Artificial intelligence can pay major dividends when it comes to managing back-office billing efforts, but the key to maximizing payments with it lies in knowing exactly where to build in coaching and automation.
That was the big takeaway from a recent webinar on AI’s ability to transform revenue cycle management for long-term care providers.
“As anyone who’s worked on the RCM side of the business knows, this is a high, high touch part of your operations and it’s, for the most part, relatively inefficient,” said Kevin Scalia, executive vice president of corporate development for Netsmart. “How do we strategically think about: How do we apply these new tools to your business to get the biggest bang for the buck? How do we try and identify things to simplify workflows and make it easier on your staff so we’re not burning them out, as billing gets more complicated?”
Erica Gregory, Netsmart’s senior vice president and general manager of RCM, said her company looked back to the beginning of the cycle when it first aimed to automate some billing functions about five years ago. Today, Netsmart’s RCM platform includes robotic process automation, large language models and chat bots that help clients a some 3,200 facilities.
The goal, the speakers said, is to have those tools serve to coach users, not for them to be used as crutches.
Gregory said her team first took a look at credentialing and payer communication processes.
“Our key challenges are at the beginning of the process and are leading us to some bad data elements,” she said.
It’s often tied to data intake, coding errors or eligibility and authorization issues. This was one of the areas Netsmart said its clients were most interested in addressing.
To help determine eligibility and define how billing and payments should flow, Netsmart created key automations and “augmented” intelligence around scheduling eligibility checks for a building’s resident population.
