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Hospitals and health systems are increasingly turning to AI to improve their revenue cycle management (RCM) as healthcare leaders change their views on the role of technology.
A survey of 101 healthcare executives by Sage Growth Partners on behalf of healthcare software developer Ingenious Med found that more health systems, hospitals and physician groups plan to invest in AI for MCR over the next one to three years, with the expectation that AI will be mainstream in revenue cycles within five years.
A third of respondents were CFOs and 17% were vice presidents or revenue cycle directors. Forty-three percent worked with health systems and integrated delivery networks and 25% were part of physician groups. Thirteen percent worked with a freelancer acute care hospital.
WHY IT IS IMPORTANT
The survey highlighted the potential of AI to address key RCM challenges, such as estimating patient payments, coding, load capturecash flow and payment management and payer refusals.
Among the findings, 82% of respondents believe AI will have a positive impact on RCM, 67% plan to use AI for rejection prevention and 65% for coding, and 51% are focused on capture accusations.
Dan D’Orazio, CEO of Sage, explained that the RCM process is filled with repetitive, high-volume tasks, such as upfront eligibility checks, mid-cycle claims status checks, and payment accounting. downstream.
“This is the first time we have seen organizations investing in AI, to automate these tasks and activities, allowing RCM teams to invest their time in higher-level tasks and activities,” he said. declared.
He added that there was also some traction in coding – not only in automating the claims editing process to ensure accurate coding, but also in the form of standalone coding, significantly streamlining that effort .
D’Orazio said the third area in terms of traction is forecasting. analytical for managing prior authorizations and denials – giving organizations the ability to prevent denials rather than dealing with them after the fact.
He recommended that organizations recognize that AI is a tool and not a complete strategy, which should be integrated as part of a broader system, rather than seen as the solution itself.
“AI is often misunderstood as a panacea, but it’s only one piece of the puzzle,” D’Orazio said.
When implementing AI solutions, organizations should focus on key considerations, prioritizing ROI by requiring vendors to provide evidence in their solutions.
This includes determining how AI can replace or augment existing staff, speed up processes such as payment collection, and reduce errors and rework.
“Many vendors market AI indiscriminately, and much of what they label as AI is insufficient,” D’Orazio said. “It is essential to ensure that AI solves specific problems rather than being adopted simply for the sake of using it.”
He added that organizations should avoid getting distracted by shiny new technologies: new solutions should not dictate implementation priorities.
Instead, organizations should focus on improving operations with technology that matches their goals.
Since RCM is at the heart of hospital, healthcare system and practice operations, the focus should be on streamlining essential workflows.
“Identify your challenges first, then find the right technology to solve them,” D’Orazio said.
THE BIGGEST TREND
Three-quarters of U.S. healthcare providers and payers increased their IT spending last year, with artificial intelligence, cybersecurity and IT infrastructure among the top areas of investment, according to a study. study by Bain & Company and KLAS Research.
AI adoption is gaining traction, with 15% of providers and 25% of payers reporting having an established AI strategy in 2024, the report said.