Drag

Unlocking Efficiency and Maximizing Revenue:

AI-Driven Optimization in Healthcare Revenue Cycle Management

Author’s Corner


In this white paper, Mark Kausel, Director of Client Services, explores the transformative impact of Artificial Intelligence (AI) on healthcare revenue cycle management. He addresses the challenges faced by healthcare organizations, including rising costs, staffing shortages, and increased administrative requirements. He also highlights the potential of AI to positively influence the revenue cycle process.

Please click on the video to the right to learn more about the author, hear his insights on this white paper, and learn what motivated him to write about unlocking efficiency and maximizing revenue.

To discuss this white paper in detail, please contact Mark using the information provided at the bottom of the page.

Every healthcare organization is faced with rising costs, staffing shortages, and increasing administrative requirements by payers to be reimbursed for the services they render to care for their patients. Inefficiencies in the US healthcare system are well documented, and healthcare organizations are turning to new ways and technologies to address the undaunting challenges they face. A recent study by Crowe RCA saw an increase in denials in 2021 of 10.2% and another 11% in 2022. Where can healthcare organizations turn to level the field? The answer is technology, or intelligent automation that utilizes Artificial Intelligence (AI).

Merriam-Webster defines Artificial Intelligence as "the capability of a machine to imitate intelligent human behavior." The potential AI offers to impact the revenue cycle process positively is tremendous. Artificial Intelligence is a technology that is not well understood but is becoming more widely adopted to solve complex challenges in revenue cycle management processes. With access to large amounts of historical transactional data AI is an excellent fit to provide guidance and direction through its predictive analytics capabilities.

In fact, AI can be leveraged at any point in the healthcare revenue cycle process to bring higher quality and efficiency. If there is that significant of an opportunity, why is adoption so slow in many organizations?

ENGINE Insights conducted a study of approximately 200 revenue cycle, IT, finance, and C-Suite executives to gauge their knowledge of AI, areas for improvement, and its use now and in the future. The study revealed that two-thirds of hospital and health system executives report using AI currently, and almost all (98%) expect to be using it within three years. Only 65% report using it for revenue cycle management today, and only in very specific areas. There is also a difference in opinion of reported usage. Revenue cycle roles reported higher use of AI (89%) than IT (63%) and non-technical executives (48%). Also, according to the study, AI is currently being used for eligibility and benefits verification (72%) and patient-payment estimation (64%). By 2023, prior authorization (68%) and payment amount/timing estimation (62%) will emerge as the leading applications.

While those areas cited in the study are important and deliver value, AI can improve all areas of revenue cycle management to address the cost-to-collect, limit denials, accelerate payments, and improve operational efficiency.

analytics-claims

As your organization considers leveraging Artificial Intelligence, consider the benefits its use can have on the following areas:

Area Considerations Benefits

Eligibility and Benefits Verification

  • Automatically verify benefits
  • Leverage chatbots to communicate directly with payers to provide updated patient information
  • Quicker benefits verification
  • Fewer denials
  • Reduce the need for manual intervention

Patient Scheduling

  • Optimize patient scheduling to utilize providers credentialed with payers
  • Providers maximize their schedule to care for the most allowable patients

Pre-Bill Audits

  • Review claims to ensure accuracy
  • Eliminate human audits
  • Improve RCM processes and increase the percentage of claims paid on the first submission

Prior Authorizations

  • Identify and gather the additional information required by payers to obtain the authorization
  • Fewer denials
  • Quicker care for patients

Patient Payment/Timing Estimation

  • Assist in calculating service costs and due dates for patients by getting information from payers
  • Faster process

Denials Management

  • Predict the probability a claim will be denied and submit the additional information on first submission
  • Generate more accurate claims
  • Quicker appeals processing
  • Prevent denials before they occur
  • Faster appeals processing
  • Avoid TFL issues

Compliance Monitoring

  • Ensure claims comply with payer rules and regulations
  • Avoid penalties

Charge Capture

  • Capture all appropriate charges
  • More accurate billing

Medical Coding

  • Analyze clinical documentation and suggest the most appropriate codes based on a patient’s diagnosis and treatment
  • Reduce coding errors
  • Ensure accurate claims are submitted

Payment Posting

  • Post payments upon receipt
  • Accurate account information

Claims Lifecycle and Analytics-Driven Workflows

  • Identify inefficient processes
  • Identify bottleneck patterns

Accounts Receivable Analysis

  • Historic payer information can help prioritize follow-up
  • Avoid following up with payers based on payer remittance history
  • Accelerate payments

Artificial Intelligence should not be considered a futuristic technology. It is here today, and healthcare organizations should be focusing their efforts to apply this technology across many revenue cycle processes. It can address the challenges that come with staffing shortages, combat higher denial rates, and slower reimbursements. By reducing denials, healthcare organizations can drive down receivables and boost reimbursements. For those organizations leveraging automation, Artificial Intelligence will enhance it by providing insights and recommendations to drive better decision-making. It allows your staff to perform at a higher level.

As healthcare organizations focus on improving areas of revenue cycle management to address the cost-to-collect, limit denials, accelerate payments, and improve operational efficiency, Artificial Intelligence can be a game changer. Not only will these organizations benefit from healthier financials, but the patients also will receive more timely and appropriate care and have a better understanding of their patient financial responsibility leading to better patient satisfaction scores.

At Vee Healthtek, we strive to leverage technology to the fullest, gaining competitive advantages while delivering Extraordinary Outcomes to our clients.

Mark Kausel

Meet the Author

Mark Kausel - Director of Client Services

Mark Kausel applies over 30 years of experience from healthcare operations, information technology, and sales and account management roles to deliver strategic solutions to client challenges, resulting in positive outcomes with long-term relationships.