Healthcare Industry widely recognizes the importance of AI. The advancement in technology is creating opportunities for administrative and process improvements, especially in the revenue cycle management area.
Many current revenue cycle processes face problems that lead to a lot of friction and waste. This waste generation occurs because of:
- Inefficiency due to inaccurate documentation and coding
- Lack of transparency between providers and payers regarding appropriate steps
Healthcare professionals want to utilize AI to mitigate waste. According to Optum’s data, 97% in the healthcare industry believe AI can handle clinical or administrative applications, while 85% are already developing or implementing an AI strategy and 55% AI to achieve positive ROI within three years.
Organizations are investing $39.7 million in AI implementation over the next five years to automate administrative tasks, to mitigate waste and abuse, and to personalize care recommendation.
These organizations need partners who know AI and know how to apply it to reinvent their workflow and processes. Hence health executives expect AI to create employment opportunities.
AI can contribute to the revenue cycle in the form of improved speed, capacity, and consistency. Automation of routine events can remove flaws, errors, and fatigue. Manual handling of the increasing amount of data in healthcare with speed and efficiency is quite tricky.
- Natural language processing (NLP), gathers data, and generates support and diagnostic coding used across care settings. NLP can also facilitate an enhanced case review, identify risk factors, and provide recommendations.
- Machine learning can optimize edits by the payer and can score denials to inform high potential appeals.
Incorporating AI can enable a case manager to extend his reach and focus on cases that need expert judgment direly.
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