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Experience AI for RCM

The RCM game is changing fast. AI is no longer a nice-to-have—it’s a competitive edge. But the question isn’t whether AI can transform your RCM process. It’s whether your healthcare company is ready to harness it. Plugging AI in to inefficient systems will breed breakage and inefficiency. To win, you need a strategy. Here’s how to know if your healthcare company is primed for RCM AI agents.

Identify Current RCM Pain Points

The first step to knowing if you’re ready for RCM AI is to take a hard look at where your current processes are holding your company back. Where is your team struggling? What’s slowing down your cash flow? Look at the data and listen to your staff. If any of these pain points hit home, it’s time to start considering AI:

High claim denial rates: Denials are the silent revenue killers. They keep your money locked up, force your team into time-consuming rework, and frustrate everyone involved.
Slow claims processing and reimbursement: A strong Days Sales Outstanding (DSO) in healthcare revenue cycle management is typically less than 30 days, with top-performing practices often achieving around 25 days. If your DSO is higher, your cash flow is stifled, which will also hinder expansion.
Inaccurate eligibility verification: Mistakes in eligibility checks can derail the entire billing process. It’s a problem that AI can fix faster and more accurately than any manual process.
Inefficient payment posting: Payment posting is critical for keeping your accounts up to date, but manual processes are error-prone and slow. AI can automate this with precision.
Staff shortages or high turnover in RCM roles: Your best people are overwhelmed, and it shows. Staff burnout and turnover are signs that the current workload is unsustainable. AI can reduce the burden and let your team focus on more strategic tasks.
Competitors are leveraging AI to outpace you: While you’re stuck in manual mode, your competitors are using AI to streamline their processes, cut costs, and get ahead. Don’t let them leave you behind.

If any of these resonate, you’ve already got a strong case for AI. These challenges aren’t going away on their own.

Identify Specific Use Cases

Not every RCM task needs AI. Start with the ones that will give you the most bang for your buck. Focus on areas that are high-impact, high-pain, and high-volume.

Eligibility verification: A repetitive task that AI can handle with higher accuracy and less frustration.
Claims processing and denial prevention: AI can identify patterns that lead to denials and help correct them before they happen. A sophisticated AI company will build in your previously successful use cases into their RAG technologies, to navigate towards desired results faster.
Payment posting and reconciliation: Let AI do the heavy lifting of posting payments accurately and reconciling discrepancies in seconds, not days.
Coding assistance: Coding errors are a big reason for claim rejections. AI-driven coding assistance tools can help coders get it right the first time.
Prior Authorizations: A notoriously slow and manual process that can delay patient care and payment. AI can streamline prior authorizations, reducing wait times and improving the patient experience.

Zero in on your biggest RCM headaches and start there. It’s not about automating everything at once—it’s about targeting your most critical needs first.

Examine Leadership Readiness and Change Management

AI adoption starts at the top. Leadership has to be on board, not just with the idea of AI, but with the commitment to drive the transformation it brings. This isn’t a plug-and-play solution. It’s a shift in how your entire RCM team operates.

Open to Innovation: If your leadership team isn’t ready to embrace AI, it’s a non-starter. They need to be advocates, not just bystanders.
Clear Communication Channels: Leaders must clearly articulate the benefits of AI to the team and address concerns upfront. Change is hard, but with strong communication, it doesn’t have to be disruptive.

Successful AI implementation hinges on leadership’s willingness to drive change. If your leaders are hesitant, address the concerns early and make sure they see the value AI can bring.

Define Success Metrics

Before jumping in, outline what success looks like. Metrics aren’t just numbers—they’re your guideposts. They tell you if you’re on track or if you need to pivot.

KPIs for RCM Performance: Think reduced denial rates, faster claim processing times, improved accuracy in payment posting, and enhanced team productivity. Define these metrics early so you can measure impact from day one.
ROI Expectations: Know what you’re aiming for. Faster claims processing? Reduced denial rates? Fewer manual errors? Define your ROI clearly to track whether the investment is paying off.

Explore Vendor Options

The vendor you choose can make or break your AI journey. This isn’t just about picking the cheapest or the flashiest solution. It’s about finding a partner who knows healthcare RCM inside and out.

Research AI Vendors Specializing in Healthcare RCM: Look for vendors with proven success in healthcare settings similar to yours. The complexity of healthcare RCM means you need a partner who already understands the back-office terrain, common goals and problems, and the platforms you’re currently operating on. You want someone who gets it—right from the start.
Pre-trained vs. Customizable AI Agents: Evaluate the benefits of both approaches to find the best fit for your needs. Learn more about the benefits of pre-trained and customizable AI agents in healthcare.
Implementation Support and Ongoing Service Offerings: Assess vendors’ capabilities in providing support during and after implementation. Their ability to meet you on-site to workshop automation plans is crucial. Timeliness matters—you’ll have multiple meetings covering detailed processes, needs, and implementation. You need a vendor who is proactive, professional, and takes the lead in guiding the process. You shouldn't have to push the AI team to move things forward—they should be driving the program and advancing your goals every step of the way.
Partner with Reputable Vendors: Choose companies with a history of successful AI agents over multiple years, serving 30+ clients, and sufficient funding to expand in a competitive market. For more insights, check out our testimonials pages.
Look for a Vendor with Experience in Multiple Facets of AI: You need a partner you can grow with. The goal is to link AI agents together, creating a streamlined network that operates your entire RCM platform on the backend. For example, Thoughtful AI’s EVA handles eligibility verification, CAM manages claims processing, PAULA takes care of prior authorizations, and PHIL handles payment posting. This interconnected army of AI agents works seamlessly to deliver optimal growth, success, and streamlined results with minimal downtime. Picking the right company at the start is imperative.

Choosing the right vendor isn’t just a decision—it’s an investment in your future efficiency and success.

Closing Thoughts

AI in RCM isn’t about automating your problems away—it’s about strategically enhancing your processes to drive better outcomes. By assessing your current challenges, targeting high-impact use cases, and partnering with the right vendors, your healthcare organization can set the standard for efficiency, accuracy, and financial health. The future of RCM is AI, and now’s the time to decide if you’re ready to lead the charge.

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Published On:

February 24, 2025

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