May 2, 2025 - In the early 2010s, few strategies held more promise than “robotic process automation.” It meant to systematize the drudgery of most workers’ jobs by launching software “agents” to handle the grunt work. Google this term today and you will find it is almost universally invoked as a failed experiment — especially in healthcare, in processes like payment coding and billing automation.

The challenge was healthcare data entry work was too complex and heterogeneous to write rules for. However, the idea is now back, thanks to large language models (LLMs), which appear to succeed where their predecessors failed. They are driving significant changes within revenue cycle management.

This article explains the value of revenue cycle management for your healthcare company and why the opportunity has grown more lucrative now that some types of software operate themselves.

Read: 4 Ways to Strengthen Any Healthcare Company → 

What is Revenue Cycle Management (RCM)?

Revenue cycle management is the strategy for stitching together all the systems, workflows, and people involved in collecting revenue into one streamlined process. This includes electronic health record systems, patient portals, internal ticketing systems, insurance interfaces, and anything else involved in sending invoices and receiving payments — including paperwork and paper checks.

We likely do not have to remind you how convoluted the process of gathering and validating patient billing information can be. There are no fewer than 10,000 possible billing codes for indications and complications, and as traditional Medicare and Medicaid payers continue to shift to managed care plans, there may be additional criteria that must be met in order to properly bill a claim.

A successful RCM system must address:

• Gathering patient information
• Verifying insurance
• Identifying pre-certification requirements
• Processing the information in your systems
• Capturing and coding charges
• Managing claims
• Patient billing
• Collections and follow-up
• Reporting

For healthcare companies that successfully complete their revenue cycle processes, there are many benefits. Improved cash flow is an important result, but organizations that successfully harness technology will also see cost-savings in terms of labor. Organizations that bill quickly after services are rendered, has less revenue caught up in “aging receivables," and incurs fewer denied claims will have better financial results and will be well-positioned to respond to other challenges in the healthcare industry. However, RCM is just as valuable — perhaps even more so — to patients.

Patients struggle to navigate a multi-payer system and may wind up in your collections process out of genuine confusion. Sixty-five percent say coordinating and managing healthcare is overwhelming and time-consuming, finds the American Academy of Physicians Associates. Another study with the disparaging title “A Patient’s Journey to Pay a Healthcare Bill: It’s Way Too Complicated,” found 87% of consumers were surprised by a bill they received and 40% find medical bills confusing.

“The topic of RCM spans disciplines, from the graphic design of bills to building data pipelines, integrating ERP systems, and upgrading systems of record,” says Steven Anderson. “Anything that helps streamline the cycle of recognizing revenue is part of this process.”

With new technology, some parts of that process are already growing more integrated — occasionally, on their own.

How RCM Suddenly Grew Far More Useful

Clinics, physicians’ practices, skilled nursing facilities, dentists’ offices, and other healthcare companies are right to be skeptical of new technology that promises to save them headaches. However, this time, the results bear themselves out. Seventy-four percent of hospitals have implemented some form of revenue-cycle automation which includes AI and robotic process automation, finds the American Hospital Association. In one of the most direct applications, it can make call centers 15-30% more productive.

The difference is these machines now think. Large-language models may stop short of general intelligence but can understand written and spoken language with enough clarity to reason through problems. Whereas prior generations of RPA systems were just complex lists of “If this happens, then that” rules, LLMs exhibit creativity in the technical definition of the word — they are able to understand undocumented workflows and change them. They can, through repetition, handle tasks they were not explicitly designed to do. For example, in 2023, the LLM ChatGPT by OpenAI passed portions of the medical license exam.

This type of autonomous technology is particularly useful in the revenue cycle process. One Californian community health care network uses AI to review claims. “The AI can flag those likely to be denied based on historical payment data and payer adjudication rules,” says the American Hospital Association. As a result, the health system experiences 22% fewer prior-authorization denials and 18% fewer denials for service not covered, without adding any additional staff.

AI in RCM tools has the potential to:

• Identify and correct billing errors before submission
• Highlight errors in medical records
• Spot patterns and trends in billing data
• Submit and track insurance claims
• Assist with compliance and regulatory updates

However, there are important things to consider before you explore AI-powered RCM for your own healthcare company. You must build it upon a strong, digital foundation, or it may not be worth building at all. You also need to ensure that you have invested in your people. The best technology in the world is rendered useless if the staff do not know how to use it.

Without Strong Data, There is Little to Automate

Revenue cycle systems and AI tools can only help with data they can access. For many healthcare companies which have long underprioritized their financial data, this is the moment of reckoning. According to our research, 30% of healthcare companies have not updated their ERP system in the past five years and one in 10 have not updated it in the past 10 years. Older systems are much less likely to offer AI features, nor integrate well with new ones, and could hinder any RCA initiative.

At the same time, any move toward modern, cloud-based software must occur with an equal investment in cybersecurity. Of all data, healthcare data fetches the highest price on the black market and healthcare companies are disproportionately the target of cybercriminals. Anything online is potentially hackable, especially as quantum computers invalidate classic cryptography. According to a survey of 1,000 business leaders, 32% of companies have experienced a cyber incident or breach in the past 24 months and just 54% provide any type of cybersecurity training to staff — to say nothing of launching a responsible AI use policy.

Between HIPAA and the No Surprises Act, it should go without saying that healthcare companies cannot simply launch open-internet LLMs for their sensitive data. It requires a whole program of preparation, from data cleansing to ERP modernization to cyber-hardening.

Investing in Your Staff Will Yield Dividends

There will always be a human component to automation, and the truly successful organizations find a way to get the best results out of both. Healthcare providers should ensure that they have well-defined training programs in place to enable their staff to use the technology to the fullest extent.

Investing in AI for your RCM process may seem overwhelming, but the payoff is great. It allows providers to significantly increase cashflow without increasing headcount and frees up staff to focus on other organizational goals.

At Citrin Cooperman, we assist our clients with both the revenue cycle management and the technology components of your business. If you would like to learn more about how revenue cycle automation could work at your healthcare company, reach out to Barbara Notardonato-Cole.