What to Automate First: A Roadmap for Smarter RCM
The promise of automation in revenue cycle management (RCM) is compelling: faster processes, fewer errors, lower costs, and better financial performance. But for many healthcare leaders, the big question isn’t if they should automate — it’s where to start. The truth is, not every task needs to be automated from the start. The key is identifying the highest-impact entry points that deliver measurable results quickly while laying the foundation for broader transformation.
Start Where the Burden Is Greatest
Healthcare organizations are often overwhelmed by the sheer number of repetitive, manual tasks across the revenue cycle. By targeting areas that drain the most staff time and carry the highest risk of errors, leaders can create momentum early. These are the “low-hanging fruit” of automation — high-volume, rules-driven processes that machines handle faster and more accurately than people.
Priority 1: Eligibility and Benefits Verification
One of the most common causes of claim delays and denials is inaccurate or incomplete eligibility data. Automating eligibility and benefits verification ensures that patient information is instantly checked against payer databases, reducing errors and preventing issues before they occur.
Priority 2: Claims Submission and Scrubbing
Submitting clean claims the first time is crucial to maintaining a steady cash flow. Automation can scrub claims for errors, flag missing documentation, and ensure coding consistency — all before submission. The result is fewer denials, faster payments, and less rework for staff.
Priority 3: Accounts Receivable (AR) Follow-Up
Chasing down unpaid claims is time-intensive and costly. AI-powered automation can prioritize follow-ups based on payer behavior, payment history, and aging buckets. By directing staff attention to the claims most likely to recover revenue, organizations maximize efficiency and results.
Laying the Foundation for More
Starting with these three areas allows organizations to see immediate benefits while building confidence in automation. From there, leaders can expand into areas such as prior authorization, patient billing, denial management, and beyond. The goal isn’t just to automate tasks — it’s to create a smarter, more resilient revenue cycle.
The most innovative automation strategies start with the areas that have the biggest impact, creating wins for both your staff and your bottom line. By following a roadmap that begins with eligibility checks, claims scrubbing, and AR follow-up, healthcare organizations can lay the groundwork for sustainable transformation.
At Lumora, we help providers identify the right entry points for automation and build a roadmap tailored to their unique challenges. Ready to get started? Contact us today.