Early diagnostics, remote patient monitoring and personalized care recommendations are just a few examples of how artificial intelligence (AI) is transforming the way healthcare is delivered. As technology advances, so do opportunities to optimize clinical and operational processes. With projected savings in the region of up to $360 billion annually, it’s no surprise that 75% of healthcare executives believe AI has reached a turning point in their industry.
Yet many providers are still just scratching the surface. Only a small percentage use AI for complex tasks like claim denial management, leaving the competitive advantage wide open. Understanding how these technologies work – and where to apply them for maximum impact – will be crucial to improve efficiency, remain competitive and above all, deliver excellent patient care.
The power of AI in healthcare
As the name suggests, artificial intelligence refers to a machine’s ability to perform cognitive tasks that would normally be associated with humans, such as problem-solving and decision-making. It can spot patterns, learn from experience and choose the right course of action to achieve a goal. Natural language processing, robotics and machine learning might all be in the mix. AI in the healthcare industry has been found to support applications like:
- Improving diagnosis through the analysis of medical images
- AI-powered wearables and virtual nursing assistants
- Patient data management
- Reducing and preventing insurance claim denials.
Artificial intelligence in healthcare isn’t a substitute for human contact, which underpins the best patient care. However, by increasing accuracy and reducing costs, it can help clinicians and healthcare administrators make better decisions that support a positive patient experience across virtually all healthcare settings.
AI & automation in healthcare: key benefits
AI and automation deliver results in the three areas that matter most to healthcare organizations: improving the patient experience and care delivery, allowing staff to perform at their highest level, and increasing revenue.
Boosting patient satisfaction through speed and accuracy
Patient feedback has a few common themes: timely access to care, clearer communication and greater financial transparency. To meet these needs (and improve those feedback scores), healthcare providers should offer patients accurate, upfront information and reduce friction wherever possible.
Tools like Patient Access Curator use AI to verify and update all necessary patient information at the front end, all at once, which drastically reduces the time and effort required to manage patient records. This streamlines patient intake and solves for bad data, which prevents claim denials and increases patient satisfaction.
Bringing in more revenue by reducing claims errors
The 2024 CAQH index estimates that 22% of current costs could be saved by shifting from manual revenue cycle processes to automated ones. Experian Health’s State of Claims Survey 2024 suggests providers are eager to capitalize on this opportunity, with 51% seeking to reduce manual work.
AI-driven solutions like Patient Access Curator and AI Advantage are designed specifically to meet these needs. Patient Access Curator automates insurance eligibility and coverage, scanning patient documentation for inaccurate information, and uses AI and robotic process automation to reduce manual errors. AI Advantage™ works to prevent denials before they happen, using predictive analytics to flag claims errors and alert staff to claims that fail to meet payer requirements.
Improving staff performance by easing burnout
The strain of manual processes doesn’t just slow down operations. It’s also a major cause of staff stress and burnout. Around half of healthcare staff report feeling burned out, costing the industry an estimated $4.6 billion each year.
By taking repetitive tasks off busy employees’ plates, AI can alleviate overwork and allow staff to focus on higher-value work, improving job satisfaction and productivity. In claims management, for example, AI Advantage, works in conjunction with ClaimSource®, to proactively identify claims with a high likelihood of denial prior to claim submission without staff intervention. This reduces the burden on staff while improving clean claim rates.
How AI Advantage and Patient Access Curator improve patient care
Experian Health’s two flagship AI-based products go even further, offering new ways to use technology to improve patient care:
Patient Access Curator uses AI and robotic process automation to streamline one of the most tedious parts of patient intake – verifying insurance eligibility and coverage. By automatically scanning patient records for errors and pulling up-to-date information from payer sources, it eliminates the guesswork and manual labor that bog down revenue cycle teams. The result is faster, more accurate eligibility verification and a smoother experience for both staff and patients.
As Ken Kubisty, VP of Revenue Cycle at Exact Sciences, put it: “Within the first six months of implementing the Patient Access Curator, we added almost 15% in revenue per test because we were now getting eligibility correct and being able to do it very rapidly.”
On the back end, AI Advantage – Predictive Denials acts as an early warning system for denials, scanning claims before they go out the door to catch errors and flag risky submissions so they can be corrected in time. Built on advanced AI and machine learning, the platform evaluates claims using historical payment data and real-time payer behavior. Its counterpart, AI Advantage – Denial Triage, picks up where Predictive Denials leaves off, sorting rejected claims according to their potential for reimbursement and prioritizing them based on financial impact. Together, they help providers minimize denials, resulting in faster reimbursement and freeing up resources that can be redirected to patient care.
Case study: See how AI Advantage helped Schneck Medical Center achieve a 4.6% average monthly decrease in denials in the first six months.
The future of AI in healthcare: what’s next?
As a quick glance at any newsfeed will confirm, AI’s role in healthcare is only going to expand. Predictive analytics will give staff increasingly powerful insights and recommendations to maximize reimbursements, while minimizing the burden on the workforce. AI’s ability to continually learn and improve means providers that embrace AI will be better placed to make full use of their data and adapt to the trends and challenges that affect patient care. As expectations grow and resources shrink, AI is likely to be the only way to deliver the scalable, responsive, high-quality care patients deserve.
Discover how solutions like AI Advantage and Patient Access Curator use artificial intelligence in healthcare to help reduce claim denials, improve patient access and more.
