Ways AI can improve RCM
by Gautam Char
With the barrage of constant changes in healthcare, manual RCM processes simply cannot keep up. Those without RCM analytics are falling farther behind and have almost no chance of catching up. Artificial Intelligence (AI) is no longer a “nice to have.” A purpose-built AI platform is essential technology that is needed to find, fix, manage and track areas of revenue leakage. AI can also provide valuable insights to fine-tune financial operations and lower expenses. Here are a few ways that AI can be used to improve the performance of your revenue cycle.
Healthcare organizations are famous for creating a plethora of data - and leaving this valuable resource largely untapped. It makes perfect sense that the first step to managing the revenue cycle is to wrangle your data into a secure and unified health data warehouse. Once data is normalized, AI and other deep analytics can be automatically applied to deliver fresh daily KPI (Key Performance Indicator) dashboards. These at-a-glance insights provide much needed visibility to the health of revenue cycle workstreams.
KPIs help managers understand what areas of their business are performing well and where they need to devote attention to bring those workstreams up to speed. Drill down capabilities to the claim level and other visual metaphors are now essential elements that are already being created and maintained by the AI in most revenue cycle management analytics platforms.
Instead of taking time to build KPI reports from an analytics toolkit, the WhiteSpace Health Platform contains hundreds of reports that automate what was previously time-consuming management reporting. AI also automates the analysis of KPI reports and prioritizes work that can quickly move the needle on your financial performance. This allows managers to immediately pivot their teams toward meaningful actions that enhance and accelerate cash.
Having fresh KPI data that is readily accessible from your laptop or mobile device has become “table steaks” for analytics platforms. And for good reason, having access to the health of your RCM workstreams is valuable. However, AI can extend the value of your data even further. For example, AI can also identify key contributing factors that are causing RCM or operational issues, adding even more value beyond KPIs.
Prioritization of work can be challenging for humans. Many of us experience shifting priorities throughout the day. Bias is also introduced that favors the tasks that we like to do. Sometimes, humans perform tasks that they are good at first and de-prioritize their least favorite – even if they are best for the business. AI can help us keep the priorities of the business in the forefront.
For example, AI can cull through your data to identify the right accounts that will allow your organization to collect the greatest amount of cash as quickly as possible. Sometimes, this is not necessarily the highest dollar accounts.
AI can also look for accounts that have been written off but could still be reasonably collected if prompt action is taken. AI can find complex patterns in your data and parse out denials and other areas of revenue leakage by type.
Machine Learning (ML) is a type of AI that determine how similar claims were successfully resolved, creating actionable intelligence. ML translates its learnings into specific steps that human RCM staff can understand, so they can resolve the claim at hand. By taking the actions proven to have the highest probability of success, humans can quickly resolve one claim or an entire batch of similar claims simultaneously, extending the leverage of machine learning even further.
Machine generated intelligence in the WhiteSpace Health Platform allows your team to be as efficient as possible and to make the best choices that get you paid faster. As your dataset grows, ML gets even more precise in its predictions. And when unforeseen changes occur that do cause a denial, ML often is the first to find them. Early identification helps you nip issues in the bud and stop them from reoccurring, ensuring your financial performance continues to be strong and predictable.
About Gautam Char