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Depending on its size, a dental practice or dental service organization (DSO) could have millions of dollars invested into tools, devices, hardware, and software that are connected to each other, the cloud, or other systems. When one is breached, it can put a halt to thousands of dollars of billings per day, not to mention the cost of recovering from a breach. Compliance issues also come into play for any of those devices or software solutions that gather, store, or exchange patient information.

This year our annual predictions will include some topics that look at how AI could help solve the challenges in our healthcare system. We begin with AI in Revenue Cycle Management. When we look at RCM we can identify these areas; patient check-in, insurance verification and pre-authorization, billing and coding, claims, patient payment and collections, to insurance denials.

We asked our experts what we might see in AI innovations for RCM in 2025. Here is what they had to say. And check out all our prediction posts looking to 2025.

Health IT Answers»

HIM continues to evolve, especially as technological advances like artificial intelligence (AI) are rapidly infiltrating health care. As the health care industry experiences this unprecedented transformation, HIM leaders offer their perspectives on the top leadership skills and strategies they consider crucial in the field today.

Like many heavily regulated industries, healthcare has seen limited progress towards the use of artificial intelligence (AI) and automation, despite the enormous potential they hold for improving productivity, accuracy, care access, and the bottom line. Much of that promise comes from use cases that span the revenue cycle management (RCM) continuum, where legacy automation tools are already having a positive impact through activities like patient reminders, insurance verification, coding, and claims status transactions.

Today, generative AI (GenAI) is poised to upend, in a positive way, healthcare’s approach to front- and back-end financial operations. It has the potential to re-imagine the massive volumes of historical and real-time revenue-related data that is flowing through RCM departments and create entirely new approaches to optimize revenue and minimize financial risk.

TAMPA, Fla. – November 15, 2024 – NeuroEM Therapeutics^® was honored last night as one of 30 companies recognized by the Tampa Bay Inno Awards for sparking change in the Tampa Bay community. The clinical-stage biotechnology research company, which is focused on delivering radio wave-based technologies to treat Alzheimer’s and other neurodegenerative diseases without drugs, was honored in the Healthtech category.

Through its awards program, Tampa Bay Inno aims to showcase the startups and entrepreneurs elevating the Tampa Bay region as a leading innovation hub, celebrating those who are working above and beyond to set the ecosystem ablaze.

Wellesley, MA — November 14, 2024 — External audit volume more than doubled in 2024 over 2023—including higher rates of pre-payment audits—and total at-risk dollars increased fivefold to $11.2 million per MDaudit customer, impacting healthcare provider organizations’ cash flow and exposing them to higher potential denial rates. Additionally, improvements in revenues and operating margins throughout 2024 were tempered by higher denial rates, including an increase in coding-related denials of more than 125% and in medical necessity-related denials of 75% for outpatient claims and 140% for inpatient claims. These trends highlight the pressing need to overhaul revenue cycle management (RCM) strategies in the coming year.

Efficient patient access operations are paramount for healthcare provider organizations to thrive in today’s tumultuous financial landscape. Inefficiencies created by outdated, time-consuming, and cost-intensive patient access and financial clearance operations create delays in the patient’s journey from initial contact to care access—which in turn contribute to revenue leakage that chip away at the bottom line and put an organization’s financial stability at greater risk.

Streamlining the patient access process not only eliminates those delays, but it helps ensure patients’ financial security and timely access to necessary medical services. However, many provider organizations are struggling to improve patient access operations, thanks to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.

Health IT Answers»

Niagara Falls, N.Y. – October 24, 2024 – Harris Data Integrity Solutions, the leading provider of best-in-class patient data integrity services and software, announced today the promotion of Rachel Podczervinski, MS, RHIA, to Senior Vice President. In her new role, Podczervinski oversees Harris Data Integrity Solutions’ mission to ensure accurate patient identity management through innovative services and software solutions.

Wellesley, MA — October 22, 2024 — MDaudit, an award-winning cloud-based continuous risk monitoring platform for RCM that enables the nation’s premier healthcare organizations to minimize billing risks and maximize revenues, announced today that its MDaudit billing compliance and revenue integrity platform is a finalist in the 2024 Fierce Healthcare Innovation Awards.

WASHINGTON, D.C. – October 23, 2024 – AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and a strategic growth partner to healthcare providers across the U.S., has received a UiPath AI25 Award for the company’s innovative use of automation and AI to support greater accuracy and efficiency in the intake and management of faxed documents.

Despite efforts to eliminate faxing, use of this cumbersome, inefficient, and costly technology by healthcare organizations remains prolific. Over 9 billion fax pages are exchanged annually at a cost of $125 billion, significantly straining already limited resources.

Revenue integrity has become harder to maintain as audits grow in volume and complexity. Payers are increasing scrutiny and regulatory agencies are reinforcing fraud mitigation. Navigating this evolving terrain requires a reimagined, automated approach to billing compliance, coding, and HIM, optimizing accuracy and efficiency to protect revenue.

We sat down with Dana Finnegan, Director of Market Strategy with MDaudit, to discuss what’s behind the scenes of reimagining revenue integrity and the role automation can play in achieving success.

What's Trending NOW is the intersection of artificial intelligence, automation, analytics, and professional services in medical coding. Host Shahid Shah is joined by with Conrad Coopersmith, General Manager, AGS Health, a company focused on revenue cycle management in healthcare. Conrad shares insights of the use of technology and AI in the coding automation journey.

Healthcare NOW Radio»

Various forms of automation have long been present within healthcare revenue cycle management (RCM). However, advances in artificial intelligence (AI) have brought the industry to a significant inflection point, where the use cases for AI tools are expanding as rapidly as their capabilities.

We sat down with Thomas Thatapudi, chief information officer of AGS Health, to discuss the current and future state of AI in RCM and what healthcare organizations need to know about effectively integrating it into workflows.

WASHINGTON, D.C. – September xx, 2024 – AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and a strategic growth partner to healthcare providers across the U.S., announced today it has been Certified™ by Great Place To Work^® in the U.S. Rankings in the annual program are determined based on surveys of current employees, 85% of whom ranked AGS Health, which was also Certified in India and the Philippines, as a “great place to work.”

Great Place To Work is the global authority on workplace culture, employee experience, and the leadership behaviors proven to deliver market-leading revenue, employee retention and increased innovation. When surveyed as part of the certification process, AGS Health’s U.S.-based employees ranked it 28 percentage points higher than the average U.S. company (57%).