In the complex healthcare reimbursement environment, patient access defines the foundation that is created through prior authorizations, insurance verification, and patient responsibility options that ensure a smooth compensation workflow. Verifiably, there has been an exponential increase in productivity and efficiency in patient access as Artificial Intelligence (AI) and machine learning are being successfully deployed in the healthcare payment lifecycle.

AI and patient access go hand in hand by expediting repetitive administrative tasks and accomplishing them in real-time using state-of-the-art automation. This technology is bringing speed and efficiency to the scheduling process, thereby reducing delays in care created by laborious insurance payer requirements.

AI Improves Patient Access

Without a doubt, AI is improving all areas of healthcare with outcomes, that before now, had seemed impossible. Hospital facilities and healthcare providers have been in a passive role, absorbing the ever-increasing insurance payer provisions and stipulations. With a fully automated AI-enhanced solution using machine learning and supported by credentialed specialists, they are now in the driver’s seat managing the data flow efficiently in real-time.

In terms of the patient experience, initiating care and scheduling treatment can now be done more smoothly and delays can be significantly reduced. As a bonus, immediate access to analytics and logistical improvement data can drive operational changes, further enhancing patient care.

AI and Prior Authorizations

Currently, a provider averages 31 prior authorizations per week, taking nearly two business days of administrative time to process and complete. With follow up and resubmissions, patient care can be delayed anywhere from three days to two+ weeks, leading a full 35% of those patients to abandon care completely.

A prior authorization solution that leverages AI, machine learning, and predictive analytics streamlines and automates the entire process while continuing to learn and adapt as insurance requirements change over time. With today’s software able to integrate with most EHR systems, necessity determinations can be made immediately, and prior authorization requests can be submitted to the various insurance payers and tracked via a proprietary web portal.

Automated Insurance Verifications

Verifying a patient’s insurance benefits, out-of-pocket maximums, and remaining deductible and co-insurance amounts is one of the most important ways to effectively capture the reimbursement due for services provided. By automating the insurance verification process with interfacing software, you can create the expectation with the patient of how their care and financial responsibilities will progress through their treatment.

Having this information verified ahead of a scheduled appointment and communicating that to patients gives them a chance to ask questions and clarify any misunderstandings they may have about their coverage. Patients often don’t understand how their insurance benefits work and look to their care providers to educate them, which creates an outstanding opportunity for you to enhance the patient experience.

Automated Patient Pay Estimates

Patients are absorbing more of the financial responsibility for their care, and hospitals and healthcare providers need to be proactive in educating them on their increasing financial role. It has never been more important to set the expectation that patient portions are due before the service is provided. An effective way to enhance the process is with real-time patient pay estimates delivered before any scheduled care which, 90% of patients will willingly pay, especially when given online payment options.

Using an AI-enhanced technology to carry this one step further, it’s possible to gauge a patient’s propensity to pay and to tailor your practice’s up-front collections process based on that information. Additionally, offering credit solutions for patients that may rate as questionable, ensures you receiving compensation before care is delivered and limits any unwelcome surprises for the patient in the end.

Healthcare is the only industry where a third-party payer dictates contractual terms and the requirements to manage them. By leveraging an AI-assisted patient access workflow, your organization can ensure timely collections for maximum reimbursement from insurance payers and patients alike directly impacting your bottom-line revenue.

Schedule a demo today and let us show you how our patient access solutions will improve your patients’ experience and your bottom line.