Next Gen AI in the Hospital Revenue Cycle- How robots are elevating financial, operational and human performance.

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.

Great News for Patients

Imagine it’s Thanksgiving. After dinner’s been eaten and a family is relaxing, dad remembers that he needs to pay a hospital bill that he had some questions about. He also wants to negotiate the payment. But will anyone answer a call on Thanksgiving? Yes. Only that someone will be conversational AI. Available 24/7/365, conversational AI gives patients the unprecedented opportunity to address their needs at their convenience. A virtual agent, trained with a client’s business rules, will be able to negotiate payments directly with the customer. If forms need to be completed, conversational AI can leverage a multi-modal patient experience to send the patient a text message with a link to a portal. Having the ability to see the transaction not only simplifies the process, but also enhances the patient’s confidence in the hospital. Prior to this advancement, a situation like this would need to be handled by a human agent during normal business hours. Traditionally used Interactive Voice Response (IVR), while it would be able to take the call on Thanksgiving, would not be able to handle the complexities of negotiating payments directly with consumers.

Great News for Administrators

Continuing the Thanksgiving scenario for healthcare system administrators, AI also delivers a win for them. First and most obviously, there’s no need to inconvenience the patient by making him wait until after the holiday to contact them about his bill. With conversational AI in place, hospitals will have a system that not only improves the patient experience, but also drives the highest possible recovery with unprecedented ease and efficiency over traditional IVR. Of course, conversational AI is just one part of the AI revolution. Robotic process automation (RPA) and predictive analytics (discussed below) are transforming healthcare RCM. Supported by these advancements, healthcare organizations have access to powerful tools that streamline operations, reduce the potential for human error, enhance the patient experience and improve financial outcomes.

A New World for Employees

Let’s wrap up the Thanksgiving scenario by taking a look at how AI will affect healthcare system employees. With or without AI, RCM employees would most likely not be working Thanksgiving. So AI would have no impact on them in this situation. However, if their employer has gone all in with AI, the big question is: will RCM employees even have a job? “Robots taking over” is a valid fear for employees. After all, AI can do what they do – only better, faster and cheaper. The good news for employees is that AI will impact their jobs, but not eliminate them. The implementation of AI will require a shift in the type of work employees do. Rather than busy work, such as data entry or other entry-level jobs, employees will become responsible for higher-level problem solving. This new reality will require that RCM employees develop a different set of skills… take conversational AI as an example. Some people may believe that Conversational AI is simply a plug-and-play model, where you download the software, flip a switch and let it go to work. However, conversational AI works only as well as it is trained. Similar to training a new human agent, conversational AI must be taught how to provide accurate responses. This takes time – and people. A poorly executed conversational AI program could actually decrease patient satisfaction. With a team of humans accounting for the variety of possible responses, reviewing and approving machine learning and continually building out new call intents, conversational AI will work as intended, increase patient satisfaction and allow for employees to have new and expanded roles within their healthcare systems.

Integrating Different Types of AI

AI advancements in RCM can be broken down into three categories: conversational AI, robotic process automation (RPA) and predictive analytics.

• Conversational AI. As seen in the Thanksgiving example, conversational AI allows 24/7 interactions that enable patients to access information and make payments on their own schedules. This not only increases cash flow without requiring any after-hours staff, but also significantly improves overall patient engagement.

• Robotic process automation (RPA). RPA gives patients access to their own “concierge-style,” completely autonomous payment process. Through this self-guided process (supported by live agent options), patients enjoy more control and convenience, ultimately resulting in an increased likelihood of a positive payment outcome.

• Predictive analytics. By using historical data, machine learning and statistical algorithms, predictive analytics identifies patterns to predict future outcomes. For example, it can identify common reasons for claim denials and flag high-risk claims before submission or identify which patients’ claims are more likely to be paid.

The integration of these three AI technologies provides healthcare organizations with a powerful end-to-end revenue cycle solution that supports and enhances front-, middle- and back-office RCM tasks. From a human perspective, all audiences benefit:

• Patients have a more streamlined, simplified and positive experience.
• Administrators see reduced costs, accelerated cash flows and a solution to labor shortages of qualified RCM employees.
• Employees are freed from repetitive, non-critical-thinking tasks and given the opportunity to focus on more complex responsibilities. 

Future Uses of AI in RCM

As AI continues to evolve and become more sophisticated, it will continue to enhance experiences and outcomes for patients, administrators and employees.

• Patients. No matter the healthcare situation, patients want to focus on their health – not billing issues. They simply expect this part of the process to work seamlessly. AI will make this process as smooth as possible. As seen with Conversational AI, AI will expand business rules to allow patients to quickly resolve their outstanding balances without waiting for open office hours or waiting on hold for a human agent. They will even be able to request copies of bills to overcome disputes on self-pay portions. As an added improvement to the customer experience, multilingual capabilities will allow consumers to change their preferred language mid-conversation.

• Administrators. While the use of AI is expanding for healthcare providers, it’s also expanding for payers (more on this below) by providing them with even more sophisticated capabilities in finding ways to deny claims. To counteract this, healthcare organizations will take advantage of AI to make their bills undeniable before they go to the payer. This will include checking codes and scrubbing data to ensure every part of the claim is accurate.

• Employees. In their new role as managers of AI, employees will focus much of their attention on compliance. For instance, AI may draft a letter, but a human will review and edit the letter as needed to ensure compliance with HIPAA and other regulations. 

AI and the 800-lb Gorilla

As mentioned above, payers are using the advanced algorithms of AI to increase claim denials. They’re also using it to slow down reimbursements. For instance, they’ll ask for more medical records to stall the payment. In this battle of the bots, healthcare systems are playing catch-up to the insurance companies. The systems that move fastest to automate RCM will be in the best position to ensure the timely processing of payments and continued cash flow. If an organization isn’t fully able to automate RCM, the next best solution will be for them to use AI to identify issues and then have employees follow claims through to payment. A worst-case scenario for healthcare organizations will be for those that fail to adopt AI into their RCM. Insurance companies will continue to evolve their abilities to deny claims through the use of AI. Organizations relying solely on people to handle RCM will be at a significant disadvantage. They will sadly be showing up to a gunfight armed only with a knife.

AI Is Awesome. But It Has Limitations.

While all healthcare organizations should be moving forward with bringing AI to their RCM, it’s important to be aware of the limitations and challenges.

• Scale. In theory, every task could be automated. However, it takes time and money to create each automation. Organizations need to identify the situations that happen often enough to make them worth the investment. 

• Independence. Generative AI (as seen in ChatGPT, for example) is not yet mature enough to allow conversational AI to create new content and responses without guidelines. For the time being, the content and responses will need to come from humans. 

• Complexity. AI in the revenue cycle historically tends to be less effective on complex issues, such as provider service issues or complicated dispute resolution. However, using conversational AI’s ability to capture the intent from the patient will increase the efficiency of human conversations with patients by passing patient verification and reason for the call directly to the human agent upon transfer. 

• Compassion. With its set rules and guidelines, AI cannot make compassion-based decisions for patients dealing with certain healthcare and life situations. To overcome this, organizations will need a way for patients to reach human agents quickly. 

• Decision Making. For the foreseeable future, AI will not be allowed to make decisions about how patients will receive care. Nor will it be given the ability to change codes on its own.

• Compliance and Data Security. Humans will continue to be responsible to make sure everything AI does remains compliant with HIPAA and that the data remains secure.

But What Can AI Do for Me Today?

Future advancements in AI will give healthcare organizations the resources they need to enhance the patient experience and battle payers effectively. However, implementing AI in its current state will bring organizations immediate benefits – starting with increased revenue. Meduit’s first step in working with new clients is to work through the backlog of unpaid debt to recover reimbursements that can be applied to your bottom line quickly. And we do mean quickly. Our process doesn’t involve building any new systems or processes. We simply work off of your existing systems to identify opportunities for collecting revenue. In just a couple of weeks, we can be up and running – and improving your cash flow.

Your Partner for the Future

Meduit has been driving innovation in RCM for more than 60 years and currently works with more than 1,100 medical providers across the country. By leveraging our experience and expertise, you can improve collections and patient satisfaction – with minimal disruption to your daily workflow. In fact, our turnkey service requires less than eight hours of time from your team. As AI continues to evolve, it will undoubtedly reshape RCM. But it’s essential to remember that AI’s true power lies in its ability to augment the human experience. Meduit is here to ensure it does just that for you. From conversational AI to predictive analytics, Meduit’s AI-powered solutions will help you maximize revenue, improve patient satisfaction and start preparing for the future today. Ready to future-proof your organization? Contact us today at: contact@meduitrcm.com. 

Meduit is one of the nation’s leading revenue cycle management companies with decades of experience in the RCM solutions arena, serving more than 1,100 hospital and physician practices in 48 states. Meduit combines a state-of-the-art accounts receivable management model with advanced technologies and an experienced people-focused team that takes a compassionate and supportive approach to working with patients. Meduit significantly improves financial, operational, and clinical performance, ensuring that healthcare organizations can dedicate their resources to providing more quality healthcare services to more patients. For more information, contactus@meduitrcm.com.