Workflow: See the proof

Q. What are some case studies of successful AI implementations in HME RCM?  

A. AI-driven solutions in HME RCM have shown promising results, with numerous providers already reaping the benefits of improved efficiency and reduced errors. We will explore three case studies that demonstrate this transformative impact. 

Streamlining prior authorization  

A mid-sized, sleep-focused provider faced significant challenges in managing prior authorizations, resulting in delays and increased administrative overhead. The provider leveraged an AI-driven automation solution for its prior authorization process, reducing manual work and approval times. Consequently, patients received timely care, and the provider experienced a notable increase in operational efficiency.  

Reducing denial rates and improving revenue recovery  

A large, full-line provider with a national footprint struggled with high claim denial rates, primarily due to missing data elements such as auth numbers and modifiers. The introduction of an AI-driven machine learning algorithm enabled the provider to identify and correct discrepancies before submitting claims, resulting in a substantial decrease in denial rates. The improved accuracy in coding and billing led to an accelerated revenue recovery process and increased overall revenue.  

Enhancing patient resupply  

A large, regional provider sought to improve its patient resupply experience and resupply revenue. By leveraging an AI-driven system, it was able to data mine, create patient-centric resupply campaigns, proactively address documentation issues, and administer an omni-channel resupply program, including phone calls, emails, text messages, web portal and mobile application. This customized approach catered to each patient’s preferences and, ultimately, doubled the provider’s resupply revenue base in just one year.  

These case studies demonstrate the transformative potential of AI-driven solutions in HME RCM. By automating manual tasks, reducing errors and enhancing the overall patient experience, AI enables providers to optimize their financial performance, while delivering better patient care. As the industry continues to evolve, AI's impact is poised to grow, offering new opportunities for providers seeking to embrace the future of health care.  

Joey Graham is chief revenue officer at Prochant. Reach him at joeyg@prochant.com.