The Problem: A large health system with more than 30 hospitals was targeted in a major cyberattack, which led to a significant claims backlog. The accumulated claims amounted to hundreds of millions of dollars, including high-dollar facility charges.
On November 30th, 2022, the world changed forever. Artificial intelligence (AI) became accessible to the public through a tool called ChatGPT.
Friends, countrymen, lend me your ears. I speak not to disprove of our healthcare system, but here I am to speak what I do know. We all did love the system once, and not without cause.
Automating authorization for care payment to providers reduces the administrative burden on physicians, allowing them to spend more time with their patients for better clinical outcomes.
Healthcare organizations are losing billions of dollars through denied claims. While some claim denials could lead to significant healthcare revenue declines, the Medical Group Management Association (MGMA) found that approximately 65% of claim denials were never corrected and then re-submitted to payers for reimbursement.
Risk Adjustment Factor (RAF) scores are the essential component of the model used by the Centers for Medicare & Medicaid Services (CMS) to predict costs for beneficiaries in various risk adjustment models.
The Gaps in Healthcare Technology: Healthcare technology is revolutionizing how care is delivered, affecting the lives of providers, patients, payers, and everyone else in between, resulting in a significant shift in the industry.
Poorly Defined Workflows Lead To Worse Outcomes: Healthcare is among the top industries that require proper operational workflow management to ensure all activities occur perfectly. In a medical center setting, several activities occur at once and it’s not easy to manage and monitor all variables without appropriate processes in place.
Health systems can thrive only when revenues are collected accurately and economically. But complex payer rules and systems bog down recoveries for patient services. This drives up staffing and software costs meant to improve results.