Transforming HME Revenue Cycle Management with AI and Analytics

The HME industry is characterized by continuous evolution to meet changing demands. Nevertheless, with challenges such as staffing shortages and escalating labor costs, HME providers are continually grappling with how to deliver efficient services while maintaining profitability.

As the nation’s leading HME billing and process outsourcing company, Prochant’s primary objective is to enable providers to meet their financial goals through scalable solutions. Our Chief Revenue Officer, Joey Graham, a self-described “child of the HME industry,” recently outlined the current state of the HME industry in 2023 and shared insights into the future of workflow management for providers.

Among the most common concerns raised by HME providers nationwide are:

  • How can we achieve more with less (staff, reimbursement, time)?
  • How can we ensure our workflow is contemporary and aligns with our business needs?
  • Is it possible to harness advanced technology for superior workflow management?

As Joey emphasizes, "just because we've always done things a certain way, doesn't mean we should continue doing it that way." Providers are now rethinking their workflow systems, and increasingly incorporating AI-driven tools and analytics to automate sections of their revenue cycles.

Integrating AI in Revenue Cycle Management

AI plays a transformative role in revenue cycle management by automating repetitive and mundane tasks. This allows the dedicated outsourced RCM team to focus on higher-value tasks that require human intuition and decision-making. AI and machine learning can efficiently manage tasks such as incoming referrals, intake, eligibility verification, prior authorizations, and documentation review, enhancing the precision and efficiency of these processes.

Moreover, real-time analytics supplied by AI can assist in identifying trends, generating predictive forecasts, and guiding decisions that lead to improved revenue generation and patient satisfaction.

The adoption of AI tools does not render human expertise and experience obsolete. Instead, it complements and augments human capabilities, allowing our team to concentrate on tasks that require a human touch, such as patient communication, issue resolution, and strategic planning.

Prochant-HME-Revenue Cycle Wheel-HME

The HME Revenue Cycle Visualized

The front office is everything that happens prior to the product or service being provided to the patient. This includes incoming referrals, intake, eligibility verification, prior authorizations, and documentation review.

The back office is everything that happens after the product/service is provided to the patient, from order confirmation to claim resolution & closure. Back office includes order confirmation (billing review), hold management, front end rejections, cash posting, denials, and A/R management. 

Here is a visual representation of the HME revenue cycle, starting with an incoming referral and progressing through the cycle. AI now plays a pivotal role in numerous stages of this cycle, ensuring efficient workflow management.

AI-driven workflow management ensures that every incoming referral is accurately tracked, and every order filled is billed and collected effectively and efficiently.

Looking for HME billing solutions now? Reach out to Joey directly at (980) 999-4293 or book a demo here to see how Prochant can help add automation to your revenue cycle.

Prochant is the only AI-driven reimbursement service provider in the home-based care industry. We deliver focused revenue cycle management (RCM) solutions to healthcare providers with 7 wholly-owned global delivery centers. Our expertise lies in providing end-to-end RCM for home-based care, infusion, and specialty pharmacies, consistently delivering exceptional results to some of the leading healthcare providers in the country. We harness specialized automation technology and deep industry knowledge to streamline the time-consuming and expensive reimbursement process. As a result, we help healthcare providers accelerate their collections, increase revenue, and reduce operational costs while managing risk. Prochant is HITRUST certified, the gold standard for HIPAA security.