How Artificial Intelligence Powers Healthcare Denials Management and Revenue Integrity

Jan 27, 2022 10:03:32 AM / by Aspirion

Whether we notice it or not, organizations of every kind utilize artificial intelligence (AI) in their everyday processes. AI is artificial intelligence presented by a machine powered by algorithms built from statistical, machine learning, and deep learning techniques to replicate human intelligence. AI uses data to identify patterns that allow our systems to make decisions without intensive human intervention.

AI is not just a buzzword, it’s a powerful driver of business operations and part of every city’s infrastructure. AI can streamline business processes, complete tasks faster, eliminate human error, and much more. It is used in different domains — from autonomous driving to logistics, e-commerce as well as healthcare.

AI is applied across the healthcare continuum. On the clinical side of healthcare services, AI is used to better diagnose and treat patients including virtual biopsy to physiotherapy using virtual reality. Additionally, AI innovations are advancing administrative efficiencies for hospitals, health systems, and provider groups of all sizes. AI-powered Robotic Process Automation (RPA) is utilized for scheduling, billing, revenue recovery and even to help address today’s staffing challenges resulting from the COVID-19 pandemic.

How Aspirion Harnesses AI for Revenue Cycle Management

At Aspirion, our primary focus is to improve and accelerate healthcare revenue recovery for our provider partners. Our advanced AI technology allows us to streamline our most complex tasks to maximize revenue collection.

However, building AI models is not a simple task. AI is not magic; it requires a vast amount of historical data to teach and train a model. Aspirion’s nationwide presence yields the comprehensive database necessary for the development of AI models that make a positive impact on healthcare revenue cycle management.

We leverage various technologies including the right architecture for every model we build. Additionally, we believe engaging with our clients from the very beginning during model development and validating the results is key in accurately defining the project scope, usage, and eliminating rework.


Healthcare Revenue Recovery Powered by AI

With the increase in claims denials in healthcare, where the volume of denied claims is greater than ever before, AI’s speed and accuracy are even more critical. Our advanced AI technology allows us to process claims more rapidly and accurately by dramatically reducing manual tasks, allowing our team to concentrate on more complex, time-sensitive aspects of claims processing. Our operational and staffing structure reflects this. AI-powered RPA bots enable us to scale exponentially, enabling us to utilize our resources per demand. Our teams of experts handle specific niches within the revenue cycle management space, enabling us to concentrate on the “hard stuff.”

We develop AI-powered RPA bots that replicate the work of claim specialists to improve efficiency and minimize human error. For example, we utilize bots to check claims status. The bots flag denials and immediately notify our claim specialists who then work on resubmission and reconsiderations.

While few learning models can predict payer decision-making, our models allow us to better forecast—at the macro level—reimbursement rates for our provider clients using historical claims databases. With AI, our RPA bots can predict claims status as well as power intelligent decisions such as prioritizing claims to generate more revenue. The models can answer questions such as, “Will a particular claim get paid or denied?” and “What is the expected payment and duration of claim payments?”

Document extraction is another area of focus. AI is progressing optical character recognition (OCR) tools that process text images and convert the text into machine-readable forms. Aspirion uses OCR to extract key medical information from patient care documents including electronic health records (EHR), uniform medical billing form (UB04), and invoices to create a historical database. We utilize the data to create and refine our claims processing models.

Our AI models also power our client BI platform, Aspirion Intelligence. Our Aspirion Intelligence BI platform provides 24-7 healthcare revenue integrity and forecasting to our client partners, empowering them with a deeper understanding of the forces shaping their complex revenue cycle management (RCM) performance.


Our Vision

AI continues to revolutionize workflow processes and we’re taking advantage of its power to shape our provider partners’ future by using predictive models to better forecast claims processing trends and overall collections. Aspirion recognizes research and innovation are the keys to robust AI performance.

Want to learn more?

Contact us here to continue the conversation.

Tags: Patient Experience, Reimbursement, Veterans Affairs, Denial Management, Complex Claims, VA Claims, Workers' Compensation, Third-Party Liability, Revenue Cycle Management, Artificial Intelligence


Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, health systems, and large physician groups looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.