AI News, Artificial Intelligence: The benefits to revenue cycle management ... artificial intelligence

| FierceHealthcare

For smaller hospitals burdened with personnel shortages, increased costs and reduced reimbursement, the challenge grows — especially when documentation demands overwhelm clinicians and limit the time and energy they have to focus on patient care.

Electronic Health Reporter

Many are now looking outside the box for solutions to help increase their operating revenue and combat the continued pressure to stretch budgets to include data security, attracting top talent and facility upgrades.

RCM Represents Prime Opportunities for AI Even as revenue cycle management (RCM) becomes increasingly more complicated, there are a number of repetitive and predictable processes involved that make it an area perfect for the efficiencies that AI and intelligent automation offer?for instance, prior authorizations.

AI can reduce the need to assign resources to repetitive, “simple” pre-authorization requests, allowing healthcare leaders an opportunity to deploy staff to more complex, acute requests that require additional clinical information, peer-to-peer review, and/or other payer required information Studies show that 84% of physicians surveyed said the burdens associated with prior authorization were high or extremely high, and 86% said the burdens associated with prior authorization have increased significantly (51%) or increased somewhat (35%) during the past five years.

The ability to apply AI to the revenue cycle provides yet another tool to identify inefficiencies, then allow hospitals to redesign their processes and re-allocate internal resources to maximize their net revenues going forward?

Southeast Clinic Uses AI to Improve Submitted Claims, Increase Insurance Payments Located in a large metropolitan Southeast city, one clinic that is part of a larger comprehensive healthcare network employs more than 2,200 outpatient clinical providers who schedule procedures that potentially require payer pre-certification of services?thus, necessitating a review of payer portals and the submission of pre-certification requests.

With limited resources available to augment the pre-certification department’s staff, the clinic implemented AI technology to help achieve several objectives: The decision was made to apply the AI technology to outpatient cardiology payer pre-certification request procedures.

Additionally, as machine learning components of AI technology learns the particulars of that organization, it will provide valuable and meaningful insights to healthcare leaders to help identify and plan for perpetual opportunities for efficiencies and increased revenue.

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