In the complex world of healthcare, managing the revenue cycle is becoming increasingly challenging due to the growing volume of data and the transactional nature of revenue cycle management (RCM). This is where the power of artificial intelligence (AI) comes in, offering a promising solution to automate and streamline various aspects of RCM. From patient access to coding, billing, and collections, AI is perfectly suited for automating manual and redundant tasks and providing real-time analytics, prior authorization, and denial mitigation.
AI is also tackling some of the biggest challenges in RCM, such as increasing revenue capture, rising wages, higher denial rates, inflation, and regulatory scrutiny. Healthcare providers face internal and external financial pressures, and AI offers a way to address these challenges effectively.
No-code AI platforms are particularly transformative. They provide deep insights into operations and enable predictive and prescriptive machine learning (ML) applications. Healthcare organizations can foresee future trends and make data-driven decisions for short-term and long-term strategies. This includes creating digital workers to handle mundane tasks and making informed decisions based on data, heuristics, and ML.
If your healthcare revenue cycle management processes are lagging and you’re looking to maximize your revenue cycle efficiency, our team of healthcare industry experts can help. Here’s what to know about AI and how it can help lower administrative costs and much more.
Understanding the distinction between automation and AI is pivotal for any effective revenue cycle management strategy. While these terms are often used interchangeably, their roles and functionalities are distinct.
Combined, automation and AI can transform the entire revenue cycle process by handling repetitive tasks and providing intelligent insights and decision-making capabilities. This hybrid approach, supported by internal teams, allows health systems to scale operations efficiently, focus on problem-solving, drive revenue, and pursue strategic growth opportunities.
AI’s role in healthcare RCM is not just about improving efficiency but also to maximize revenue potential. It can do so in the following ways:
The ever-changing coding and stringent documentation requirements make healthcare revenue cycle management complex. Automation, however, shows rapid ROI, making the case for upfront investment more compelling. Experienced RCM vendors and healthcare industry experts can set realistic expectations for automation and help prioritize areas based on the unique needs of your healthcare organization.
Let’s look at a couple examples of an efficient, automated revenue cycle management process. A 99-bed acute care facility in central New York implemented a customizable automation solution for coding workflow challenges. This led to a 40% improvement in coder efficiency, a 50% decrease in discharged but not final coded (DNFC) days, and a 4.59% increase in the Case Mix Index, optimizing reimbursement by $592,742. Overall, the impact on the revenue cycle was $1.03 million.
Similarly, a 470-bed healthcare facility saw a 38% drop in DNFC days and a significant enhancement in cash flow by implementing automation in its revenue cycle. Their rejected claims and complex denials also saw substantial reductions.
In short, AI can be invaluable in maintaining financial stability and allowing your practice to better provide healthcare services. An automated revenue cycle management process can mean significant improvements in the overall financial performance and key performance indicators of your healthcare organization.
As more healthcare organizations report successful outcomes from AI and automation, we’ll see a surge in demand for these technologies. They offer a path to improve patient care quality and financial health in the face of increasing challenges. While automation alone won’t solve all healthcare problems, it drives efficiency and can be a key tool in overcoming financial threats. To learn more about expanding patient access with your revenue cycle management process, contact PayrHealth today. We’re an industry-leading team of experts in helping healthcare organizations improve revenue cycle management, payor contracts, and much more.