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AI And Automation: The Power Behind Data Curation

POSTED November 28, 2022

By Dean Paluch, Chief Revenue Officer

In its 2021 joint poll, the MGMA (Medical Group Management Association) and Change Healthcare reported that 69% of healthcare leaders surveyed reported an increase in claims denials. Ironically, the upward trend cites the traditional root causes. The survey concluded that three of the top four issues were tied to front-end workflows (e.g. registration, eligibility) and accounted for 50% of denials.

The 2021 CAQH Index Report data analytics identified that $391 billion was spent on manual administrative complexity in the United States healthcare system. The current reimbursement system is highly complex, making it increasingly difficult for providers to get paid.


The RCM Industry Solution

The current revenue cycle response is to create software that organizes the errors into work queues, forcing providers to throw people at the data queues to correct the errors manually. With relentless pressure to reduce or maintain current cost levels and being faced with high employee turnover rates and constant onboarding of new staff, maintaining a consistent team can be challenging. The error queues and the related task lists grow exponentially, acting like a conveyor belt that never reaches an endpoint. By now, you’re thinking, ”there’s got to be a better way.” And you’re right…there is!

The Wave HDC Approach

To deal with this issue in the most efficient manner, you need what most organizations do not possess:

  • Access to the accurate data
  • The subject matter expertise to determine what to do with the new (corrected) data
  • Automation to make the corrections without human intervention

Data Curation combined with artificial intelligence (AI) and Robotic Process Automation (RPA) is the perfect trilogy of subject matter expertise, data resource capability, and automation muscle that allows healthcare providers to automate previously manual revenue cycle tasks. The conversion from a staff-based data correction model to a technology-based solution increases productivity and reduces costs, and you can find hidden revenue opportunities in your current AR.

Solving healthcare data challenges is what Wave HDC is all about. We’re using advanced automation to find errors and correct them, helping our customers clear their aging A/R and resolve their endless work queues. If bad data is compromising your organization’s bottom line, contact us today!


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