Many factors make revenue cycle management (RCM) a big headache for U.S. health care providers. Aakarsh Sethi, Senior Product Manager at Infinx, lists the forms of “fragmentation” in payments: not just many different payers, but different plans with different coverage at each payer, along with pharmacy benefit managers (PBMs) and other third party managers, and rules that are constantly changing.

Establishing eligibility, getting prior authorization, and billing are a “very manual process today,” which not only slows down the revenue cycle but leaves a lot of space for inaccuracies to enter and trigger denials.

Infinx (pronounced “in-fin-ex”) works currently with more than 4,000 providers, applying machine learning to automate RCM. Stuart Newsome, VP of Marketing at Infinx, describes the company’s “intelligent payer mapping,” an LLM-based service that determines whether a procedure needs prior authorization, and then whether the patient’s condition and symptoms meet payer guidelines.  Infinx is taking a novel approach to mapping out a healthcare organization’s payers to make sure the list of payers is updated properly.  It’s done with a multi-modal approach, where the system cascades through clearinghouse connections with payer portal automations to fill in the gaps.

We all know that the future of RCM is going to be around AI and automation.  Done smartly, you can see the RCM benefits that are described by Sethi and Newsome from Infinx.  Not that these automations are going to replace the revenue cycle management professional.  That’s not happening.  However, these technology solutions are freeing up the revenue cycle management staff to be able to focus on the more complicated RCM challenges that take a human.

Watch the video for more details on RCM and the benefits of automation.

Learn more about Infinx Healthcare: https://www.infinx.com/

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