How do healthcare providers enhance patient satisfaction, lower costs, and speed up reimbursement? The solution is to turbocharge revenue cycle management (RCM) with artificial intelligence. Also you can help Newark medical billing services for a quick and professional solution.
Initial automation stages have eradicated as much as 40% of manual labour. However, administrative complexity in the US healthcare system continues to squander an estimated $265.6 billion yearly.
You can now couple automation with current AI technologies like generative AI through an application named agentic process automation (APA).
Semi-autonomous decision-making via APA applies to automate processes with more sophistication across various IT systems and payers’ silos.
Look at the APA addressing five of its highest RCM issues: accuracy, timeliness, staff shortage, cost of resources, and the complexity of the payer’s policy.
Enhance claims, appeal, and prior authorization accuracy
With such an excessive number of claims to be dealt with and facts scattered throughout diverse systems, the group of workers operates under excellent pressure. Mistakes are sure to happen.
By automating records gathering, you could ensure that claims are sponsored with complete, correct facts. This complements your easy claims rate (the percentage of claims settled on the primary submission without using any extra facts required).
Of course, as soon as you’ve got the installation and the capability to use APA, you could maximize many different RCM New Jersey Billing expert techniques with it. Prior authorization, for instance, may be completed through clever sellers whose sole purpose is to speak with the payer and ensure clinical necessity. Automating previous authorization appreciably cuts down on errors.
By automating and proactively processing PA claims, APA complements its percentage of authorized claims. Moreover, by detecting the claims that aren’t simple in want of PA and verifying clinical necessity, APA complements the general RCM technique by streamlining the complete method.
Streamline claims and appeals.
The quicker providers can submit a claim, appeal, or prior authorization request, the faster they receive payment. Funds locked up in accounts receivable cannot be used to treat patients.
RCM processes commonly involve massive amounts of manual labor in spread-out data sources and computer systems. APA’s forte lies in the capability of coordinating several intelligent agents to execute an entire process faster, frequently involving simultaneous processing. Humans are needed only when required, but they are delegated to perform tasks of a higher order, like decision-making.
Deal with labour shortages.
Apart from the widely reported scarcity of medical doctors, there is also a lack of RCM specialists. The Medical Group Management Association survey reveals that coders are the most challenging position, followed by billers (compliance and audit specialists).
The APA assists in two respects. First, it makes your team much more productive so that they can handle more claims and appeals. A human specialist can write six appeal letters daily, whereas an AI employee can produce them within minutes.
Second, you can embed some of your team’s knowledge into an AI agent, which enables new, less experienced team members to reach higher performance levels.
This allows your seasoned staff to concentrate on exceptions and questions that need human input instead of repetitive work that can be automated or outsourced with the aid of AI.
Do more appeals
With manual processes, there is a threshold below which it is not worth filing an appeal. The processing effort costs more than you would get back. This threshold may be as low as $125, but added together, these small amounts can have a significant impact.
You can appeal all denials with APA since the process is practically automated. You can have one person in the loop for oversight, review, and approval. However, that individual can work extremely effectively because they have all the information, including the appeal letters.
Understand payer policies
Grouses that fall outside the payer policies get denied, and reimbursement is lost, or the doctor must devote extra administrative effort to submitting a complaint.
However, it’s not easy to maintain all the provider policies from all the providers due to how rapidly they change. But AI can eat up lots and lots of info and spit back what matters. Add it to your current healthcare software, and you can intervene automatically if a treatment is being booked or claimed and not going to be reimbursed. Your system may detect that a claim code must be more detailed so the payer will take it. In this way, you can get it right the first time and have a higher percentage of approved claims.
Let RCM soar with APA
Working on siloed IT systems and distributed data sources causes RCM to suffer from accuracy, agility, and cost. Moreover, providers struggle to find competent professionals and stay on top of payer policy changes.
With APA managing bots and intelligent agents, automating as much as 80% of manual processes in RCM is feasible.
