CHAPTER 7

Leveraging Technology in the Mid-Cycle

CHAPTER 7

Leveraging Technology in the Mid-Cycle

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Artificial intelligence (AI), robotic process automation (RPA), machine learning (ML), and other automation technologies can help improve mid-cycle efficiencies by preventing denials on the front end and streamlining denial rework on the back end. Providers can leverage these technologies to conduct in-depth root-cause analysis to identify where denials originate and what corrective action should be taken to prevent them in the future.

The benefit of automation technology is that it can identify requirements for prior authorizations and the need for additional documentation, which helps prevent denials and, thus, reduce delays in care and reimbursement.

RPA is particularly beneficial in helping prevent mid-cycle-related denials by automating much of the coding and billing processes. RPA works by mimicking human tasks through rules-based actions to conduct transactions and complete repetitive processes without human intervention.1 RPA can reduce errors that often occur during manual data entry and can flag instances where data is missing or does not match specific criteria. This enables coders to correct claim issues before they are submitted.

eBook: Navigating the Heart of Healthcare Revenue

A Comprehensive Guide to the Mid-Cycle and Revenue Maximization

This eBook offers an extensive overview of mid-cycle operations within healthcare provider organizations. It emphasizes the critical importance of coding, clinical documentation integrity, revenue integrity, and health information management. The guide underscores that these processes are not isolated but are integral to both the front-end and back-end of the revenue cycle, affecting overall financial health and compliance.

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