AI Innovation in the Clinical Space: Bridging the Gap Between the Modern Medical Practice and Revenue Cycle Management

Artificial intelligence (AI) and financial innovation are revolutionizing many facets of our lives, and the clinical space is no exception. In particular, AI technologies in revenue cycle management (RCM) are poised to bridge the gap between innovation and operational efficiency, offering promising solutions for common challenges. This article explores how the role of AI, machine learning (ML), automation, and outsourced revenue cycle management can drive efficiency and improve cash flow in contemporary clinical practices. 

The Role of AI, Machine Learning, and Automation in RCM 

AI-enhanced claim scrubbing is crucial for increasing accuracy and efficiency of claims processing. Algorithms can increase first-pass clean claims rates by detecting and correcting errors, and increase adherence to up-to-date regulatory and payor-specific rules prior to claims submission. Machine learning can analyze large amounts of data to identify patterns and enhance decision making. Predictive analytics, powered by AI, can forecast revenue based on historical data and current trends, optimize staff allocation, and anticipate patient payment patterns to improve cash flow management. Lastly, these algorithms will learn over time, improving accuracy and quality.  

Automation in RCM can streamline repetitive tasks and reduce manual data entry. Technology can automate patient eligibility, claims submission, auto-post explanation of benefits (EOBs) information, and identify, categorize, and address claims denials which can reduce resolution times and revenue leakage.

“As market dynamics shift, we see incredible opportunities to create efficiencies upstream to reduce the revenue cycle management process from days to minutes for providers and patients by leveraging both artificial intelligence and machine learning,” said Hannah S. Barber, MBA, M&AP, VP Product Management, Nextech. 

Driving Efficiency and Cash Flow 

AI and automation can significantly reduce the administrative workload on your clinical staff allowing them to focus more on patient care. Automation of routine tasks frees up time for staff to engage in more value-added activities. Automated systems minimize human errors, enhancing the overall efficiency of the RCM process, and reduced manual intervention translates to lower administrative burden. 

By optimizing RCM processes, AI can directly impact a practice’s financial health. Increased first-pass clean claims rates can lead to quicker reimbursements and cash flow stability. Predictive analytics can provide enhanced financial planning leading to better insights into future revenue streams, as well as more accurate financial planning and budgeting. 

“I believe automation is crucial for the financial success of my practice and in improving patient care. Rapidly rising staff costs and limitations on physical space in the practice can negatively impact our ability to scale,” said Dr. Michael Diesenhouse, president, Eye Associates of Tucson.  

Outsourced RCM Services 

Outsourcing revenue cycle management to a specialized RCM services partner can offer several advantages including access to a team of experts who are well-versed in your specific area of medicine. Additionally, they enable a practice to rapidly scale, putting less strain on internal resources and allowing your billing and collections to grow with you and not lag behind or prevent your growth.  

“In order to succeed, I think having a partner that you can rely on for RCM gives you the ability to think big and provides you the independence to consider growing your business in ways that will help you to survive and thrive in the coming years,” Diesenhouse said. 

Outsourced partners often use cutting-edge technology and AI tools that are cost-prohibitive for many individual practices.  By collaborating with an RCM partner, practices that might not have had the resources on their own can tap into the power of today's most innovative technologies. 

“Emerging AI technologies in healthcare hold transformative potential, but their high costs and complexity often place them out of reach for many individual practices. By collaborating with an RCM partner, practices can leverage cutting-edge solutions that would otherwise be unattainable, gaining access to the innovations necessary to enhance efficiency and patient care,” said Samantha Akhtarzandi, Head of Physician RCM, Assembly Health. 

Embrace the Transformation of RCM 

 The integration of AI and financial innovation in the clinical space is transforming RCM, making it more efficient, accurate, and cost-effective. Automation, AI-driven claim scrubbing, and machine learning are key components driving this transformation. Additionally, outsourced RCM can be an easy to implement, cost-effective, and scalable solution. By embracing these innovations, medical practices can improve cash flow, reduce administrative burdens, and ultimately enhance patient care. 

Dr. Jason Handza serves as Nextech’s Chief Medical Officer. Dr. Handza brings his vast experience to this role while working alongside both the Development and Sales teams to improve our ophthalmology offerings. With nearly 20 years of experience in ophthalmology, Dr. Handza is a Founding Partner of Sight360 and a practicing retina specialist in Clearwater, Fla., as well as Medical Director and Principal Investigator for his Clinical Research Center in Pinellas Park, Fla.