Medical Billing Automation Challenges
Medical billing automation offers enormous potential to streamline repetitive tasks in healthcare revenue cycle management (RCM). Despite its promise, the adoption of automation in medical billing has been slower than expected. While awareness of automation and AI is widespread, the industry faces several challenges that have hindered its progress.
Understanding Automation vs. AI in Healthcare
One of the biggest medical billing automation challenges is just a lack of understanding what it is. A common if not pervasive problem limiting adoption in the medical billing industry is the confusion between automation and artificial intelligence (AI). While AI often takes the spotlight at conferences and certainly gets all the attention in the media, automation focuses on streamlining repetitive tasks without the need for advanced machine learning. Both concepts are valuable, but confusion between them can delay the adoption of practical automation solutions.
The Technology Is Not the Problem
Automation technology has been available for decades, so it is not one of the medical billing automation challenges. In the past, implementing automation required extensive coding and scripting. However, advancements in user-friendly tools have made automation accessible even to non-developers. The technology is not the barrier—it is the industry’s readiness to embrace and implement these solutions. Nor is the availability of engineers or developers who are capable of developing or implementing these automation solutions. There are enormous numbers of people availble to be hired full time or via project and gig work sites.
Healthcare’s Technological Lag
The healthcare and medical billing sectors lag behind other industries in adopting new technologies. Many medical billing company owners come from clerical or administrative backgrounds rather than technological ones. This lack of technical expertise and familiarity with innovation has contributed to the slow adoption of automation. Part of the problem is that the industry is somewhat fearful of technological innovation.
The Impact of Offshoring on Automation
Offshoring has played a significant role in delaying automation adoption. Even worse, most medical billing companies still very much have a services rather than a product mindset. Many companies find it easier and cheaper to outsource tasks to countries like India or the Philippines than to invest in technology. This lingering perception of nearly free labor enables companies to mechanical turk things and just throw bodies at a solution instead of focusing on technology solutions. The availability of low-cost labor also often provides a quicker return on investment compared to potentially higher upfront costs of automation, even if it might offer a much better ROI over time. The significant complexity and requirement for internal resources that are proficient with technology in order to be successful in automation is not something that most medical billing companies have built up.
However, increasingly offshore labor comes with its own challenges, including human errors, rising costs, and high employee turnover. These issues are creating more incentives for automation as the industry evolves and competition intensifies.
Process Complexity
Medical billing processes are more complex than they might appear. The industry lacks process design experts who can map out workflows and handle exception management. This lack of structured process documentation makes it difficult to create specifications for automation tools.
Smaller billing companies, which make up a significant portion of the industry, often lack the resources to develop comprehensive training and documentation. Without clear specifications, implementing becomes a daunting medical billing automation challenge.
Bridging the Knowledge Gap
A significant barrier to automation is the gap between billing operations expertise and technical know-how. Billing managers are often unfamiliar with advanced data analysis or process documentation needed for automation. Bridging this gap requires collaboration between technical experts and RCM professionals, as well as investment in training and resources. Even the most basic requirements for automation like documentation of internal rules or basic standard operating procedures (SOPs) is often non-existent, which makes setting up automation imopossible even with the right tools and technology development resources. It’s like having a builder with no architect – there is nothing for them to do.
Overcoming Medical Billing Automation Challenges
Despite the medical billing automation challenges, it is growing steadily. As the industry begins to address knowledge gaps, streamline processes, and recognize the limitations of offshoring, automation will likely gain traction. All of these challenges can be overcome, and the future of medical billing automation depends the industry making fundamental changes to surmount these systemic barriers by fostering a culture of technological innovation.
