South Florida Hospital News
Sunday July 5, 2020

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August 2019 - Volume 16 - Issue 2

What Does Artificial Intelligence Mean in the Revenue Cycle?

Artificial Intelligence (AI) and Robotic Processing are the newest buzzwords in healthcare. We have often heard them used in the clinical realm, specifically the automation of clinical workflows to improve outcomes, lowering of costs and improving the overall patient experience. There are also large teaching hospitals and systems who are now investing in new clinical technology to prevent disease. But in the business side of healthcare, we are now hearing more and more now about the use of the AI in the Revenue Cycle.

What is AI? In a nutshell it is the use of complex algorithms and software to estimate complicated data. AI spots patterns, learns from experience and creates a solution to solve the problem. In the Revenue Cycle AI could assist in the reduction of manual repetitive tasks performed by staff allowing us to redirect the resources into other functions such as improving patient experience.
Providers are now beginning to re-think through their workflows and how they can incorporate AI into their Revenue Cycle. Some target areas are as follows:
• Front-end Scheduling
• Patient Check-In
• Collection of Patient Responsibility Amounts
• Denial Prevention
Since denials management and the collection of upfront patient responsibility amounts are two resource consuming, repetitive process functions within the Revenue Cycle, providers are beginning to look at opportunities to utilize AI to reduce the manual intervention that is used today to deliver these tasks.
Moving towards predicting denials based on historical claim results is how we will prevent denials of the future. Payer guidelines are constantly changing causing disconnects in ensuring claims will be processed. Using AI to identify these disconnects upfront is our challenge.
There are a few ways to get started. Forming internal focus groups to identify the repetitive tasks you would like to focus on. There are also several IT vendors with solutions to allow you to hone in on scrubbing your historical data to identify trends and new workflows.
Automating the Revenue Cycle using Artificial Intelligence can significantly streamline and improve financial processes which will allow providers to focus their efforts on improving the overall patient experience and patient care.

Kathy Ruggieri, Principal, WithumSmith+Brown, PC, can be reached at

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