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RCM Survey of more than 200 healthcare providers reveals that claim denials pose an expensive problem, but AI and RPA prove helpful to those that embrace them

The “Plutus Health Revenue Cycle Management Challenges Index, 2023” details some of providers' top issues and how they plan to tackle them. The index by Plutus Health Inc. surveyed more than 200 healthcare providers about their revenue cycle management (RCM) processes and plans.

The responses highlight several insights into the daily struggles that healthcare providers face with RCM, but they also reveal just how effective technological solutions can be when the industry embraces them.
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“Our new ‘Plutus Health Revenue Cycle Management Challenges Index, 2023’ shows how big of a burden insurance denials are for healthcare providers. With 40% of survey respondents reporting that they are losing more than half a million dollars in annual revenue every year simply because of insurance denials, the scale of the problem is immense,” said Thomas John, Founder and CEO of Plutus Health, Inc.

“Despite AI [artificial intelligence] and RPA [robotic process automation] offering proven solutions, providers still seem hesitant to implement these new technologies into their RCM process. We hope this survey shows just how urgent it is for the healthcare industry as a whole to embrace these new technologies, which have the potential to drastically increase revenue for healthcare providers across the country,” he said.

Claim denials stood out as the top challenge for providers — and it’s costing them a lot of money. More than 40% of the healthcare providers we surveyed 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, and 42% said denial management was one of the stages in their RCM process that is regularly due to staff shortages.

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

Managing staffing needs also causes stress for healthcare providers, with about 40% of respondents reporting it as one of their most significant 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.

Healthcare providers who’ve tried new technologies — such as RPA and AI — have seen improvements in their overall RCM process.

Nearly 20% of the respondents who use AI and RPA said the greatest improvement since implementing the technology was improved efficiency in filing claims, and 18% reported reduced data-entry errors.

Nearly 30% of respondents who used AI and RPA said it resulted in faster cash flow and collections, while about 20% said it resulted in more insightful and readily accessible business analytics.

Bridging the gap between healthcare providers and technology-based solutions is our passion at Plutus Health because we know what it means when we get it right: better patient care.

That’s why we offer services like our claim status-check bots, which leverage automation to make the claim status-check process more efficient and error-free. Additionally, our automated eligibility verification process allows providers to assess eligibility before providing services to a 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,  find more insights as well as the full “Plutus Health Revenue Cycle Management Challenges Index, 2023” report on our website.