How Leveraging AI Improves the Patient Experience

There has been a lot of attention on the patient experience and consumer-centered initiatives in healthcare recently.  Hospitals and providers are coming to understand that mega-expensive marketing strategies with splashy print and media ads can only go so far in impacting consumer behavior.  It turns out that what patients want is a positive encounter that is executed smoothly.

Patients expect quality care, but when they receive an efficient, well-organized encounter, they will tell family and friends, as well as leave the all-important reviews that at least partially drive 70% of today’s customer decisions.  So what are some ways that an organization can provide a stand-out experience — by ushering patients through the administrative requirements in the most effective, informative, and coherent way.

A Better Patient Experience Through Automation

Unique to healthcare, third-party financial responsibility adds a layer of complexity that is often confusing and deliberately complicated.  Taking the time to educate patients on their insurance plan requirements and how the billing process works is the first step in empowering decision making and ultimately building loyalty towards your organization.

Through Artificial Intelligence (AI) and machine learning, hospitals and providers can now proactively engage insurance payers and meet them on a more level playing field.  Through automation and AI-driven software, insurance plan requirements can be updated and maintained with data accessible and actionable in real-time, creating up-to-the-minute results that empower rather than overwhelm patients.

Insurance Verification and Benefit Eligibility

It is critical to gather and confirm precise patient eligibility information, including co-pays, co-insurance, deductibles met and remaining, and out-of-pocket maximums.  While this automated process has more industry-wide acceptance with, on average 85% of organizations using at least partially automated workflow, there are still efficiencies to be gained, and more importantly, patients to be educated about their financial consequences.

Concurrently, using an integrated, automated, and comprehensive platform solution would allow this information to also include patient pay estimates and prior authorization (PA) requirements.

Collecting the Correct Amounts for Patient’s Portion

Financial surprises are a big reason why consumers distrust the healthcare industry.  A recent survey from the University of Chicago states that 70-80% of consumers see either hospitals or physicians as responsible for “surprise” billing.  With plans continuing to evolve into more complex and tiered networks and deductibles continuing to rise, this trend should only increase in the future.

How can your organization reverse the trend and improve the patient’s outlook?  By informing and educating patients on their financial responsibilities, including copays and deductibles in advance of their actual treatment (if possible), and providing alternative options for payment upfront.  Utilizing an automated patient pay estimation package allows the patient to more fully understand and process the financial impact of their care and arrange or plan how to pay.

Prior Authorizations

The single most significant area in need of modernization is utilization review and PAs.  The 2018 CAQH Index states that on average, only 12% of providers have fully adopted an electronic solution for managing PAs which means that countless hours are being spent on hold with insurance payers trying to obtain approvals or following up on rejected requests.

Through today’s technology and a unified workflow, automation and AI-driven software enables hospitals and providers to manage the PA process in real-time electronically.  From submission to follow-up and appeals, PAs can be electronically managed, and when completed, they can be routed to the scheduling department in real-time, giving further evidence to patients of efficient and organized care.

AR and Claims Denials

Last, the revenue cycle concludes with the management of claim denials.  By leveraging AI and machine learning technology, denials can be managed effectively, and revenue captured that may currently be abandoned entirely.  Hospitals alone, lose on average, $262 billion per year on denied claims.

When claims are denied, they are often passed through to the patient and are a major source of “surprise” billings.  Utilizing an automated AI-driven denials management solution, hospital and provider organizations can significantly reduce the high number of claims that are returned or rejected, further reducing the reported “surprise” billings that rightfully upset patients.

Changes in healthcare are going to continue, and being prepared by utilizing the available technology to improve the patient’s experience will position your organization for the future.  By utilizing AI and machine learning technology, your organization will be able to streamline administrative functions freeing up people (the human intelligence) to educate and guide patients and improve their satisfaction and loyalty.

Find out more about leveraging automated technology to improve your patients’ experience.


About the Author

Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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