Insuranceciooutlook

Ways Artificial Intelligence can Streamline Healthcare Claims Processing

Insurance CIO Outlook | Sunday, April 24, 2022

Hospital employees who must spend their time correcting errors or manually completing repetitive, tedious tasks are unable to devote that time to more important tasks, such as patient care.

Fremont, CA: The healthcare industry is experiencing a record-breaking year in digital well-being investments. This means that, while the pandemic has had a significant impact on the financial well-being of healthcare establishments, they are increasingly turning to digital and artificial intelligence (AI) options that streamline behind-the-scenes capabilities and reduce administrative and operational spending.

Many hospitals are seeing immediate results from investments in departments and capabilities that perform error-prone, repetitive, time-consuming tasks. Claims processing and reimbursement are two operations that are fraught with such responsibilities.

Though claims processing and reimbursement are critical components of the healthcare revenue cycle, they involve a slew of stakeholders and steps, such as justification, validation, authenticity, and cost. Every step of the procedure is as important as the last, so effective and timely communication among all stakeholders is critical for success.

The Challenges Hospitals are Facing

It's no surprise that the reimbursement and claims processing workstream is primarily comprised of high-volume and repetitive tasks, such as gathering and entering patient and supplier information. When administered manually, both front- and back-end hospital employees must spend numerous hours inputting data, which can lead to clerical errors. Despite everything, we are solely human!

When a mistake is made in the course of, such as incorrect billing or incorrect patient documentation, the method is further delayed. Payers, providers, and patients are all subjected to additional back-and-forth communication to confirm details for the medical claim.

Hospital employees who must spend their time correcting errors or manually completing repetitive, tedious tasks are unable to devote that time to more important tasks, such as patient care.

This situation extends beyond the billing cycle and may have an immediate impact on payers as well. Frequently delayed claims as a result of errors may cause hospitals to be wary of accepting certain plans and even total carriers. Because there are fewer accepted plans, profit brokers can only offer a limited number of options and price points to their clients. Finally, employers who want to provide ample and reasonably priced well-being plans to their employees have only a limited number of options to choose from.

How Synthetic Intelligence is Transforming Hospitals

As more hospitals recognize the significance of these issues, they're implementing artificial intelligence (AI) options to streamline the claims processing and reimbursement course. AI automates these critical but repetitive tasks to reduce errors, improve workflows, and free up hospital workers to handle more complex tasks that require human interaction.

In terms of reimbursement and claims processing, hospitals are utilizing AI in a variety of ways to outsource and automate repetitive, high-volume tasks, which reduces worker workloads and accelerates the overall revenue cycle. With AI's accuracy, hospitals are eliminating the possibility of errors in affected person entry or pre-authorization claims, as well as reducing the need for pointless back-and-forth communications caused by errors.

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