How to Utilize AI in Denial Management to Transform Practice Revenue

The healthcare sector often has various operations other than caring for patients. One such operation that ensures practice success is revenue cycle management. It is a process of streamlining the financial process, from initial patient registration to final payment collection.

During this process, many challenges occur and claim denials are one of them. Most healthcare providers have faced struggles in denials as it significantly drains the practice revenue.

Denials with evolving medical coding and service explanation cost a huge loss of revenue in the US Healthcare Sector. 

However, Artificial Intelligence (AI) has transformed many industries, including healthcare. The US Healthcare sector has implemented AI in RCM and has experienced substantial advancement. 

This blog post shares how you can utilize AI in denial management to significantly transform healthcare practice management.

Revenue Cycle Management in Healthcare

Revenue cycle management is a crucial healthcare operation that ensures practice success. It is a process of streamlining healthcare financial operations, from the initial patient registration to the final patient payment collection. 

However, it seems like a complex task, it is a crucial process that every healthcare practice should efficiently focus on to improve financial health. The process of revenue cycle management includes:

• Patient scheduling and registration
• Insurance eligibility verification process
• Patient service and care
• Medical coding of services
• Charge capture and entry
• Claims preparation and submission
• Payment posting and reconciliation
• Denial management and appeals
• Patient billing and collections
• Financial analysis and reporting

During the process, claim denials become a huge problem for healthcare providers. Efficiently managing claim denials is crucial to ensure a smooth end-to-end financial process.

Related: The Ultimate Guide for Independent Practices to Master Revenue Cycle Management

Denial Management

While claim denials have become a big concern for healthcare providers, implementing strong denial management will help to address and rectify claim denials.

Denial management is a crucial part of RCM. This process involves identifying the reason for claim denials, appealing to the insurance payers, and preventing claim denials. Denial management itself involves many steps:

• Receive claim denial notification
• Identify the denial root cause
• Review claims for errors
• Gather supporting documentation and evidence
• Prepare and submit an appeal
• Follow up on appeal
• Implement preventive measures identified
• Monitor denial trends continuously

And more other steps. The ultimate aim of this process is to reduce the financial impact of rejected claims on healthcare organizations. 

According to a Journal of AHIMA, around 20% of all claims filed are subject to denial by insurers. Through denial management, healthcare organization strives to minimize this impact.

How to Use AI in Medical Claim Denial Management?

There are various ways AI can be implemented in the denial management process.

1. Optimizing Claim Validation

Claim scrubbing is a process of checking the claims for any mistakes before submitting them to the insurance companies.

AI-powered solutions will help to identify problems such as incomplete information in claim documents, procedure codes, or inaccuracy in patient data. This way, healthcare practices can lower the number of appeals to be sent in the future.

2. Classifying Denial Reasons

Claim denials have various categorizations by payer, claim type, or any particular denial reason. 

AI brings a comprehensive solution by categorizing each claim denial automatically when it receives them. This way, the staff members can prioritize appeals efficiently, and accelerate the procedure.

3. Streamlining Appeal Processes

AI proposes or generates appeal letters for common denial causes, which saves time on a procedure that is usually difficult.

These recommendations, which offer personalized letters that are ideal for your practice, are based on past data.

4. Ongoing Data Analysis

Artificial Intelligence monitors appeals and claim rejections, gradually spotting trends and areas for improvement.

By gaining knowledge about common denial causes, payer tendencies, and types of denied claims, you may improve procedures, payer interactions, and compliance procedures, which will lower the number of denials in the future.

5. Utilizing AI and Automation Techniques

Claim denial management can benefit from AI and automation integration to collect more entitled revenue.

Simplifying processes and the gathering of data-driven insights free up employees to concentrate on important work, which improves the bottom line and makes the business more sustainable.

Related: 9 Strategies You Should Follow to Improve Revenue Cycle Management

Challenges in Claim Denial Management that Practices Need to be Aware of

Healthcare practices often face many challenges during the denial management process. By efficiently overcoming these challenges with comprehensive solutions, healthcare practices can sustain revenue.

• Following outdated strategies: Denial management consistently changes based on the current trends. For instance, many healthcare practices still use paper-based which is less efficient. This type of manual process doesn’t support decision-making.
• Not Utilizing Automation Solution: Many healthcare practices still rely on manual processes which are time-consuming and prone to errors. Those who deny the automation in denial management compromise the advanced claim reporting and customized decisions.
• Lack of Staff Training: More than implementing any technologies for denial management, conducting staff training is crucial to empower them to experience its full potential.
• Lack of Standardization: One of the biggest challenges facing practices is the lack of standardization and consistency with which health insurers reject claims for patients with insurance plans. Practices find it challenging to prevent denials in the future as a result of their inability to manage denials, unpaid claims, and the reasons behind them.

Tackling all these challenges is crucial for efficient claim denial management.

Revenue Cycle Management Solution from Vozo

At Vozo, we understand your struggle navigating through all the revenue cycle processes such as regulations, medical coding, and reimbursements. 

That’s why we bring the best cutting-edge service to optimize your revenue cycle management from start to finish. Here’s how Vozo can help you transform your practice’s financial performance.

• Automated tools for error-free coding and faster reimbursements
• User-friendly billing to keep patients satisfied and payments flowing
• Robust data security and compliance protocols to protect your practice
• Detailed reporting and analytics for smarter business decisions
• Solutions that grow alongside your evolving needs

With Vozo RCM service, you can reduce the headaches associated with revenue cycle management and focus on what matters the most – quality patient healthcare delivery.

“Partner with Vozo RCM Service and unlock the full potential of your healthcare practice and maximize its revenue”.