It is not unreasonable to assume that the demands on the healthcare system over the last several years have been unlike any other time. While the pandemic was largely unexpected until the early part of 2020, other issues, such as the move to electronic medical records, started several years ago.
However, the move to more automation through artificial intelligence (AI) in healthcare systems has significantly increased at a time when healthcare systems are already stretched beyond capacity.
With decreased staff, problems with supply chain, and increased hospitalization rates, the move to integrate technology needs to be strategically planned for each system.
Options to Consider
The most important and critical question for any healthcare system is determining how to integrate the new technology requirements to stay in compliance or to keep up with the increasing demands for automated and self-serve services for patients, payers, and providers.
The two options to consider for integration are if full integration is the best choice, or if a graduated or strategic implementation of the technology and the associated data migration, is the best option. Either possibility will benefit from partnering with an outside specialized company, also known as a business process outsourcing partner or BPO, to manage all aspects of coding, billing, and management of collections.
The change with any type of strategic transition, either enmasse or staggered, is the gaps that occur in the accounts receivable department. This can lead to problems with entering information, managing the accounts receivable system, and in claims management of existing claims in the system.
Managing Two Platforms
Either cutting off the old system at a pre-selected future date or immediately migrating to the new system will require a period of time when both systems are in use. The old system, called the legacy platform, must stay operational to ensure data is correctly transferred and system operations are functioning correctly.
In some cases, older data types may not directly transfer to the new system. In this case, the data conversion needs to be considered as a critical part of the migration process.
Having the in-house team trained in both systems and the BPOs team also working on the same two systems is helpful. Ideally, having one group remain responsible for current claims in the system and the other group taking on new claims once the transition is implemented provides the greatest level of efficiency. This helps to address issues with a claim where an active claim is in the old system, but new service dates occur after the cut-off or transition date.
Human Oversight of AI Systems
New systems, such as computer-assisted coding, can be an asset to any healthcare system, adding efficiency and reducing the demand on in-house staff. However, AI systems have to learn, which means they require human oversight to “understand” how to manage data correctly.
Human oversight and intervention to evaluate and make corrections with computer-assisted coding processes requires staff that is experienced, accurate, and also understands the technology. This typically means senior staff, which can create a gap in the staff working with new claims and managing the existing claims.
To work around this, BPOs are the ideal solution. These companies provide both accounts receivable services as well as oversee the implementation of computer-assisted coding programs.
Top BPOs use offshore staffing to manage healthcare systems throughout the USA and around the world. They specialize in healthcare system support and employ both certified medical coders as well as specialized healthcare professionals to detect possible issues and manage the “learning curve” of the AI system.
A crucial function of any AI system is to utilize clean data. Having a partner with the ability to ensure clean data entry will set up the system for success. In addition, the BPOs have experience in assisting other healthcare systems with the migration, allowing them to spot potential issues with data formatting or inconsistent data that may create an issue with “dirty data” in the system.
The choice of how to strategically integrate healthcare technology into any healthcare system is no longer optional. Today, healthcare systems that are not modernizing will find they have greater problems with revenue cycles and reduced levels of patient experience in the future.