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How AI is Transforming Healthcare Revenue Cycle Management


Strategic revenue cycle management (RCM) is essential to a healthcare system’s survival, but some of the manual processes associated with RCM can be burdensome, especially amid the ongoing pandemic and healthcare labor shortage.

Revenue delays associated with inadequate prior authorizations and claim denials are among the many current pain points for healthcare organizations struggling to reduce costs and increase profitability. Yet a growing number of providers recognize that an AI-enhanced, fully integrated RCM solution allows them to automate otherwise redundant processes and decrease the errors that impede the revenue pipeline.

According to a recent Healthcare Financial Management Association (HFMA) survey, nearly 80% of health systems have begun to implement RCM automation solutions that employ artificial intelligence, largely due to the effects of the pandemic and labor crisis. While many of these programs are in their infancy, nearly 20% of those with automated RCM services reported positive results from these AI-driven technologies.

AI technology is still young and evolving, but it has already revolutionized the way healthcare organizations can manage their revenue cycles. For providers seeking to overcome the challenges associated with the pandemic and the economic climate, the answer may lie in an end-to-end RCM solution.

The Need for AI and RCM Automation

Prior to the pandemic, many medical coding teams were already utilizing AI-enhanced software to identify and validate codes. However, this innovative technology was typically being deployed in limited capacities. So what prompted so many health systems to suddenly invest in AI-enabled automation solutions?

There are two primary factors that have made AI and RCM automation a necessity. First, the pandemic dramatically heightened the demand for healthcare services. The impacts of the coronavirus were compounded by the Great Resignation, which hit the healthcare industry particularly hard.

As healthcare systems struggled with significant patient loads and difficulties attracting and retaining skilled employees, they began turning to outsourcing and RCM technologies that allowed them to automate crucial revenue cycle operations.

AI and the Healthcare Revenue Cycle

AI technology is capable of accurately processing and interpreting massive volumes of data. In the context of revenue cycle management, core benefits of an AI-enabled RCM solution include:

Rapid Prior Authorization

Tasks related to benefits verification and patient pre-authorization are traditionally time-consuming and ripe with opportunities for errors that slow the revenue cycle.

AI-fueled automation technologies allow healthcare organizations to expedite the prior authorization and benefits verification processes. In turn, this frees up physicians and other clinical staff to engage in other tasks that positively impact workflow and patient experience.

Fewer Claim Denials

Healthcare claim denials have soared during the pandemic, with some providers reporting denial rates as high as 10%. These denial rates not only disrupt the revenue stream, they put some healthcare systems in a financial danger zone.

Yet these initial denials are often attributable to inadequate data or other preventable data entry errors. AI-backed automation allows claims information to be input and parsed quickly and accurately.

Improved Medical Coding and Billing

Medical coding errors lead to claim denials and other problems that clog the revenue cycle. In fact, coding mistakes contribute to more than two-thirds of all improper healthcare payments.

Yet many medical coding and billing tasks can be automated. AI-enabled RCM technology improves coding and billing accuracy, and leads to faster claim processing. A fully integrated RCM system can also facilitate code validation and help manage claim appeals.

Streamlined Path to Payment

Mistakes in data entry and delays in claim processing can cost healthcare organizations thousands of dollars.

End-to-end RCM solutions with automation capabilities help organizations clear those roadblocks to prompt, proper payment. AI-assisted automation can be employed in nearly every stage of the revenue cycle to improve efficiency, and accelerate claim approvals and payments.

Better Patient Experience

RCM solutions that incorporate artificial intelligence don’t just benefit healthcare systems and their staff; AI can also strengthen the patient experience.

The automation of time-consuming tasks frees up clinical staff for more patient interaction. AI-enabled RCM solutions also reveal valuable insights regarding patient demographics, level-of-care assessments, and other analytics that can be used by key decision-makers to inform new RCM tactics.

Strategies for Current AI Features

While AI technology is still developing, there are several areas in which healthcare providers can deploy AI-based automation to strengthen their revenue cycles:

Replace Error-Prone Manual Tasks

When implementing automation, healthcare organizations should start by identifying front-end tasks that are prone to errors.

Many processes associated with scheduling, eligibility verification and pre-authorization can be automated. As noted above, automation can also assist with medical coding, claims submission and accounts-receivable duties. While automation is not intended to replace humans, it can make up for some staff shortage issues and help current team members perform their jobs more effectively.

Proactively Prevent Claim Denials

Machine-learning RCM software gives health systems the ability to proactively prevent claims denials.

It accomplishes this by improving up-front coding accuracy and conducting automated claim reviews that can flag common errors such as incorrect patient identification information or missing claims codes, and routing the claims to the appropriate personnel for review and resolution.

Perform Predictive Analysis for Billing

In order to maximize the benefits of their RCM technologies, healthcare systems can also leverage patient demographic data and patient trends to predict payments and adjust their billing approaches. As artificial intelligence progresses, it may become possible to fully automate entire RCM functions while also gaining a more thorough understanding of every step of the patient journey.

GeBBS Healthcare Solutions: Advancing RCM Technology

AI and automation have transformed how healthcare providers manage their revenue cycles. But that doesn’t mean innovation stops with today’s RCM services.

GeBBS Healthcare Solutions is a leader in health information management (HIM) and RCM technology, and our forward-thinking, results-driven resources are designed to optimize healthcare revenue cycles and augment the patient experience. To learn more about our scalable, end-to-end RCM services, request a consultation today.

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