Transforming Hospital Revenue Cycle with AI: Carilion Clinic’s Success Story

In the evolving landscape of healthcare, the financial health of hospitals and the financial experience of patients are inextricably linked. Andrew Bess, executive vice president of Ensemble, emphasizes this connection, advocating for innovative solutions to enhance both aspects.

Carilion Clinic’s AI-Driven Partnership

Carilion Clinic, a comprehensive network of seven hospitals located in Roanoke, Virginia, made a significant leap in 2024 by partnering with Ensemble to develop an end-to-end revenue cycle management strategy powered by artificial intelligence (AI). This collaboration aims to streamline operations and enhance financial performance across the healthcare system.

Streamlining Operations for Better Performance

Since integrating their operations onto a unified platform in September, Carilion Clinic has reported notable improvements. As Matt Barr, vice president of revenue cycle and accounting services at Carilion, explains, consolidating formerly siloed operations has improved exit denials and acceptance rates. These enhancements not only bolster financial outcomes but also facilitate swifter access to patient care.

Enhancing Patient Experience through AI

The adoption of AI has transformed the patient experience at Carilion Clinic. The introduction of a personalized approach via the provider’s phone system, in addition to multi-channel conversational AI, allows patients to navigate the healthcare system with greater ease. This innovation signifies a pivotal shift towards more patient-centered care.

Linking Financial Health and Patient Satisfaction

“Our objective is to not only fortify the financial well-being of our health system but also elevate the financial experience for our patients,” noted Andrew Bess. His statement highlights the belief that the two elements are interlinked. A seamless experience fosters patient satisfaction, leading to increased engagement and timely payments of co-pays, coinsurance, and deductibles.

Positive Outcomes and Metrics

Carilion Clinic’s efforts in revamping its revenue cycle have resulted in measurable outcomes, including a reduction in unbilled days from ten to just four. Additionally, insurance claims have decreased by over 10% within a 90-day timeframe. The effectiveness of AI extends beyond billing, with improvements in referral appointment timelines and a dramatic reduction of 39% in outpatient wait times.

Continuing the Dialogue on Revenue Cycle Improvement

For those interested in delving deeper into strategies for optimizing the revenue cycle, a conversation featuring Matt Barr, Andrew Bess, and Susan Morse, editor-in-chief of Health Financing News, is available for listening. This dialogue explores the intersection of AI and revenue cycle management to further enhance hospital performance.

Further Exploration and Resources

For additional insights on harnessing AI to improve revenue cycles in healthcare, explore the following resources:

• Hospitals leverage AI to improve revenue cycle
• AI makes a difference in revenue cycle collection
• AI Drives Revenue Cycle Reimbursement
• AI and technology spark a billion-dollar shift in healthcare
• Healthcare leaders invest in AI to improve revenue cycles
• Event: The Growing Role of AI in Revenue Cycle Management

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