A lot of health professionals agree that prior authorization is the most challenging aspect of revenue cycle management. American Medical Association reports that about 86% of doctors call the burden of prior authorization high or extremely high, and about 88% say it has only increased in the past five years.
Because of the transactional nature of prior authorizations, it’s almost the perfect area for AI implementation. With machine learning and real-time analytics, AI can quickly determine cases requiring prior authorization and save a lot of time.
Determine Patient Setting
Claim Status Checks And Follow-Ups
Proactively Stop Denials Before it Comes
Claim denials are among the biggest headaches for hospitals or health institutions to deal with in the revenue management process. Research by Change Healthcare states that yearly, 9% of all claims get denied by the insurance companies or payers . Even though they eventually recover 63% of these claims, the administrative costs of reworking them lead to more losses.
The possibility of using AI to stop denials before they occur is an exciting aspect to explore, and it could work in the following way:
- Investigate and determine what causes denials by CPT code and payer
- Use this gathered intelligence in all of the claim review processes
- With this new information, it will be able to quickly flag areas with incorrect data. This could include incorrect identifiers with a procedure or missing charges.
- Inform staff to follow up on the identified areas
Staff would then correct the errors in the claim before submission, effectively reducing claim denials.
Want to find out how we do it? Read on, or contact us for a quick chat.
Use Patient Demographics To Determine Appropriate Billing
Based on previous information, AI can also determine the most efficient type and schedule of messaging that a patient would be most receptive to. AI’s advanced technology can detect early signs that a patient may default on the payment plan and alert financial services to these signs.
Predict Claim Payment Period
Advantages of AI In Revenue
While several traditional methods may have applications in the RCM areas above, none can handle them as efficiently as Artificial Intelligence. Here is why AI could be a much better option:
- It boosts revenue growth by minimizing errors in claims.
- Artificial intelligence speeds up the process while maintaining a high accuracy rate.
- Unlike manual processes that are done by humans, artificial intelligence functions 24/7, making it more efficient.
- AI ensures there is no lost information in the patient registration stage and other vital revenue cycle management stages.
- Changes and updates in medical billing will be implemented automatically with artificial intelligence. This technology keeps the health institution updated while avoiding errors and denials.