Healthcarercm

  The COVID-19 pandemic has had an unprecedented burden on healthcare systems worldwide. However, the pandemic has also accelerated the digitization of healthcare operations. This is especially true for hospitals and other primary care providers' billing and coding departments. With error-free, consistent documentation and claims processing becoming the primary factors for a sustainable revenue cycle for healthcare organizations, digitization is imperative to increase payer-provider synergy. Medical coding  has several objectives: to capture patient services, influence future medical decisions based on patient history, and submit accurate claims to payers for full reimbursement. However,  claims are frequently denied due to coding errors  and missing documentation.  Studies  have noted healthcare enterprises lose $8.6 billion annually on claim appeals. Understanding the Key Reasons for Denials Claims are denied for various reasons, including incorrect or in...

  There is no end in sight to the chronic coding and  revenue cycle management (RCM) staffing shortage  that has healthcare organizations looking for new ways to keep revenue flowing with too few qualified professionals to handle critical processes. As we discussed in a recent HIT Consultant article,  A Hybrid, Technology-Driven Approach to Overcome Coding and RCM Staff Shortages , the worsening shortage and its short- and long-term impacts have moved staffing to the top of priority lists for many health information management (HIM) directors, revenue cycle leaders, and CFOs – leaders who are already dealing with the extreme financial pressure as well as greater regulatory uncertainty and audit scrutiny. Many are also realizing that the smart strategy to address these woes is one that focuses on optimizing the productivity of existing teams by adopting a hybrid approach that augments internal teams with outsourced coders and a substantial focus on automation wherever...

Advances in artificial intelligence (AI) and the highly transactional nature of revenue cycle management (RCM) have set the stage for AI to address many of RCM’s biggest pain points, while increasing revenue capture and helping achieve revenue integrity. Whether it’s automating manual and redundant tasks within patient access or billing or applying AI to real-time analytics, prior authorization, workflow prioritization/optimization, and denial mitigation, the potential for  AI in RCM  is already being realized by early adopters. However, when it comes to deploying any AI strategy, selecting the right technology vendor can make or break the entire project. The Right Fit The best AI vendors will be those that not only understand the problem AI is expected to solve but are also willing and able to analyze the prospective customer’s existing operations to identify and address issues in ways that fit well with the organization. Prospective vendor partners should have a proven track...