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How AI Can Modernize Your Revenue Cycle Management

It's no secret that revenue cycle management has become increasingly more complex over the years. Increased patient financial responsibility, complicated payer contracts, and the transition to value-based payments are just three of the pieces that add to the complexity of RCM, and healthcare organizations still struggle with collections. Here we will explore how artificial intelligence (AI) is shaking up healthcare by streamlining outdated processes and providing new intelligence to the claims lifecycle.

AI in the revenue cycle has moved beyond being a buzzword and is now actively being used to improve revenue cycle efficiency and outcomes. We know artificial intelligence is the future of revenue cycle management, but how?

We asked the RCM experts at Revele how AI can enhance and modernize the revenue cycle. Here’s how AI can modernize revenue cycle management based on feedback from our in-house team of RCM experts. 


Claim Denials

Let’s start with claim denials. You can proactively identify problem claims with claims life-cycle AI. Artificial intelligence solutions that can identify denials with the highest likelihood of being overturned means revenue cycle managers can develop a more focused denial management strategy that leads to faster payments.

After all, claim denials are pricey. According to Becker's Healthcare, it’s estimated that hospitals lose more than $260 billion annually from insurance denials.

By leveraging AI, denials can be prevented with pre-submission features that assist with addressing authorization issues. AI can also play a role in your denial management strategy by helping teams understand which denials are more likely to be resolved faster, therefore helping to allocate resources to those claims most likely to be overturned.


Capturing Revenue

A recent survey from the National Association of Healthcare Revenue Integrity (NAHRI) shows charge capture is the number one supporting function for healthcare revenue integrity programs. However, most providers struggle with documentation and coding which often leads to missed revenue. And while most healthcare organizations have implemented technology to assist with medical code selection, human error continues to exist and impact the bottom line. It's no wonder that human error continues to plague revenue cycle management. It was recently reported that billable codes have now crossed a total number of 70,000+. 

Insert artificial intelligence. AI helps to detect missing charges before claims are filed so that a more complete claim can be filed and paid timely. AI can even be used in place of rules-based methods that are often time consuming and difficult to maintain. 


Patient Financial Experience

Today, patients are paying more out-of-pocket costs than ever before and considering the highly competitive market, practices can't afford to lose patients. The experience a patient has doesn't stop when they leave the office. Confusing statements or inaccurate statements can seriously damage the relationship between the patient and provider or the patient and the practice.

AI is helping to improve the patient’s financial experience by automatically identifying patients who qualify for financial assistance and providing the price transparency patients desire. Patients want to know the cost of their visit prior to the actual appointment and AI is making this possible.

Considering AI for your revenue cycle management? Contact us at Revele to learn how we're implementing AI to build better revenue cycles.

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