Iodine Software is releasing next-generation artificial intelligence technology to identify revenue opportunities that fall through the cracks after a patient is discharged from the hospital.
The cost savings could help health systems justify investment in other AI technologies that haven’t yet proven traditional return on investment, like AI scribes.
The AI-driven revenue cycle management company is launching AwarePre-Bill, a post-discharge auditing tool, which could help hospitals and health systems save an additional $3 million to $4 million per month, or an extra 25% of missed revenue opportunities.
The algorithm prioritizes patient records for review that have missing documentation needed for billing or recommend billing codes better suited to the data in the patient record. The software aims to stop revenue leakage at multiple points in the patient journey and to relieve administrative burden related to billing.
Iodine Software’s concurrent billing product prompts documentation accuracy during a patient stay, saving its customers $2.4 billion per year, it says. Its RCM software is deployed in thousands of hospitals across the country.
Potential revenue is left on the table, though, when patients leave the hospital, CEO William Chan told Fierce Healthcare in an interview.
“There are things that occur at the very end of the patient stay that don't always get captured until the patient has been discharged, and so there's always a need for a post-discharge round of review, if you will, to ensure that everything is being captured from the documentation perspective and then that's being translated accurately into the code,” Chan said.
The solution comes with other perks, like AI agents and an outcomes-based pricing model.
During a hospital stay, patients rack up data points from testing and provider notes, so finding an exact proof point can prove difficult in retrospect. Iodine’s generative AI agents can query a patient’s health record to find the proof points needed for billing documentation, which Chan equated to finding a needle in a haystack.
Accurate clinical documentation drives patient care and financial performance for health systems, Chan said. He came across the problem 15 years ago when a hospital was trying to manually review documentation to look for revenue leakage and asked him whether technology could assist with the process.
Early on, the company decided to deploy machine learning to interpret clinical data and identify opportunities for cost savings.
“The importance of documentation as a life blood in the financial revenue cycle of the hospital has become paramount,” Chan said. “And I think that has helped Iodine grow as well.”
Addressing the provider burnout crisis has been a major focus of hospitals' and health systems' AI purchasing decisions. AI scribes have seen a boom in adoption because of their promise to reduce documentation time and reintroduce the provider-patient connection during appointments.
However, while AI scribes have proven to reduce feelings of burnout, they have not yet proven a financial return on investment for provider organizations, the Peterson Health Technology Institute (PHTI) found in a recent report. It will become increasingly important for the organizations to provide financial returns, the PHTI writes.
Chan said Iodine Software is in talks with AI scribe companies to partner with its RCM solution, which has proven to save millions in lost revenue per month. The company has not yet made any announcements in the space, but the certainty of financial savings and improved provider well-being could be an unprecedented boon for the healthcare industry.
Iodine Software’s technology could also improve upon ambient AI scribe solutions, Chan said, because it can surface relevant patient information from the chart that is not discussed during the visit, he said.
“Most health systems have secured executive support for pilot-level initiatives but have not necessarily aligned the requisite data analytics and measurement tools to conduct a rigorous assessment of impact across a comprehensive set of process, experience, financial, and quality metrics,” the PHTI report says. “As a result, executives do not have all the information they need to decide to scale or refine implementation.”