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Back to the blogFeb 22, 2024

Maximizing Healthcare ROI: Optimize by Utilizing AI in Revenue Cycle Management

Maximizing Healthcare ROI: Optimize by Utilizing AI in Revenue Cycle Management

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High patient volumes and increasing revenue are signs of a thriving healthcare practice. But without proper revenue cycle management, your practice might be leaving money on the table. Inefficient revenue cycle management processes can cost you more than you think, due to issues ranging from ineffective manual processes to wasted hours spent on accounts receivable activities. Is artificial intelligence (AI) in revenue cycle management the solution? Some AI vendors providers will espouse to you that it is. However, you have to leverage AI in the right way to maximize healthcare ROI.

Healthcare RCM: What It Is, and Why It's So Challenging

Although revenue cycle management may sound like a fancy term, it actually covers a fairly standard set of business functions. Revenue cycle management in healthcare (RCM) is how your practice manages medical coding and billing, plus the accounts receivable process and, finally, posting revenue. Healthcare RCM is full of unique challenges due to payor reimbursement structures and patient collections.

For instance, accounts receivable can be particularly difficult. The Consumer Financial Protection Bureau (CFPB) reports that up to 43 million Americans have allegedly unpaid medical bills on their credit reports. That equates to a lot of hospitals and private practices carrying large self-pay receivable balances. Coding, eligibility, and authorization errors also cause significant headaches in the healthcare RCM process.

When practices lack the appropriate tools and staff to optimize the revenue cycle, it's easy to spend untold hours on RCM activities. The extra work pulls your team's focus in the wrong direction, negatively impacting the patient experience. Unsatisfied patients are less likely to return, which further hurts revenue. Unless each step of the RCM process is optimized, it's nearly impossible to achieve maximum ROI. That's why healthcare providers look to technology solutions like AI for help.

AI to the Rescue for Healthcare Revenue Cycle Management?

Just a few years ago, artificial intelligence existed solely in the realm of highly sophisticated tech companies. Little by little, though, AI has become a part of everyday life. The smartphones we carry in our pockets feature digital assistants that can answer questions and perform tasks. Robots now play a big part in manufacturing, shipping, and receiving. Even today's vacuum cleaners possess synthetic intelligence.

Over the past couple of years, AI has made inroads into businesses of all types. Given the challenges healthcare practitioners face with RCM and maximizing ROI, introducing AI tools is a natural fit. One study found that two-thirds of healthcare systems use AI to aid some facet of revenue cycle management. For example, 64% of payment estimates use AI-powered applications for improved accuracy.

Artificial intelligence holds the potential to revolutionize the healthcare business. Think of what you now know of AI in business applications. Now imagine how AI-powered applications could optimize inefficient revenue cycle practices as they support understaffed and overworked administrative teams. Picture AI guiding capacity planning, optimizing the claims process, automating collections, and advising on revenue management.

How to Intelligently Leverage AI in Revenue Cycle Management

It's easy to imagine these scenarios because, in many cases, they're happening in real life right now. However, how to leverage AI to maximize ROI in revenue management is the trick. Since AI is the hottest new trend in the world of business at this moment, you'll find a lot of options on the market. Many tech companies offer automation solutions that seem like they could be a quick fix. But will they properly integrate into a healthcare workflow?

If a solution doesn't fit neatly into your everyday workflow, implementation could be a lengthy (and costly) process. You might need a dedicated team of consultants, such as Team TempDev, to implement and deploy the solution. Training staff on new systems can be time-consuming and expensive. Remember that every sales pitch is designed to make it sound like adopting the latest tool and automation solution will solve your problems. What you really need, though, is to optimize the tools and processes you already have. It is also important to stress that while many companies may purport to offer AI solutions, many of the solutions are actually complex business rules engines that have massive gaps in them when analyzed in depth.

The most intelligent way to leverage AI in revenue cycle management is to invest in tech that enhances your current processes. Your practice likely already has plenty of technology solutions: electronic health records and a robust HIT infrastructure, all built on top of a modern enterprise architecture. Instead of grafting on an external tool, look for solutions that integrate AI naturally.

A consulting team can help you identify where the inefficiencies in your revenue cycle process are and then help you identify the right vendor to partner with to solve the issues. There is a lot of hype in the market around AI and many solutions on the market are not able to actually solve the issues. It’s important to do a deep dive before a vendor is chosen to determine if they will actually fit the business needs.

Turn to TempDev for Healthcare Consulting and NextGen Expertise

As the industry's premier healthcare consultancy, TempDev's team of consultants, developers, and trainers can help your practice maximize ROI in the revenue cycle. From workflow design to automation and integration with health IT systems, TempDev offers you the tools you need to make the most of the NextGen PM system.

To learn more about TempDev, contact us here or by calling 888.TEMP.DEV.


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