Becker's Hospital Review

SPOTLIGHT ON CLINICALLY AWARE AI: Automating clinical validation with Natural Language Processing (NLP) and machine learning Clinical validation, the reverse of traditional CDI, looks for gaps in evidence, instead of gaps in the documentation. NLP assists CDI professionals with the challenging task of clinical review by applying artificial intelligence to access reasoning guided by clinical expertise and regulatory/ payer policies. The results can either affirm or reject the coded condition by presenting appropriate corroborating or contradictory evidence. While we can probably agree that innovation is the key to turning revenue cycle management into a growth opportunity, it's hard to know where to spend precious resources in order to get the best possible return on your investment. Artificial Intelligence (AI) is a popular buzz word, but what does it really mean in today's revenue cycle? Consumerism is also trending from a patient satisfaction perspective, but without solid direction when it comes to impacting revenue growth. And what about payer/provider alignment to reduce denials? How does innovation play into the equation and who is leading the pack when it comes to partnering on innovation strategies that can immediately affect your bottom line? Let's explore three innovation strategies that you can implement today. Automate processes with clinically aware AI Artificial intelligence (AI) is the big-ticket item that everyone is talking about. It's been around for quite a while, but how you use it could make or break your innovation strategy. Clinically aware AI, leveraged at the point of care, can dramatically impact accurate and timely documentation and coding by automatically reviewing high volumes of clinical data to flag key facts, assign codes and identify potential gaps in documentation and quality events. Another example of innovatively positioning AI is in the area of patient admission decisions. AI can help automate the thorough evaluation of all cases (not just a percentage) for possible physician review and, in instances of second level review, volumes of regulatory, clinical and case review data are scoured and flagged to support appropriate admission decisions. By applying an AI-centric strategy, organizations can move toward an exception-based work environment in which employees only take on tasks automation cannot. This strategy eliminates high-volume administrative and repetitive tasks, allowing your most skilled employees to be strategically reassigned to more impactful duties. Enhance patient interactions with financial transparency Patients have a heightened sensitivity to the prevalence of high-deductible plans and out-of- pocket costs; and providers are aiming to attract, acquire and retain the loyalty of patients by providing a seamless financial experience. Building the right patient financial experience is not a one-size-fits-all formula. Providers are looking to deliver a best-in-class financial journey that empowers all parties from the point of recognizing the need for care through final payment. A strategy that employs state-of-the-art service innovations such as a professionally staffed patient engagement call center will help retain and attract new patients by streamlining authorization processes, offering self-service scheduling tools and providing cost of care estimates, financial counseling and convenient methods for payment. Today's health care consumers expect the same level of service from their medical provider that they experience in other industries. This rise in consumerism extends to the revenue cycle — with consumer-directed health care plans shifting much of the financial responsibility to the patient. By ensuring that encounters are documented and coded correctly the first time, NLP can improve the accuracy of patient financial data, which leads to timely, accurate billing. The result? Greater patient satisfaction. Reduce denials on edits, rules and information gaps by aligning payers and providers Provider-payer relationships are particularly complicated, with the average health care organization dealing with multiple public and private insurance relationships. Each has their own contracting guidelines, reimbursement outcomes and data sharing workflows that create standardization challenges and administrative burdens. Alignment happens and outcomes improve when a strategic partner delivers innovative ways of helping providers identify errors or information gaps that cause denials and then provides clear and actionable guidance on how to fix those errors prior to claim processing. This type of approach allows providers to submit complete and accurate claims, removing costly, unnecessary rounds of back and forth between the payer and provider. These strategies can be implemented in full or in part, depending on the unique needs of each organization, and are most successful when utilizing a flexible deployment model. While it's not realistic to expect every hospital, provider or health system to develop innovations from scratch, it is possible to form a strategic partnership with an organization that continually invests and reinvests in order to stay at the forefront of health care technology and services. Three key revenue cycle innovation strategies you can implement today. Optum360 ® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. © 2019 Optum, Inc. All rights reserved. WF1305269 06/19

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