AI's automation can transform the revenue cycle
It's important to have IT and operations work together and to get employees onboard, say experts speaking at HFMA.
From left: Patrick Murphy, general manager of TruBridge and Wes Cronkite, chief technology and innovation officer, spoke at HFMA about the use of AI in the revenue cycle. Cronkite asked ChatGPT to write a parody and it came up with lyrics and a tune to the song “Can’t You See” by The Marshall Tucker Band, which Cronkite played during the session.
NASHVILLE - Automation, particularly through AI, holds the promise of greater efficiency and fewer denials in the revenue cycle.
There's $9.8 billion in potential savings through automation in the revenue cycle, according to statistics provided by TruBridge, a consultant and IT services provider. Nine percent of all claims are rejected in error or from prior authorization denials; 23.9% of denials are due to eligibility issues.
Seventy-five percent of hospitals are working on an AI strategy to tackle revenue cycle challenges, said Patrick Murphy, general manager of TruBridge and the former CFO of a health system in Alabama.
Speaking at the HFMA annual conference, Murphy outlined the revenue cycle pain points: overwhelming information requests; mundane, tedious tasks, which can lead to employee dissatisfaction and turnover; and lack of meaningful data, to name a few.
The benefits of automation are an improved patient experience, a reduction in accounts receivable days, greater employee satisfaction and accurate and real-time data analytics.
Patients want to be able to pay their bills, and, if they have questions, they want to talk to someone who can answer their inquiries, even if it's an automated AI response.
Staff too are able to just ask a question of AI, rather than having five dashboards open, said Wes Cronkite, chief technology and innovation officer, TruBridge.
"What we see a lot of is staff doing mindless rote tasks to get to payment," Cronkite said. "We want to get digital employees in place. Use the power of AI to help summarize what's going on. A patient billing question is an opportunity to have a digital employee answer questions."
Ultimately, he said, regular employees are needed to fight insurance companies to get the revenue owed.
AI, on the front end, can help with patient intake and liability estimates. In the middle of the revenue cycle, it can aid in computer assisted coding, clinical documentation improvement, claims scrubbing and submissions.
AI can give insights into claims that aren't going to go well, before they're denied.
On the back end, AI is able to look at denials and insurance payments and automate appeal letters. It's able to get onto payer sites and portals.
"Let a bot handle that," Cronkite said.
However, he added, there is no silver bullet plug-in to AI.
Also, said Murphy, the IT department and operations must work in collaboration on AI.
Employees must also be onboard before hearing, "the senior leader is going to automate things," Murphy said.
Cronkite came up with the idea for a Dream Factory to ask employees for ideas to ease revenue cycle pain points. They got 250 responses and set a time frame of a month to put those ideas into production. Thirty-four teams of 160 employees went after their goals, with a total of $400,000 being awarded to the staff.
After that, Cronkite recommends that AI be treated as an actual employee that can even be given a friendly name.
Revenue cycle is hard, Murphy said. The challenges of 25 years ago are still around today.
"There's no better time to embrace AI," Murphy said, "to reduce debts and increase cash."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
