Healing the Financial Strains - AI’s Prescription for Healthcare Payment Challenges!

The Prognosis

If I start this piece by saying that for an industry with a market size of USD 9.4 trillion globally, and a mostly ‘not for profit’ operating model, only 78% of payments are received on time, would you believe me? 

But this is the reality- as per Dun & Bradstreet, AR (Accounts Receivable) and DSO Report Q2 2023, Health services 11% of the claims are paid late by 30 days and 11% of claims take even more time going beyond a period of 6 months at times. 

The diagnosis

For an industry already battling staff shortage post the pandemic, current inflationary pressures and change in healthcare needs - challenges with payment integrity, posting and processing, claims management, denials, recoveries and bad debts are putting pressure on CEOs and other senior executives of community hospitals on the edge. 

But these are just the symptoms, a first diagnosis will reveal that the key agents putting stress on the Care continuum include reasons like incomplete or inaccurate insurance claims, coding errors on invoices, Medicare/Medicaid issues, managing receivables from uninsured patients, pre-authorization disputes, co-payment and deductible discrepancies etc.

Even with the most coveted data management and integrity practices mandate by regulation, it is quite a riddle how the sector struggles to recover its dues. The situation is even grave for independent surgeries and practices spread across the world since they do not have the privilege of a structured shared services model to resolve these exceptions. For a segment investing 26% of its revenue into Technology, we expected better.  

The Care

Critical patients need attention from a specialist. AI (Artificial Intelligence) could be the one Healthcare provider industry is looking for. Imagine if it's possible to predict the various exception scenarios listed above on the first interface with the patient, it is possible to plan the end-to-end care continuum and ensure the payment integrity is kept as well, without putting undue stress on the hospital system. 

With new diseases and epidemics appearing and a burgeoning population, it is extremely critical that the financial health of the healthcare companies is kept stable. A resilient healthcare system will invite newer investments in innovation, and will make the care personal, more accessible and more affordable as well. 

AI can make it real. At Pinaka AI, we have developed a cutting –edge AI solution, which predicts the claim issues and payment hiccups ahead of time, at the time of patient registration itself- so when it comes to collecting receivables from the payer, there are no last-moment shocks and surprises

With our robust technology solution, the 4.4% delayed claims which take ages to arrive- would not exist, while the other 17.5% will arrive on time. It is important to understand that Dun & Bradstreet numbers are a median representation, depending on the stress on the healthcare system for a certain region or company, the problem could be even more grave. But Doctor AI is here to help.

If you are into healthcare business and wish to know more, how can we help you improve your collections, recoveries and bad debts, please reach out to me at: mufaddal@pinakaai.com 

Mufaddal Dhorajiwala

Vice President – Global Sales & Customer Relations

PINAKA AI