Leveraging AI to Enhance Revenue Cycle Management

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Artificial Intelligence (AI) has emerged as a pivotal tool in revenue cycle management (RCM), offering healthcare practices a more effective way to enhance their operational efficiency and bottom line. AI can help automate elements of coding, claim processing, and patient registration, thereby minimizing denials and improving cash flow.

Integrating AI into the Revenue Cycle

One of the areas of the revenue cycle where AI can help through automation is in the patient registration process. AI-powered tools such as pMD’s pDemographics service can validate patient information and verify insurance eligibility allowing for more effective claims processing.

Within claims management, AI could be leveraged to not only detect errors that could lead to denials but eventually predict which claims might be denied based on historical data. In a previous post, we highlighted how one research paper found that an RCM company using advanced machine learning algorithms could predict denials with up to 95% accuracy.

Thinking ahead, AI could eventually play a role in streamlining the coding and billing step of the revenue cycle. For example, healthcare providers at hospitals in the future could rely on AI to automatically extract the bits of information important to billing from unstructured data such as clinical notes and enter accurate coding for claim submission. This would not only reduce the chance of denials due to coding errors but also give providers back time to spend on patient care.

AI Improving Revenue Cycle Outcomes for Small and Medium Practices

A Change Healthcare study found that two-thirds of large healthcare systems are already using AI to improve parts of their revenue cycle. This is an indicator that it is increasingly important for smaller and medium-sized practices to maintain pace by partnering with an RCM company that also uses the latest technology. Staffing shortages caused by COVID-19 have been another driver for practices to find more efficient solutions to manage the billing process. Amidst increasing healthcare costs and declining reimbursements, partnering with an effective RCM company that can leverage AI to improve efficiency is not only desirable but essential for practices to continue providing unparalleled service to patients.

How pMD® Can Help

At pMD®, our mission is to streamline and optimize the patient care episode and the revenue cycle. Through our advanced, end-to-end practice management and revenue cycle solutions, we can help practices consolidate vendors, reduce costs, streamline workflows, improve patient care and satisfaction, and collect their maximum reimbursement more quickly.

Not sure what a vendor could do to improve your behavioral health billing? Contact pMD® for a no-commitment financial impact analysis by our team of healthcare RCM experts free of charge!

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealth, and secure communication software and services, please contact pMD.

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