The pandemic has caused financial hardship for hospitals and health systems with continuing patient volume volatility, ballooning costs of labor, staffing shortages, and payer complexity. Organizations are trying to respond to shifts in service which involve moving out of the acute space into higher volume, lower reimbursement models.
The Path Forward
Jamie Davis talks about how there is an increasing focus on cost containment, value-based care and pricing transparency which should bring payers and providers into a more symbiotic relationship. He suggests that this could be achieved by consolidating systems, sharing adjudication systems, billing edits, unified datasets on members, pricing transparency and incentivizing outcomes.
There have been successes in unified data sets and integrated delivery/financing systems, such as an integrated care management system from 2005. However, there is still a long way to go until there is frictionless relationship between providers and payers. Fortunately, due to the pandemic, conversations about these issues are becoming more serious and certain initiatives are being implemented, such as joint EOB patient statements, shared billing edits, and pricing transparency.
The Role of Technology in Revenue Cycle Management
Technology is playing a big role in improving revenue cycle management. Chat GPT and OpenAI have passed a medical licensing exam, showing that AI can be used to automate complex workflows to reduce cost to collect and improve efficiency. Existing technologies such as EMRs should be maximized before investing in new ones. Chat GPT can be used as a scribe to prompt for quality indicators and reduce administrative burden on providers.
Chatbot technology can be used to query physicians in real-time and help them document appropriately in order to make more accurate determinations about patient care. This eliminates the need for nurses to review charts and records, reducing administrative burden and making it easier to achieve value-based care.
AI chat technology is not likely to replace CDI specialists, as there will always be a need for humans in patient care. AI technology can help automate some of the more complex work, freeing up time for CDI specialists to focus on cases that require human intervention. InterQual should be used as a guide, but not as a replacement for human judgment.
Note: This is an AI generated transcript, not edited by a staff writer and is solely intended for educational purposes. If you have any questions/concerns, reach out to events@beckershealthcare.com
This panel was live on 04/05/2023 at the event listed here.
If you are interested in event like this, you can visit our Upcoming Conferences.