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Since payer contact centers experience huge call volumes, there are wait times of as high as 20-60 mins. Also 5-10% of calls get dropped during the hold times and BPO agents have start all over again. Hence this process of calling payer contact center and checking claim status is outsources to BPO companies. This is a big pain point of BPO companies as their agent are spending time on a completely non-value adding activity.

Another pain point is that, when the payer agent picks up the call, BPO agents check status of multiple claims on a single claim. Once the call is over, the BPO agents have to feed information into the internal system for each of the claims. This is referred as disposition and it takes 10-15 mins to make entries in the internal system and since this is a manual process, it often has errors. These errors if identified by the RCM companies can lead to penalties.

At this roundtable, we will bring together industry leaders, experts, and professionals to explore the challenges faced in RCM processes and the innovative solutions that are reshaping the healthcare financial landscape.

Presenting Partner

Engagely is a leading No-code CX automation platform augmented with Microsoft Azure Open AI, Generative AI, and Voice AI technology. From BFSI to Healthcare to Pharma, Engagely empowers enterprises across industries by automating their customer support and CX. Engagely helps BPOs upgrade their manual, resource intensive operations with efficient contact center software- all this with minimal setup time, enterprise-grade security, flexible deployment options and no additional IT overheads.

The ready-to-use industry specific pre-built AI models, real-time analytics, multilingual support, omnichannel presence, and seamless integration capabilities help enterprises accelerate growth with improved efficiency by delivering exceptional experiences for customers and employees.

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Challenges with RCM Processes

The process for healthcare providers (hospitals) to get the payments from insurance companies (payer) is very complicated and takes time with a lot of queries back and forth between insurance companies and hospitals. This results in:

Huge call volumes at the payer contact center

Prolonged wait times for the agents

Increased number of errors due to manual disposition

Huge penalty to the RCM company due to the errors in manual entry

Decreased agent satisfaction and productivity

Delay in payments to Hospitals

Billing and Coding Complexities

Compliance and Regulatory Changes

Costly

Benefits of RCM Automation

Reduced Manual Data Entry/Disposition minimizes errors caused by human input and speeds up the process

Automated Eligibility Verification reduces the risk of claim denials due to eligibility issues

Claim Generation and Submission through Voice AI reduces the risk of errors and delays associated with paper claims

Coding and Charge Capture ensures accurate billing & reduction the likelihood of denied claims due to coding errors

Claim Adjudication Automation streamlines reimbursement process while reducing the need for manual intervention

Denial Management system flags & categorize denied claims, to identify the reasons for denial and take appropriate action to resolve issues promptly

Reporting and Analytics helps in monitoring their financial health, identify trends, and make data-driven decisions

Seamless integration with Electronic Health Record (EHR) systems, practice management software, and other healthcare IT systems

Compliance and Regulations help in staying compliant with changing healthcare regulations and standards

Improved agent productivity

Cost effective

Why Attend?

Pioneering insights - Gain insights into the latest trends and technologies in RCM automation

Collaborative learning - Share your expertise and learn from industry peers

Real-life success - Discover real-world success stories and case studies

Networking - Join hands with professionals for shaping the future of healthcare revenue management

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