AI’s Advantages to Overcoming Revenue Cycle Management Challenges for Providers

HIT Consultant August 30, 2024
Jeff Carmichael SVP of Engineering and Analytics XiFin, Inc.

Healthcare providers face staffing shortages, increasing regulatory requirements, and pressure to reduce costs while delivering effective care. Compounding provider problems are payor policy, behavior changes and ongoing fee schedule cuts that compress revenue, as well as mounting denials and additional documentation requests from payors.

Coding, claim processing, and the collective revenue cycle management (RCM) tasks required to ensure appropriate reimbursement for billable service are all critical to financial success. However, all carry an administrative burden and associated costs.

A key factor driving this increase is the payors’ expanding use of artificial intelligence (AI) in prior authorization determination and claim adjudication. To overcome the many challenges and bring more efficiency to the process, many providers are turning to AI for some...

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