Artificial intelligence (AI) and computer automation are finally beginning to impact healthcare. Payers are implementing generative AI to improve the customer experience. Researchers at Stanford use AI to review X-rays and detect pathologies in seconds.Today, AI and automation can remind patients about appointments and even provide a portion of their treatment via robotic surgery devices.
While groundbreaking AI and automation technologies are in the news, adoption by the majority of healthcare providers has been slow despite research showing these tools could eliminate up to $360 billion in spending. It’s a startling statistic that illustrates the reality of AI and automation applied to the revenue cycle: These tools quite literally can pay for themselves.
The case for applying artificial intelligence and automation in healthcare
Successful revenue cycles depend on thousands of daily tasks, which means efficiency lies at the heart of these endeavors. However, there are a lot of improvement to be made. Experian Health’s State of Claims Survey 2022 shows the current state of the average healthcare revenue cycle:
- Reimbursement cycles are running longer.
- Claim errors are on the rise.
- Denials are increasing.
More than one-half of U.S. hospitals reported financial losses in 2022. A 2023 America Hospital Report (AHA) report showed:
- 84% of hospitals admit the cost of complying with payer reimbursement requirements is increasing.
- 95% report spending more time on pursuing prior authorization approval.
- Over 50% of hospitals and health systems have more than $100 million tied up in A/R for claims six months old.
These challenges stem from the increasing complexities of working with third-party payers, but also the by-hand human workflows embedded within provider revenue cycles. The State of Claims Survey 2022 showed that 61% of providers say they rely too heavily on manual processes and lack the automation they need to streamline reimbursement. As costs rise and revenue cycles tighten, there is increasing pressure to do more with less—faster. However, chronic healthcare staffing shortages have only exacerbated how hard it is for providers to get paid.
Technology solves many of the problems plaguing healthcare’s revenue cycle. AI and automation offer better revenue cycle management tools with fewer errors, less manual work, and more streamlined processes.
How AI and automation improves revenue cycles
Increasingly complicated reimbursement processes are the perfect testing ground for new technologies. These tools can improve the revenue cycle from the first point of patient contact to collections long after the procedure is over.
For example, AI and automation software can greatly reduce errors and increase the accuracy of claims information before submission. When billing becomes more accurate, it lessens the volume of rejected claims, which take up an inordinate amount of staff resources and lengthen the time from service delivery to reimbursement. But AI and automation also impact the backend of the patient encounter by helping collections teams prioritize accounts most likely to pay.
Four applications for AI and automation in the revenue cycle include:
1. Applying automation to patient registration
The revenue cycle begins at patient registration, and that’s also where providers can begin to apply technology to increase cash flow downstream. Patient registration is often cumbersome, an in-person process tied to a clipboard, paper, and open office hours. Yet Experian Health’s State of Patient Access 2023 report shows that 73% of patients want to handle these processes online. Self-scheduling offers patients more flexibility for scheduling appointments when they want and on their preferred digital device. It can remove the friction from a frustratingly manual paperwork process while decreasing no-shows with automated messaging by text and email.
Experian Health’s automated patient scheduling software reduces time spent on traditionally manual scheduling tasks by 50%. Providers that select these tools increase their patient show rate to nearly 90%. From a revenue cycle perspective, providers that implement online self-service scheduling can see up to 32% more patients each month—which is money in the bank.
2. Finding hidden financial resources to reduce bad debt
Experian Health’s Coverage Discovery® automates the insurance verification process to match patients’ responsibility with the best financial resources possible given their policy limits.
Coverage Discovery scans proprietary databases and historical information for primary, secondary, and tertiary coverage. The platform seeks to find all available financial resources to lower the volume of accounts that end up as write-offs or in collections.
In 2022, Coverage Discovery found $64.6 billion in patient coverage. In 2023, this software discovered previously unknown financial options for 32.1% of patient accounts, giving these customers more options for reducing debt.
3. Preventing denials by improving data quality
Many claims are rejected by payers each day simply due to human error. Some of the most common reasons for claims errors include missing or inaccurate information caused by manual processes. From eligibility verification errors to incorrect insurance details, when paperwork is still by hand and this complex, it’s far more likely to make an error than not.
Experian Health’s Patient Access Curator software automatically verifies eligibility and coverage while scanning patient documentation for obsolete or inaccurate data. The software leverages artificial intelligence and robotic process automation (RPA) to apply computer rigor to previously manual workflows to reduce manual errors. Significantly, this new technology performs these tasks in seconds, freeing up staff time and improving the patient experience.
4. Using artificial intelligence to prevent and mitigate denials
How much does the endless pursuit of denials management tie up potential revenue? One survey showed half of hospitals report more than $100 million in delayed or unpaid claims at least six months old. The good news is that 85% of the errors that lead to denied claims are preventable with the help of existing technology.
Experian Health’s AI Advantage™ solution works in two critical areas to prevent denials before they happen—and correct any denied claims quickly:
- At the front end of the claim, by correcting errors before submission. AI Advantage – Predictive Denials spots the submissions most likely to kick back from the payer. This early warning system reduces the volume of denials by flagging claims with errors stemming from human mistakes or payer requirements changes.
- At the back end of the claim, for those rejected by the payer. AI Advantage – Denial Triage takes the volume of claims rejections and prioritizes them by those with the highest ROI for the provider organization. Not all denials offer the same volume or potential for revenue collection. This solution helps prioritize the highest returns quickly to increase revenue collection.
Benefits of applying AI and automation to healthcare’s revenue cycle
There is little argument across the healthcare industry that the strategies that once worked to create a healthy revenue cycle still apply. Fortunately, today’s AI and automation software allow these organizations to modernize their approach to these complexities—and win the revenue cycle game.
The benefits of applying modern AI and automation tools at every point of the revenue cycle are substantial:
- Faster and more accurate patient scheduling and registration.
- No more manual data searches that tie up staff time.
- Fewer data entry tasks that lead to errors.
- Fewer claim denials.
- Less time spent chasing claims.
- Fewer days in A/R.
- More cash on hand.
A high-performing revenue cycle is possible with the latest technology tools. Experian Health offers a suite of technology solutions that utilize artificial intelligence and automation designed to get providers paid faster, free up staff time, and improve the patient experience. Improving the revenue cycle is a necessity, and Experian Health helps healthcare organizations achieve this goal.
