Technological advancements, specifically artificial intelligence, have propelled everyday life, improved business and productivity, and changed how different industries work. Within healthcare specifically, AI has had a revolutionary impact, completely changing how operational processes work. AI in healthcare revenue has helped healthcare institutions avoid errors, creating a more profitable facility that can better help more patients.
AI in Healthcare Revenue
Believe it or not, AI in healthcare was first observed in the 1950s, though limitations of the early models prevented it from being accepted. Today, healthcare institutions heavily rely on technology, and within the last 20 years, they have begun implementing AI-based technology.
What is the Healthcare Revenue Process?
In healthcare, revenue streams are not a simple transaction: monies for a service. Instead, with insurance, a specific billing process requires coding for various treatments, prescriptions, labs, diagnostics, and more.
Medical billing and coding professionals prepare claims to be submitted to insurance companies for payment. Unfortunately, most insurance plans do not cover 100% of the cost for their patients, so the healthcare facility must go through the whole process with co-insurance, such as for Medicare patients.
Finally, if the bill is not reconciled with the insurance plans, the healthcare institution must send a bill to obtain payment directly from the patient. If debts aren’t paid, healthcare institutions must use debt collection services to recoup their costs if they are unsuccessful in reaching the patient directly.
Understanding Healthcare Revenue Errors
Healthcare revenue errors can significantly impact the healthcare institution, resulting in missed revenue, delayed payment, and potential compliance issues.
Why Do Errors Happen?
Although AI in healthcare revenue can drastically help improve operations, it has not always been available. For decades, the revenue process was handled by humans, but as we all know, humans are not infallible. Mistakes happen, and unfortunately, they can be costly for both the patient and the facility.
Types of Errors
There are a number of different types of errors that can impact the healthcare revenue process when a human is handling these tasks. AI in healthcare often can eliminate these problems before they exist.
1. Coding Errors
For medical institutions or healthcare facilities, each diagnosis or procedure must be assigned a code so that it can be submitted to insurance companies and paid out. If the wrong code is provided to a patient’s insurance company, a number of issues can occur. The misclassification of a medical code can result in delays in payment, incorrect payments, and denials. All of these issues can impact patient satisfaction and have serious consequences for a healthcare facility’s bottom line.
2. Billing Errors
Billing errors are also a bane of healthcare facilities because they often result in the facility receiving an incorrect payment, and the work to rectify the issue can result in more work to recoup the lost costs. It can also mean some services are missed entirely, which means the provider is working for free. Both errors can impact the overall financial health of a healthcare institution.
3. Claim Denials
When bills are submitted with incorrect codes or other issues with insurance claims or billing errors, insurance providers will often deny the claim. If the error isn’t caught, the patients are forced to pay out-of-pocket for services that should be covered. Unhappy patients can negatively impact revenue streams when they seek out new providers. Patients will leave a good doctor if the operational issues, like billing and scheduling, are a problem.
4. Data Entry Errors
People are human, which means they occasionally make mistakes. While no person is perfect, and it is unrealistic to expect them to be, data entry errors can result in issues with payments by the patients themselves or their insurance.
Minimizing Errors: AI in Healthcare Revenue
The good news for healthcare facilities is that when AI in healthcare revenue is used, they see a number of benefits—the most important being reduced errors.
Automated Coding
When the human component is eliminated from billing and coding, errors are often reduced. Billing and coding is technical work that can be tedious, monotonous, and time-consuming. By implementing the automation tools that AI in healthcare revenue can provide, healthcare organizations can see a reduction in human error mistakes. This also makes the workflow more efficient.
Predictive Analytics
AI in healthcare revenue also provides a number of reporting tools and analytics to help improve overall operations. Some of those tools can include predictive analytics where AI is able to analyze claims submitted and determine which ones end up with the highest rates of denials. By knowing this in advance, coding can be done more carefully and properly, which results in a higher percentage of payouts. AI in healthcare revenue not only helps to reduce errors but it also helps to prevent the circumstances where issues could potentially occur as well, which increases the probability of claim success and full payment.
Review Claims For Errors
The beauty of AI in healthcare revenue is that its automation processes are incredibly helpful for quickly identifying missing information or incorrect details before claims are submitted. This way, any errors found can be rectified, which avoids payment delays due to denied or delayed claims processing.
Benefits of AI in Healthcare Revenue
Overall, there are a myriad of reasons why AI in healthcare revenue is a smart choice. From minimizing errors to improving processes, AI in healthcare is a great way enhance revenue streams. The bonus is that it can also improve compliance by reducing those errors, and it improves operational cost and efficiency, which allows healthcare facilities to focus on what they do best: helping people.
Get Help Implementing AI in Healthcare Revenue
Are you interested in minimizing errors in your healthcare revenue process? Contact Credence Global Solutions to learn how AI in healthcare revenue can improve your overall business operations today!
