The business context
Revenue-cycle teams manage a moving collection of exceptions. Claims may require coding checks, eligibility concerns may need attention, denials may warrant an appeal and payments may need reconciliation.
The challenge is deciding which item to examine next, understanding the reason for that priority and carrying the relevant context between teams.
The project
Smart RCM is a prototype that brings several revenue-cycle activities into a connected operational view. Its scope includes denial intelligence, claim checks, appeals prioritization, eligibility-related risk, payment reconciliation and revenue exploration.
The project also includes conversational assistance for examining claim-level information and preparing summaries for review.
An illustrative scenario
A team begins the day with claims awaiting correction, a growing appeals queue and unresolved payment differences. Reviewers need to identify which cases deserve attention and understand the recommended follow-up.
Smart RCM explores how those decisions can be supported through a clearer view of claim status, relevant concerns and possible next actions.
What a pilot could evaluate
A pilot could measure how useful the recommendations are to staff, whether prioritization improves work allocation and how reliably the prototype handles representative data and exceptions.
Operational and financial improvements would need to be established through that evaluation.
Who it is relevant to
Healthcare revenue-cycle teams, billing operations, RCM service providers and teams evaluating decision support for claims management.
Private walkthrough
Select one revenue-cycle problem and examine whether a focused prototype could support the people responsible for resolving it.
Explore an RCM pilot for your team →