Healthcarercm

  Looking back across 50 years of  coding technologies as we did in our recent white paper  reveals a pattern to the catalysts for change. The lion’s share of technology advances traced in the paper emerged from an urgent need to accelerate the coding process, improve accuracy, mitigate risk of denials and audits, and boost productivity – despite the still-ongoing shortage of coding professionals. While advanced technologies, such as predictive analytics, artificial intelligence, machine learning, natural language processing, and Clinical Language Understanding (CLU), can help minimize the impact of labor shortages, they cannot overcome this issue on their own. However, they do up the ante in terms of identifying the  right outsourcing and solutions partner  to fill staffing gaps and ensure a healthcare organization has access to – and is properly using – the latest coding technologies to stay on top of rapidly evolving code classifications, regulatory mand...

  Deciding to use  offshore support  to help manage your revenue cycle and contain revenue is an important decision that shouldn’t be made lightly. Using offshore talent isn’t new. Those working in IT have used offshore talent for decades. But is working with offshore talent for revenue cycle management (RCM) right for your organization? Increasing rules, regulations, and annual updates to medical codes add pressure to medical coders who struggle to keep up. Add  labor shortages  to that list of challenges, and it becomes clear how offshore talent can be beneficial. Know more about  What is revenue cycle management in healthcare But not all offshore RCM vendors are created equal. Our new  eBook shares how AGS Health stands apart from the crowd  and how our customer-centric approach enables leading healthcare organizations to improve their revenue cycle accuracy, productivity, and efficiency, leading to reduced denials, more reliable cash flow, and...

  Automation and artificial intelligence (AI) in revenue cycle management (RCM) have numerous real-world applications as healthcare organizations seek to implement advanced technology and tools. This first article in our three-part RCM automation series explores the automation continuum and the various forms of automation that are reshaping the healthcare industry. Discovering the Automation Continuum The automation continuum can be categorized across four progressive stages of increasing complexity and capability: basic automation, advanced automation, intelligent automation, and generative AI. Basic Automation  emphasizes rules-based processes designed for repetitive tasks, which operate under predefined instructions. This foundational level of automation performs simple, routine operations, reducing manual workload and minimizing errors. An illustrative example in healthcare is the automated claim status query process, where a standard transaction prompts a predetermined r...

  Clinical denials   are a growing challenge for healthcare organizations, leading to lost revenue and increased administrative burden. With the rise of payer automation and stricter policies, hospitals are facing mounting pressure to defend their care decisions. However,   artificial intelligence   (AI) is emerging as a powerful tool to transform clinical denial management from a reactive to a proactive approach. Below are five ways AI can make a difference in successfully  fighting clinical denials : Automated Medical Necessity Reviews AI-driven systems can flag documentation gaps and predict medical necessity denials before they occur. By identifying high-risk cases early, healthcare organizations can take proactive measures to strengthen documentation and prevent denials. 2.  Predictive Modeling for Risk Stratification Advanced analytics powered by AI enable predictive modeling to assess the likelihood of denials based on historical data (payer, diagnos...