Becker's Hospital Review

30 RCM LEADER 'It's no longer a theory. It's here': Tampa General's revenue cycle chief on the age of AI agents By Madeline Scheetz F or Paul Chausse Jr., senior vice president of revenue cycle and chief revenue cycle officer at Tampa (Fla.) General Hospital, the shi to agentic AI is no longer on the horizon, it's arrived and is reshaping how health systems operate. "It's no longer a theory, it's here," he said during a Becker's "CFO and Revenue Cycle Podcast" episode. "AI powered bots are now handling functions that previously were dedicated to a lot of [full time equivalents] in the revenue cycle and elsewhere in healthcare and the country. e workflow is being restructured, not just optimized." Tampa General is staying on top of the AI game by deploying agents across areas like billing and claims follow up, denial management, appeal letter writing and release of information. e hospital is working across three tools, making decisions based on the specific problem at hand. e tools are Palantir, Epic and Anthropic within Cowork. Regarding what separates meaningful AI deployment from hype, Mr. Chausse was direct. "You're not just doing ChatGPT and saying, 'Hey, do this.' It's actually, here's the problem I'm trying to solve, the outcome should look like this, and it goes out and solves the problem." Tampa General has approximately 15,000 employees and providers. Mr. Chausse stressed that workforce displacement is not the goal when implementing new technology tools. "We're not automating people out," he said. "We're automating the repetitive [tasks] so people can be more focused on the complex. at's the real key here, getting folks to understand that there is something better at the end of the tunnel." With 35 years of healthcare experience under his belt, Mr. Chausse urged the next generation of RCM leaders to balance formal education, operational patience and technical fluency. "Be patient, go through the learning curve, lead people you're managing and understand what they're doing," he said. "e leaders who will win are the ones that combine technical [expertise] along with good leadership and AI-forward thinking." n A third player enters the AI arms race By Mackenzie Bean A new class of contenders is entering the AI arms race between payers and health systems. Several AI startups are now using large language models to fight insurance denials on behalf of patients with early results that are turning heads. Claimable — founded by British physician and entrepreneur Warris Bokhari, MD, in 2023 — uses an AI model trained on insurance law, medical literature and legal precedents to generate and file appeal letters on behalf of patients. For $50, users submit their case details on the company's website. Claimable sends the resulting letter to the insurer's appeals department and, in some cases, to executives, politicians and journalists to add pressure, Bloomberg reported April 22. About 4,000 patients have used the platform, with about 3 in 4 seeing their denials reversed. In one case, a denial was overturned within a day after Claimable escalated it to the patient's senator, governor, the insurer's CEO and investor Mark Cuban, who emailed the employer's CEO and posted publicly about the situation on LinkedIn. Claimable is also moving beyond the direct-to-consumer model. The company has signed deals with four drugmakers and is negotiating with health systems to handle appeals on behalf of their patients who have had treatments denied. In addition, the company is exploring a litigation arm to pursue class-action lawsuits when it identifies patterns of allegedly wrongful denials across payers. Sheer Health, another startup, takes a broader approach, handling the entire appeals process on behalf of patients for $40 a month or a percentage of money recovered, according to CBS News. Users submit their bill via photo upload and the company manages all insurer communication and paperwork. "Our goal is for people to never have to deal with their health insurance again," co-founder Ben Howard told the publication. The startups are entering a market shaped by years of escalating friction between payers and hospital revenue cycle teams over claims and prior authorization. AI is accelerating that dynamic on both sides. As automation makes it faster and easier to deny claims, it is also making it faster and easier to fight them. Whether patient-facing tools like Claimable and Sheer Health can meaningfully shift that balance remains to be seen, but the gap they are targeting is real. Claimable estimates insurers deny 850 million claims annually, extrapolated from federal data, though the company did not disclose which dataset or how the figure was calculated. Consumers appealed fewer than 1% of denied claims in 2023, and when they did, insurers upheld their original decision 56% of the time, KFF data shows. Lawmakers are also starting to take notice. Arizona passed a law that takes effect this June requiring licensed medical providers to have the final say on coverage denials, and Louisiana is advancing similar legislation that would require human clinical review before any denial is issued. n

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