Artificial Intelligence (AI) and machine learning technologies are disrupting and transforming many major industries and fields. Healthcare is no exception. Advances in treatment and diagnosis get the most attention, but AI technology in healthcare payments is just as revolutionary. AI will have profound effects on revenue cycle management and the patient’s payment experience.
Many key figures in healthcare cite revenue cycle management as the area most in need of innovation and disruption. Like almost everything else in healthcare, revenue cycle management is complex. It often entails multiple stakeholders and vast quantities of data across multiple computer systems at different organizations, with strict regulatory requirements for data security and compliance. AI technology, featuring capabilities such as machine learning, natural language processing, and advanced data processing and analytics, provides new opportunities for technology to become a powerful force multiplier for healthcare administrators.
AI Capabilities
Artificial Intelligence is a catch-all term for a cluster of emerging capabilities made possible by cloud-based computing, big data, and rapid increases in computer speed and power. There are three major components to what we call AI in a modern context.
- Machine learning: Using advanced algorithms and access to vast data, machines can essentially teach themselves to complete repetitive tasks such as pattern recognition. Given the volume of data generated in the healthcare sector, this is a technology expected to pay dividends in healthcare.
- Natural language processing: When you ask Alexa or Siri a question and they provide an answer, that’s natural language processing. Natural language processing allows computers to read, understand, and formulate a reply in human language.
- Artificial Intelligence: AI makes a computer work more like a human brain. Instead of being limited to programmed rules, AI can teach itself using algorithms and analyze tasks using this trove of knowledge. It essentially analyzes data at incredibly high speeds and predicts how a human would act upon it using its machine learning-trained algorithm.
AI can automate functions that once required human workers to complete. It does so with no need for breaks and no drop-off of efficiency or accuracy when tired or hungry. It can analyze data and present analytics that enable human analysts to make data-driven decisions, improving efficiency in many areas. AI excels at replacing or augmenting human staffing in functions that incorporate elements of the following three criteria:
- Repetitive
- Rules-based
- High volume
AI Technology in Healthcare Payments and Claims
AI technology shows great promise for use in several areas of revenue cycle management. This includes claims status verifications, claims denial management, healthcare billing, and patient collections / payment experience. The technology serves as a force multiplier; sifting through and processing claims and payments and highlighting those that need human intervention.
An excellent example of this is Alaffia Health’s AI-driven payment-integrity-as-a-service platform. Alaffia partners with healthcare payers to tackle the endemic problem of healthcare fraud, waste, and abuse costs. They address this with advanced AI technology that scans medical claims, automatically flags inconsistencies and unusual charges, and requests supporting documentation from the healthcare provider. Alaffia’s team of medical billing and coding analysts then reviews the claims flagged by the AI. preventing or recovering improper payments on behalf of healthcare payers.
Alaffia’s AI platform uses pattern recognition and machine learning capabilities to automate the workflow of checking claims, scanning through many more claims than a human staff could on their own. Human experts can focus on claims with discrepancies flagged by the AI, vastly increasing their efficiency. AI allows Alaffia to recover a much higher percentage of fraud, waste, and abuse costs for their healthcare payer partners than would be possible by using traditional methods. Cutting down on these types of costs reduces healthcare costs for everyone.
Artificial Intelligence And The Patient Experience
AI’s power to enhance the patient experience goes beyond the back-end. Many payment processors are using AI to provide customized financing and payment options seamlessly integrated into the patient journey. 91% of healthcare administrators believe AI implementation is boosting access to care for patients.
Some people worry AI will replace humans in healthcare workplaces. However, as seen with Alaffia, AI’s strongest use case is often as a tool to make human staff more efficient. With margins shrinking and healthcare costs rising, AI’s potential to ensure accurate payments couldn’t have emerged at a better time.
For healthcare systems and payers wondering where to implement AI to get the biggest bang for their buck, AI technology in healthcare payments is an opportunity to get immediate results and significant positive impact to their bottom line. Alaffia Health’s AI platform integrates seamlessly with existing systems as a turnkey solution to improper healthcare payments.
Alaffia’s combination of innovative technology and human expertise saves healthcare payers an estimated $150 million per member per year. Organizations just dipping their toes into the waters of AI gain peace of mind from Alaffia’s contingency-based fee structure. Alaffia only gets paid for results. Book a call with Alaffia Health and learn how your organization can use AI to build a better patient financial experience.