It will be some time before RCM solutions develop the capabilities to complete tasks like coding with accuracy.
As popular as revenue cycle technology solutions like bots and AI are, there are some tasks that require a certain level of expertise—a level that these solutions have yet to reach.
Denials and prior authorization are a consistent challenge for even the most efficient revenue cycles. With payers growing more and more stubborn with denial appeals, many organizations are looking for solutions capable of completing complex tasks involving coding and documentation.
HealthLeaders previously looked at the results of a study examining the accuracy of large language models (LLMs), state of the art artificial intelligence systems, when used for medical coding. The results showed that LLMs have not yet reached the point where organizations can utilize them for a task like coding. However, there are ways to leverage it alongside the efforts of revenue cycle staff.
Automated solutions are best utilized to complete repetitive, more administrative tasks, which enables staff to dedicate attention to more complex tasks. This can also present an opportunity to staff to upskill and expand their revenue cycle knowledge, such as becoming a certified medical coder.
Sherri Lewis, director of revenue cycle for Boulder Centre for Orthopedics, recently told HealthLeaders about how she’s able to get her staff on board with implementing rev tech into their processes.
“It’s [important] to show them the value [of the technology], get their buy in, and have them realize how it affects the whole practice,” she said.
Lewis is one executive looking forward to the ways AI and other rev tech solutions evolve over time, but believes that a human touch will always be needed.
“If I had an AI company [do our] coding, would they pull the right strings? Would they not transpose numbers?” she asked.
“Would they do it so great that we would all lose the ability to code after a while and just trust that they’re doing the right thing?”
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
As effificent as some RCM solutions have proven to be, many are still lacking in their capabilities.
The speed of the solutions should be leveraged alongside the efforts of revenue cycle staff for seamless workflow.