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AI As A Catalyst For Financial Success In ASCs: Unlocking Revenue Potential

  • John Lee 
AI as a Catalyst for Financial Success in ASCs

Ambulatory surgery centers face unique financial challenges in the fast-paced healthcare industry. With AI, ASCs can unlock untapped revenue potential. AI revolutionizes revenue cycles, optimizes billing processes, and drives significant financial growth in ASCs.

Healthcare is slower to adopt new technologies than manufacturing and retail. In our blog “Must Have Medical Practice Technologies to Boost Revenues,” we discussed the essential client experience-impacting technologies for modern medical practices: EHR, robust practice website, patient portals, and RPM or remote patient monitoring. AI’s role in medical billing and claims collections continues the tech in healthcare theme.

Clinical settings have embraced AI. You’ve probably heard about AI’s impressive cancer, retinal, and COVID-19 diagnosis results. Did you know that medical billing companies and payers use AI in claims collection and revenue cycle management (RCM) to improve efficiency and accuracy?

What Is AI, and How Can It Benefit the Healthcare Revenue Cycle?

Medical billing is one of the most complicated administrative tasks in a medical practice. Medical billing can only be scaled without technology by hiring highly trained billing staff, which is difficult. Many healthcare entrepreneurs and medical billing companies are investing in AI-powered medical billing software to streamline and reduce human dependence.

AI in medical billing improves data collection, analysis, and decision-making throughout the transaction-centric RCM process, boosting practice revenues and patient engagement. AI improves medical billing and revenue collection.

Two-thirds of hospitals and health systems use AI for revenue cycle management, according to Change Healthcare. 72 percent use AI for eligibility/benefits verification and 64 percent for payment estimation (likely due to the No Surprises Act). AI affects revenue cycle management (RCM) beyond these areas. The National Association of Healthcare Revenue Integrity (NAHRI) 2022 State of Revenue Integrity survey lists AI-enabled RCM products and functions in charge description master (CDM) maintenance, charge capture, denials management, payer contract management, physician credentialing, and claim to audit. 

AI can analyze claim denial trends and warn HIM professionals before billing. Pre-bill review and correction are possible. AI dashboards that track denials by type or payer can help reduce repeat denials and improve workflows and education. AI can help self-pay patients find financial aid and provide price transparency.

AI-Enhanced Revenue Cycles

Role of AI in Prior Authorizations

The Council for Affordable Quality Healthcare, Inc. (CAQH) reported that manual authorizations cost $4.31 more in 2019 than in 2018. Automating prior authorizations reduces transaction costs to $2.11 and processing time to four minutes. Fully electronic prior authorizations could save billions in healthcare administration.

Prior authorizations are the best healthcare AI use case because they are transactional. Real-time analytics, machine learning (ML), and payer follow-ups are used in authorizations.

AI informs providers about payer approval for medical treatment, making decisions easier. Real-time reports show patients’ financial clearance status and next steps. Accuracy reduces claim rework and increases revenue by capturing every dollar.

Role of AI in Patient Eligibility

The U.S. government has required patient care estimates for two years. In healthcare, buyer cost estimates are complicated. The manual patient-cost calculation requires practice staff to check many systems with limited precision. AI-powered software checks patient eligibility in real-time using contracted rates and patient-specific costs. The AI software uses patient data from the practice to improve patient eligibility estimates.

AI-powered patient eligibility software estimates out-of-pocket costs before patients receive care, so they know what they owe. It reduces last-minute cancellations due to treatment costs, which pleases providers. The medical practice can increase point-of-service collections by discussing patient payment options in advance.

Role of AI in Claims Tracking

AI is also tracking insurance claims. Medical billers manually check claim statuses on multiple payer websites. RPA is now mimicking payer website logins. The medical billing software alerts the collector if a claim is denied or needs intervention. Payment-approved claims never reach the collector.

RPA robots ping or call payer firms to check claim denial appeals and other statuses for software companies. Payers increasingly use robots to respond.

Some AI claims processing software provides information on the likelihood of a claim being rejected before it is submitted to the payer, allowing practice staff to scrub claims before submission and speed up claim submissions.

Change Healthcare and ENGINE Insights surveyed 200 revenue cycles, IT, finance, and C-suite decision-makers about AI in healthcare. Most respondents intend to use AI in RCM extensively in the coming years. Prior authorization (68%) and payment amount/timing estimation (62%) will lead RCM AI applications by 2023.

AI-based predictive analytics

AI-powered predictive analytics is a game-changer for Ambulatory surgery center optimizing revenue cycles. AI algorithms can predict revenue trends, identify bottlenecks, and provide actionable insights by analyzing historical data and patterns. ASCs can proactively address financial issues, identify areas for improvement, and make informed decisions that boost their bottom line.

AI-Powered Billing

AI can speed up and reduce errors in billing. AI-enabled billing workflows reduce coding errors and ensure accurate documentation. Ambulatory surgery centers can reduce revenue leakage and streamline billing by using AI.

Should you invest in AI? 

Healthcare practices should make an investment in AI, but do you have the budget to develop your own AI-based software? Also, it requires a lot of expertise & time, so should you invest is a real question because all this revenue betterment is only possible if you do it today while not making a dent in your pocket. 

So, what’s the solution? Third-party billing companies have it all. They developed an AI-based EHR-based medical billing solutions for ASCs that leverage the power of AI for just 399$ monthly. Also, you do not have to make any investments and wait. So don’t DIY rather outsource & leverage its benefits.