The Top 3 Ways AI-Powered Claims Submission is Dramatically Reducing Denial Rates to Save Time & Money

Amid the bustling activity in healthcare administration, one of the most critical tasks is managing Revenue Cycle Management (RCM). From claim submissions to managing denials, the complexities inherent in this process make it a prime candidate for innovation. Today, we delve into how AI-powered automation dramatically reduces denial rates, saving time and money.

1. Reducing Human Error

Claims errors happen, and when they do, delays and denials become a reality. Revenue Cycle Management is a resource-intensive, error-sensitive, costly, and, let's face it, tedious process. And yet, it's critical.

To keep up with the demands of primary claims processing and lower costs, many organizations outsource or offshore these RCM administrative tasks. However, while outsourcing can drive down costs, it can also exaggerate human error due to factors such as fatigue, distractions, misunderstanding of complex guidelines, and inherent variability in human performance, leading to inconsistencies and mistakes in data entry and processing.

Luckily, AI workers combat this problem, drastically reducing human error in multiple ways:

  • Standardization: RPA standardizes tasks across the board, ensuring consistency and uniformity in data entry, interpretation, and processing.
  • Error Checking: Robotic process automation uses algorithms for data validation, detecting and correcting errors in real-time before they escalate into more significant issues.
  • Integration with OCR: Optical Character Recognition (OCR) technology, when integrated with RPA, automatically extracts and interprets data from claim documents, eliminating errors from manual data entry.
  • Data Handling: RPA manages large volumes of data efficiently, reducing the chances of data mix-ups or misinterpretations that could lead to claim denials.
  • Rule-based Operation: AI Workers can operate on predefined, pre-approved rules, which lowers the risk of non-compliance or deviation from standard procedures.
  • 24/7 Operation: Unlike human workers, AI Workers systems can work around the clock without fatigue or cognitive decline, ensuring the quality of work doesn't deteriorate over time.
  • Predictive Analysis: Advanced AI Workers systems use machine learning and data analytics to predict possible errors or denials, making proactive corrections before claim submission.
  • Process Improvement: AI-powered AI Workers continually learns from its tasks, identifying patterns, trends, and potential pitfalls, and then adjusts its processes to minimize future errors.

And this is backed up by data. For example, our AI worker, Claims Navigator, can reduce claims denials by 75%.

2. Lower Costs and Resource Optimization

AI's economic impact on RCM is monumental. Replacing low-cost outsourcing with automated AI Workers quickly pays off the initial investment by cutting overhead costs associated with human labor, such as benefits, vacation, or sick leave.

At the same time, organizations can leverage their workers for more creative and complex tasks that help move the company forward. When workers are freed from tedious primary claims admin work, they have more time to spend on high-value tasks that require a personal touch, such as patient care and satisfaction.

Our Claims Processing can reduce manual time spent on cleaning and submitting claims by an eye-watering 95%.

3. Productivity and Efficiency

Efficiency is a cornerstone in the case of AI-powered RCM. While a human worker has a finite capacity, AI Workers operate 24/7, handling a larger volume of claims and denials with a faster turnaround.

Furthermore, AI Workers can predict denials using data analytics and machine learning, ensuring necessary corrections are made before submission. This proactive approach speeds up the revenue cycle, improving cash flow.

Final Thoughts

In a world where time equals money, AI-powered automation represents a seismic shift in RCM. This technology is an invaluable ally in managing primary claims by reducing human error, cutting costs, and significantly enhancing productivity and efficiency.

Embracing AI is no longer about staying ahead but not getting left behind. So here's to smoother RCM processes, lower denial rates, and improved bottom lines through AI-powered automation - a clear path toward uncompromising precision and unfaltering productivity.

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Published On:

July 19, 2023

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