During an interactive session at Becker's 30th Annual meeting: The Business & Operations of ASCs, Dan Parsons, Co-Founder and Chief Experience Officer at Thoughtful AI, and Kathrynne Johns, Chief Financial Officer at Allegiance Mobile Health, discussed the implementation and benefits of AI in revenue cycle management.
The session covered current challenges in healthcare RCM, such as increased claim volumes, continually evolving player complexities, and high attrition rates among RCM teams. The speakers outlined the benefits of leveraging agentic AI agents to alleviate these pains, by streamlining various tasks like eligibility verification, prior authorizations, claims processing and payment posting. They also addressed common barriers to AI implementation, such as high costs and integration complexities, and emphasized the importance of leveraging existing systems and data to identify opportunities for AI deployment.
3 Takeaways:
1. AI can help address RCM staffing challenges.
Staff turnover is a significant challenge for healthcare RCM teams, making it difficult for ASCs to keep up with increasing claim volumes and complexity. Johns explained how she avoided adding more headcount by using AI Agents to automate key RCM processes at Allegiance Mobile Health, the largest private provider of medical transportation and 911 emergency services in Texas.
"I challenged my RCM director - I said, “I'm not giving you any more people this year, I'm giving you agents. So, let's talk about how we're going to grow with the agents versus people,” Johns said. "We added nine 911 contracts this year. We added 42 trucks and almost 5,000 transports per month this year with no extra headcount in RCM."
2. AI-powered agents can significantly improve key RCM metrics like first-pass claims acceptance and cash collections.
By automating tasks like eligibility verification, prior authorizations, claims scrubbing, and payment posting, Johns' team drove rapid improvements in key RCM performance metrics like first-month collection rates, which went from single digits to over 20%.
“Before Thoughtful AI, we were in single digits. We're up over 20% now and we've got our 60-day collection rate to over 75% and our 90-day rate up over 85% just with these two agents."
3. Iterative implementation and alignment on outcomes are key to successful AI adoption in RCM.
A successful RCM transformation starts with a clear strategy and alignment on goals. As the Co-Founder for a company that transforms RCM departments for mid-sized and enterprise healthcare organizations with automation, Parsons emphasized the importance of a phased, iterative approach to implementing agentic AI Agents, starting with the highest-impact use cases first. He also highlighted the need for providers and tech partners to align on specific performance metrics and outcomes that will be used to measure success.
“Our customers’ success is our success. We want to be a partner in transforming RCM teams, and to support this we even put outcome guarantees in our contracts.” Parsons said, “So, we'll say, 'hey, if your goal is to reduce this team size, we believe we can get you to that. Or your goal is to improve your denial rates. We have conviction, we can get you to that. We don’t win unless our customers win.”