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Lia, the A.I. Assistant: "A Win for Jeanine"

Posted by Dana Adams on Jan 24, 2018, 8:46:36 AM

A DAY IN THE LIFE

A revenue cycle specialist at a nearby hospital—let’s call her Jeanine—walks into her office. Her day begins with a standup meeting with her boss and team. They recap the previous day, highlight a few wins, but also lament the many challenges they faced in working with insurance companies to pre-certify patients for procedures.

Afterward, Jeanine sorts through a stack of papers, voicemails, sticky notes, and doctors’ calendar and starts plowing through pre-certifications, deciphering oncology reports, manually keying in endless streams of data, and waiting for screens to load.

Jeanine works under constant pressure, fully aware that patients are counting on her to deliver pre-certification for the surgery, prescription, or medical device they need, and that the provider is counting on her to keep patient treatments on schedule and secure revenue in a timely manner. Meanwhile, the insurance company expects her to stay on top of their ever-changing rules and restrictions (which can change without prior notice).

Midway through her day, Jeanine is pulled into a fire drill by the clinical team and has to drop everything to pursue a dead-end pre-cert. She knows from her 15 years of working with this insurance provider that it’s too late to get the procedure approved, but she’s been told that she always needs to “at least try.” Then she has to reschedule three procedures because she missed the cut-off date. Those three patients are frustrated and distraught. Meanwhile, Jeanine’s provider call list is growing.

Ten exhausting hours later, Jeanine has already worked two hours of overtime and is still barely keeping her head above water. She leaves work with a pit in her stomach and a sense that she, the provider, and the patients are all losing.

Isn’t there a better way?

PAIN POINTS

The Jeanines of the world are mission-oriented, customer service–driven workers who have groaned alongside frustrated patients when the pre-certification process breaks down and fails them.

In addition to their concern for patients, revenue cycle specialists like Jeanine are responsible for securing revenue for the healthcare provider in a timely manner, all while trying to stay one step ahead of insurance company gamesmanship and rule-shifting.

The expectations of healthcare providers, insurance companies, and patients all converge on the shoulders of Jeanine, the revenue cycle specialist. But without better tools to do her job well, Jeanine will keep getting barraged with erroneously denied claims and delayed treatment schedules that damage patient goodwill.

JEANINE, MEET LIA

Simply put: LiaTM is a win for revenue cycle teams.

Lia is an A.I. assistant that works with your existing software, workflows, and teams to automate, accelerate, and (re)prioritize pre-certification tasks to maximize authorizations and secure revenue.

Lia is a digital colleague, designed to re-prioritize tasks and help enter data into existing interfaces (EHR, Medicaid, payer, etc.) more quickly, so the Jeanines of the world can work smarter and more efficiently.

Unlike other proposed solutions to revenue cycle issues, Lia doesn’t require an 18-month on-ramp of training with complicated software. Rather, it integrates seamlessly with your existing systems. Lia lives right in the sidebar of your screen. (No, not like that annoying 90s-era paper clip!)

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  Learn more about Lia here

 

UNLOCKING THE VALUE OF A.I. IN THE REVENUE CYCLE

The pre-certification process is one area where A.I. can come alongside employees to plug the holes in revenue cycle leakage and deliver the best patient care possible, minimizing surprise denials, treatment delays, and inflated medical bills.

Right now, Jeanine’s revenue cycle toolbox holds her work ethic and all those blasted sticky notes. What she needs is a digital tool that will streamline her workflow and help her do her job better, faster, and smarter. 

Andreessen Horowitz operating partner Frank Chen believes we are in the “golden age” of producing technologies that make humans “smarter, more effective.” He likens these A.I. tools to Jiminy Cricket, sitting on our shoulders and guiding us toward the best possible decisions for the best possible outcomes.[1]

This is where Lia comes in, empowering employees like Jeanine by freeing them up to do high-level, value-added work.

LIFE WITH LIA

This is what a workday could look like for Jeanine after implementing Lia: she walks into her office, has a daily standup with her boss and team where they happily report that they’re ahead of pre-cert revenue goals for the month.

Instead of sorting through a stack of papers, Jeanine consults her digital assistant Lia to see: (1) how much data entry Lia was able to do overnight to tee up Jeanine’s pre-certs and call list; and (2) Lia’s recommendations in the smart-queue for which pre-certs Jeanine should work on first to maximize revenue and on-time procedures.

Working with Lia, Jeanine breezes through the data entry for pre-certs three times as fast and has plenty of time throughout the day to make calls to payers and work through more complex cases. She has fewer reschedule issues because Lia has helped her reorder tasks and inputs in order to work within the approval timetables from payers.

Jeanine also faces fewer clinical team fire drills because Lia can recommend, with quantifiable evidence and data, when a pre-cert is worth chasing and when it’s a lost cause (and Jeanine’s boss believes the data Lia provides, and has empowered Jeanine not to chase dead ends).

Jeanine leaves at the end of a fruitful eight-hour day, having supported the patient care mission, and goes home to her family.

WHO'S BEHIND LIA?

Digitize.AI is a fast-growing independent Artificial Intelligence firm seeking to grow trust, transparency, and courage in healthcare communities through the creative application of A.I.

We’re a group of people who get excited about bringing new, practical technologies to historically underserved areas in order to accelerate results and improve the quality of life at work for employees.

We’re excited to unveil Lia and unlock the value that A.I. can bring to the revenue cycle.

Visit us at HIMSS18 in March in Las Vegas! Find more information here.

Want to see Lia before Conference? Click here to schedule a demo to see Lia in Action.

 

 

[1] Frank Chen, “AI: What’s Working, What’s Not,” https://a16z.com/2017/12/07/summit-ai-update-frank-chen/

Dana Adams

Written by Dana Adams

Topics: AI, Prior authorization, Intelligent automation, Artificial intelligence, Revenue cycle management, Healthcare IT, Pre-certification