Using AI to reduce the cost to collect in the healthcare sector

Challenge

Maintaining margins in an evolving reimbursement environment

The healthcare provider revenue cycle is in flux. Payers are consolidating, and reimbursement guidelines are changing. The shift to value-based care (VBC) is creating uncertainty while patient access and care delivery processes are evolving and margins are getting squeezed.

At the same time, denial rates are rising. Collections teams are becoming overwhelmed, and the cost to collect is going up. Healthcare providers need to digitize and automate in order to survive and thrive in the current environment while also preparing for the shift to value based care.

Solution

Revenue cycle transformation made easy

Firms must get smarter about leveraging data analytics and automation to improve per-agent collection rates, reduce denials, and analyze their revenue cycle processes. At Genpact, our models use intelligent data, claims, and contractual denial analytics techniques to allow firms to accurately assess the collection probability of individual accounts. We help clients apply artificial intelligence (AI), machine learning (ML), and quick process automation to help firms avoid denials, while the application of descriptive and predictive analytics delivers new insights into their end-to-end revenue cycle.

Genpact's RCM approach includes four key pillars:

• Claim Analytics and Recovery Engine (CARE): improves per-agent collection by leveraging data from contractual denial, clinical and trend analysis, and past claims data to assign collection probability
• aiPlay: focuses on denial management through predictive analytics. aiPlay is a solution developed on a deep neural networks that is applicable across industries and functions for predicting denials. When this tool predicts claims with a higher probability of denial, teams can take action to proactively rectify them
• Automation hub: provides a dedicated group of experienced automation experts bringing different skill sets together from large platforms like UiPath and Automation Anywhere to engineers for creating small and medium macros. This approach helps our clients consolidate and optimize their automation efforts
• RCM Analytics Suite: a revenue dashboard and business intelligence tool that uses descriptive and predictive analytics to uncover new insights from end-to-end RCM operational metrics including order-to-bill, bill-to-collect, and collect-to-cash

Our solutions are part of a wider suite of innovative RCM services that include patient access services, medical coding, and patient financial services. Our flexible engagement approach also allows clients to co-develop a proprietary solution, leverage partner technologies, or do a combination of both.

Impact

Better today, better tomorrow

Genpact's RCM solutions help clients collect at a higher rate while also reducing the cost to collect by up to 30%. Other benefits include:

• Improved action on claims by up to 81%
• Improved per-agent collection rates up to 47%
• Reduced cost to collect by up to 35%
• Reduced bad debt write-offs by up to 20%

Case study

Better analytics, better revenue cycle outcomes

When two major California-based hospitals wanted to improve their revenue cycles, enhance their collections, and reduce their resource costs, they went looking for a partner that could help them leverage data and analytics across processes.

Genpact deployed a team of software engineers, analytics experts, and industry operators who focused on helping drive diagnosis and procedure code assignment, clinical documentation improvement, denial reduction, education, and feedback. This enabled the hospital system to improve workloads to more than 400,000 patient cases annually.