At a glance
From AI-based claims management tools to revenue cycle automation, artificial intelligence (AI) and automation in healthcare is being adopted in countless ways, and providers are already seeing the benefits.
Key takeaways:
- AI and automation are rapidly changing the healthcare landscape for providers and patients, with solutions such as AI-powered denial prevention, billing automation, and patient access automation.
- Providers are experiencing reduced staff burnout and smoother revenue cycle workflows, while patients benefit from a better overall experience.
- Experian Health Data shows that 69% of organizations using AI solutions have already experienced fewer denials or a higher resend success rate.
Artificial intelligence (AI) and automation in healthcare are steadily gaining momentum, rapidly modernizing healthcare operations and revenue cycle management. As providers face increasing financial pressures, ongoing staffing shortages, complex payer requirements, and new compliance requirements, the need for smart technology has never been greater.
This article discusses some of the key ways smart technology, such as artificial intelligence and automation, helps providers reduce administrative burden, minimize denials, and improve financial stability.
Why are AI and automation important in healthcare CMR?
AI and automation are rapidly changing the healthcare landscape revenue cycle management – from patient registration to collections. Providers who need to keep up with rising patient volumes, rising healthcare costs, and staffing shortages are turning to solutions powered by artificial intelligence and automation to improve baseline data accuracy, streamline billing, and reduce staff burnout.
Artificial intelligence and automation in healthcare can also generate significant savings for the industry. A recent CAQH Index Report claims that replacing manual processes with smart technologies, such as artificial intelligence and automation, could save the healthcare industry at least $20 billion. Until now, 63% of suppliers have introduced AI into their workflows in some way, according to data from Experian Health, and 15% say they have fully integrated AI in your standard RCM operations.
How do AI and automation reduce the administrative burden in healthcare?
AI and automation can help reduce the administrative burden for busy staff at every stage of the revenue cycle, from initial registration to claims management and patient collections.
As staffing shortages continue, healthcare workers are often expected to do more with less, which can lead to burnout. By 2025, just over four in ten (43%) providers will report being understaffed, according to Experian Health Claims Status Report.
AI and automation can help alleviate administrative burden and minimize staff burnout throughout the revenue cycle, including:
- Front register: On the front-end, tools like Experian Health Patient Access Curator™ (PAC) Use AI to collect accurate patient data. Demographics, eligibility, COB, MBI, and discovery are combined into a single workflow, so patient intake data is accurate from the start.
- Insurance Verification: Manual insurance checks are cumbersome and consume administrative time. Automation solutions such as Insurance Eligibility Verification Enable staff to perform real-time eligibility checks and instantly verify patient insurance details, detect outdated information, and prevent billing errors that lead to denials.
- Claim Submissions: Tools like ClaimSource® Help ensure claims are submitted correctly the first time. Automatically analyzes claims, payer compliance, insurance eligibility, and patient demographics to detect errors that lead to denials.
- Patient Collections: Busy billing teams reduce time spent searching for self-pay accounts with patient collections solutions like Collections Optimization Manager. Collection Optimization Manager uses machine learning to segment and prioritize patient accounts with the highest propensity to pay.
How do AI and automation minimize claim denials?
As denial rates continue to rise, preventing claim denials is a top priority for 82% of revenue cycle leaders. Claim submission errors that lead to denials are often the result of inaccurate or incomplete information.
Many denials can be prevented by removing human error from manual workflows, often early in the revenue cycle. Adopting AI and automation helps providers identify major denial triggers early and ensure claims are submitted correctly the first time.
Healthcare organizations that have adopted technology solutions in the revenue cycle are already beginning to see the benefits. Experian Health data shows that almost 7 out of 10 suppliers Using AI solutions reports fewer denials or higher resend success rates.
Here are two ways AI and automation can improve denial rates:
- Improve front-end data accuracy: Preventing claim denials begins at the time of registration. The slightest error or lack of information can result in a delay or denial. Experian Health Patient Access Curator uses AI-based data capture technology, robotic process automation and machine learning to verify necessary patient information. With PAC, information remains accurate and up-to-date throughout the revenue cycle, effectively reducing denials.
- Predict and prevent claim denials: Using historical payment data and data sets from Experian Health, AI™ Advantage Analyzes denial patterns to flag problems before shipping. Claim outcomes are predicted mid-cycle and urgent tasks are moved to the front of the queue, allowing staff to focus on claims with the highest financial priority. And with machine learning, AI Advantage continually learns and adapts, improving results over time.
What role do AI and automation play in the patient experience?
Artificial intelligence and automation help improve patient satisfaction throughout the patient journey, from admission to collection.
Automating patient data capture helps ensure data is more accurate from the start. Incorrect data can cause headaches that erode patient confidence, such as claim denials, inaccurate patient estimates, interruptions in care, and billing issues. But when data is accurately collected and verified from the beginning, it reduces friction for patients, minimizes frustrations, and improves trust.
Frequently asked questions
Artificial intelligence and automation in healthcare are used to support key areas of patient care, operations, and revenue cycle management. This intelligent technology uses algorithms and machine learning to analyze data, support clinical decisions, and automate administrative tasks. These tools are being rapidly adopted by both providers and payers.
Artificial intelligence and automation in healthcare can help reduce claim denials by minimizing error-prone data collection processes and identifying and correcting errors before submission. AI and automation also help busy staff prioritize high-value resubmissions and analyze denial patterns, improving the overall claims management process.
Looking ahead: What future trends should healthcare leaders expect in AI and automation?
Experian Health Data shows that healthcare leaders expect AI and automation to become widespread in the next three to five years for revenue cycle management. Additionally, advances in predictive analytics, natural language processing, and automation in healthcare are expected to continue. To remain competitive and financially resilient, healthcare leaders must be prepared to invest in emerging automation and artificial intelligence technology and have a deep understanding of how to apply these tools strategically.
See how they like the tools Patient Access Curator are helping Experian Health clients transform healthcare operations.
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