AI is a crucial tool for healthcare providers today, from revenue cycle management to operational efficiencies and more. Don't miss this VB On-Demand event for a look at the ways AI is transforming how clinics deliver patient care. AI is transforming how clinics deliver healthcare, at every point of the the healthcare revenue cycle, with the sheer amount of valuable data that healthcare clinics produce, plus the maturity and capabilities of AI products in the market now. Not only is it delivering an increase in efficiency in the back office, it is helping healthcare providers serve the patient better. "Everybody expects good healthcare, but when it comes to revenue cycle management and the billing process, that's particularly where patient surveys fall down," says Tina Eller, VP of revenue cycle management (RCM) tech-enabled transformation, Change Healthcare.

Technology has started to play an even bigger role in the revenue cycle as staffing shortages seem to have hit a high. To this point, more than 57% of health systems and hospitals have more than 100 open roles to fill, with one in four finance leaders needing to hire more than 20-plus employees to fully staff their revenue cycle departments, according to a recent survey. Automation has been a clear solution to not only alleviating staffing issues in revenue cycle but making the administrative process more efficient overall. While, according to survey, the use of automation in revenue cycle operations increased in 2021 from 66% to 78%, there remains a demand for further implementation to relieve the burden on staff. In fact, one recent revenue cycle leader HealthLeaders spoke to about its automation journey was Jamie Davis, executive director of revenue cycle management at Banner Health.

Today, nearly every role in every industry is facing some level of disruption. We are tasked with achieving more with less – less time, less resources, less information, and often less support. No industry has experienced this more than healthcare. Healthcare workers, from clinicians to administrative coordinators, are feeling the pressure to simultaneously improve patient outcomes and experience, reduce operating costs and increase billings. Though it's not front and center, one major component within any healthcare system that greatly impacts all three of these goals--and where administrative and clinical workflows are intertwined--is revenue cycle management.

From spiraling claim volumes to more stringent payer requirements and increasing reporting obligations, today's health practitioners face higher challenges than ever. As a result, diagnostics providers across the country are effectively looking for new revenue streams, improved payer relations, cost-cutting opportunities, and more predictable reimbursement rates. For example, high-quality and carefully designed data sets facilitate improved analytics, and the use of Artificial Intelligence (AI) can expedite the Revenue Cycle Management (RCM) process while also enhancing financial and operational performance. Council for Affordable Quality Healthcare, Inc. (CAQH) used data from medical plans representing nearly half of the US insured population to find that electronic prior authorizations adoption rose by just one percentage point to 13 percent from 2018 to 2019. For years, visionary healthcare providers have been using technology to improve care for people suffering from sleep problems, eye illness, cancer, and now, even COVID-19.

The global pandemic resulted in numerous changes in healthcare, both in terms of practice and behind-the-scenes procedures. As we head into the new normal where technology has become the way of life, healthcare organizations are rethinking their strategies, thus making artificial intelligence (AI) in healthcare and revenue cycle management a hot topic. It is no mystery that revenue cycle management has gotten more challenging. Increased patient financial responsibility, convoluted payer contracts, and the shift to value-based payments are just a few of the factors that make RCM more difficult. AI is no longer just a buzzword in the revenue cycle; it is a strategy leveraged to enhance the efficiency of RCM and the associated outcomes.

As the world continues to battle Covid-19, its effects on population health are just one facet of the crisis. The economic fallout is also seriously impacting both people and businesses, including hospitals and other healthcare facilities. The American Hospital Association (AHA) estimates the country's hospitals and health systems could lose $120.5 billion between July and December 2020. This is in addition to AHA's previous financial impact estimate -- losses of $202.6 billion between March and June 2020 -- bringing total losses for the calendar year to at least $323 billion. Half of all hospitals could be operating in the red during the second half of 2020, according to analysis prepared by Kaufman Hall and released by the AHA.

From denied claims to missed earlier approvals, there are a lot of procedures within the revenue cycle that can be tedious, and prone to human mistake. The chance to handle these challenges through artificial intelligence (AI) and automation can be of major value to your business and revenue cycle management. Figure out how AI and automation can enable your organization to eliminate denials coverage, speed up collections, and improve ROI. A high-performing revenue cycle depends on data analytics. In any case, observing and synthesizing all the information that flows through your company can be challenging.

The presence of artificial intelligence has been increasing in the healthcare industry, and with the technology maturing and becoming more viable, the opportunities for it to make administrative and process improvements have been increasing – and revenue cycle management is one area in which this is especially manifest. The problem with many current revenue cycle processes is that it can result in a lot of friction and waste. In a HIMSS20 digital presentation, Mark Morsch, vice president of technology at Optum360, cited data indicating that there can be as much as $200 billion in administrative waste in the healthcare system due to inefficient revenue cycle practices. "That's waste in the system between providers and payers that's generated from a lot of inefficiency, from inaccurate documentation and coding, a lack of transparency, and both sides not being aware of the appropriate steps a lot of times," Morsch said. Hiring data provided by Optum360 illustrates the extent to which administrative spending has increased.

Interest in artificial intelligence (AI) is soaring in the healthcare industry, according to a recent Optum survey of 500 US healthcare executives from hospitals, health plans, life sciences organizations, and pharmaceutical and device companies. The survey found an 88% increase this year in the number of healthcare leaders who said their organizations are implementing an AI strategy compared to 2018. Sixty-two percent of the respondents said they had implemented such a strategy, up from 33% last year. The average organization expected to invest $39.7 million in AI over the next 5 years ― $7.3 million more than was estimated last year, Optum found. Many respondents also anticipated a return on investment (ROI) in the near term.

That's something all healthcare organizations must do, and do well, especially during a period of changing financial models and expectations. Revenue cycle management systems are bread and butter when it comes to what healthcare organizations need in health IT. But the next generation features and functions of revenue cycle management systems may be anything but ordinary, according to experts. For one thing, expect next-generation revenue cycle management systems to boast quite advanced analytics, said Kellye Sherbet, president of RCM services at Aprima Medical Software, which markets EHR, practice management and revenue cycle management systems for medical group practices. "Healthcare organizations require sophisticated analytics to perform a deep dive into their information and look at the margins for ancillary services provided," Sherbet said.