For many, the future of revenue cycle management (RCM) in the age of artificial intelligence (AI) is difficult to imagine. How can this technology improve the revenue cycle and impact the day-to-day working of the back-office in healthcare? Of course, at this point, nobody knows precisely when AI will be the industry standard, but there is some buzz around possible benefits AI may soon offer.
The most significant impact on a medical biller’s day-to-day may result from ‘deep learning’ of users’ interaction with EHR and billing software. “Using artificial intelligence to learn a user’s habits, anticipate their needs and display the right data at the right time is a top priority for nearly all of the major health IT vendors.”1 Automatically retrieving and manipulating information has the potential to drastically reduce labor spent on manual billing tasks and allow staff to make better decisions about the next steps for denial resolution.
A key feature of AI will be its ability to analyze text and the spoken word. Systems will be able to learn the language for procedures and diagnosis and assign accurate codes. This capability could have a profound impact after code set updates to ensure correct codes are used and documentation is compliant, reducing the transition that happens with coding updates. Imagine how much easier the transition from ICD-9 to ICD-10 could have been if AI had been used!
One of the most valuable aspects of AI will be its ability to make conclusions and predictions. Today, it can take hours, sometimes even days, to get a pre-authorization from a payer. Future systems could be able to analyze a patient’s health data and determine the medical necessity of a procedure within a few seconds. The good news for medical billers is that an automated process will ensure authorization has been obtained and its corresponding data captured, greatly reducing (or eliminating) pre-authorization denials due to lack of an authorization number.
AI technology will be used across all industries, not just healthcare. Customer service advances could considerably influence the way patient communications are handled; for example, bots which are utilized for patient interactions such as appointment scheduling and collecting payment. A major benefit for providers and billers is that the process can be standardized, significantly reducing the incidence of difficult patient interactions about billing and potentially improving the relationship patients have with billing staff.
Artificial intelligence will undoubtedly increase efficiency and thus profitability in the future. However, an even larger opportunity to increase revenue may lie in AI’s ability to analyze information and make learned decisions. An example of this would be a situation where denials are rising due to lack of medical necessity, lacking documentation or coding mistakes. AI would analyze the denials to find the cause and then create prompts within the HER/PM to rectify the issues, capture all information for correct coding and ensure the provider’s notes are complete.
It is not only healthcare providers and medical billing staff that stand to benefit from AI advances, but payers as well. According to CMS, the fiscal year 2018 experienced an overall improper payment rate of 8.12% or $31.62B.2 Substantial savings from ‘smart’ AI systems have the potential to save payers money, which will (hopefully) drive down the overall cost of healthcare for patients.2
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