The role of CIO has been growing and developing for many years and is now on the edge of a transformational surge as healthcare embraces the future with Artificial Intelligence (AI) and machine learning. As future strategies are being developed and innovations implemented, AI will be central to defining how the hospital system’s clinical and financial processes move forward.
Initially, the healthcare CIO was a technician or engineer–responsible for installing automated systems and keeping them maintained. Then, the CIO’s role evolved into more of a project management and system implementation-focused role – all critically important to the digitization of healthcare. Now, the CIO is emerging as an innovator and strategy developer and with this new shift, comes changing needs in terms of access to accurate real-time data and analytics.
AI Helping Hospital CIOs Gather Financial Data
AI is capable of perceiving patterns consistently that are sometimes missed by trained professionals and is poised to have a transformational influence on healthcare. The days of automation and technology being for process and codification are long over. Now, insight and knowledge are the basis of value creation and bring a huge competitive advantage. By 2020 and beyond, AI will be a priority for healthcare systems as stakeholders are becoming acutely aware of how it can transform their business.
AI, predictive analytics, and machine learning can automate functions in the healthcare payment lifecycle and unleash actionable insights related to patient access, including prior authorization and patient propensity to pay, as well as revenue cycle management (RCM), including denial and rejection management. By automating important, but time consuming and repetitive tasks,
AI Possibilities in the Patient Access Area
CIOs, utilizing real-time analytics, can now examine, strategize, develop, and implement game-changing systems revitalizations based on quantifiable and repeatable observations. AI is reframing the prior authorization arena, as well as in determining patient pay estimates and propensity to pay. The potential impact on the bottom line is enormous.
- Prior Authorization – Imagine determining the need for preauthorizations on a per claim basis, processing and submitting those prior authorizations to the various insurance carriers, and following up on sluggish or lagging responses in real-time with human intervention only required for rare outliers and exceptions. Additionally, specialty-specific requirements, such as Clinical Decision Support Mechanism (CDSM) reporting, can be handled through AI-driven software modules obtaining certified compliance certificates for radiology, imaging, and cardiology.
- Patient Pay Estimation – AI is helping hospital CIOs explore revenue enhancement with increased patient collections–bringing a significant amount of previously uncollectible revenue to the bottom line. As patients assume more and more of the costs for healthcare, hospitals need to be proactive in estimating amounts due prior to care being delivered as well as a patient’s propensity to pay.
AI Possibilities in Revenue Cycle Management
Once RCM issues can be quantified and categorized, hospital CIOs are instrumental in designing and streamlining workflow to capture delayed or abandoned revenue, while also reducing unnecessary salary costs. As with the patient access components, RCM can be re-envisioned through leveraging AI-strengthened automation for denial management and accounts receivable.
- Denial Management – With an automated and intelligent denial management effort, hospitals can forecast which claims are collectible, prioritize A/R follow up using predictive and deterministic rules, and laser focus dollar recovery. These efforts can be supported by a highly trained team of experts to handle any outliers and exceptions as required.
- Accounts Receivable – AI and predictive technology can be used to focus efforts and predict success on aged A/R recovery ensuring full reimbursement at the maximum contracted rate by insurance payer.
With AI enhancement, hospital departments, provider practices, and the related financial departments can be interlinked and working in tandem to maximize revenue collection. By capturing real-time data analytics, hospital CIOs will be crucial players in the strategy development to meet future challenges, achieve and maintain financial viability in an uncertain market, and ensure patient loyalty and satisfaction.
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