Artificial Intelligence – What Is It, What Does It Do, and How Will it Impact Healthcare?

How AI Will Help Automate and Enhance the Healthcare Revenue Cycle

As recently as a decade ago, artificial intelligence was still something of a science fiction concept. Movie makers imagined talking cars that could drive themselves and robot assistants that anticipated our needs before we even knew we needed them. After several years of research and development, artificial intelligence is now commonplace and growing more and more pervasive. We use AI in our everyday lives, sometimes without even recognizing it as such. According to a recent PEGA survey, 33 percent of respondents initially thought they used AI technology. However, further probing revealed that 77 percent actually use AI-powered services and/or devices.

Artificial Intelligence in Health Information Management and the Revenue Cycle

But what is artificial intelligence? And how can it be applied in health information management and the revenue cycle? Merriam-Webster defines “artificial intelligence,” or AI, as “the capability of a machine to imitate intelligent human behavior.” IBM breaks down this definition even further by explaining that AI leverages computers and machines to mimic the problem-solving and decision-making capabilities of the human mind.

A majority of people are optimistic about the benefits of artificial intelligence, but they are also often confused and uncertain about how AI is currently used. There are several examples of AI in many of our daily routines. Some examples of artificial intelligence (AI)-enabled technology include the Roomba vacuum cleaner, smartphones with speech recognition in talk-to-text, autonomous driving vehicles, and other vehicle safety features such as self-parking and driving assistance lane departure warnings.

Home assistant devices such as Google Assistant and Amazon Alexa use artificial intelligence to play music, order products and services, make phone calls, activate or deactivate other devices, and many other tasks—and the list is growing. Artificial intelligence is being implemented in so many areas that it may be hard to keep up with all of the new developments.

Why Hospitals Are Using AI To Up Their Revenue Cycle Management

A research study by Change Healthcare found that two-thirds of healthcare facilities and health systems are using AI to assist their revenue cycle. Of those, 72 percent of respondents are using AI applications for eligibility/benefits verification and 64 percent for payment estimations (likely due to the No Surprises Act).

While AI plays a role in just these areas, it also plays a significant role in revenue cycle management (RCM). According to the State of Revenue Integrity survey published by the National Association of Healthcare Revenue Integrity (NAHRI), other areas with AI-enabled products and functions for revenue cycle management include charge description master (CDM) maintenance, charge capture, denials management, payer contract management, physician credentialing and claim auditing. Patients who pay for their own healthcare can benefit from artificial intelligence, which integrates financial assistance technology that checks for any financial aid the patient might qualify for, as well as being used in price transparency.

How Provider Documentation Can Be Improved by Using AI

Provider documentation can also benefit from the use of AI, with speech recognition to dictate directly into provider notes and with integration into formatting documentation and placing specific dictation into specific areas of provider notes.

Providing artificial intelligence (AI) tools for providers to use with their documentation helps reduce queries from coding professionals, which speeds up claims submissions and helps to keep account receivable days within benchmark standards.

Using AI To Increase Charge Capture And Reduces Claim Denials

With rule-based technology and natural language processing (NLP), charge capture can be automated to ensure documented charges are not overlooked prior to claim submission. Computer-assisted coding (CAC) uses natural language processing to highlight specific terms within documentation and then apply an appropriate ICD-10-CM diagnosis, procedure code, and CPT code. Some AI-enabled technologies are used for autonomous coding, whereby the coding effort is eliminated.

How AI-Enabled Technologies Will Transform Healthcare

Through the use of AI-enabled technologies, healthcare professionals can improve quality and efficiency where there would otherwise be a need for more human resources. In the health information management profession, associate degree programs have been shuttering steadily across the nation over the past 10 years. The challenges of recruiting and retaining skilled healthcare personnel have been compounded by an increase in demand for qualified professionals.

The unemployment rate in the United States has fallen to record lows. The US had an unemployment rate of 3.8 percent in 2018 and currently has a rate of 3.5 percent. (The birth rate is also declining.) A study by the University of Southern California has found that, because of the imbalance between children and retirees, “the economic burden on a child born in 2015 will be nearly twice that of a child born in 1985.” Overall births in the US have declined each year since 2007 and are not yet sufficient to replenish our workforce.

As an industry, we need to educate ourselves and our healthcare colleagues on the definition, benefits, and potential applications of artificial intelligence. We need to ensure staff comfort with the emerging technology and reinforce that it is not a replacement to our knowledge, skill set, or expertise but instead a tool to succeed in our ever-changing environment of healthcare information management.

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