Revolutionizing Revenue Cycle Management with AI

Artificial intelligence (AI) has the capability of transforming hospital revenue cycle management (RCM) — creating an opportunity to reduce errors, improve decision making, ensure compliance, and maximize revenue. It sounds like it does everything that most of today’s practices need to work on, but the reality is AI can do much more. 

Depending on the application and goals, AI’s data processing, pattern recognition, and decision-making capabilities enable a wide range of practice improvements. By utilizing AI to automate tasks, it’s possible to put people where they need to be while reducing the number of manual tasks they have to do. There's no reduction in overall patient satisfaction or employees' needs, but there is an opportunity to greatly enhance efficiency in RCM.

Benefits of AI in Revenue Cycle Management

Though the healthcare industry often lags behind others in the implementation of new technology, AI is already making its presence known with numerous enhancements. The advantages of integrating AI into RCM show exactly what that is.

• Improved Accuracy: AI eliminates human errors. It has the ability to detect and correct coding errors immediately. One study from 2018 found that coding errors could represent as much as 39% of hospital income. 
• Improved Efficiency: By automating repetitive tasks, AI enables significantly improved efficiency. Instead of the time it takes a team of professionals to enter data or submit documentation, AI can do so in moments without the risk of errors. 
• Identifies Missing Revenue: For many organizations, missing revenue is an incredibly costly loss, yet it is also difficult to pinpoint. AI can gather data and analyze it in moments, providing opportunities to capture missing charges immediately and boosting revenue in the process. 
• Proactive Issue Management: With so much data available and processed, AI can also use predictive analytics to create proactive strategies for management concerns, reducing risks, compliance problems, and improving overall customer satisfaction in the process.
• Streamline Processes: At the heart, AI cuts down on the burden of work that does not require human-specific interaction. In doing that, it helps to reduce the burden on your administrative team, enabling them to do more of the important work to keep your practice growing.

Current Challenges in Revenue Cycle Management

Hospitals and healthcare providers today face numerous challenges within RCM, many of which cost the organization money and can risk their reputation. Some of the most common concerns include:

• Data silos where valuable data and insights are not accessible or easily managed
• Collecting payments in a timely manner that maintains true efficiency
• Constant changing regulator requirements and processes 
• Complexities of billing processes that require significant labor management
• Lack of deep insight into revenue cycles 
• Coding errors and lost revenue from it

Consider, for example, the time spent on RCM. Within most organizations, hospital staff and medical providers need to spend as much time as possible with patients. Yet, the complexities of updating, managing compliance, and keeping technology updated to provide efficient billing is challenging.

How AI Can Address These Challenges

AI offers a transformative opportunity to reduce nearly all of the most common challenges in healthcare revenue cycle management. Consider how:

• AI automates tasks. That immediately reduces the workload of employees and staff.
• Integrates disparate data sources. This enables this fast-moving tool to gather data from numerous sources and combine it as needed, providing more consistent access, structure, and information. 
• Accurately interpret medical codes. Errors in medical codes are virtually eliminated due to the automation features of AI. 
• Regulatory compliance mandates met. Once AI knows the rules, it will ensure that all processes completed will meet the specific regulatory compliance requirements. 

Consider that, AI in RCM right now is playing a vital role in eligibility and benefit verification, enabling enhanced data collection, verifying patient criteria and qualifications, and ensuring there is no oversight in care provided. More so, it can provide payment estimations in moments and help with prior authorization management, reducing speed to getting the patient the care they need.

Implementing AI in Revenue Cycle Management Best Practices

Hospitals ready to implement AI in RCM have numerous opportunities to do so, with more solutions available today than ever. Consider these best practices:

• Navigate change management from the start. Put in place processes, training, and a slow step-by-step implementation process.
• Always ensure data is quality. AI can only provide accuracy when data is accurate. 
• Implement cybersecurity that meets all regulatory requirements. 
• Choose AI vendors specific to the RCM industry that offer key features such as continuous monitoring and fine-tuning AI models to ensure accuracy and compliance. 
• Ensure proper training from the start and education for employees and patients when necessary.

Potential Impact of AI on Revenue Cycle Management Jobs

While concerns exist about job displacement due to the inclusion of AI, the reality is that AI cannot do all of the work. Instead, it augments human capabilities, enabling people to do more of the patient-centered tasks with more precision and less stress and strain. AI creates support for healthcare professionals, offers new job opportunities through the use of AI-focused data analytics, and may help to create better practices that support improved patient outcomes. Working as AI model trainers and data analysts are new positions developed thanks to AI’s inclusion. AI is meant to support and enhance your workflow, not replace your people resources.

The Future of Revenue Cycle Management: Embracing AI

Critical for nearly all hospitals and healthcare practices is the inclusion of AI in RCM. The strategic advantages are impossible to ignore, including streamlining processes, minimizing revenue loss, and improving overall financial performance. With a strategic and careful approach to AI implementation, organizations can achieve better outcomes while meeting the needs of their patients.

Integrated properly, AI offers an incredible opportunity for the healthcare industry to improve RCM costs, effectiveness, and compliance. Though it does not replace humans, it definitely offers a clear strategic advantage for those organizations that put it into place.