The rise of ChatGPT has many industries debating what tasks should or shouldn’t utilize the popular AI chatbot. With its language-based model used to simulate surprisingly human-like conversations at times, in some instances, is it better to trust artificial intelligence over human expertise? What does this mean for the healthcare industry?
As the leading technology-driven healthcare reimbursement firm, Prochant keeps up with technology trends and learns what benefits they can provide healthcare businesses. On The Modern Healthcare Back Office podcast, hosts Chuck Ellis and Rachel Schools wanted to test who knew more: Prochant’s infusion pharmacy revenue cycle management (RCM) expert Tina Ratliff or ChatGPT.
Tina Ratliff has more than 25 years of infusion pharmacy back-office experience. Her expertise in the industry allows her to help infusion providers improve their KPIs, staffing issues, and more. Will ChatGPT be able to approach RCM issues better?
Our podcast hosts asked the AI chatbot a series of questions to see if it or Tina knew more about infusion pharmacy. Find out the results below of Prochant’s version of AI vs. human.
Request: Describe the revenue cycle for an infusion pharmacy business.
ChatGPT: The revenue cycle for an infusion pharmacy business involves several key steps that ensure the efficient delivery of infusion therapy services and the collection of payments for those services. The infusion pharmacy business provides specialty medications and services for patients who require intravenous IV therapies, subcutaneous injections, and other infusible treatments often in their homes or in outpatient infusion centers.
Chuck: How are we doing so far, Tina?
Tina: Yep, so far, that is infusion pharmacy!
Next, ChatGPT broke down the revenue cycle for infusion pharmacies step by step.
ChatGPT: 1) Patient referral and intake: The revenue cycle starts when a healthcare provider refers a patient to the infusion pharmacy for specialized infusion therapy services. During the intake process, the infusion pharmacy collects the patient's demographic information, insurance details, and medical history.
Chuck: How do we feel about that?
Tina: That’s right. There’s a piece it left out, but maybe that’s in number two.
Chuck: What do you think they left out?
Tina: They need to actually verify the benefit.
Chuck: Oh my gosh. You're not going to believe what number two is…
Tina: [laughs] Verify benefit!
ChatGPT: 2) Insurance verification and authorization: The infusion pharmacy verifies the patient's insurance coverage for the prescribed therapy, ensuring the necessary authorizations and pre-approvals are obtained from the insurance company. This step is crucial in confirming the reimbursement rates and patient eligibility for the services.
Rachel: I can confirm that that is the same step for every other healthcare service.
Chuck: Okay, so, Tina, do you concur with the robot?
Tina: The robot is correct!
Chuck: What do you think the next is?
Tina: Well, that would be like the clinical piece, the dispensing.
ChatGPT then went on to state number three as “treatment planning and drug preparation,” followed by “delivery and administration of therapy” for number four.
Chuck: What do we think number five is?
Tina: I hope it's that they will contact the patient and let them know that they did receive this order, and that they are going to be making a delivery.
Rachel: Yeah, it skipped a step.
Tina: There should be some form of patient contact at this point to set up the delivery of the medication, or yes, like Rachel said, even before that.
Chuck: Okay, it looks like things are a little out of order here, because then it does go to number five—
Tina: [rejoicing for humans] Yay, one for humans!
ChatGPT: 5) Billing and reimbursement: Once the therapy has been administered, the infusion pharmacy generates a claim, which the appropriate billing codes for the services provided. The claim is submitted to the patient's insurance company for reimbursement. The reimbursement amount depends on the contracted rates, deductible copay, and coinsurance amount.
Chuck: We're already diverging, so that's interesting.
Rachel: It’s not diverging, it just missed a step.
Tina: Medication is sitting on their porch that they don't know they're receiving.
Rachel: We missed a human step!
ChatGPT: 6) Patient financial responsibility patient financial: After the insurance company processes the claim, the patient may be responsible for any outstanding balance, such as deductibles, copays, or coinsurance amounts. The infusion pharmacy will send a statement to the patient with the details of the amount due.
Tina: They didn't post any payment.
Chuck: Ah, interesting, so it is leaving steps out.
Tina: Two for humans!
ChatGPT: 7) Collection and account follow up: Infusion pharmacy follows up any unpaid balances working with the patient to set up payment plans or apply for financial assistance programs if needed. The pharmacy also tracks and resolves any denied or underpaid claims by working with the insurance company to provide additional documentation or correct any errors.
Chuck: That's where [Prochant] really comes in and starts to shine.
Tina: Yeah, but I would have signed up for those copay assistance plans in the very beginning, because they can take a little bit of time to coordinate and get paperwork.
Chuck: And I know that it's leaving some more stuff out, because the final step is reporting and analysis.
ChatGPT: 8) Reporting and analysis: The infusion pharmacy regularly analyzes its revenue cycle program by tracking key performance indicators (KPIs), such as days and accounts receivable, claim denial rates, and collection rates. This data helps the pharmacy identify areas for improvement and optimizes its revenue cycle process to maximize reimbursement and maintain a healthy cash flow.
Chuck: That's kind of right, but it's just kind of throwing a bunch of stuff out in one bucket at the end.
Rachel: This is where ChatGPT gets really creepy, because I would take that and then I would take it a step further and say, “I'm the revenue cycle expert, and this is the order, and the steps, and it would go deeper.”
Request: Explain cash to net revenue.
Chuck: Think of a KPI that we could throw at it that might stump ChatGPT.
Tina: Cash to net revenue?
ChatGPT: Cash to net revenue, also known as cash collection rate, is a key performance indicator (KPI) of the revenue cycle management for an infusion pharmacy business. This metric helps the infusion pharmacy business understand how well it is converting its accounts receivable to cash and identify areas for improvement to its revenue cycle business.
ChatGPT went on to correctly state how to calculate this KPI.
Rachel: For grins and giggles, let's do one more thing to it. Say, “Great, now explain it like I'm eight.”
ChatGPT went on to give our podcast hosts and Tina an example about a lemonade stand that was amazingly accurate. The team asked another question to ChatGPT that providers may find most helpful.
Request: What advice would you give to an infusion pharmacy business to optimize their RCM?
ChatGPT: Step 1) To optimize the revenue cycle management (RCM) of an infusion pharmacy business, consider the following: Streamline patient intake and insurance verification. Ensure that your team is efficient in collecting accurate patient information, verifying insurance coverage, and obtaining necessary authorizations from insurance companies. This helps prevent delays and claim denials due to inaccurate or missing information.
Chuck: What do we think of that?
ChatGPT: Step 2) Establish clear billing and coding processes. Train your billing staff in correct coding practices to minimize errors and ensure accurate claim submissions regularly. Update the team on changes in billing codes, regulations, and reimbursement policies to stay compliant and reduce the risk of claim denials.
Chuck: I actually recall Tina saying something very similar to that in a webinar we did.
Tina: Yeah, you know what's funny is these sound like the bullet points from my webinar.
Chuck: It might actually be stealing from our webinar, I don't know. Robot Tina.
ChatGPT: Step 3) Use technology to automate and optimize processes. Implement an efficient RCM software or an electronic health record (EHR) system to automate tasks, such as insurance verification claims submission and payment processing. These systems help reduce errors, save time, and provide real time updates and the status of claims and payments.
Tina: I think we had a whole webinar or podcast on that.
ChatGPT: Step 4) Monitor key performance indicators (KPIs), regularly track and analyze KPIs, such as cash to net revenue, accounts receivable, denial rates, and collection rates. This data helps identify areas for improvement and informs decision making to optimize your RCM process.
Tina: One of the things that it kind of left out was what I would see when I would go do consulting. I would see a lot of understaffing in collections. It seems like that's the place where offices are often understaffed. That was another thing we talked about in our webinar about making sure you're properly staffed.
Chuck: Yeah, which leads us to number five!
Tina: Oh, I thought it was done!
Chuck: Nope, there's 10!
ChatGPT (condensed version): 5) Improve communication and collaboration between your pharmacy team and insurance companies. 6) Follow up on outstanding claims and accounts receivable. 7) Offer financial assistance and payment options. 8) Invest in staff training and education. 9) conduct regular audits and reviews periodically. 10) Seek expert advice and support. If needed, consider consulting with our RCM experts or outsourcing some of your revenue cycle functions to specialized companies. They can help you optimize your processes, navigate complexion regulations, and maximize revenue connections.
Chuck: Thank you, ChatGPT!
The podcast hosts and Tina went on to ask ChatGPT a little more about how to help infusion pharmacies. That conversation and more can be found in the full episode below.
How helpful is ChatGPT for your infusion pharmacy business? To put it in the AI chatbot’s own words, “ChatGPT can be a valuable tool for generating new ideas, solutions, and strategies to address challenges and opportunities in the infusion pharmacy business. While ChatGPT can provide valuable assistance in many areas, it's important to remember this is an AI language model and not a substitute for professional advice or expertise.” Well said!
In the meantime, Prochant’s experts remain the best source of information for all things infusion pharmacy reimbursement related. If you have questions about your infusion reimbursement processes or general revenue cycle inquiries, please email Tina Ratliff at firstname.lastname@example.org. To learn more about Prochant’s pharmacy reimbursement solutions, visit here.
Prochant has a proven track record of helping HME and pharmacy providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national pharmacy and HME providers and health systems.