Use AI to appeal denials three times faster – and regain lost revenue
EmpowerMe, a healthcare provider that provides services to more than 1,000 senior living communities in 38 states, regularly receives denials from its insurance company about procedures or treatments they are supposed to cover.
That means staff members have to go through a lengthy process to appeal these denials to get money the health care organization should receive.
THE PROBLEM
This was incredibly time-consuming and required board-certified physicians to spend hours understanding each individual case to prepare and submit the appropriate appeals. As the sector faced a labor shortage, the problem was even more challenging.
PROPOSAL
The proposal from Crosby Health, provider of an artificial intelligence-powered technology called Apollo, was to do most of the work of drafting appeal letters for EmpowerMe.
“Apollo analyzed each case and drafted the appeals, and all our physicians had to do was review them instead of starting from scratch,” said Dr. Jody Mitchell, chief medical officer at EmpowerMe. “Using AI, EmpowerMe would be able to target all of our calls, instead of having to prioritize our bandwidth for the most important ones.
“This would mean that more appeals would be filed and that our doctors would not be overwhelmed by the workload,” he continued. “It also meant that we could apply the AI technology more upstream after we had completed the appeals processes.”
For example, the staff used to have regional directors who were trained physicians who manually performed audits of the compliance cards. With the AI, EmpowerMe could first tackle denial management, understand the back-end processes, and then use the same technology to solve the problems on the front-end.
MEETING THE CHALLENGE
The service provider needed something that could reflect what its practitioners did day in and day out. A meeting was held with the seller and we hit it off immediately, Mitchell recalled.
“For EmpowerMe, adopting this technology was a no-brainer; it can leverage the same knowledge base as our physicians and processes denials faster,” he explains.
“On the case management side, the vendor has worked very closely with our leadership and professional team physicians to ensure our integrations run smoothly. We are now working with two of our EHRs – first with Clinicient and now with NetHealth.
“We started to understand the technology and mapped out all the different use cases, from chart audit to clinical calls,” he continued.
“We have decided to start with appeals, but we don’t stop there. With their integrations into our EHR, there are numerous applications that will have a meaningful impact on our business and automate administrative workflows that would otherwise take up clinical resources.
The supplier worked with the provider’s professional team for months, doing everything they could to apply the technology to the right areas. It continues to gather feedback from the provider’s team moving forward.
RESULTS
The technology completely revamped EmpowerMe and saved the organization time and team bandwidth, Mitchell reported.
“It helps build our physicians’ confidence in the use of AI in healthcare,” he noted. “Using Apollo has improved the efficiency of our appeals team and streamlined our revenue cycle management tasks at lightning speed.
“Using AI allows our physicians to do what they do best: be physicians and manage patient outcomes,” he added. “Specifically, we can now write calls at three times the speed, allowing our team to focus on higher-leverage tasks.”
ADVICE FOR OTHERS
It’s fair to be so wary of AI in healthcare, but using proven technology to perform easily automatable tasks is a no-brainer, Mitchell advised.
“We are not using AI for anything that affects the patient,” he noted. “We use it internally to save our team time and effort so they can do what they were trained to do and what they love: taking care of people and not paperwork,” he said. “We were able to find an easy-to-use model that our physicians learned quickly, and it helped them do a tedious part of their work three times faster, while regaining lost revenue for our business.
“By choosing solutions with intuitive interfaces that can be quickly integrated into existing workflows, the success of the AI implementation will largely depend on your team’s willingness to embrace and use the technology,” he continued. “Providing adequate training and support will facilitate a smooth transition and ensure physicians can effectively use the tool to improve their productivity.”
Above all, it is imperative to continuously monitor and evaluate the impact of the technology on both operational efficiency and patient care, he emphasized.
“Healthcare organizations should seek feedback from physicians and all staff to identify areas for improvement and optimization,” he concluded. “By fostering a culture of innovation and continuous improvement, healthcare systems can leverage the power of AI to streamline processes, improve quality of care and improve patient outcomes.”
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