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Using Artificial Intelligence to Combat Revenue Cycle Inefficiencies

By Valerie Barckhoff, principal and healthcare advisory practice lead, Windham Brannon.

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Valerie Barckhoff

Hospitals and health systems throughout the country are constantly looking for ways to streamline finances and fine tune operating margins. 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. Artificial Intelligence (AI), as an example, is showing promising results in healthcare to more effectively address revenue cycle inefficiencies.

AI has penetrated nearly every touchpoint in medicine, from the way emergency medical technicians (EMTs) are dispatched to assisting physicians during surgery. AI is enabling smart devices to detect cancer or a stroke, and consumers can even get help to quit smoking or address opioid addictions with the help of AI. So, it was only a matter of time to apply AI to tackle health revenue cycle inefficiencies. But how?

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.

Prior authorizations, the process by which insurance companies and payers determine if they will cover a prescribed procedure or medication, are meant to help patients avoid surprise bills and unexpected out-of-network costs. However, this largely manual process is time-consuming and error-prone, resulting in $30 billion in annual costs for wrongful denials, inefficiencies and clerical errors. 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? to focus on more patient care instead of administrative burdens. There is a huge opportunity to gain 25- to 50-percent efficiencies for hospitals and health systems.

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Health IT Trends for 2019

Healthcare technology continues to proliferate the sector, the developments almost too many to track. The sector abounds with innovation and push forward in the name of better – even the minutest – advancements of care and better care outcomes. The coming year will be no different. As we enter the final year of the 21st century’s second decade, we’ve witnessed a tremendous amount of evolution in just 19 years. What role will our healthcare technology play in the healthcare industry in the next year?

A lot. And not just for a few, but members of many, many areas, even those peripherally involved with the boundaries of care. We must understand where current innovation is, but also the challenges these migrations attempt to solve. Being aware of the trends ahead can give us all a better grasp of how care delivery is changing and we can better understand how new areas can resolve real industry problems.

To help us navigate the year ahead for healthcare and its technology, the following are some of the trends that it leaders, observers, insiders, consultants and investors think are important or need to be taken notice of in 2019.

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