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AI-Fueled ROI (Release of Information) Can Improve Your Revenue Cycle

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Artificial intelligence (AI) has already demonstrated its value across multiple healthcare revenue-cycle processes, from patient access through claims management to billing.

As technology advances and healthcare providers struggle with a workforce shortage, evolving patient preferences, and increasing state and federal compliance demands regarding healthcare data, AI also deserves greater consideration in administering release-of-information (ROI) requests. For providers, the pertinent question is not, “Are AI-driven ROI responses coming?”; it’s “Are we ready to adopt digital ROI?”

The ROI Conundrum

The pandemic spurred many providers to change, or at least reconsider, how they coordinated ROI requests.

Some health systems halted in-person requests and redirected requests to digital portals or remote, third-party ROI specialists. As the pandemic waned, some providers maintained these approaches as a means to cope with the ongoing healthcare labor shortage; some have also discovered the benefits of alternative ROI methods, including improved accuracy and workflow.

While there are release-of-information standards, there is also a disparity among providers in how ROI requests are managed and how data is shared. Paper records are still used in many cases, and outdated, incompatible technologies are used in others.

As the move to electronic medical records (EMRs) and interoperability intensifies, capturing, processing, and sharing patient data will be critical. And with technology that deploys artificial intelligence and natural language processing (NLP), that can be accomplished with precision and speed.

The Demand for Digital Health Services

Modern healthcare information technology systems are engineered for interoperability, efficiency and security, though providers are just beginning to tap into their potential and the opportunities their inherent artificial intelligence presents. These AI-augmented capabilities include parsing information requests and releasing protected information safely and electronically to authorized stakeholders.

This forward-looking technology is also designed to meet growing preferences for digital services. Consumers at a broad level have embraced digital services that involve sharing sensitive data, from banking to mortgages to payroll to shopping.

Patients have also welcomed digital resources within the healthcare sector. Consider the ease and popularity of online scheduling and the rapid rise of telehealth.

However, the benefits of the digital release of information extend beyond patient satisfaction. The ability to request and promptly recover data digitally can accelerate patient care and improve patient outcomes.

AI-based ROI processing also reduces the burden on internal staff, who must often prioritize and respond to ROI requests among their regular patient-centric duties. Digital ROI allows staff to dedicate their attention to patient care and key revenue-cycle functions.

Release-of-Information Requests Critical Component of RCM

ROI requests are critical components of revenue cycle management (RCM). However, as a recent commentary about AI-enhanced ROI in ICD10 Monitor observed, healthcare leaders often consider the release of information as a health information management (HIM) function.

Yet release-of-information requests are not always conducted by dedicated HIM departments. ROIs are often handled by others who are more directly engaged in revenue-cycle operations.

A patient access team may release data to payers to determine eligibility and establish pre-authorization for services. ROI also occurs in utilization review, in which information may likewise be released to payers to gain endorsement for an extended patient stay or to authorize transfer to another facility. The billing team may release patient information in support of a pending claim or the appeal of a denied claim.

The commonality among these situations is the exchange of segmented patient data between providers and payers for care and reimbursement. And these are just a few examples of instances in which release of information touches revenue-cycle activities.

As these situations suggest, manually processing ROI requests outside of a singular HIM department can create workflow complications. In some cases, ROI requests may not be logged, or sensitive information may be given without proper permission or notice.

AI and ROI: Intelligent Information Exchange

The shift to the digital release of information is not as formidable as it may seem. Optimal healthcare IT platforms have AI-enabled applications that facilitate patient-data sharing based on preset parameters and machine learning.

Digital ROI accommodates the selection of what information can be shared among involved parties, and it can automatically update and communicate changes between these entities. Digital ROI that employs AI and NLP is not intended to replace the human element in the release of information but to reinforce it.

AI-assisted ROI empowers human resources to perform more effectively and allocate their time and effort to more complex and dynamic tasks. Digital ROI facilitates productivity in part through accurate, clean and timely data.

As health systems amplify the transition to EMRs and strive to meet interoperability goals, and as healthcare data breaches have gained attention, there is understandable concern regarding ROI and security. The technology that encompasses patient data and is capable of processing ROIs must have multiple levels of authentication and meet applicable Health Insurance Portability and Accountability Act (HIPAA) and Centers for Medicare and Medicaid Services (CMS) standards for protected health information (PHI).

Digital ROI offers greater control of and safety for patient data than the maintenance and exchange of paper records or decentralized technology systems. Digital ROI is centralized and prevents the accidental sharing of otherwise private information or the disclosure of personal data to unauthorized parties.

AI-fueled, digital ROI is an essential step forward for medical data and the ability of patients, providers and payers to exchange vital information quickly and securely. An experienced technology partner can help expedite a successful digital ROI strategy.

GeBBS Healthcare Solutions: Forward Thinking

GeBBS Healthcare Solutions has earned extensive acclaim for its comprehensive RCM services and advanced healthcare technology incorporating deep AI automation capabilities.

We’re dedicated to providing our clients with confidence and measurable results. GeBBS is proud to be recognized as a Leader by Everest Group’s Revenue Cycle Management Operations, one of Black Book Market Research’s Top 20 RCM Outstanding Services, one of Inc. 5000’s Fastest-Growing Private Companies in the United States, one of Market Research’s Top 20 RCM Outstanding Services and one of Modern Healthcare’s Top 10 Largest Revenue Cycle Management Firms. Connect with GeBBS Healthcare Solutions today at gebbs.com to schedule a consultation and learn how we can help you meet today’s challenges and prepare for those on the horizon.

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