How AI Can Save Physician Billing

The next time you’re driving around your city, look around. It used to be that medical offices had signs emblazoned with the name of the physician who started the practice. Not anymore. Now, your local provider’s office has a major hospital’s name on it.

Why is this happening and what does it mean?

It’s easy to assume that these takeovers are hospital system success stories. That being gouged anytime you pop in for something as simple as seeing if your daughter’s bloody nose is a serious problem — Personal story there… — is now just a part of our current reality. But it’s more than that.

Physicians endure years and years of school. They accumulate tons of student and medical debt for the privilege of opening their own practice. And these days, so many of them end up watching their homegrown business go out of business. They’re not giving up on their dreams and selling out to a hospital, the market is failing them.

Physicians endure years and years of school, culminating in medical school. They accumulate tons of student debt and medical debt for the privilege of opening their own practice only to watch their homegrown business go out of business.

It’s more than market dynamics.

It’s not as simple as market dynamics. Think back to the last time you paid your doctor a visit. I wouldn’t be surprised if you picked up on a negative vibe. The staff at medical offices are often populated with unhappy staff and unhappy management.

  • No one is getting where they want to be with their career.
  • Everyone is struggling to make ends meet and cover rent (Their own and the office’s).
  • There’s the added financial pressure of medical insurance and marketing costs.
  • They must constantly be worried about competition.
Add to all of that that insurance companies are becoming more difficult to work with. They’re paying less per claim and paying a smaller portion of the claims submitted. Not a profitable combination for the provider

Add to all of that that insurance companies are becoming more difficult to work with. They’re paying less per claim and paying a smaller portion of the claims submitted. Not a profitable combination for the provider.

Medical providers are struggling with inadequate tech.

Staff members are saddled with outdated software systems. These systems lack connectivity. Windows-based desktop computers and EHR software are pervasive in practice management.

Imagine if someone swiped your shiny new MacBook and left you with a PC circa 2002, then tasked you with getting through your work day. This is the day-to-day reality for most medical office employees.

Imagine if someone swiped your shiny new MacBook and left you with a PC circa 2002, then tasked you with getting through your work day. This is the day-to-day reality for most medical office employees. They’re trying to be productive and efficient using legacy systems bought many, many years ago. This issue plagues every kind of software they use including practice management, EHR and clearinghouse.

You can think of these legacy systems as the walking zombies of software companies. Despite the fact they can’t afford to innovate their offerings, they don’t lose their customers. Their customers are trapped, unable to move their data from their old system to a newer more effective system.

And the payers aren’t making it any easier on their end.

While some of the major payers have well-mainted websites, may do not. Medicaid and state payer websites are in a perpetual state of disrepair. So, what do you do when you can’t get what you need done online? You pick up the phone.

Medical billing associates across the nation are making tens of thousands of phone calls to insurance companies every day. And these aren’t quick, simple calls. They’re long, slow and laborious — No wonder these employees are miserable!

Follow that data!

While on the phone with the payer, medical office staff are also trying to pull data relevant to their call from multiple systems because none of their software is interconnected. And, as you can imagine, with mutiple people plugging info into multiple systems, mistakes happen. Lots of them.

Aside from putting physicians in a situation where they have to keep increasing their staff — And their costs — Just to manage their billing, their software reveals zero business insights.

Aside from putting physicians in a situation where they have to keep increasing their staff — And their costs — just to manage their billing, the software they’re using reveals zero business insights and makes it easy to lose data. And lost data is lost money.

Staff expectations are unrealistic.

Losing money makes everyone feel frantic. Physicians invest in software that’s supposed to help their practice. When the software doesn’t deliver on results, they shift the responsibility to make up the software’s shortcomings to their staff.

When the software doesn’t deliver on results, they shift the responsibility to make up the software’s shortcomings to their staff.

Back office billing work isn’t glamorous. Billing generally requires a large amount of time to keep up with the volume of claims your typical doctor’s office submits every month. Their role consists of high volume, highly complex tasks. This is work that often goes underpaid and under appreciated.

For example, an individual billing staff worker may be expected to work 80 accounts per day. This includes:

  • Investigating and creating claims from poorly cited encounters
  • Submitting claims through a multitude of software systems
  • Attempting to adjust a claim with the payer, who can wait anywhere from 15 days to 15 months to respond
  • Checking on payer websites and making phone follow-up calls to the payer to get a status update on an “electronic” claim

The fun doesn’t end there. If the insurance company decides not to pay a claim. it’s their job to fight the denial. This is rarely easy work, even when the issue is a technical one (i.e. the payer is requesting supporting documents).

The less the insurance company pays to the service provider, the more the insurance company wins. This market dynamic introduces unnecessary complexity to the payer-provider relationship.

The medical office staff members are struggling to keep up with all the new hoops that the payer now wants them to jump through. As a consequence, collections are decreasing. Management is now upset they have to consider selling their business. Many are hesitant to sell to local hospital system because they don’t want to become just another employee on the payroll. They don’t want to see their dream disappear.

The good news is there’s hope.

This is where artificial intelligence comes in.

Like many other industries, artificial intelligence is the answer to the challenges facing medical practices.

What do we mean when we say artificial intelligence? We don’t mean a super computer like Watson replacing doctors and triaging patients. What we’re talking about is the elimination of the work it takes to run a medical practice like:

  • Billing
  • Claim collections
  • Payment information gathering
This requires more than a machine learning algorithm. Robotic process automation is necessary to log into various systems and complete tasks. It’s the automation of tedious, high-volume tasks employees routinely make mistakes performing.

This requires more than a machine learning algorithm. Robotic process automation is necessary to log into various systems and complete tasks. It’s the automation of tedious, high-volume tasks employees routinely make mistakes performing.

AI pulls the strings behind the scenes telling the bots what actions to take in which systems. Companies who claim to be implementing robotic process automation without an underlying AI engine aren’t doing much more than shifting data from one system to another. This is done without many rules or much logic.

This tactic won’t fundamentally replace work. It just replaces a few tedious tasks. That’s not very compelling. True AI use combined with automation can eliminate workflow entirely.

Analytics are important.

Business rules need to be derived from direct human experience, as well as from data analysis. Putting rules in place to optimize outcomes is AI low-hanging fruit. The real value is in the analytics. Analytics can help you discover the most beneficial rules to add and running those analytics means new, better rules will be created over time.

The best way to discover those rules is to use business analytics tools, as well as, software programs like ours that allow for supervised machine learning.

AI fears tend to be unfounded. The technology is a long way off from replacing the business rules and logic actual people can provide. Right now, the focus is identifying the rules and adding them to the machine. The best way to discover those rules is to use business analytics tools, as well as, software programs like ours that allow for supervised machine learning.

What can robotic process automation accomplish?

An organization can run smarter and leaner with the use of analytics and robotic process automation. This can make it possible for physicians’ to become profitable again. Maybe for the first time in a long time. Medical providers can:

  • Streamline the way they see patients
  • Optimize the way they bill insurance companies
  • Eliminate two-thirds of the work necessary to get paid by insurances companies and their patients.

Keep the all-stars on payroll.

Robotic process automation can make the billing department’s workload managable. Physicians will have an easier time retaining top performing employees. Funds have now been freed up to reward the highest performing members of the team.

This is an opportunity for physicians to top hiring the wrong people and start investing in the right people.

This is an opportunity for physicians to top hiring the wrong people and start investing in the right people.

These top-performers can be placed in the role of :

  • Maintaining AI operation
  • Overseeing the work completed by AI
  • Filling in the gaps when things like phone calls or advanced decision making come into play
Revenue cycle workers have often been treated as cogs in a giant wheel. Using AI, the average revenue cycle worker can become a revenue cycle professional and get paid and respected accordingly, while benefiting the medical practices and hospitals that they serve, helping them spend less to collect more, and helping them stay independent and profitable.

Revenue cycle workers have often been treated as cogs in a giant wheel. Using AI, the average revenue cycle worker can become a revenue cycle professional and get paid and respected accordingly, while benefiting the medical practices and hospitals that they serve, helping them spend less to collect more, and helping them stay independent and profitable.

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About RCM Brain
$400 billion per year is being spent on today’s existing revenue cycle, which is 15% of all healthcare costs. RCM Brain believes we can lower that costs for the customers we serve by more than half. Not only in the cost of collections, but also in the collection of dollars owed. Learn more about the solution to your revenue cycle problems.