In many ways, the healthcare RCM industry looks nothing like it did just a few short
years ago. AI, robotic process automation, and analytics have changed everything for
the better and sometimes for the worse.

Organizations equipped with AI-inspired solutions are navigating ongoing workforce
shortages effectively and mitigating claim denials, while those lagging behind are facing
financial consequences that are more immediate and severe than ever before. Whether
an organization views AI as an asset or an obstacle largely depends on where it stands
in the adoption process.

In the November issue of Cycle Up, Meduit’s award-winning RCM magazine, you’ll find
articles that cover both perspectives, including:

• How Meduit’s Denials Playbook helped a medical center escape a negative RCM cycle
• Key steps to assess and elevate your business office
• Why cutting costs often worsens RCM challenges rather than solving them

It's a fascinating time in healthcare RCM, and we hope you find this edition of Cycle Up
to be informative and engaging. Please feel free to submit any comments or questions
regarding any of the topics covered. Thanks for reading!

Click here to read Cycle Up now.

What should an academic medical center with multiple hospitals do when facing a surge of claim denials and a growing backlog of aging accounts receivable (AR)? Asking for help is smart. However, asking for help from a partner with a comprehensive claim denials playbook can be truly transformative.

The introduction of AI to revenue cycle management (RCM) is having a dramatic impact on healthcare systems across the country. By automating and bringing more accuracy, speed and efficiency to mundane tasks, such as processing, coding and billing, AI helps systems reduce costs while accelerating cash flow. As technology advances and AI becomes even more integral to RCM, one question can’t be overlooked: what does the expanded role of AI mean for humans? To see the effect of AI on patients, administrators and employees, let’s take a look at a possible scenario.

With AI-driven claim denials skyrocketing and a shortage of qualified revenue cycle employees available to tackle the resulting workload, hospitals and health systems are failing to collect the revenue they’re owed at an alarming rate.

“The advance of technology is based on making it fit in so that you don’t really even notice it, so it’s part of everyday life.” – Bill Gates

The introduction of artificial intelligence and automation has been nothing short of transformative for healthcare RCM. After only a few years on the scene, it’s difficult to find an area of our industry that hasn’t been impacted by AI, from coding and billing to streamlining patient payments.

As we approach the halfway mark of 2024, healthcare costs in the United States continue to reach unprecedented heights. In 2023, expenditures were expected to reach up to $4.7 trillion. In 2031, that number is projected to be $7.2 trillion. (1) These dollar amounts underscore how critical it is for hospitals, health systems, and private practices to have the right revenue cycle infrastructure in place. Without one, collecting the funds required to expand services and meet the changing needs of patients is virtually impossible. 

Insurance denial rates have increased 20% in the last five years, according to a report by Healthcare Finance News. These rising denial rates are negatively impacting reimbursements and causing huge administrative burdens for hospitals, health systems and physician groups.

Managing denied claims has long put a financial strain on hospitals and health systems. In the past few years, the problem has only worsened as payers use AI to help delay payments and turn the claims process into a labyrinth for hospitals to navigate.

An astonishing 84% of health systems cite lower reimbursement from payers as a top cause of low operational margins, according to a report published by the Healthcare Financial Management Association (HFMA) and Eliciting Insights, a healthcare strategy and market research company.