Sales Enablement Tool

RCM Automation Workflow

How Kipu transforms manual revenue cycle processes into automated, intelligent workflows.

The Problem Nobody Wants to Quantify

The average behavioral health facility loses 8-15% of collectible revenue to manual processes, documentation gaps, and timing delays. The problem isn't that billing teams aren't working hard—it's that they're fighting systems that weren't designed to work together.

Eligibility checks happen after intake. Authorization tracking lives in a spreadsheet. Claims get coded by hand from clinical notes that weren't written with billing in mind. Denials get discovered 45 days after the fact. And collections follow-up depends on whoever remembers to check the aging report.

Every one of those gaps is a revenue leak. And every one of them is automatable.

The Kipu RCM Automation Workflow

Six steps. End to end. Each one eliminates a manual failure point.

1

Patient Admission & Eligibility Verification

Automatic real-time eligibility verification at intake. Insurance benefits, coverage limits, and authorization requirements surfaced before the first clinical note is written. No manual phone calls. No fax machines. No surprises at billing.

Auto-triggered at registration
2

Clinical Documentation & Compliance Validation

Real-time compliance checks embedded in clinical workflows. Documentation templates enforce payer-specific requirements at the point of care—before notes are signed, not after claims are denied. ASAM criteria alignment, medical necessity language, and concurrent review documentation built into the clinician's natural workflow.

Inline validation at point of care
3

Authorization Management & Tracking

Automated prior authorization submission with clinical documentation pre-attached. Concurrent review tracking with proactive alerts before authorization windows expire. No more missed authorizations turning into write-offs.

Auto-submission + expiry alerts
4

Intelligent Claim Generation

Claims generated directly from the clinical record—no manual coding, no data re-entry, no handoff between disconnected systems. CPT/HCPCS code suggestions based on documentation content. Claim scrubbing catches errors before submission, not after denial.

Auto-coded from clinical notes
5

Denial Prevention & Pattern Analysis

Predictive denial risk scoring identifies claims likely to be denied before they're submitted. When denials do occur, root cause analysis traces back to the documentation source—not just the billing code. Pattern detection surfaces systemic issues across facilities, payers, and providers.

Predictive scoring + root cause analysis
6

Payment Posting & Collections Automation

Automated ERA/EOB posting with exception flagging. Patient responsibility calculation and statement generation. Aging-based follow-up workflows that prioritize high-value accounts. Real-time dashboards showing collections performance across all facilities.

Automated posting + intelligent follow-up

Before & After: The Numbers

Side-by-side comparison of manual processes versus Kipu automated workflows.

Before: Manual RCM

Clean Claim Rate 75-80%
Average Days in AR 45-60
Denial Rate 15-22%
Billing Staff Hours/Week 40+
Revenue Leakage 8-15%
Eligibility Verification Manual calls
Claim Coding Manual entry
Auth Tracking Spreadsheets

After: Kipu Automated RCM

Clean Claim Rate 98-99%
Average Days in AR 22-27
Denial Rate 3-5%
Billing Staff Hours/Week 12-15
Revenue Leakage 1-3%
Eligibility Verification Real-time auto
Claim Coding Auto-generated
Auth Tracking Automated alerts

Impact Metrics

What automation actually delivers, measured across live implementations.

98.5%
Clean Claim Rate

Up from 77% manual average

25
Average Days in AR

Down from 52 day manual average

4%
Denial Rate

Down from 18% manual average

2%
Revenue Leakage

Down from 12% manual average

Manual vs Automated: Key Metrics Comparison

Typical Revenue Recovery Timeline

Automation Value by Ownership Archetype

Same platform. Different value story. How automation manifests by ownership type.

Tier 1

PE-Backed

Board-ready dashboards updated in real-time. No more waiting for your biller's monthly report to understand revenue performance. EBITDA impact visible within 90 days.

Speaks to: margin expansion, board reporting, portfolio visibility

Tier 1

VC-Backed / Growth

Scale census without scaling billing headcount. Automated workflows mean your 3rd facility runs the same optimized process as your 1st—without hiring another billing FTE.

Speaks to: unit economics, operational scalability, runway extension

Tier 2

Owner-Operator

Stop spending evenings worrying about billing. Automated eligibility, claim generation, and follow-up mean you can focus on patients, not paperwork.

Speaks to: peace of mind, control, personal time recovery

Tier 2

Nonprofit

Every dollar recovered through automation goes back to mission delivery. Grant reporting data captured automatically. Compliance built into workflows.

Speaks to: mission alignment, grant compliance, financial sustainability

Tier 3

Hospital-Owned

BH-specific automation that integrates with enterprise systems. Specialized workflows for concurrent review, group documentation, and residential billing—without disrupting system-level processes.

Speaks to: IT compatibility, BH specialization, margin contribution

Specialized

OTP Networks

42 CFR Part 8 compliance automated. Dispensing documentation, callback tracking, and take-home dose protocols built into the workflow. SAMHSA survey-ready documentation generated automatically.

Speaks to: regulatory compliance, audit readiness, dispensing accuracy

Integration Architecture

How data flows through the Kipu ecosystem, from clinical documentation to payer reimbursement.

Kipu EMR

Clinical Source of Truth

Generates:

• Clinical documentation (ASAM-aligned)

• Treatment plans & progress notes

• Patient demographics & insurance

• Concurrent review documentation

• Group session attendance

Kipu RCM Engine

Automation & Intelligence Layer

Processes:

• Real-time eligibility verification

• Automated claim generation & scrubbing

• Prior auth submission & tracking

• Denial prediction & prevention

• ERA/EOB posting & reconciliation

Payers & Clearinghouse

Revenue Realization

Receives:

• Clean claims with documentation attached

• Prior auth requests with clinical support

• Concurrent review packages

Returns:

• ERA/EOB remittance data

• Denial reasons & adjustment codes

The Key Difference

In legacy workflows, these three systems are disconnected. Clinical staff document in one place, billers re-enter data in another, and payer communications happen in a third. Every handoff is a potential error. Every re-entry is a potential delay. Kipu eliminates the handoffs by making the clinical record the single source of truth for the entire revenue cycle.

Ready to See the Workflow in Action?

Start with the ICP Validation to identify your prospect's archetype, then explore the Discovery Template for the right conversation approach.

Every automation step maps back to a specific pain point surfaced during discovery. The workflow isn't a feature list—it's the answer to the problems your prospects describe when you ask the right questions.

ICP Validation

Identify the archetype

Discovery Template

Run the right conversation