Rev Cycle Leaders Expect AI to Do More Than Number-Crunching

Allegheny Health, a member of the HealthLeaders Mastermind program on AI in revenue cycle managemet and finance operations, is using the technology to help executives understand the data and make better decisions.

Healthcare has a people problem, especially in revenue cycle management and finance operations. There just aren’t enough people filling those roles, and the competition with other industries is fierce.

This is where AI fits in.

Whereas the human touch is a critical part of clinical care, when numbers are concerned, the fewer hands the better. Revenue cycle and finance managers are looking for AI tools to reduce human interaction in areas like coding, claims, denials and prior authorizations.

“We’re all trying to remove touches from the claims process,” says Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network. “We’re all trying to come up with ways to make that process more efficient.”

“We look at AI for any workflow that's high volume [and] requires a lot of analysis,” he adds. “If it requires looking through clinical documentation or large data sets to respond. We're trying to use AI to help drive and make those workflows more efficient.”

Ice, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and financial operations, says RCM and finance executives have been working with automation for years, and they’re leery of the flood of vendors coming into the space with so-called AI tools that really don’t use AI.

“Vendors that say they can do what we're looking for are a dime a dozen,” he says. “There's a lot of them out there that say they can do different things. Finding a vendor that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it,” is an elusive goal.

And what Ice is looking for now is AI that can learn the complex algorithms involved in rev cycle and finance operations and generate pathways to efficiency. Apart from transcribing documents and analyzing utilization workflows, that might mean identifying the right codes, smoothing out the prior authorization process, even predicting when a payer might issue a denial and working toward a quicker resolution.

We want to “take some of the back and forth out of it,” Ice says, adding that payers are also interested in using Ai to improve collaboration with providers.

The key, Ice says, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it’s in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.

Ice says AI is still a new technology, and one that needs careful monitoring as it learns the workflows. Every outcome generated by an AI program still needs to be checked by the “human in the loop.”

“When you automate something, you're trying to do something at a high volume to produce a significant amount of output without human intervention,” he says. “So if you have quality issues in that space, you can create a pretty significant mess for yourself in a hurry.”

That may not always be the case, however. The hope is that AI tools in RCM and finance eventually become reliable enough to run in the background, enabling those humans in the loop to focus on other tasks.

For now, Ice says, Allegheny Health has an expansive governance team in place, representing a wide range of departments within the health system. Their tasks range from  reviewing vendors and products to monitoring the development and installation of all AI programs to continuous quality control.

“There's still an extreme amount of investigation and research that goes into approving these technologies before they would ever be … deployed within our system,” he says.

The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com