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AI in the Healthcare Industry: Benefits to RCM Operations

Aruna Nadesan
June 13, 2023
AI in healthcare

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The growth of artificial intelligence (AI) has dominated the news recently. However, much of the discussion centers around the negative aspects of AI. Words such as “danger” and “risks” and “warning” dominate Google search results around AI. Many in the healthcare industry share these sentiments. They worry about the negative aspects of AI on the industry, specifically as it pertains to clinical outcomes. However, operational areas of hospitals and health systems, including RCM departments, could benefit from AI.

Clinical concerns

The biggest concern around AI in healthcare is any errors that may result in patient injury or other negative outcomes. Humans are imperfect and make mistakes. But there is a trust between a patient and a healthcare provider. The patient trusts that a healthcare provider is well-trained, has the best intentions, and makes every effort to keep errors at a minimum. This trust doesn’t exist with AI.

“People will need to see evidence that health AIs are beneficial overall, even though they won’t be perfect and will make mistakes,” said Microsoft co-founder Bill Gates in a recent article about AI.

In addition, the World Health Organization (WHO) recently issued its first report about AI in healthcare. In it, the WHO cautions against overestimating the benefits of AI for health, especially when this occurs at the expense of core investments and strategies required to achieve universal health coverage.

Some of the other challenges and risks it addresses include the unethical collection and use of health data, biases encoded in algorithms, and risks of AI to patient safety, cybersecurity, and the environment.

Of course, private and public sector investment in the development and deployment of AI is critical. But the unregulated use of AI could infringe on the rights and interests of patients and communities. The powerful commercial interests of technology companies could be seen as more important. Or the interests of governments to maintain surveillance and social control could be seen as paramount and of greater importance.

Back-office benefits

The WHO noted that AI does hold great promise for improving the delivery of healthcare and medicine worldwide. But ethics and human rights must be at the heart of its design, deployment, and use.

In addition, according to a report from the U.S. General Accounting Office (GAO), administrative AI tools have shown promise in reducing provider burden and increasing efficiency by recording digital notes, optimizing operational processes, and automating laborious tasks.

Another area where AI is making a significant impact is in revenue cycle management (RCM). AI is transforming this process by streamlining operations, improving accuracy, and reducing costs in areas such as patient registration, clinical documentation, claim submissions, and payment collection.

AI can effectively address the most pressing RCM issues, including prior authorizations, claim status checks, and out-of-pocket cost estimates. And it can do this while getting the information that needs human intervention to the right person at the right time. Individuals can share information with different stakeholders, eliminating redundancy, reworking, and retrospective queries. And AI-powered RCM technology can do this in real time – something the revenue cycle has struggled to achieve due to its high volume of transactions.

Adopting AI

AI and machine learning solutions are only in their infancy. But these solutions are already transforming the way healthcare is being delivered. Health organizations have accumulated a vast amount of data — health records and images, population data, claims data, clinical trial data, and so much more. AI technologies can quickly analyze this data and uncover patterns and insights that humans cannot. With AI, healthcare organizations can use this analysis to help make better business and clinical decisions, as well as:

  • Provide user-centric experiences: Using large datasets and machine learning, healthcare organizations can find insights faster and more accurately with AI, improving patient satisfaction.
  • Improve efficiency in operations: By examining data patterns, AI technologies can help healthcare organizations make the most of their data, assets, and resources, increasing efficiency and improving the performance of operational workflows, processes, and financial operations.
  • Connect disparate healthcare data: Healthcare data is often fragmented and in various formats. By using AI and machine learning technologies, organizations can connect disparate data to get a more unified picture of the individuals behind the data.

In addition, AI could greatly enhance certain operational functions and administrative tasks. Letting machines do what they can leaves humans free to do what only humans can do — provide care. Some of those tasks include:

  • Patient scheduling: Allowing patients to schedule appointments without intervention from hospital employees frees up employees to focus on other tasks while improving the customer journey.
  • Patient engagement: AI-driven, patient-specific financial engagement drives patient self-service and reduces the staff hours it takes to collect payment.
  • Claims management: The claims management process involves many manual and repetitive tasks, such as inputting, processing, and evaluating documents and data. Automating these time-intensive tasks can eliminate human errors during claims processing.
  • Denials management: Proper categorizing, prioritizing, and routing of denials reduces write-offs while providing data for root cause analysis.
  • Regulatory compliance: Healthcare providers can track and document each process step in structured log files. This enables the company to comply with external audits. It can also improve data confidentiality.

A bright future

“The Age of AI is filled with opportunities and responsibilities.” This quote from Bill Gates sums up how the healthcare industry should view the role of AI.

Healthcare leaders must balance fears about the downsides of AI with this technology’s ability to improve people’s lives. To make the most of AI, those in the world of healthcare need to guard against the risks while spreading the benefits to as many people as possible.

This means using AI to increase efficiency in operational areas. Healthcare leaders can then hire more staff and invest in better medical technology with the related cost savings. Ultimately, this will benefit your organization and your patients.

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