Is Your RCM Ready for AI? Key Insights for Healthcare Leaders

By Spencer Allee, Chief AI Officer, Aspirion
LinkedIn: Spencer Allee-Yeh
LinkedIn: Aspirion

The next frontier in revenue cycle management (RCM) is here—denials prevention, resolution, and recovery powered by artificial intelligence and machine learning. The best chance hospitals and health systems have to combat growing numbers of denials is to implement AI in their denials management workflows. Here are five considerations any health system should bear in mind when exploring AI solutions:

Use Cases Serve as the Foundation

Anytime a business is developing technology, they must start with the use case. Predicting whether a denial will be overturned successfully is an essential use case. Do you have the right account with the right person at the right time? Use cases drive business value and can span the revenue cycle—automated coding and billing, claims denial prediction, and appeal-letter generation to name just a few.

Harness Data using AI

Robust data is crucial for creating reliable AI solutions that provide accurate predictions. Outside of the EMR, data can be locked in the text of medical records, managed care contracts, and payer policies and guidelines. We now know how to unlock that data, using large language models to extract the right information in a programmatic way to facilitate workflows.

The Right Platform Makes a Difference

An optimal platform provides the tools, infrastructure, and capabilities to develop, deploy, and manage AI solutions safely and effectively in concert with core RCM workflows. Good platforms include analytics to measure the impact of your investments and safeguards to protect data. Providers must determine whether they have the bandwidth to build their own platform, or if they should find an experienced vendor partner that has already created one.

Skilled Talent Is Necessary to Be Successful

At the end of the day, we work in healthcare because we care about people and patients. Skilled talent facilitates the effective development, adoption, and management of AI initiatives to ensure success. Critical talent will include data scientists, engineers, product managers, designers, RCM operations subject matter experts, and learning and development specialists.

Start Your Journey with Incremental Steps

When beginning your journey, don’t try to bite off more than you can chew. Start by asking:

  • What are the most important business problems you need to address?
  • How will AI help?
  • How will you source or build the solution?
  • What is the minimum scope necessary to demonstrate value?
  • How will you measure success and over what timeframe?

AI is already in everything that we do on a day-to-day basis—in our phones, our cars, and our homes. We are at the beginning of a sea change in how we do business, similar to the early days of the internet. AI is unlocking new possibilities that will transform the way we work over the next decade.

It’s not a question of “if” or even “when,” but rather a question of “how” and “how fast” for you and your business.