Plutus Health RCM Index: Insurance denials cause massive revenue losses: AI and RPA come to the rescue

Health insurance claim denials are one of the biggest challenges facing healthcare providers right now, but those who embrace new technologies are finding relief.

Here at Plutus Health, Inc., we recently surveyed more than 200 healthcare providers about their revenue cycle management process (RCM), and we are sharing  the results in our “Plutus Health Revenue Cycle Management Challenges Index, 2023.”

The responses highlight several insights into healthcare providers' daily struggles with RCM, but they also reveal where some have found solutions.

Claim denials clearly stood out as the top challenge for providers. Strikingly, more than 40% of respondents said they lose more than half a million U.S. dollars in annual revenue each year due to denied insurance claims. And 18% reported losing more than a million U.S. dollars annually.

Nearly 60% of respondents said that dealing with insurance denials was one of their most significant RCM challenges, while 42% said the denial management stage in their RCM process is regularly due to staff shortages.

So, it’s no surprise that 43% of respondents said denial management was among their top priorities in 2023. And 20% of respondents noted that achieving clean claim rates and lower denial rates were also top key performance indicators (KPIs) that the RCM teams tracked in 2023.

Healthcare providers also shared with Plutus that managing staffing needs was a significant concern for them, with about 40% of respondents reporting that it was one of their greatest challenges. Nearly half of the respondents also revealed that they rely on external support for RCM, either using a combination of internal and external teams or outsourcing to one or more vendors.  

New technologies — such as robotic process automation (RPA) and artificial intelligence (AI) — offer hope though.

Nearly 30% of respondents using AI and RPA reported improved cash flow and collections speed, while about 20% said it resulted in more insightful and readily accessible business analytics. About 20% of the respondents who use AI and RPA said the most remarkable improvement since implementing the technology was improved efficiency in filing claims, while 18% reported reduced data-entry errors.

At Plutus, we’ve seen this first-hand. Our claim status-check bots leverage automation to make the claim status-check process more efficient and error-free, while our automated eligibility verification process allows providers to assess eligibility before rendering a service to the patient or submitting a claim to the Payer.

For more insights into the challenges healthcare providers face in their revenue cycle management and the ways they’ve found to solve them, read our full report, “Plutus Health Revenue Cycle Management Challenges Index, 2023.”