Automation is not the answer. You might be thinking, “Wait, what? Isn’t Voyant a company that does RCM automation?” Yes, we do automation. So for us to say automation is probably not the answer, for you, there’s a good reason, and it’s not that we don’t believe in automation. We absolutely believe in automation. There’s an enormous amount of value, particularly for repetitive tasks, but also even in terms of data extraction, automation can be extremely powerful.
Why RCM Automation Fails
One of the things that we find when we get engaged to do RCM automation, let’s say, for example, somebody’s trying to engage us to do a payment posting automation, is that most organizations are not prepared to actually put in place that type of automation and have it be successful. And there are two reasons why that’s the case.
Lack of Business Rule Documentation
The first is developing a set of specifications that are able to be transformed into software to begin with. That’s kind of one level, but that’s actually not the most significant one. We and other organizations typically can help with that. The bigger problem, and this is the reason why we sort of caution people, is that if the business rules aren’t really rock solid, it’s going to be a disaster. Imagine building a house, and you’ve got a bunch of people who have built a house before. Imagine that your builders are something like builders. They’re constantly building houses. They’re constantly doing work on a house. Some of that, like they’re doing payment, they know what they’re doing on a daily basis. Now you’re going to try to get a machine to do that. Well, it’s kind of like saying, “Okay, we’ve been building a house, and then you go say to some other people, go build the same house, not the same people, but a new set of people, and you haven’t put together incredibly detailed plans for them to do that. It’s not going to work. The house is not going to get built, or it’s not going to look at all like you want it to, right?”
Importance of Operations and Documentation
It’s very rare that the business rules are even written. Oftentimes we don’t even see that there are business rules at all. But two, even when they are, they tend to be written for somebody who already knows the rules. It’s sort of like a reminder, like, “Oh, don’t forget to use “X field” or something similar. Or, “When you post for Medicaid, do this.” But the “do this” isn’t okay. Well, what is Medicaid? All Medicaid, some Medicaid, you know, what about like, you know, variations on Medicaid plans or something like that. And how is that selected? From the drop-down? How do you select which Medicaid it is now when you’re doing the payment posting, and, by the way, when you’re making adjustments, does it change based upon these set of conditions, or this, or what about when there’s these exceptions? And what about this? All of those things need to be written down, forgetting even to the earlier point, about like in a way that a machine could understand, or an engineer could take it and code it in a way that somebody who has no experience with the system and no experience, you know, with this particular function for this client in this building organization could pick up and do it instantly.
The Key to RCM Automation Success
We don’t want to really suggest that automation isn’t key. We love automation. That’s at the core of what we do. And we have to caution, you can’t just throw automation at something without really focusing on the operations and the documentation. That’s really the secret sauce. That’s what’s going to make sure it’s successful. Because there’s a lot of people who can develop code, who can write software. That’s not the tough part. The tough part is making sure that the business rules and requirements and everything are really well understood and well documented, such that when something is executed, it functions the way everybody expects and wants it to.
