RPA in Healthcare: Use Cases and Impact to Improve RCM Operations
Introduction RPA or Robotic Process Automation focuses on automating repetitive, rule-based tasks. It also refers to Agentic AI which enables systems to make decisions, learn, and adapt autonomously. In traditional healthcare revenue cycle management (RCM) processes, every task was done manually by human staff which led to errors and delays. Since many companies integrated RPA […]
Read MoreUnderstanding Medicare Advantage Plans & AI’s Role in Compliance
Understanding Medicare Advantage Plan & AI’s Role in Compliance TL;DR, Medicare Advantage Plan or MA market is fast-changing and highly competitive. According to the Chartis Report of 2023, Special Needs Plans (SNPs) have driven much of the market’s growth this year which reflects changes in beneficiary needs and insurer strategies. However, with time SNPs are […]
Read MoreHow to Write an Effective Insurance Appeal Letter?
Denial claims are one of the biggest challenges in the healthcare industry. RCM professionals consider them the worst nightmares. They can disrupt revenue management, impact cash flow, and create unnecessary frustration which diverts their focus from patient care. However, for the tld;r, a claim denial occurs when an insurance company refuses to reimburse a healthcare […]
Read MoreHow can Gen AI help win more Appealing Insurance Denial claims for healthcare providers?
U.S. healthcare staff have to write effective appeals daily. The major struggle is not writing them but winning them. As, appealing insurance denial creates administrative burden for healthcare providers teams. Staff needs to draft and submit appeals daily. Among the most frequent denials, medical necessity denials stand out which requires thorough documentation and precise justification […]
Read More4 Best Analytics Tools to Reduce Healthcare Denials by 30-50%
Healthcare denials are a significant issue for providers that directly affects their revenue stream. How? Each time providers resubmit a claim, they incur additional costs. To maximize revenue, modern healthcare organizations must focus on minimizing claim denials. Healthcare organizations should use denial management analytics to reduce claim denial rate. Effectively managing claim data requires expertise, […]
Read MoreRevolutionizing Healthcare Revenue Cycle Management with Predictive Analytics
Introduction Claim denials cause a significant challenge in healthcare. It can lead to financial losses, operational inefficiencies and disruptions in patient care. It is hard to manage and mitigate these denials which requires substantial time and resources. However, it often diverts providers’ attention from patient-centric activities. AI in denial management for healthcare can provide a […]
Read MoreSmart Appeals Management: Reclaiming Revenue with AI
Introduction Unsolved claim denials are a common issue in the healthcare industry. On average, denied claims cause hospitals an annual loss of $5 million, representing up to 5% of net patient revenue. The major drawback behind this revenue loss is the cumbersome traditional outdated healthcare appeal process. Creating appeals requires the manual effort of writing […]
Read MoreRevolutionizing Healthcare Appeals – The Power of Generative AI in Streamlining Revenue Cycle Processes
Overview Having high volume of healthcare appeals in backlog is like leaving money on the table. This statement could be correct before the AI powered solutions get into the game. Generative AI has played so well in tech industry but now it is getting popularity in order to streamline complex processes within healthcare RCM. Most […]
Read MoreRoad Map to Winning Medical Necessity Denials Appeal
Overview Ever received a denial from your health insurance company, leaving you confused and frustrated about medical treatment coverage? This can be especially concerning when the denial is based on medical necessity. Rest assured, you are not alone navigating health insurance policies can be a frustrating and often confusing experience for healthcare providers, especially when […]
Read MoreTransforming Healthcare Revenue Cycle Management with Generative AI – Tackling Claim Denials
Overview The healthcare industry specifically claim denials management is undergoing a digital revolution but what’s the weapon of choice behind this transformation? Artificial intelligence, specifically a powerful kind called Generative AI. This isn’t your average AI assistant; it can create entirely new data, and it’s becoming a game-changer in Revenue Cycle Management (RCM). So, while […]
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