Ritesh Ramesh discussed the role of augmented intelligence in achieving revenue integrity to help healthcare organizations regain solid financial footing post-COVID-19.
Wellesley, MA — February 23, 2021 —Cloud, data, and augmented intelligence (AI) have critical roles to play in solving key business problems around operational and financial areas for healthcare organizations as we enter 2021 and beyond. That was the message shared by Hayes CTO Ritesh Ramesh during a rapid-fire panel focused on Patient Care in the Era of COVID – Data and Systems during the virtual 2021 Health Datapalooza and National Health Policy Conference, hosted by AcademyHealth.
During his presentation, “Empowering Better COVID-19 Billing Compliance With AI-Enabled Revenue Integrity,” Ramesh focused on the application of AI to claims and billing data to boost compliance and strengthen revenue integrity at a time when COVID-19 has left many healthcare organizations in dire financial straits. Noting that, by the end of January 2021, a cohort of Hayes’ customers using its flagship MDaudit Enterprise platform had submitted nearly 9 million COVID-19-related claims encompassing nearly 4.5 million unique lives and totaling more than $68 billion in gross charges, Ramesh illustrated use cases around the critical importance of AI in enabling real time insights and forecasts around compliance risks, denials and cost of care.
“The key is not to chase down the technology, but rather to focus on good problem statements and align with business stakeholders on clear outcomes that can be measured and iterated,” he said. “Be sure to use impactful visualization and storytelling to turn data into actionable insights that can deliver on those outcomes.”
The rapid-fire session, which took place on February 17, 2021, focused on the challenges and opportunities around sharing clinical, social, and operational data and insights in a timely manner that can impact care during the pandemic across various patient settings and communities. It was moderated by Daniel Kurowski, MPH, a senior researcher with the Health Care Cost Institute. Joining Ramesh as session presenters were:
- Tianna Fallgatter, MPH, Assistant Director, Rural Programs, for the Association of Washington Public Hospital Districts in Seattle, who presented “A Technology Roadmap to Improve Clinical Data Sharing Among Rural Facilities”.
- Joel Gurin, President and Founder of the Center for Open Data Enterprise (CODE) in Washington, DC, who presented “Using Data on Social Determinants of Health to Fight the Pandemic”.
- Jayson Marwaha, MD, General Surgery Resident and Postdoctoral Fellow in Biomedical Informatics at Harvard Medical School in Boston, who presented “Temporal Characteristics of Codes in EHR and Billing Data Used to Identify COVID-19 Patients”.
Concludes Ramesh: “Going forward, increased oversight and optimal revenue capture will be crucial themes for healthcare organizations. That is why Hayes is laser-focused on ensuring MDaudit Enterprise drives the operational productivity, actionable insights and revenue outcomes our customers need to not just survive, but to thrive.”
Hayes, makers of the industry’s leading integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, moved quickly to respond to the shifting regulatory and reimbursement landscape created by the COVID-19 pandemic. It repositioned MDaudit Enterprise to help organizations alleviate current and future integrity risks caused by evolving guidance, achieve and maintain billing compliance, avoid revenue cycle bottlenecks, and offset devastating financial losses by capitalizing on all appropriate revenue opportunities. This included the addition of new billing codes to enable searches for services related to COVID-19, “risk area” telehealth worksheets to facilitate auditing, and curated Ad Hoc reports to track COVID-19 related denials.
“Our recent investments in technology and analytics are resonating with the overall market and our customer base,” said Hayes CEO Peter Butler. “They exemplify our ongoing commitment to the continuous innovation of MDaudit Enterprise to serve the industry as it turns the corner in 2021 and beyond.”
