From saving millions in cost avoidance to improving accuracy and boosting patient engagement, many healthcare organizations are experiencing the benefits of implementing AI and automation solutions to enhance revenue cycle management. According to a Change Healthcare study, nearly 9 out of 10 revenue cycle management leaders are currently using AI. Unfortunately, many leaders face complex challenges around using robotic process automation, including:
- Unclear and inconsistent workflows
- Upstream dependencies
- Integration challenges
- Inability to measure success
So, how can revenue cycle leaders overcome these barriers? No matter where you are in your AI and automation journey, adopting a solid philosophy, building a comprehensive governance strategy, and joining forces with the right partner can help you realize a return on investment (ROI) that advances clinical, operational, and financial goals across the enterprise.
The intelligent automation philosophy: streamlining revenue cycle for patients and providers
Intelligent automation can help improve the revenue cycle experience for patients and providers by simplifying decision-making, freeing up resources, and improving efficiencies. A successful intelligent automation effort should be built around a philosophy that incorporates these ideas:
- Be effective, then efficient. Optimize manual processes before automating them to reduce variation.
- Leverage existing IT investments and layer in additional solutions using a shared platform.
- Enhance success and sustainability through strong partnerships across business and technology functions.
5 pillars of a strong AI and automation governance plan
Developing a mature AI and automation governance program with refined and efficient processes will take time. Thoughtful methodology and alignment to your organization’s strategic plan and IT priorities can expedite your progress. A winning plan should:
- Provide a streamlined approach to managing resource constraints.
- Establish focus areas and evaluate top use cases.
- Build upon existing structures and leadership.
- Connect AI and automation governance to competing demands or quantify ROI and reimbursement opportunities.
- Prioritize training, education, and operational change management to combat low technology literacy.
Real-world results: boosting revenue cycle management with an AI and automation partner
An end-to-end strategic partner can walk you through all the stages of intelligent automation, from process selection, mapping, and validation to creating a monitoring and maintenance plan and providing technical resource staffing, advisory services, strategic execution, and turnkey solutions. Here are real-world examples of this powerful approach:
Custom development
APPROACH: A 20-hospital integrated healthcare delivery system worked with Nordic to design and launch 40+ bot automations focused on hierarchical condition category code capture, problem list maintenance, and medication reconciliation.
RESULT: The organization processed 1.2 million patients across eight hospitals, resulting in $7 million in cost avoidance.
Turn-key solution
APPROACH: A four-hospital health system with 1,000 physicians partnered with Nordic to implement and integrate custom machine learning (ML) models within their Epic workqueues to predict denial overturn propensity and assist staff’s daily workqueue prioritization.
RESULT: The health system experienced accurate prediction of 99%+ of incremental overturned dollars in the top 30% of denied claims and operationalized ML prediction scoring across all hospital billing and professional billing denial workqueues.
Epic AI optimization
APPROACH: A federally qualified health clinic collaborated with Nordic to optimize Epic schedule templates and staff- and text-based appointment confirmation campaigns powered by ML no-show predictions.
RESULT: The project reduced no-show rates from 20% to 15%, improved the appointment kept rate, and decreased unused hours.
Epic automation optimization
APPROACH: A multistate integrated health system worked with Nordic to optimize late charge rebill automation and estimate automation.
RESULT: The initiative enabled the organization to implement more than 2,000 elective services price estimate templates (auto-generated from scheduled orders with 80%+ accuracy) and build over 50 late charge automations, processing 100% of all late charges.
AI and automation offer a wealth of benefits for revenue cycle management but navigating implementation hurdles is crucial. By adopting a foundational philosophy that prioritizes optimization, uses existing systems, and fosters cross-departmental collaboration, healthcare organizations can build a robust strategy and governance plan. Partnering with an experienced strategic consultant can help leaders navigate complex challenges faster and achieve meaningful results like improved cost avoidance, more accurate denials prediction, and reduced no-show rates to transform your revenue cycle and the overall healthcare experience for the better.
Want to learn more about AI and automation for your organization? Discover how Nordic can help.