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Artificial Intelligence and Bot Technology in Revenue Cycle

Many hospitals and health systems have suffered serious financial losses due to COVID-19 and other industry changes within revenue cycle. Recovering from this financial crisis is vital in truly moving forward post-pandemic and returning to a “new normal.”

There are many strategies organizations can use to strengthen their finances, from optimizing elective surgery schedules to evaluating the use of their internal workforce for revisions and identification of inefficiencies. However, for the best results, organizations will need to evaluate every process and department, rethink what has been and consider what could be.

Artificial Intelligence (AI) and bot technology is already being used in a multitude of ways for healthcare, and until now, a large part of the conversation has focused on how AI can enhance patient diagnosis and care. But AI can improve more than just the clinical aspects of healthcare. Using AI in the “back office” can have profound and lasting effects on your organization’s revenue cycle management processes.

With AI, you can create a standard operating procedure that drives an automated billing process (it’ll even emulate keystrokes for you). What previously took 15 minutes per case can now be completed in a matter of seconds and works 24/7. In fact, AI automates the process so well, there will be many cases where your staff only needs to print the letter and mail it to your patient (this also could be done with automation via email or portal). No further work is required. Now your staff will focus on special cases that require human intervention, leading to faster resolutions, consistency and faster payments to your organization.

AI doesn’t just automate—it learns and predicts. AI can recognize trends before they become problems.

Let’s look at an example. Two different patients undergo the same procedure, but each has a different insurance provider. Patient A’s insurance fully covers the procedure, while Patient B’s insurance doesn’t cover it at all. The AI bot has learned to recognize what each individual insurance provider is willing to cover and eliminated the need to submit all the claims to see what gets approved. So, the AI bot sends the bill for Patient A’s procedure to the insurance provider and Patient B’s bill is sent directly to the patient since they will be paying out of pocket, or payment may be collected in total prior to the service being rendered. By sending the bill directly to the party responsible for paying it, your organization receives payment faster. With this logic and other insights from AI, your organization will be able to make educated decisions about patient care and billing, which will ultimately lead to better outcomes across the board.

Artificial Intelligence works to increase cash flow and create a more efficient staff, each a critical part of getting your organization on the road to financial recovery. To learn more about how Allscripts uses AI in our revenue cycle management solutions, go here.

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