AI Tools Streamlining Healthcare Administration and Improve Patient Experiences

By David L. Morris, Executive Vice President & Chief Commercial Officer, Cedar Gate Technologies
LinkedIn: David Morris
LinkedIn: Cedar Gate Technologies

Healthcare is no stranger to extensive administrative work – from billing and insurance claims to appointment scheduling and record-keeping. On average, physicians allocate 15.5 hours per week to paperwork and administrative tasks (nine of those on EHR documentation alone). Staying apprised of a constantly evolving landscape of healthcare regulations and insurance policies further compounds the administrative challenges for physicians and care teams. All of this can lead to inaccuracies, inefficiencies, and potential care delays.

An over-reliance on clinicians handling administrative duties can also significantly inflate expenses. Healthcare organizations lose money when they have to pay personnel for repetitive administrative work that could easily be completed without human intervention. This is another piece of the administrative costs puzzle, which various studies over the last two decades show are increasing—amounting to a staggering estimated $600 billion to $1 trillion annually.

With increasing adoption and advancements in AI, machine learning, and automation, healthcare organizations now have an answer. These transformative solutions can streamline administrative processes, reduce overhead costs, and ultimately enhance the patient experience.

AI: A Breakthrough for Administrative Efficiency

AI’s integration into healthcare has generated considerable attention with its advancements in enhancing patient care. While perhaps less exciting, it also holds tremendous promise for simplifying labor-intensive administrative functions. Algorithms can decipher the complexities of administrative tasks, uncovering patterns and minimizing the need for manual data input. With the right level of human oversight, these tools have the potential to optimize processes and alleviate strain on healthcare systems.

Here’s how AI tools are boosting productivity for entire care teams:

  • Automated Documentation
    AI-powered transcription tools convert spoken words into written text efficiently and accurately, reducing clinicians’ time typing in patient and encounter information manually.
  • Streamlined Billing and Claims Processing
    Billing and insurance-related expenses in America are alarmingly high. Tasks such as insurance claim management, clinical documentation and coding, and prior authorization challenges take up significant time. It adds up to about $68,000 per physician each year in time spent handling billing-related affairs.
    AI-powered tools can help coders find the correct billing codes based on care provided, and scan for errors before submitting claims. It eliminates time-consuming tasks for billing teams when claims come back with errors and someone has to go through it manually to correct and resubmit it. It also speeds up the time to complete the claims process for a more efficient revenue cycle.
  • Administering Complex Value-Based Care Alternative Payment Models
    For organizations participating in value-based payment models like capitation and bundled payments, AI tools are essential to success. The tools can be used to track changing patient populations throughout the year to ensure accuracy in capitated payments each month. They can also help identify, design, and execute prospective bundled payment opportunities that will lower costs and improve care quality for patients.
  • Clinical Decision Support
    AI enhances data management by organizing and categorizing vast amounts of patient data. The incoming data can be synchronized with the EHR and refreshed regularly so it’s always up to date. When enriched and augmented data is accurate and readily accessible, care teams have the tools to improve clinical decision making and patient outcomes.

AI integration in healthcare administration is redefining the way we care for people. When it’s done right, it gives clinicians and care teams more time to focus on patients instead of paperwork. Its ability to streamline administrative processes, reduce human error, and optimize resource allocation can be a valuable ally in improving care quality, reducing costs, and improving patient satisfaction in a value-based care world.