AI Is Giving Rev Cycle Management a New Look

At the HealthLeaders Revenue Cycle Technology Mastermind forum this week in Savannah, RCM executives talked of how the technology is giving them a new profile — and compelling them to work more closely with clinical and administrative leaders.

Revenue cycle executives who are integrating the latest AI tools are seeing challenges that have less to do about technology and more to do about workflows.

In short, AI is creating a culture change. And that needs to be addressed well before anyone starts talking about deliverables and ROI.

That was one of the big takeaways from the HealthLeaders Revenue Cycle Technology Mastermind forum, an in-person event held Wednesday in Savannah just before the HealthLeaders Revenue Cycle Technology Exchange. The forum brought together executives from nine health systems to discuss the latest strategies and roadblocks, as well as debate new ideas like ambient AI integration, clinical and administrative collaboration and patient engagement.

The consensus was that AI is changing RCM and will be instrumental in boosting efficiency and outcomes, but making sure everyone is on the same page is a much harder task. That ranges from training (and in some cases retraining) RCM staff to manage new workflows and expectations, to working with clinical, financial and administrative leaders to define the ROI of a new tool to more than one department.

"It's about changing the old idea that revenue cycle management is just about the money," noted Allyson Keller, VP of the Patient Connection Center at Piedmont Healthcare.

In many cases, AI has raised the profile of the RCM department by highlighting how it can improve the health system's bottom line. But as RCM leaders integrate the technology into traditional workflows to improve operations, they're finding new challenges in marrying that potential with the health system's overall strategy. For example, the pace of change has been accelerated, so that five-year plans are unrealistic and are being replaced by one- to, at most, three-year plans.

That shortened time frame means executives need to be nimble in evaluating new technology. Short-term ROI is crucial, and that often means looking for rev cycle value in a clinical tool or talking with clinical leaders about how a tool that benefits the rev cycle can also add value to clinical operations.

That's a challenge. Joann Ferguson, the Henry Ford Health System's VP of Revenue Cycle, and Beth Carlson, VP of the Revenue Cycle and Chief Revenue Cycle Officer at WVU Medicine, echoed more than one executive in saying it's important to have clinical advisors as part of the RCM team, while Steve Kos, Senior Director of Revenue Cycle Application Support at Jacksonville, Florida-based Baptist Health and others spoke of the value of revenue cycle informaticists (and the difference between them and clinical informaticists).  Without those connections, they said, it's often difficult to get in front of clinical leaders.

Part of the problem is that healthcare delivery has long been siloed. Finance and revenue cycle executives focus on the money, IT sticks to technology, and clinicians focus on what they do best. Lynn Ansley, VP of Revenue Cycle Management at the Moffitt Cancer Center, said clinicians often don't understand how to navigate the financial or administrative spaces, just as RCM execs don't necessarily understand clinical workflows.

But AI is changing that paradigm. It's enabling – some might say forcing – disparate parts of the hospital enterprise to work with each other. Clinical leaders need to know how the latest tech tool of platform not only improves clinical workflows and outcomes, but also how it impacts IT and RCM. To that end, an ambient AI tool that can also capture coding opportunities and improve patient handoffs would have value to multiple departments and catch the attention of the CFO and CEO.

And as AI takes away the traditional tasks associated with RCM, it's prompting RCM leaders to develop new job descriptions for their staff, including taking on more patient-facing tasks. The idea that AI can help clinicians reduce their time in front of the computer and spend more time with their patients also applies, in part, to RCM leaders and their staff. And that opens up opportunities to work not only with clinicians, but with payers to reduce denials and improve prior authorizations, even work with patients and understanding and managing their financial obligations.

RCM executives at the Mastermind forum were quick to point out that while AI can and does help with data-crunching and problem-solving, it doesn't replace the need to audit the technology or its outcomes. That ‘human in the lop' is just as important in RCM as it is in the clinical space.

But it does redefine RCM. Evan Martin, VP of Revenue Cycle Management at ZoomCare, pointed out that AI is taking what has always been a transactional process and is giving it a human face to the patient. No longer is RCM confined to the back offices of the hospital, and no longer are RCM leaders and staff relegated to number-crunching.

At the end of the day, one attendee noted, this is all about making better decisions for patient care.