Healthcare Reimbursements and why they require a robust technology like AI
By ClearCycle Team

While most payment processes are fairly straightforward, healthcare reimbursements are often quite convoluted and require robust payment systems that can keep up. This is primarily because unlike other financial transactions, healthcare reimbursements occur once the services have been rendered. As a result, the reimbursement process is rather long, stretching for months on end, and filled with a stream of back-and-forth conversations to ensure accurate data and approvals.

Healthcare organisations rely quite heavily on smooth reimbursement processes as it takes a substantial bank of revenue to offer high-quality care, retain talented physicians, maintain the labour force, procure the latest equipment and even ensure that there’s appropriate training for using cutting edge technology. Without quick and efficient reimbursements, healthcare organizations can crumble under the weight of their losses.

How can healthcare organisations optimise their reimbursement strategy?

Technology has changed the payments landscape over the last decade, which is why it is essential to keep up with the latest developments in the field. By optimising your existing reimbursement strategy (or crafting a new one that fits with today’s world), you can ensure fewer delays, lower operational costs, fewer errors, and even faster approvals.

Technologies such as AI and automation bring a myriad of benefits to the table, making them worthy of your consideration. Here are a few ways that AI can help:

  1. Improve your overall efficiency

No matter how reliable and professional your staff may be, it is fair to say that everyone makes mistakes occasionally. Processing patient information along with mountains of data, multiple times a day, can certainly increase the scope for human error. AI and automation combats this through the automatic extraction of pertinent data from files that have been digitized. As a result, there is no scope for errors anymore, no matter how many times the task is repeated in a day.

With this, you can expect fewer delays in the reimbursement process as you will have fewer files coming back for data verification. Additionally, by incorporating AI into your system, you can expect your tools to uncover patterns that may escape your staff. As a result, if there are any pertinent flags that can put your organisation’s billing in jeopardy, the tool can ensure they are caught in time so that they can be fixed.

  1. Generate scope for reimbursement

Speaking of patterns, AI looks at the larger picture, no matter what industry it is applied in. As a result, it is able to see things that human beings often miss. By seeing pertinent patterns, AI can help you uncover more opportunities for reimbursement. In fact, it also can help you identify reimbursable charges for any deliveries, services, or supplies before you generate your invoice – thereby ensuring that your reimbursement amount is higher than what you may have thought it was.

This added revenue can be used to expand business operations further and aid in your mission of offering high-quality patient care at all times.

  1. Reduce risks related to patient revenue

With so many high-deductible healthcare plans offered in the market, patients often find themselves buckling under the pressure of paying medical bills. Often, with expensive treatments and procedures on the horizon, patients often elect to have the same pushed in an effort to build the required finances to pay for them. Uncovered procedures also increase the hospital’s debt burden as patients often renege on their payments if they cannot afford the same.

Using AI software can help you minimise such risks substantially. This is because AI can help identify potential insurance coverage, offer cost estimates to the patient, and also confirm whether any authorisations are required for the procedure to take place. By collecting data, AI can also evaluate how likely a patient is to pay, and can even identify the best methods for patient outreach when the healthcare organisation must present the bill. With these advantages, AI can help improve the cost transparency and even make the payments process much easier. This increases the rate of collection for the hospital and also helps safeguard the financial experience of the patient on the whole.

Of course, it is essential to note that healthcare organisations need to invest time and effort to teach high-quality information to their AI software. Doing so has a direct impact on the value that you then get out of using the software. Using multiple data sources, such as different payers and providers, can help you create an accurate picture of your operations and healthcare organisation, which will then allow the AI software to deliver accurate insights.

Value driven payment models, evolving payer requirements, the changing financial landscape, the need for accurate documentation, and the shift towards patients from payers with regards to payment responsibilities towards patients have made reimbursement processes quite challenging for healthcare organisations. This is why you need robust technologies such as AI and automation in place.

To know more about how we can help you optimise your reimbursement processes, get in touch with us today!


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