees – led by our regional operators. We have enhanced the CPT mismatch analytics tool by adding denial data, and our operators are engaged in helping resolve concerns related to prior authorization and registration-related denials. Collectively, they have improved staff/provider education, corrected IT setup issues, and made other valuable improvements. Most importantly, our operators feel connected and empowered to address issues. The results? Over a two-year period, we’ve reduced prior authorization denials by 47% and registration denials by 41%. Getting paid on first pass is a double win – for patients whose bills quickly adjudicate for billing transparency, and for providers who receive timely compensation for the care they provide. AI use cases in document scanning, CDI and process intelligence A few years ago, our scanning specialists were working around the clock to ensure documents were available in the electronic chart within 24 hours. This manual process was not sustainable, so we turned to an AI partner. The tool “reads” images using optical character recognition (OCR) technology, and our HIM teams trained it to index the document in the patient’s chart with a high degree of accuracy. Approximately six months after going live, the tool improved scanning productivity by 1100% and accuracy over 95%.  Not only did we improve our operational metrics, but we also improved clinician and patient satisfaction. Clinical documentation integrity (CDI) is a hot spot in RCM right now. Hospitals are discovering that not only are they potentially leaving money on the table, but their quality metrics also may be understated because of incomplete or inadequate clinical documentation. CDI work is resource-intensive and relies on expert clinical acumen. We knew there were gaps with manual processes and short stays where patients aren’t under our care long enough for queries to finalize. We chose an AI company that looks for both coding and CDI querying opportunities, and flags for a final review prior to billing. In the 8-month pilot across three hospitals, the tool identified almost 10,000 more query opportunities than our baseline. Approximately 20% of total queries were attributed to the clinical validation of sepsis, acute blood loss anemia and respiratory failure. One hospital improved its sepsis mortality index by 43% and all pilot sites similarly experienced a rise in quality and financial impacts. We will soon expand these tools to additional hospitals. The revenue cycle is riddled with many steps, and some occur between the “ping-ponging” of info exchanged between providers and payers. Operational Intelligence is a newer offering from an AI partner that manages daily automations such as prior authorization and enriched claims status. Their Operational Intelligence solution finds the “diamonds in the rough” – those one-off workflow inefficiencies that are difficult to find. For example, it found unnecessary account transfers between billers and coders on hundreds of accounts, which routinely delayed $1M-$2M in monthly cash flow. Another hidden insight resulted in a 96% reduction in coding review transfers, saving valuable time. These insights have led to new automations, staff training and process improvements. Conquering fear and finding the “why” Embracing new and creative technologies can be difficult and scary. Data analytics are powerful, but they require humans to validate information. Fears of job cuts or erosions to current state performance are why some technological adoptions fail. Using data to objectively evaluate outcomes allowed our teams to adopt and champion the benefits. In the case of CPT mismatch, we were solving prior authorization denial root causes that led to significant rework, patient complaints and A/R write-offs. For HIM scanning, we wanted to deliver a faster, quality service that also improved customer satisfaction and resource costs. We began with the end in mind, and in virtually every case, the patient was at the center of the “why”. At UCHealth, our mission is to improve lives. Staying congruent with our mission was key to adopting the tools rapidly and proficiently. Our people are more empowered than ever with the tools and insights they need to succeed in a challenging environment. Looking Ahead As Generative AI technologies mature, the potential for further transformation is huge. Clinical documentation automation and agentic AI are examples of trending technologies. As our industry’s adoption grows, RCM will change with it. Realizing this potential requires thoughtful investment in infrastructure, talent and change management. Success depends on leadership commitment, cross-functional collaboration and a willingness to embrace continuous improvement. The post The Future of Revenue Cycle Management (RCM): AI and Data Analytics appeared first on HealthTech Magazines.

Source: https://www.healthtechmagazines.com/the-future-of-revenue-cycle-management-rcm-ai-and-data-analytics/

By Keisha Downes, VP of Middle Revenue Cycle, Beth Israel Lahey Health Ten. That was the number of clicks it took me, using an encoder, to manually code a simple tension headache- G44.209. While clicks may seem like part of the job, each unnecessary click matters and adds time to tasks. Saving time in multi-step workflows benefits everyone, from a medical coder accurately assigning codes for claim submission more efficiently to a clinician spending less time on paperwork and more time with patients. In today’s healthcare landscape, the financial health of an organization is deeply tied to the efficiency of its revenue cycle. Yet traditional methods of managing this process are no longer sustainable. To remain competitive and financially stable, organizations are turning to artificial intelligence (AI), automation, and data analytics as powerful tools to streamline processes, reduce errors, and enhance revenue capture. My organization has embraced these technologies not only to optimize performance but also to foster a culture of proactive, data-driven decision-making. Continued advancements in AI provide a playground for visionary leaders to push the envelope and consider options that were once inconceivable. The Role of AI and Automation AI and automation have become cornerstones of revenue cycle optimization. By removing administrative burden and reducing human error, these tools create space for teams to focus on higher-value work. For staff, this means less time spent on administrative “busy work” and more capacity to focus on higher-value problem-solving. AI extends the value of automation by introducing intelligence into the process. Patient engagement platforms powered by AI, such as chatbots and self-service portals, are transforming financial conversations, making it easier for patients to understand and manage their bills. Natural language processing (NLP) tools assist with clinical documentation integrity (CDI) by analyzing provider notes and suggesting clarifications that ensure accurate coding and reimbursement. While these examples have offered significant support to revenue cycle teams, continued advancements in AI provide a playground for visionary leaders to push the envelope and consider options that were once inconceivable. The impact is clear: AI and automation make the revenue cycle more efficient, accurate, and patient-friendly. By shifting from reactive problem-solving to proactive prevention, organizations can safeguard revenue while improving satisfaction for patients, staff, and payers alike. The Power of Data Analytics Data analytics within the revenue cycle is an excellent tool for determining inefficiencies  and identifying opportunities to consider new technology. Revenue cycle analytics deliver real-time insights into performance, allowing leaders to monitor denial rates, days in accounts receivable (A/R), and discharged-not-final-billed (DNFB) days. This visibility helps pinpoint bottlenecks, benchmark productivity, and identify opportunities for change. Beyond monitoring, advanced analytics empower organizations to predict outcomes. For example, denial analytics can uncover payer-specific trends, enabling teams to proactively adjust workflows or educate clinicians. Dashboards bring this information to life, equipping both staff and executives with actionable insights at a glance. Ultimately, data analytics turns information into intelligence, which helps organizations make informed decisions that lead to sustainable improvements in financial performance. Personal Organizational Experience Using robust data, my organization identified opportunities within hospital coding and documentation integrity. The analysis revealed potential nonoptimal code and diagnosis-related group (DRG) capture, as well as denial vulnerabilities that would otherwise require significant staff support. This conundrum presented a space to consider how AI and new technology adoption could contribute to improvements. Evaluating new technology requires a structured process: defining our business needs, comparing them to vendor functionality and cost, and acknowledging that no single solution fits all. After a rigorous review, we selected a pre-bill AI software capable of reviewing 100% of inpatient hospital discharges for documentation, coding, and DRG optimization. A key factor in selecting this tool was its human-centered AI approach. While the software autonomously compared coded summaries against the medical record to identify opportunities, final decisions remained with our internal coding and CDI teams. Staff accepted or rejected AI suggestions, provided feedback, and used the results for education and upskilling. This hybrid human–AI model proved essential for adoption. It empowered staff rather than replacing them, built strong buy-in, and maximized both outcomes and ROI. As a result, our teams are more efficient, and our claims are cleaner. The Importance of Vendor Collaboration Equally important to selecting the right technology is fostering a strong partnership with the AI software vendor. Close collaboration ensures that the tool evolves alongside organizational needs, with ongoing support, training, and refinement of features. A vendor who acts as a true partner, listening to feedback, adapting workflows, and sharing best practices, helps maximize adoption and ROI. This partnership approach has been key to sustaining success, ensuring that the technology continues to align with our operational goals and support our teams effectively. Looking Ahead The next frontier in revenue cycle management (RCM) will bring even greater integration. Generative AI holds promise for simplifying coding, streamlining prior authorizations, and personalizing patient financial engagement. Predictive analytics will evolve into true real-time prevention, helping organizations anticipate challenges before they arise. Yet the future is not about technology replacing people. Success will depend on aligning tools with human expertise, fostering collaboration between revenue cycle leaders, clinicians, and IT teams. Organizations that strike this balance will not only protect revenue but also improve patient satisfaction and long-term sustainability. Conclusion AI, automation, and data analytics are no longer optional enhancements—they are essential components of a modern revenue cycle strategy. These tools optimize performance, strengthen compliance, and improve patient financial experience. My organization’s journey has shown that embracing this transformation delivers tangible results: a path to cleaner claims, reduced denials, and empowered staff. As healthcare continues to evolve, those who integrate technology with human expertise will set the standard for financial integrity and operational excellence. The post AI and Automation: The Next Frontier in Revenue Cycle appeared first on HealthTech Magazines.

Source: https://www.healthtechmagazines.com/ai-and-automation-the-next-frontier-in-revenue-cycle/

By Devin Shirley, CISO, Arkansas Blue Cross and Blue Shield Everything is changing fast. Since the development of the integrated circuit, we have seen technology continue to change and increase on a logarithmic scale. The pace of technological improvement is also increasing, forcing companies to adapt to keep up with or stay ahead of competitors. As a result, there is a continual drive to improve and gain efficiencies, enabling organizations to offer better products with greater efficiency and an improved customer experience. Unfortunately, with all the good technology brings, there is a dark side. Bad actors leverage technological advances to achieve various objectives, ranging from political activism and monetary gain to simple mischief and pride. Regardless of motivation, attacks on technological systems can be significant, impacting the organization and its ability to continue operating effectively. To alleviate the impact of an attack, organizations can manage this risk by leveraging cyber insurance. With attacks on the rise, cyber insurance has become a critical part of any security strategy to help organizations as they adapt to the changing cyber and technology landscape. Cyber insurance has become a significant risk management tool to ensure companies can successfully absorb the financial impacts of a cybersecurity attack. The impact of cyber attacks continues to grow as they become more sophisticated. While early attacks leveraged mostly backdoors and other vulnerabilities, current capabilities have created a wider group of bad actors who can do more, faster. Perpetrators have grown beyond sophisticated nation-state organizations conducting espionage to criminal organizations and individuals seeking monetary gains. The emergence of malicious organizations, such as Ransomware as a service (RaaS), and other similarly organized efforts, offers capabilities to less savvy individuals looking to cash in quickly or make a name for themselves. And while vulnerabilities are still present, social engineering makes it easier to gain access to system environments. As an example, phishing and smishing attacks take advantage of individuals who inadvertently allow attackers easy access into an organization where they exercise tactics and deploy tools to accomplish their goals. And, though ransomware continues to be a popular method of monetary exploitation, denial of service attacks are on the rise. And this list of attack methods continues to grow as technology continues to advance, enabling bad actors to do more with less complexity.With the rise in data breaches and multiple cyber attacks, new compliance requirements continue to push companies to maintain a minimum set of standards for cybersecurity. While compliance does not protect against cyber attacks, compliance with frameworks, regulatory requirements, and customer requirements can help frame security strategies, drive budget requests, and help companies meet a base level of assurance for their stakeholders.Cybersecurity insurance can also help provide companies a way to mitigate the results of a cyber attack. Most security strategies and planning focus on detecting and preventing threats, but there has been a shift among security professionals to place an equal amount of focus on business resiliency. To ensure resiliency, cyber insurance assists with the financial impact of a security incident. While it does not necessarily cover all costs associated with the attack, it can lessen the impact. From a risk point of view, this is known as risk transference, where a third party absorbs a portion of the risk. In this instance, the insurance company shares part of the financial risk of the company that suffered the cyber incident.Cyber insurance can be a great combat multiplier to help companies in their fight to defend, protect, and recover from attacks. As previously stated, a good cyber insurance policy can help a company maintain resiliency by absorbing part of the costs of recovering from an attack. However, bringing on a cyber insurance policy also aids with defending and protecting, as it typically requires compliance with a minimum set of security controls. A security program can integrate these controls into their company and leverage them to continue building the security program and obtain budget, staff, capabilities, and support from senior-level and board leadership.When signing up for cyber insurance, an organization will need to determine the right coverage, based on their risk appetite. Companies should consider various risk scenarios to determine the impact on the company in the event of a security incident. Though most costs occur immediately, organizations should also weigh the long-term impact of an incident, considering multi-year costs that may not be immediately realized, such as legal fees and loss of business.Cyber insurance has become a significant risk management tool to ensure companies can successfully absorb the financial impacts of a cybersecurity attack. While they may not cover all costs, they will help to maintain resiliency and manage the impact of the incident. By providing input into an organization’s security program, they play a role in guiding an organization’s strategy and security decisions, such as which forensics firm to use and guidance for paying ransoms. Cyber insurance may not be part of every organization’s security program, but when a major event occurs, it does help to know a company can partner with someone to lessen the impact and partner with the organization in the time of crisis. The post Changing Landscape of Cybersecurity and the Role of Cyber Insurance as a Combat Multiplier appeared first on HealthTech Magazines.

Source: https://www.healthtechmagazines.com/changing-landscape-of-cybersecurity-and-the-role-of-cyber-insurance-as-a-combat-multiplier/