Revenue cycle management software providers are increasingly turning to artificial intelligence to give health systems of all sizes – regional systems such as West Tennessee Healthcare with multi -state health systems like Advenhealth and giants like the Cleveland Clinic – lightness on the improvement of the main performance metrics.
With suppliers expenses continuing to increase and lower reimbursement leading to drop in marginsThey seek to keys income drivers, such as fully making the use of operating rooms, attracting refused complaints and accelerating and improving coding operations. Several new product and services announcements are aimed at helping.
Stimulate growth, reduce the burden
West Tennessee Healthcare, a non-profit health system that serves 500,000 patients in 19 counties of its state and southeast of Missouri, has been able to increase its or use using artificial intelligence planning software which corresponds to independent surgical cases to open spaces on operating room programs.
The health system has increased its orthopedic service line by 9% in the first 100 days of reservation of priority surgical cases via a planning system based on an algorithm, which led to a quadrupled return on investment, according to an announcement of its software supplier, Qvetus.
Like many of its rural peers, the processes of the health system for the planning of operations for surgeons were based on a traditional first arrival basis, first served – leaving income -generating resources on Thursday and preventing surgeons in the region from accessing robotic assets, society announced on Thursday.
The west of Tennessee wanted to facilitate independent surgeons to bring their cases to its gold and turn to automatic learning tools which allow external clinical planners to reserve surgical time.
With automatic learning analyzing planning requests between or locations, the health system added 61 cases to its calendar during the first 100 days of use, an increase equaling 90% of its investment in AI, according to Qventus.
“Being able to see the time of the room available in a few seconds while programming in a few minutes is everything for my staff and my patients,” said Dr. Keith Nord, president of orthopedic surgery from western Tennessee, in a press release.
“We made an impressive return on investment with the west of Tennessee in a short time, and we continue to work together in close collaboration to generate even more growth for their team and increase surgical access for their community.”
Surfacing repayment potential
Advenhealth used the preheating software for iodine software to analyze and prioritize patient files that predicted AI will have the most important reimbursement potential and directs the cases to examine the teams, said the company in an advertisement on the wider availability of the software.
Its algorithms exclude cases of low value and validate the codes by identifying the missing documentation, by recommending more appropriate codes and by surfaceing the main alternative diagnoses. Qavetus said that the new generation software also identifies monitoring opportunities, missing doctors support flags and detects events that can justify the documentation or coding of updates.
The iodine has said that its Awarepre-Bill product aims to help providers approach the trend in refusal of climbing complaints, which affects their income margins. While most of the refused complaints are finally canceled, 80% according to the company, hospitals often do not continue calls due to limited resources, leaving money on the table.
With Rev Cycle Automation, Iode said that its customers have experienced an average reduction of 63% of complaints examining and, in 2024, reached a total reimbursement of $ 2.394 billion on more than 1,000 health systems.
“We have seen a significant elevator in high impact queries that stimulate both income and quality results,” said Dr. Christopher Riccard, vice-president of hospital medicine and CDI in Advenhealth, in the press release.
“The ability to prioritize the right cases – not only more – has transformed the productivity of our teams and strengthened our financial performance.”
Help with a complex coding
The Cleveland Clinic said it joined forces with the AKASA generative AI developer to add automatic learning treatment to its income cycle operations in all its American locations.
The health system said in its announcement on April 30 that its staff examined more than 100 clinical documents per case, including progression tickets, exit summaries and pathology reports, then selects codes of more than 140,000 options.
Each case, often complex at the clinic, could take up to an hour by meeting with a patient.
Thanks to the partnership, the Cleveland Clinic will allow the tools of the Aksana platform to intercede on documentation and coding of tasks between patient care and invoicing, the mid-term cycle phase, aimed at rationalizing and improving cases.
“AI can be transformational for health care – not only in patient care – but also to help the operations of the health system take place more easily and more efficiently,” said Rohit Chandra, PH.D., digital director of the Cleveland Clinic.
Coders will be able to use an AI coding assistant tool that supports complete, effective and precise practices. He can read a clinical document in less than 2 seconds and process more than 100 documents in 1.5 minutes, according to the announcement of the health system.
“Because we are dealing with some of the country's most acute patients in the country, our income cycle activities are incredibly complex,” added Dennis Laraway, executive vice-president of the clinic and financial director. “Thanks to autonomous coding, we aim to provide greater efficiency and greater precision to these complicated and long tasks, something that AI is perfectly suited to address.”
The two partners also collaborate on a tool for integrity of clinical documentation to further improve the management of the health system income cycle.
Andrea Fox is editor -in -chief of Healthcare It News.
Email: afox@hims.org
Healthcare It News is a publication of the Himss media.
