Among the changes the COVID-19 pandemic has brought to healthcare, one of the most concerning is an increase in claims management difficulties.
According to Experian Health’s 2024 State of Claims survey, 77% of healthcare finance and operations decision-makers say payer policy changes occur more frequently, and 73% say claim denials are increasing (up more than 10 and 30 percentage points, respectively, since 2022). Claim errors and reimbursement times are also growing. While multiple factors are at play, the survey found that two of the biggest are a lack of automation and insufficient data analytics.
In the complex landscape of U.S. healthcare, revenue cycle management solutions help providers navigate these and other challenges to optimize financial operations. The industry is evolving quickly and poised for significant disruption as RCM companies adopt artificial intelligence, robotic process automation and adaptive learning, says Landon Tooke, COO and chief compliance officer of Impact Healthcare Solutions.
“Instead of being reactive in your decision-making, you can shift to becoming proactive,” Tooke says. “For a healthcare organization operating in a highly regulated and complex payment environment, that can be incredibly empowering and strategically advantageous.”
Yet Tooke, who is also a healthcare attorney and past president of the Healthcare Business Management Association, cautions that due diligence is crucial in the race to leverage AI. For example, he says, providers need to know that RCM partners have appropriate standards and controls to ensure that their solutions protect patient data and comply with regulations.
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