Healthcare Leaders Focus In On Revenue Cycle Automation

By Julien Dubuis, Chief Commercial Officer

The HFMA 2024 Annual Conference brought together industry leaders and innovators to discuss the latest trends in healthcare financial management. This year, the spotlight was firmly on revenue cycle automation. In this article, Julien Dubuis, Chief Commercial Officer at Nym, shares his top three takeaways from the event:

1. Revenue cycle automation is a top priority

Revenue cycle automation continues to dominate conversations and investments in the healthcare industry. The significant interest is driven by the need for healthcare providers to streamline processes, reduce costs, and improve accuracy in billing and coding. Key points include:

  • Increasing Investment: Revenue cycle automation has become a priority for venture capital firms as providers are under increased pressure to improve operational efficiency post-COVID. While investments are certainly being made into companies that automate front and back-end revenue cycle tasks, the current focus seems to be on companies that can automate mid-revenue cycle functions such as medical coding and billing.  

  • Leadership Focus: Revenue cycle automation is being prioritized at the CEO and CFO levels in health systems, highlighting its increasing importance as we head into the remainder of 2024.

  • Build vs. Buy Dilemma: Even large health systems find it challenging to develop in-house automation solutions, especially as resources remain strained under the current healthcare workforce shortage. As a result, many health systems opt to purchase from specialized vendors, both in the US and offshore.

  • Promising Solutions: Autonomous medical coding, clinical documentation improvement (CDI) solutions, and ambient scribing are emerging as some of the solutions most capable of delivering true value within the revenue cycle space.

2. Startups Drive Innovation, Forcing Larger Vendors to Evolve

Innovation in revenue cycle management (RCM) is being led by startups, but larger, established vendors are quickly adapting and developing their capabilities. Here's a closer look:

  • Startups Leading the Way: Disruptive innovations continue to emerge mainly from startups, and as such innovations gain traction, larger RCM vendors are being forced to evolve and invest more in automation.

  • Adoption by Large BPOs: Big Business Process Outsourcing (BPO) companies, iconic in the RCM space, are evolving to integrate more automation.

  • Partnerships and Acquisitions: Many larger RCM players are partnering with startups to enhance their offerings and expand their research and development (R&D) capabilities. Some of these partnerships could lead to mergers and acquisitions (M&A) down the line as the revenue cycle automation space continues to develop.

  • Fragmented Market: There is no company capable of supporting end-to-end revenue cycle automation, with most companies focusing specifically on the automation of either front-end, mid-cycle, or back-end revenue cycle processes.

  • Looking to the Future: Technology vendors and healthcare providers alike have begun to engage in discussions around what it will take to build revenue cycle automation solutions at scale, with the cost of R&D being a specific area of focus. 

3. The spotlight shines on autonomous medical coding

Autonomous medical coding, previously a nascent technology, is now being recognized as a more established solution and proven use case for revenue cycle automation. Key insights include:

  • Proven Value: Multiple autonomous medical coding vendors have demonstrated clear value through case studies, specifically highlighting significant improvements in coding efficiency and reductions in coding-related costs.

  • Multi-specialty Capabilities: Many autonomous coding vendors started in one or two specialty areas (e.g. radiology, emergency medicine). Today, the capabilities of autonomous coding have expanded into many different specialties, but vendors still have work to do when it comes to having referenceable, truly multi-specialty solutions. Healthcare providers and investors are watching closely to see which vendor gets there first.

  • Growing Demand: While demand for autonomous coding is accelerating, the industry has yet to experience the phase of exponential growth (commonly referred to as the "hockey stick" effect).

  • Integration with Emerging Technologies: There are questions about how autonomous coding will integrate with other emerging technologies like CDI automation and ambient scribing, but if such solutions can integrate successfully, the benefits will be worth keeping an eye on.

Final Thoughts

The HFMA 2024 Annual Conference highlighted the growing importance of revenue cycle automation in the healthcare industry. With increasing investment and M&A activity, prioritization from C-suites, and ongoing innovations from both startups and larger vendors, the future of revenue cycle management looks promising. As autonomous medical coding and other RCM automation solutions continue to expand their capabilities, healthcare providers are poised to benefit from increased efficiency, reduced costs, and most importantly, improved patient outcomes.

Interested in learning more about autonomous medical coding with Nym? Check out these helpful resources!

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