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AGS Health is using an AI-powered system to streamline revenue cycle management (RCM) processes and increase efficiency. The system allows the company to handle claims more quickly and with greater accuracy which has resulted in less stress on staff, more timely payments, and improved customer satisfaction.
AGS Health calls their AI system, the Intelligent RCM Engine. To learn more about it and the impact it has had internally at the company and for customers, the Healthcare IT Today team sat down with John Anilraj, Senior Vice President of Operations and Ryan Christensen, Executive Director of Product Management.
Key Takeaways
- The automated and AI-enhanced routing of claims allows staff to specialize in handling claims for specific payers which speeds up processing.
- The Intelligent RCM Engine chatbot offers personalized guidance on claim denials and next steps to staff – reducing errors and improving outcomes. The information from the chatbot is specific to the needs of each customer.
- Customers and staff appreciate the power, accuracy and time savings that the Intelligent RCM Engine offers. Customers are very happy that their cashflow accelerated, enabling more accurate views into their current financial metrics and access to more funds for reinvestment.
Claims Workflow Orchestration
According to the company’s website, the Intelligent RCM Engine is “a propriety suite of workflow orchestration tools. It seamlessly integrates artificial intelligence, machine learning, analytics, and digital workers to allocate work, automate tasks, and enhance decision-making.”
“It is all about getting the right claim to the right person at the right time to do the right thing,” explained Christensen. “The system can identify claims that do not even need human interaction and process it automatically.”
The “right person” to handle the claim is often an AGS Health team member who has a deep understanding of and experience with a particular payer. This knowledge means that claims issues and denials can be resolved faster which means cash flows to customers in a timelier manner.
This specialization was not possible without the Intelligent RCM Engine.
Positive Impact for AGS Health and its Customers
Anilraj shared an example of how the Intelligent RCM Engine helped deliver improved service to one of the company’s customers who had been experiencing a significant increase in staffing levels.
“Our customer was having a difficult time managing their claims inventory,” said Anilraj. “To help them, we had to maintain a 70% excess staffing level. We then did a pilot with the Intelligent RCM Engine and showed how it could improve not just efficiency, but quality as well. We have now rolled it out to the entire organization and have reduced excess staffing by more than half, down to just 28%.”
At another customer Intelligent RCM Engine was able to improve the cash position by 25-30%.
Custom Chatbot Allows Staff to Deliver Better Service
A key feature of the Intelligent RCM Engine is its chatbot, which offers personalized assistance to staff based on the specific needs of each customer. AGS Health team members can use the chatbot to get real-time guidance on claim denials and next steps. The bot’s customized responses ensure that staff get the most up-to-date and timely assistance to deal with claims.
“The chatbot might tell the staff member to go to the payer portal to gather more information to process the claim,” shared Christensen. “It may even include the appropriate form you need to use in its reply.”
“Every denial scenario is embedded in the chatbot,” added Anilraj. “Whether it is a coding denial, medical necessity or prior authorization, I can just go and ask the chatbot. It asks me questions to gather more information and leads me to the right action.”
Preventing denials can yield approximately $5 million in annual revenue for a typical hospital. In addition, it is estimated that 85% of claims denials are preventable. Focusing on preventing denials always makes financial sense.
“We did a pilot internally at AGS Health with a group of the bottom performers,” continued Anilraj. “Within a month of using the chatbot, they were performing at the right quality standard.”
AGS Health’s technology has allowed their team to outperform competitors by delivering faster, more accurate results for their customers. Intelligent RCM Engine has reduced the pain of claims processing.
Learn more about AGS Health at https://www.agshealth.com/
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