Oracle Health Advances Revenue Cycle Management with AI
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Native AI capabilities will help connect and simplify revenue cycle workflows to help healthcare organizations optimize financial performance and enhance patient financial experiences
"AI gives us an opportunity to prevent revenue cycle problems before they lead to denials and delayed payments," said
Clinical, financial, payer, provider, and operational activities all influence reimbursement and financial performance, yet many organizations continue to manage these activities across fragmented systems and manual workflows that create inefficiencies, reimbursement delays, and administrative burden. Oracle Health revenue cycle management solutions connect workflows across patient access, clinical documentation, patient accounting, contract intelligence, payment operations, enterprise analytics, and financial management.
Organizations can leverage native AI embedded across existing Oracle Health revenue cycle solutions while modernizing at their own pace.
The new embedded AI capabilities1 include:
- Prior authorization: Checks coverage, retrieves documentation requirements and pre-fills the information, attaches evidence, coordinates authorization activities, and supports payer interactions to help limit authorization-related delays and denials
- Clinical document quality integrity: Reviews reimbursement-related documentation, identifies documentation gaps, and surfaces contextual recommendations to help enhance documentation and coding quality
- Charge capture and integrity: Analyzes clinical and reimbursement context, modifiers, and service details within charge review workflows to help limit revenue leakage, limit denials, and optimize reimbursement outcomes
- Medical coding for professional fees: Analyzes clinical documentation and patient context to surface coding recommendations within existing workflows to support reimbursable claim readiness
- Appeal Management: Analyzes the remittance received, identifies payment variances, and automates the creation of appeal packets when a decision to appeal is made to help limit turnaround times
As part of its planned product direction, Oracle Health intends to further connect reimbursement workflows with enterprise financial operations, including financial reconciliation, revenue accounting, treasury management, and analytics through solutions such as Oracle Fusion Cloud Applications. This can help health systems connect reimbursement activity, financial operations, and enterprise analytics to support informed operational and financial decision-making.
To learn more, join the live action today at the Oracle Health and Life Sciences Summit by visiting https://www.oracle.com/health/health-life-sciences-summit/.
1 The new AI capabilities are planned for general availability in the coming months.
About Oracle
Oracle offers integrated suites of applications plus secure, autonomous infrastructure in the Oracle Cloud. For more information about Oracle (NYSE: ORCL), please visit us at www.oracle.com.
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Oracle, Java, MySQL and NetSuite are registered trademarks of Oracle Corporation. NetSuite was the first cloud company—ushering in the new era of cloud computing.
Future Product Disclaimer
The preceding is intended to outline our general product direction. It is intended for information purposes only and may not be incorporated into any contract. It is not a commitment to deliver any material, code, or functionality, and should not be relied upon in making purchasing decisions. The development, release, timing, and pricing of any features or functionality described for Oracle's products may change and remain at the sole discretion of Oracle Corporation. Products and features may vary country to country and timing of availability may depend on regulatory approvals in applicable jurisdictions.
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SOURCE Oracle
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