5 RCM operational automation priorities hospital CFOs need to get right
Automation offers a solution to the healthcare understaffing that runs rampant in most sectors. Innovators have produced medical systems capable of efficiently completing tasks that once required multiple workers.
Despite this progress, hospital CFOs have failed to implement features that would streamline some workflows. Practices that maintain sluggish advancement may find more modern competitors absorbing their market share.
Here are the RCM technology priorities hospital CFOs need to target.
Staff Training
While some systems operate well without human involvement, many still rely on staff oversight. Most medical AI tools are designed to enhance workers rather than replace them. If misused, these programs can actively undermine an organization’s success.
Since automation encourages small, highly trained workforces, practices can drive toward building an elite staff. Competent providers will leverage machine/human interactions to improve their employees’ efficiency.
Automatic Updates
Medical billers semi-frequently must contend with rapidly changing government and payer standards. These shifts often disrupt claim submissions through legal restrictions or by making a denial inevitable. While some practices instantly receive rule changes, updating standards accordingly remains slow.
Automated programs adjust in-house worker guides by replacing old details with newly-sanctioned information. A clinic-wide network will apply approved adjustments instantly on all connected devices. These uniform, quick updates ensure staff stays informed about current or new requirements.
Clinical Documentation Improvement
Clinical documentation improvement (CDI) helps reduce miscommunications between the patient, provider, biller, and payer. CDI software reviews patient data on EHRs. In cases where this data fails to provide adequate detail, the AI alerts users of the revision or revisions needed.
Other software improves physicians’ record-taking. CDI programs prompt clinicians to write down details regarding services and patients. This oversight ensures that staff has sufficient information to create approvable claims. So, coders can reliably use physician notes to code the service or procedure properly to eliminate or drastically reduce denials.
Claim Denial Tracking
If a payer rejects multiple claims over a short period, the denials likely share similar causes. Most insurers will detail the reason for each denial. However, re-issuing a payment request costs time and may risk exceeding a submission deadline.
AI systems can find claim errors before sending them to the payer and help revenue cycle management in medical billing. These programs will highlight problems for human adjustment or fix them outright. Pre-emptive corrections save valuable billing time and effort.
Claim Denial Analysis
After discovering a denial trend, providers must invest in overhauling problematic parts of their workflow. Data-driven systems can produce the map for this overhaul with analytics.
Analytics will reveal what errors occur most frequently and under what circumstances. When paired with internal audits, this information can completely reform a practice. Auditors can target specific areas that need revision, eliminating unnecessary review.
Keeping pace with rapidly improving technology challenges even the savviest CFO. Plutus Health offers an end to this struggle by supplying modern RCM automation and quality at an affordable price. We provide the highest-end, most up-to-date healthcare RCM service technology and automated software to complement our expert billing team. To jump to the front, take advantage of our blended model, and bypass technology chasing, connect with us today.
Key Takeaways
1. Staff remains a necessary component of technological advancement.
2. Automated programs quickly update billing guidelines.
3. CDI software reduces miscommunication.
4. Systems identify claim errors before submission.
5. Data analysis AI categorizes denials for review purposes.
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FAQs


ABA providers are grappling with high staff turnover (up to 65%), rising burnout, administrative overload, and stagnant reimbursement rates. These challenges directly impact care continuity, clinical outcomes, and operational performance.


Operational inefficiency costs ABA teams up to 10 hours per staff member per week, contributing to burnout, denied claims, and longer accounts receivable (A/R) cycles. These inefficiencies ultimately result in reduced revenue and patient dissatisfaction.


Burnout leads to costly turnover, lower client retention, and decreased productivity. Recruiting and replacing a BCBA or RBT can cost up to $5,000 per hire, plus months of lost revenue and disruption to morale.


High-performing ABA organizations invest in clear career pathways for BCBAs and RBTs, align compensation with market benchmarks, and foster peer-led mentorship, flexible schedules, and wellness programs.


Automation tools like Plutus Health's Zeus streamline eligibility verification, denial management, and billing, reducing manual workloads by 5–10 hours weekly per clinician and improving clean claim rates by 95%.


Outsourcing revenue cycle management can improve collections, reduce denials by up to 30%, and free clinicians from billing-related admin tasks, resulting in better client care and financial outcomes.


One $200 million ABA network partnered with Plutus Health to automate eligibility and accounts receivable (A/R) processes. The result: $2M reduction in legacy A/R and a 97% Net Collection Rate.


By improving operational efficiency, investing in technology, and ensuring workforce stability, ABA leaders can align outcomes with reimbursement. Plutus Health supports this transition with scalable RCM and automation strategies.
FAQs


ABA therapy billing is the process of submitting claims to insurance or Medicaid for Applied Behavior Analysis services provided to individuals with autism or developmental disorders. It includes using correct CPT codes, proper documentation, and adherence to payer-specific policies.


Common CPT codes for ABA therapy in 2025 include:
- 97151 – Assessment and treatment planning
- 97153 – Direct therapy with the patient
- 97155 – Supervision and modification of behavior plan
- 97156 – Family adaptive training
- Always check with payers for any annual changes.


To bill Medicaid for ABA services, providers must ensure credentialing is complete, services are pre-authorized, and claims use the correct codes and modifiers. Medicaid requirements vary by state, so always follow state-specific billing rules.


Common ABA billing mistakes include:
- Incorrect or missing CPT codesplan
- Lack of documentation or treatment
- Uncredentialed providers rendering services
- Submitting duplicate or late claims


Without proper credentialing, providers can’t get reimbursed. Insurance and Medicaid require that BCBAs, RBTs, and organizations are credentialed and contracted. Delays in credentialing often cause revenue losses and claim rejections.
FAQs


CMS proposes a 2.4% increase in Medicare ASC payment rates, contingent on meeting ASCQR quality reporting requirements. Plutus Health helps ASCs meet these compliance benchmarks by integrating quality reporting data into RCM workflows, ensuring eligibility for full payment updates.


The ASC Covered Procedures List will expand by 547 procedures, including cardiology, spine, and vascular surgeries. Plutus Health supports expansion into new service lines by customizing RCM processes for high-acuity procedures, minimizing claim denials during the transition.


Site-neutrality narrows the payment gap with hospital outpatient departments, enhancing ASCs' cost-efficiency appeal. Plutus Health helps leverage this advantage in payer negotiations by providing performance dashboards and cost-justification analytics to secure stronger reimbursement terms.


Complex procedures increase denial risk and slow cash flow. Plutus Health's automation-first RCM model delivers 95%+ clean claim rates, reduces A/R days, and safeguards margins, even as your case mix becomes more complex.