Oracle Health and Life Sciences Summit Oracle Health announced new AI capabilities across its Revenue Cycle Management portfolio. The company plans to release these capabilities in the coming months. The new tools aim to help US healthcare organizations address reimbursement problems earlier.
Revenue Cycle Management teams often spend a lot of time cleaning up after the fact. These could be denials, missing information and authorization issues. They can also include erroneous charges and late payments. So Oracle Health is introducing AI into the earlier stages of the revenue cycle.
The approach involves scheduling, financial clearance and clinical documentation. It also includes charge capture, billing and payment processes. These capabilities can help identify risks before they impact reimbursement. They can also automate routine activities in revenue cycle workflows. Oracle Health also wants to link clinical, financial, payer and operational information. This connection can help organizations to solve issues before it creates payment delays. It can also help mitigate lost revenue risk.
“AI gives us an opportunity to prevent revenue cycle problems before they lead to denials and delayed payments,” said Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences. “Oracle Health is delivering a comprehensive revenue cycle solution that brings AI across the front, middle, and back office, connecting clinical and financial workflows from the first patient interaction through payment. This can help healthcare organizations reduce administrative work and revenue leakage, get paid faster, and strengthen their financial stability so they can stay focused on delivering excellent patient care.”
AI Connects Healthcare Revenue Workflows
Clinical, financial, payer, provider, and operational activities all affect reimbursement. They also influence overall financial performance. However, many healthcare organizations still rely on fragmented systems. They also manage several processes through manual workflows. As a result, these challenges can create inefficiencies and reimbursement delays. They can also increase administrative workloads for healthcare teams. Oracle Health Revenue Cycle Management solutions address these disconnected processes.
The solutions connect workflows across several important areas. These include patient access and clinical documentation. They also cover patient accounting and contract intelligence. Furthermore, the portfolio supports payment operations and enterprise analytics. Oracle Health also connects these functions with financial management capabilities. This approach can give organizations a more connected view of revenue cycle activities.
Meanwhile, organizations can use native AI within their existing Oracle Health solutions. This allows healthcare organizations to modernize their operations at their own pace. The company has planned several embedded AI capabilities. These capabilities target important areas across the healthcare revenue cycle.
New AI Capabilities for Revenue Cycle Management
Prior approval: The AI capability examines coverage and gets the necessary documents. It also has the ability to put the necessary details and add supporting documents. At the same time, it coordinates authorization processes and helps with the payer interaction process. These functions are able to minimize delays and denials associated with authorization.
Clinical document quality integrity: The capability analyzes relevant reimbursement documentation. It detects any missing parts in clinical documents and provides contextual suggestions. So, healthcare companies can make sure they improve their documentation and coding quality.
Charge capture and quality: The capability looks at clinical and reimbursement aspects. It also looks through modifiers and service information in charge processing workflows. As a result, organizations can decrease their losses and denials.
Medical coding with professional fees: The AI looks at clinical documentation and patient context. It then shows the recommended coding within existing workflows. This process allows for making claims ready for reimbursement.
Appeal Management: The capability looks through the incoming remittances and identifies any payment discrepancies. When an organization makes a decision about an appeal, it helps in automatic generation of the appeal package.
Connecting Reimbursement with Financial Operations
Oracle Health also outlined its planned product direction for Revenue Cycle Management. The company intends to connect reimbursement workflows with broader enterprise financial operations. These operations include financial reconciliation and revenue accounting. They also cover treasury management and analytics. Oracle Health plans to support these connections through solutions such as Oracle Fusion Cloud Applications.
This approach can help health systems link reimbursement activity to financial operations. It can also bring enterprise analytics into the same operational view. Furthermore, linked financial information can facilitate more informed decisions. These capabilities allow healthcare organizations to have a combined view of operational and financial activities.
The improved Revenue Cycle Management capabilities also reflect a wider use of AI in healthcare. Oracle Health wants to solve revenue cycle problems earlier with AI embedded in current workflows. The range of the process goes from the first patient contact to the final payment. This allows healthcare organizations to link clinical and financial workflows across the revenue cycle.
Oracle Health is also extending AI capabilities across its entire Revenue Cycle Management portfolio. Planned tools include authorization, documentation, coding, charge capture and appeals tools. They also support links to wider financial activities. Oracle Health intends to leverage these capabilities to aid healthcare organizations in streamlining revenue cycle workflows. The company also aims to help organizations address reimbursement challenges and enhance their financial processes.
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News Source: PRNewswire.com
