The Future of Revenue Integrity Is Artificial Intelligence

The Future of Revenue Integrity Is Artificial Intelligence

Artificial intelligence (AI) is no longer a topic exclusively used in science fiction or Hollywood blockbusters. Nowadays, AI is a tool that’s employed by a growing number of healthcare experts and C-suite executives.

Faced with difficulties like the high number of patients enrolling in high-deductible health plans, the considerable expense of essential facility upgrades and increased competition, hospital leaders require innovative solutions to keep costs down and doors open.

According to a recent report, high labor costs tend to consume more than half of a hospital’s overall operating revenue. In an effort to tamp down on costs, hospitals are turning their attention to one of their most labor-intensive departments: revenue cycle management. That’s where AI comes in.

Briefly defined, AI can process and learn from large sets of clinical data, offering hospitals automated tools to improve organization-wide efficiency, accuracy and reliability. In fact, some revenue cycle management experts consider AI to be the future of revenue integrity. According to the National Association of Healthcare Revenue Integrity (NAHRI), the goal is, in part, to “prevent the recurrence of issues that could cause revenue leakage or compliance risk.” AI’s ability to automate routine tasks and discover meaningful patterns in analytics could be a game-changer.

A Dynamic Duo

Though the rapid rise of AI may arouse some skepticism, AI is actually well-suited to address common woes in revenue cycle management. Take the problem of denied claims, which can trigger a time-consuming series of back-and-forths attempting to resolve the problem.

If a solution is not found quickly, a denied claim can sit in accounts receivable for weeks or even months. This cuts into the hospital’s operating expenses and means more work for an already busy staff.

However, integrating AI-enabled healthcare IT into hospital revenue cycle management could eliminate tedious, error-prone tasks and result in a wealth of short- and long-term benefits such as:

  1. A streamlined workflow. Using intelligent, automated tools can free up staff from mundane and redundant tasks, such as shifting through mountains of paperwork or performing tedious data entry. Plus, skilled hospital staff could shift their focus to more meaningful tasks, likely executing a higher volume of claims more efficiently and over a shorter period of time. Similarly, AI can also prove advantageous to hospitals struggling with workforce shortages, helping rural facilities attract talent and larger facilities retain talent.
  2. Reduced compliance risks. Moving toward an automated workflow also reduces or eliminates the likelihood of error. By removing the risk of mistakes associated with an administrator continually entering patient data or simply copying information, hospitals can better protect patient confidentiality and ensure compliance. Just as predictive algorithms have reduced unnecessary hospitalizations or identified life-threatening conditions, AI can help mitigate risk in revenue cycle management.
  3. Predicting denials. Research from the American Medical Association found that the healthcare industry could save a whopping $15.5 billion every year if claims were processed correctly the first time. Fortunately, AI has the ability to predict denials before they happen by acting as a filter to highlight errors, missing information or other problematic patterns. By analyzing historical transactions, AI has the extraordinary ability to learn from past patterns and data, which hospitals can then use to predict and prevent future errors.

The healthcare industry is in a constant flux, evolving from one day to another with a new series of challenges and complications. AI can attack these challenges and help sharpen your organization’s competitive edge, delivering cost-saving solutions to help you accomplish more with less.