Fifth Third Bets Big Data Will Tame Healthcare’s Revenue Storm

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In healthcare, information and money never stop moving.

Every day, medical records, claims, payments and denials flow among patients, providers and payers in a constant stream that is as complex as it is essential.

That scale of communication and transactions creates pressure on medical providers’ revenue teams tasked with keeping records accurate, reconciling accounts, and ensuring patients understand what they owe. For providers and financial institutions, accuracy, efficiency and trust hinge on the ability to process payments and data seamlessly.

That is the challenge and opportunity discussed by Adam Keck, senior vice president and director of Managed Services Solutions at Fifth Third Bank, and Traci Barney, RCM system administrator at OrthoAlliance, in a panel led by PYMNTS. Both panelists underscored how the industry’s persistent pain points, from medical record requests to denials to reconciliation, are being reshaped by data-driven tools.

Even the most basic workflows can be cumbersome without data centralization, Barney said.

“We take a ‘less is more’ approach,” she said, adding that her firm uses a simple SharePoint log to track and document all incoming payments. “It gives us a centralized real-time record the team can use for posting and reconciliation. Each payment is logged with account information and payer details to help with accuracy.”

The complexity of the revenue cycle is compounded by mergers, acquisitions and legacy systems, Kech said.

“There is continued M&A happening across health systems, which are getting bigger, bringing in private practices, creating that legacy spider web of systems that you have to integrate,” he said.

Rising denials and payer scrutiny only heighten the challenge.

For Fifth Third, the answer lies in efficiently aggregating data into a single environment.

“The faster this is done, the faster we can provide tools and a single platform that can reduce days in accounts receivable and improve cash-to-net-patient revenue collection,” Keck said.

Barney pointed out that the rise in payer requests for medical records, often on tight timelines, has forced her team to create a dedicated unit just to manage them.

“One of our biggest challenges currently is the influx of medical records requests that we’re getting from payers,” she said. “These often come with a very tight turnaround time and are sometimes complex.”

The need for an environment to aggregate and turn data into valuable insights and drive automation efficiencies led Fifth Third Bank to acquire Big Data Healthcare in 2023, Keck said.

That consolidation gives providers faster visibility, reduces unposted cash, and frees up staff for higher-value tasks like denial prevention, he said.

Barney agreed that centralizing workflows has been critical to meeting deadlines and reducing errors.

Both panelists said artificial intelligence will play (and is already playing) an expanding role in the revenue cycle. Barney said OrthoAlliance is already experimenting with AI for repetitive tasks like registration and payment posting.

“The goal is to reduce repetitive manual workflows and free up our teams for more complex tasks,” she said.

Before moving anything into production, her team tests each application and observes its performance.

“Once it goes live, we continue to monitor its output to ensure accuracy and consistency,” Barney said.

Thoughtful deployment is important, Keck said.

“You don’t want to run the risk of creating any scenarios with the AI where there could be hallucination or other challenges that go on,” he said.

To avoid that, “We actively have several different proofs of concept going on across the portfolio with AI to see how we can drive more efficiency for our clients,” he added. “At the end of the day, all this automation adds to value that we can return back to the providers we work with.”

The value of AI depends on the data foundation beneath it, Keck said.

“The AI at a certain point will become more commoditized,” he said. “It’s really about who owns the data and can turn that into meaningful analytics or action to remove workflow and tasks.”

That makes partnerships like Fifth Third’s Big Data Healthcare acquisition crucial, since AI tools require structured, accurate information to spot trends in denials or accelerate claims processing, he said.

Denials are a persistent pressure point.

“Denials remain one of the biggest challenges for revenue cycle leaders across the industry,” Barney said.

Her team uses data to drill down into denial categories, track root causes and prevent errors at the source.

“By identifying those patterns, we’re able to go back and realign processes by either providing targeted training to the staff making the errors, or we create custom edits in our systems, so we stop the claim from going out wrong in the first place,” she said.

Underlying all this innovation is the need for strong data security.

“Healthcare and payments is one of the most targeted areas by fraudsters, and something where there just needs to be continued investment,” Keck said.

Traditional and modern safeguards that span multifactor authentication and tokenization help ensure that bank account information is not exposed, he said.

For patients, the benefits of better data and automation show up in simpler, clearer bills and faster refunds.

“Our goal is to be straightforward and stress-free as possible for the patient,” Barney said. “One of the biggest pain points with patients is they still have a really hard time understanding their specific coverage. And it is very overwhelming to them.”

Keck echoed that focus.

“The more that you can help the patient understand what they’re responsible for, give them the payment options and in a seamless environment … the more successful you’re going to be in collecting payments,” he said.

Both panelists said they expect the role of data to grow. Barney said she hopes AI will increasingly prevent denials and coding errors before they happen, “which means less frustration and faster reimbursement and more confidence in the process for patients and providers.”

Keck said the sector is at an inflection point.

“I think we’re [at] an interesting crossroads in the market … [centered] around finding those scalable partners and technology that will be the most meaningful and impactful to our customers,” he said.

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