The innovations in AI have ramped up increasingly in the last 12 months and Generative AI has really opened possibilities of this being the next best technology innovation by humans after the internet, according to Bill Gates. While AI technology have been dismissed by many analysts as hype in the past, the entry of many low-code to no- code technologies has raised optimism over the ease and adoption of these technologies into the enterprise. Many enterprises are exploring the use of this innovative technology within their spaces to drive value.
Our AI Vision
Our guiding philosophy is not to use AI for the sake of it but to apply the technology to specific business problems within the billing compliance and revenue integrity areas to increase productivity, revenue opportunities and mitigate risk. We believe even with the advent of these technologies, there is a need for humans to be involved in the loop to augment and train AI technologies to specific domain expertise. This process is not a zero-sum game but a relentless and iterative pursuit towards value creation.
Our design principle is simply that we must put relentless focus on the human experiences and operational processes it impacts rather than amplifying the technology itself. Our innovative strategy is to work with our customers, prospects, and partners to create value. We cannot do it alone. We are extremely lucky to be working with strategic partners who are leading the charge with continuous innovation and investments in their infrastructure stacks – be it Cloud, AI or Security. We are collaborating with them to accelerate our innovation cycles to bring new solutions to the market.
How are we executing our vision?
MDaudit is the leading healthcare compliance and revenue integrity SaaS platform. We work with the 70+ of the top 100 IDN’s (integrated delivery networks) in the U.S. to enable their compliance and revenue integrity goals. Annually, $3.5B+ of the total charges flow through our platform for audits that unlock critical compliance and revenue risks. $100B+ of initial denials are analyzed by our customers. We are continuing to grow and scale more customers.
As healthcare organizations are fighting for every dollar to maintain healthier bottom lines, they are demanding solutions in our space to below problems.
- How can I continuously monitor billing and coding risks with real time data in this volatile healthcare landscape?
- How can I really manage my reimbursement risk by understanding the payer behavior in a granular manner to act?
- How can leverage the platform with minimal resources required to create sustainable value?
- How can I communicate the insights and outcomes across my peers in other functions to scale the impact of the outcomes to the enterprise level?
MDaudit’ s answer to these critical business questions is to first be a data driven platform at its core. We leverage data and embed insights at every critical touchpoint to guide intelligent workflows to enable automation, insights, and communication tools to drive tangible business outcomes.
Below are a few specific examples.
- Insights.ai makes it fast and easy to access the deep insights needed to drive strategic decision making. Whether it’s information about at-risk facilities, providers, coders or which DRG had the highest number of denials for medical necessity in a specific timeframe, Insights.ai democratizes insights across all levels of a healthcare organization – from billing compliance auditors, revenue cycle analysts, operational leadership and to the C-suite – by responding to questions posed in natural language with precisely the insights being sought. Insights delivered are then tightly integrated with actionable workflows to drive outcomes.
- Integrated into our External Audit Workflow module, SmartScan.ai leverages AI technology and serverless architecture to deliver intelligent functionality to automate and accelerate management of external payer audits. It allows users to upload payer request letters from multiple payers in different formats, which are then automatically processed for workflow activities. SmartScan.ai eliminates tedious manual work of reviewing hundreds of letters from payers every week, expediting the overall resolution of audits in a quicker timeframe, resulting in faster revenue retention with less resources.
- Our anomaly detection capabilities with billing and denials data provide the capability for any healthcare organizations with a complex interplay of entities (facilities, providers, coders, payers) to continuously assess risks in real-time and then focus their actions and activities on those risks to drive measurable outcomes. With healthcare organizations optimizing their costs and resource allocation, data and technology becomes a critical enabler to achieve those goals.
In closing
It’s very difficult to argue against the potential benefits for a healthcare organization from AI capabilities and those who resist exploring it will be left behind in the long term. There is a caveat though – AI has the potential to transform healthcare and drive sustainable outcomes only if software vendors put a relentless focus on human experiences and operational processes it impacts rather than amplifying the technology itself. With this principle in mind, MDaudit will continue to evolve its capabilities as a technology platform to innovate and deliver AI solutions into the future.
