Future of Revenue Cycle Management: Role of AI in Healthcare Billing

By: Joey Graham, Prochant Chief Revenue Officer 

The unfolding future of artificial intelligence (AI), especially generative AI and large language models (LLMs), is no longer confined to science fiction. It's a reality that sectors like healthcare are embracing swiftly due to its transformative capabilities. AI has already brought about unprecedented advancements in disease diagnosis, predictive analytics, personalized medicine, drug discovery, and robotic surgery. 

What are generative AI and large language models (LLMs)? 

Generative AI is a type of artificial intelligence that can create new content, like images, text, charts/graphs, and even software coding. LLMs are a kind of generative AI that can generate human-like text, answering questions or creating stories based on the input they receive. They learn from vast amounts of data to understand and generate language. 

AI tools, such as large language models like ChatGPT, are sparking revolutions across industries, much like the early adoption of the internet in the 1980s. What’s different now versus then is accessibility of these AI tools to the public, for free. The world is currently observing this transformation driven by generative AI and LLMs. For healthcare, an industry often seen as trailing technology due to patient data security and HIPAA compliance concerns, these advancements hold immense promise. 

AI isn't just revolutionizing patient care, but also paving the way for automation of labor-intensive administrative tasks, such as medical billing. This increases efficiency and precision for providers in various healthcare settings, including HME / DME, home infusion, ambulatory infusion centers, specialty pharmacies, home health, and hospice. 

Over the next two years, we anticipate a considerable transformation in the role of AI within billing and revenue cycle management. Companies are poised to employ generative AI and LLMs to produce detailed explanations and procedural steps through AI chatbots similar to ChatGPT. By distinguishing tasks requiring human attention from those suitable for automation, AI enables medical billing professionals to concentrate on complex issues and patient engagement. As the revenue cycle evolves, homecare providers will increasingly rely on AI for effective navigation of billing complexities, resulting in enhanced patient care, streamlined revenue cycles, and a more efficient healthcare system. 

Embracing the Future: Streamlining Your Medical Billing Operations with AI 

The journey towards this transformative shift can start with your procedural documents - your SOPs and user manuals. Training a language model to function as an interactive chatbot can provide real-time solutions to your employees. This AI-powered assistant can offer instant responses based on your company's SOPs and contracts, saving your billing team from manual searches for procedure-specific information. This not only saves time but also boosts accuracy and efficiency, thus enhancing business performance. 

The Future of Jobs in Revenue Cycle Management (RCM) 

AI will reshape roles within RCM, but that doesn't equate to job loss. AI is set to lighten the administrative load, allowing staff to focus on high-value tasks and possibly creating new tech-centric roles. Instead of replacing humans, AI aims to augment human productivity, improve efficiency, and free up staff for more complex operations. 

AI can automate several tasks in revenue cycle management (RCM), such as: 

  • SOP review and interpretation 
  • Insurance eligibility checks 
  • Medical/billing coding process automation 
  • Claims error checks 
  • Identification of common reasons for denials 

As we navigate the future, the landscape of healthcare might seem riddled with "what ifs". Instead of being daunted by these uncertainties, we should be inspired to be proactive. Implementing AI tools in your operations today is not about staying trendy - it's about future-proofing your business. Let's seize this opportunity to harness the power of AI and revolutionize the dynamic future of healthcare. 

Joey Graham is an industry veteran with 20+ years of experience in HME and pharmacy operations and revenue cycle management. In his current role as Chief Revenue Officer for Prochant, he is focused on helping providers meet their financial goals with scalable solutions, years of experience, and advanced technology. 

Joey’s experience includes executive roles at large HME/DME providers and software companies, including Brightree. He has a bachelor’s degree in finance and an MBA from the University of West Florida. Joey started his HME career right out of high school, spending several years as a service technician.