Oracle Health launches 5 AI revenue cycle tools to prevent denials

Oracle Health has announced new revenue cycle management capabilities that use AI toward the front-end of the revenue cycle to prevent denials in the first place.

Revealed at the Oracle Health and Life Sciences Summit yesterday, the health IT giant said five AI capabilities for RCM will be embedded within its revenue cycle solutions in the coming months. The capabilities include AI-driven prior authorizations, clinical document quality integrity, charge capture and integrity, medical coding for professional fees and appeals management.

The company said the new capabilities aim to mitigate reimbursement problems early in the patient and payment journey by targeting common areas for errors, such as missing information, authorization issues and inaccurate charges.

"AI gives us an opportunity to prevent revenue cycle problems before they lead to denials and delayed payments," Seema Verma, executive vice president and general manager of Oracle Health and Life Sciences, said in a press release.

With the new capabilities, Oracle Health hopes to feature AI across each part of the revenue cycle -- front, middle and back -- to connect clinical and financial workflows, from registration through payment, according to Verma.

"This can help healthcare organizations reduce administrative work and revenue leakage, get paid faster, and strengthen their financial stability so they can stay focused on delivering excellent patient care," she stated.

RCM remains a fragmented, often manual process despite major technological advancements in the administrative side of healthcare. AI is largely contributing to greater efficiencies in certain areas, but RCM vendors are increasingly looking to connect capabilities to deliver a more seamless experience across the revenue cycle.

This can help address some of the leading causes for claim denials, they argue. Missing or inaccurate data, patient registration and eligibility errors, and prior authorization failures are among the top reasons for providers' claim denials, followed by coding mistakes.

Typically, providers receive denials and must rework the claim to obtain reimbursement. But getting information, precertification and clinical documentation right from the start can prevent delayed or rejected reimbursements.

Oracle also revealed product plans to further connect reimbursement workflows with enterprise financial operations, including financial reconciliation, revenue accounting, treasury management and analytics through solutions such as Oracle Fusion Cloud Applications.

The company said this product direction should link reimbursement activities, financial operations and enterprise analytics to enable better operational and financial decisions.