Digital Innovation and AI in Revenue Cycle Management


Digital Innovation and Artificial Intelligence are two huge topics recently in the world of Healthcare IT. We’ve talked about the many areas in which they are actively making a difference, and the areas in which they could make a difference, if applied. Let’s now take a look at how it can impact Revenue Cycle Management!

We reached out to the Healthcare IT Today Community for their insights on this topic. The following is what they had to say.

Amit Jayakar, Vice President Commercial Operations at Fathom

Coding is the key to successfully generating revenue, yet highly specialized medical coders are underutilized. Most coding-related revenue risk occurs with denials, auditing, and complex cases. While trained coders are equipped to manage these, after hours of fully coding basic encounters they don’t have the bandwidth to address these critical issues. Autonomous medical coding solves this problem, codes the majority of encounters without human touch, and frees coders to focus on critical issues.

Amy Brown, CEO at Authenticx

Revenue cycle is often the customer touch point that provides the most insight into how customers experience the overall health system and care journey. The reality is, patients, caregivers and all customers talk about what they appreciate and value, as well as what frustrates and confuses them about their experience during their bill paying interactions.

Tech innovations like AI and ML are empowering healthcare leaders to efficiently monitor, track and analyze millions of diverse patient voices, including those captured during revenue cycle conversations. Analyzing conversational data helps identify human coding errors, reduce disruptive billing claim processes, prevent fraud and guide decision-making. Revenue cycle leaders can use this analysis to understand gaps in care and develop patient-focused investment strategies.

Hadi Chaudhry, Chief Executive Officer at CareCloud

AI capabilities can speed through burdensome RCM tasks to help healthcare providers avoid denials, reduce coding errors and improve price transparency for patients. At the end of the day, healthcare providers operate a business, and to stay operational and continue to provide quality care to patients, they must have financial viability. The increased adoption of AI is not only improving processes for these businesses but also continuing care and enhancing experiences.

It’s reported that somewhere around 80% of medical bills contain errors, which hurts the patient and the provider. If incorrect patient health information is shared between providers, consequences could be dire. Coding errors can also prohibit providers from capturing the correct revenue, as claims could be delayed or even denied. This problem supports a great case for the use of AI in RCM services, as they use natural language processing to assess a physician’s notes and propose the correct codes to use.

Dawn Crump, Sr. Director Revenue Cycle Solutions at MRO

With hospital margins the lowest we’ve seen in decades, now is the time for healthcare provider organizations to level up their people, processes, and technology to prevent payer audits and denials. Between 8% and 12% of claims are typically denied or audited. This represents a large chunk of provider revenue lost during a year when every penny matters. While 36% of organizations still use Excel spreadsheets to track and analyze payer denials, these legacy tools no longer suffice.

The payer complexities have become too unwieldy, multiple departments are involved, and the appeal process spans months or even years. Beyond revenue recouped, the move away from legacy spreadsheets to more advanced denial and audit technology saves time and resources for revenue cycle teams that are already understaffed and underbudgeted.

Craig Adkins, VP Revenue Cycle Management at AdvancedMD

Despite significant progress over the past three decades, efficiencies offered through Electronic Data Interchange (EDI) are still underutilized in healthcare Revenue Cycle Management. For example, most physician practices, and billing offices, still spend a lot of time calling payers, or manually logging into payer web portals, to check the status of a claim(s) when the same information could be obtained from the payer electronically, through a 276/277 Claim Status Inquiry and Response transaction.

Bryan Ten Broek, Vice President at Nordis Technologies

Providers are missing a big opportunity to advance their digital transformation while improving the patient financial experience. InstaMed found 73% of healthcare consumers want eStatements but 75% of providers primarily use paper and manual processes for collections. Whether staying in-house or outsourcing RCM, incorporating digital channels with a cloud-based communications platform can help providers drive patient financial engagement and payments. Improve revenue and cashflow, meet patient expectations and deliver on digital initiatives – these are today’s revenue RCM imperatives.

John Bou, COO and Co-Founder of Modio Health

Provider credentialing is a critical, but often overlooked, element to a successful revenue cycle management process (RCM). Prioritizing credentialing into your healthcare organization’s RCM process can help avoid major challenges including delays in payor enrollment, billing denials, and administrative errors. A modernized credentialing system and process is even better. Not factoring it in at all can be problematic and have a negative impact on your bottom line.

So much to consider! Comment down below how you think digital innovation can impact revenue cycle management.


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