The Meduit Innovation Lab Blog

Solve Hospital RCM Problems with AI

Posted by Meduit RCM on Apr 7, 2021 8:00:00 AM

When an eight-hospital system required assistance resolving claim denials, health system leaders reached out to Meduit. After analyzing the issues, the Meduit team leveraged its artificial intelligence (AI) solutions to process coordination of benefits denials in less than 60 days.

To resolve one of the hospital system’s largest denial reasons, the MeduitAITM team developed and released a second application, a targeted Modifier 25 Appeal Process. This application was released within the first 90 days of the contract. The team is developing two additional applications within the next four weeks. These two applications will handle:

  • Medical record uploading to payers requesting medical records
  • Medicare wellness reporting

Ten additional applications are in the design phase. In total, the team has released seven applications designed to work within the system’s electronic medical records (EMR) and one application that is not specific to the EMR. These applications solve the following issues:

  • Claim status for multiple commercial payers
  • Timely filing appeals (fully automated with zero human intervention writing and filing an appeal letter)
  • No authorization appeals (fully automated)
  • COB appeals (fully automated)
  • Coding appeals (fully automated)
  • Claims edit clearing – (live and clearing 60% of the edits that previously had to be manually worked for a large, multi-site, multi-specialty physician group)
  • Automation of secondary adjustments

In less than 60 days of meeting with the client, the Meduit team had the first application live and fully functional and will launch on average one new automation every two weeks. These applications can be customized and quickly re-deployed in other EMR system environments to resolve revenue cycle challenges for hospitals and health systems.

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Topics: AI