Applying AI to RCM: The Right Vendor is Integral to Success

By AGS Health

May 9, 2023

Advances in artificial intelligence (AI) and the highly transactional nature of revenue cycle management (RCM) have set the stage for AI to address many of RCM’s biggest pain points, while increasing revenue capture and helping achieve revenue integrity.

Whether it’s automating manual and redundant tasks within patient access or billing or applying AI to real-time analytics, prior authorization, workflow prioritization/optimization, and denial mitigation, the potential for AI in RCM is already being realized by early adopters.

However, when it comes to deploying any AI strategy, selecting the right technology vendor can make or break the entire project.

The Right Fit

The best AI vendors will be those that not only understand the problem AI is expected to solve but are also willing and able to analyze the prospective customer’s existing operations to identify and address issues in ways that fit well with the organization. Prospective vendor partners should have a proven track record of revenue cycle expertise that goes beyond a single specialty to ensure they are able to address all needs.

It is also important that vendors bring realistic expectations to the table rather than over-promising during the sales process and ultimately under delivering once the deal is signed. Honest perspectives and achievable goals are imperative to long-term success.

Prospective partners should use industry-standard AI tools such as natural language processing (NLP) and knowledge graphs and provide configurable solutions rather than one-size-fits-all – which is crucial because not every platform is ideal for each customer. Additionally, end-to-end RCM capabilities and data standardization must be part of the deal.

The right vendor will be transparent about the viability of AI and automation across all tasks. The reality is that there are several complex tasks and processes within RCM where these technologies have not yet reached the level of maturity to operate fully autonomously. As such, it’s important to seek out a partner that can also augment internal staff with highly trained and educated professional services. This hybrid approach enables healthcare organizations to easily scale their operations based on changing demands and volumes.

Finally, look for a vendor that offers a cloud-based platform and provides seamless integration for a single source of insights.

Positioned for Success

Successful integration of AI and automation into the revenue cycle starts with understanding what can be expected of these technologies and evaluating the revenue cycle department’s people, processes, and current technologies to identify a proper fit. It also involves working with honest partners who can provide the knowledge and solutions that specifically meet the needs of the healthcare organization.

Thus, taking the time to vet any prospective AI vendor fully and carefully is critical to ensuring that, once the technology is in place, its impact on RCM is optimized to meet the healthcare organization’s specific and unique needs.

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AGS Health


AGS Health is more than a revenue cycle management company—we’re a strategic partner for growth. Our distinctive methodology blends award-winning services with intelligent automation and high-touch customer support to deliver peak end-to-end revenue cycle performance and an empowering patient financial experience.

We employ a team of 12,000 highly trained and college-educated RCM experts who directly support more than 150 customers spanning a variety of care settings and specialties, including nearly 50% of the 20 most prominent U.S. hospitals and 40% of the nation’s 10 largest health systems. Our thoughtfully crafted RCM solutions deliver measurable revenue growth and retention, enabling customers to achieve the revenue to realize their vision.

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