The Silent Revenue Killer In US Healthcare – And The Tech That Is Fighting Back

Healthcare providers in the US are facing significant financial pressure, with lower reimbursements from payers among the most cited reasons, alongside higher labor costs and more expensive supplies. As the revenues of hospitals, clinics, and ambulatory surgical centers (ASCs) shrink, this threatens their financial viability, putting the public's access to medical care at risk. This is further complicated by continuing medical inflation and frequent changes in payment rules.

Faced with these challenges, even large hospital networks seek external support to help them navigate the complicated bureaucracy of medical billing. They look for companies that can implement technological and personal solutions that make their medical billing systems and processes more efficient and effective, enabling them to capture the revenue that they are missing out on due to the fragmented healthcare revenue cycle.

One large hospital system in the US benefited from these technological solutions, implementing an innovative platform and various tools to strengthen its billing ecosystem and other capabilities. Across a review period lasting from May 1 to October 31, 2024, the customized revenue and growth solutions partner, Fellow Health Partners (FHP) evaluated top providers within the hospital system, finding means to significantly improve charges and collections. The partnership resulted in over 5% greater collections compared to the same period in 2023, with a potential to reach 10%. 

The initial improvements were achieved through a mix of process remediation and physician education, such as, but not limited to, schedule to charge reconciliation(s), clinical documentation improvement(s), physician education on payor and CMS guidelines, payment adjudication, and an overall improvement in denial remediation tactics. 

The partnership begat the introduction of various technologies, including the SimpleSwitch process, which ensures a smooth transition to a new system; the SAVi technology platform, which generates and analyzes billing data; and the TruTest process, which is a series of checkpoints in the billing system, identifying ‘hot spots' where billing mistakes could potentially arise. 

These implementations utilized technologies such as robotic process automation (RPA), which replicates human interactions with technology, mimicking common tasks such as payor status queries, cut/paste, and merging. RPA can be rapidly scaled up or down depending on business requirements, allowing quick deployment or rollback as the situation demands. Another technology is cognitive automation, which employs algorithms to extract concepts and relationships from data and "understand" their meaning, learning independently from data patterns and prior experience. This can be used in contract management, creating standardized and consolidated key information and enabling more accurate tracking and decision making.

By helping the hospital system remediate various operational inefficiencies, enhance their legacy billing systems, and create new standard operating procedures, FHP is placing the client in a better position to navigate the various financial challenges posed by the fragmented medical billing system and continued healthcare inflation. The review, which lasted only six months, uncovered just the tip of the iceberg, with many more issues being resolved and efficiencies being achieved across the continuing partnership. 

According to Michael N. Brown, founder and CEO of Fellow Health Partners, healthcare providers are being held back by an "archaic" and "broken" billing landscape, which makes medical care even more inaccessible to the average American. This inspired him to establish FHP as a reliable partner for healthcare providers, harnessing his extensive experience in creating operational and financial business strategies.

"Providers don't have to tackle their problems alone," Brown says. "Fellow Healthcare Partners aims to be a trusted ally of healthcare providers, such as hospitals, clinics, and ASCs, optimizing their billing systems and processes and allowing them to concentrate on their core mission – delivering life-saving treatments to people in need."

Image Credit: Fellow Health Partners

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