Who Runs the World? AI.
In a recent ImagineSoftware webinar titled "Who Runs the World? AI.", Rob Gontarek, Senior Vice President of Data Science at ImagineSoftware, shared insights into the vast potential of artificial intelligence (AI) and how organizations can leverage its power. Gontarek's presentation focused on the effective use of AI and automation tools, particularly in the realm of revenue cycle management (RCM). This blog explores the key takeaways from his presentation and delves into the exciting possibilities that AI and automation offer for the healthcare industry.
Embracing AI in Revenue Cycle Management
Labor Challenges: The current job market landscape presents unique challenges, including labor shortages and increased labor costs. Moreover, the new generation's preferences for digital experiences over traditional roles have exacerbated these issues. In response, businesses are turning to smart technologies, such as AI and robotic process automation (RPA), to streamline processes and minimize human errors. Gontarek acknowledges these challenges, humorously stating, "We don't live in a perfect world." Exceptions in processes, especially in high-volume areas like radiology, often lead to friction, slowing down operations and impacting cash flow. These exceptions can take various forms, from data mapping errors to claim denials, necessitating human intervention.
The Path to Efficiency: To achieve a more efficient and profitable operation, it is crucial to address the root cause of these exceptions programmatically. The goal is to transition from a state of chronic leakage to one where processes flow seamlessly and as much as can be automated is. Automation becomes a vital tool in reducing friction in RCM, making the process more efficient and effective.
As Gontarek points out, “Everybody knows about reimbursement pressure, which obviously is driving interest in containing costs in RCM administrative areas. There is this really interesting and cool availability that we have in these smart technologies, like artificial intelligence and robotic process automation, and even just kind of rules-based systems, where things that we could get away with in the past programmatically would be okay with humans taking the additional steps, but today, we really don't have that luxury. So you're seeing a tightening and improvement in the overall automated products that are delivered.”
Robotic Process Automation (RPA): RPA emerges as a powerful tool to reduce friction in RCM. Bots, while "dumb" in nature, can be programmed to automate repetitive tasks, freeing up human users for more important responsibilities. RPA is easy to implement and can significantly improve efficiency without eliminating jobs.
AI and Automation in Action
Machine Learning and Natural Language Processing (NLP): ImagineSoftware leverages machine learning and NLP to enhance RCM processes. These technologies play a pivotal role in autonomous coding, evaluating clinical records, and selecting the most appropriate codes. Gontarek emphasizes the importance of deploying multiple techniques and models to solve complex problems.
Data Record Mapping: Data record mapping, crucial in determining insurance company matches, often involves multiple models running in parallel. AI continually learns and adapts, leading to improved accuracy over time.
Predictive Denials: AI evaluates claims before they are filed, predicting whether they will be denied. By setting the right confidence threshold, AI can automate decision-making or involve human intervention based on prediction accuracy.
Tailoring Billing: AI technology allows for dynamic billing cycle adjustments based on individual profiles. This personalized approach can significantly improve payment outcomes and reduce friction in the billing process.
Ensuring AI Accuracy and Adaptability: To maintain AI accuracy, ImagineSoftware employs an inferencing engine and a feedback loop. Users' actions are compared to AI predictions, providing insights to fine-tune the system. This ensures that AI remains valuable and precise in its predictions.
“We can actually monitor this, and we can calculate on an almost hour-by-hour basis how much time AI has saved our clients individually, as well as collectively,” emphasizes Gontarek.
The Future is AI-Powered
Rob Gontarek's insights in the "Who Runs the World? AI" webinar shed light on the transformative potential of AI and automation in revenue cycle management. By addressing labor challenges, reducing friction, and harnessing the power of AI and automation tools, healthcare organizations can optimize their processes, improve efficiency, and ultimately enhance patient care. As the industry continues to embrace AI, ImagineSoftware is at the forefront, innovating and leading the way towards a more automated and efficient future for healthcare revenue management.
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