In a recent article from the Healthcare Financial Management Association (HFMA), health systems shared how they’re pushing back against AI-driven tools used by payers to deny claims more aggressively—and automatically. The takeaway? Automation without visibility isn’t just ineffective, it can be harmful.
It’s a fact, the industry has entered a crusade for automation – at every healthcare conference, the booths are plastered with the same buzzwords: AI. RPA. Automation. Ambient listening. Intelligent bots. The excitement is real—but so is the disconnect.
Too often, revenue cycle leaders are sold tools that automate the wrong tasks. Think about bots calling bots, portals pinging other portals—all exchanging vague, incomplete data. That’s not intelligent. That’s noise.
Even RPA (Robotic Process Automation), which can be useful when deployed correctly, requires clean, reliable data to function. Without it, automation just repeats inefficiencies at scale—and often at high cost.
And as for the biggest buzzword of them all—AI. Artificial intelligence is only as smart as the data it’s trained on. If your AI engine is relying solely on the standard data sets found in every PM and EHR system, it will miss the deeper issues. The real answers are buried in human-generated data—the actions your staff take every day to move claims forward. Without capturing and analyzing that manual work, you can’t truly diagnose the health of your revenue cycle.
The unfortunate truth is that many organizations jump to automation before they even understand where their breakdowns are. That’s where MedEvolve’s Effective Intelligence® makes a difference. By analyzing human behavior and interaction with claims across the revenue cycle, MedEvolve helps practices discover where real work is being done—or wasted.
Seefeld shares a real-world example:
“We recently worked with a group that thought authorizations were their biggest problem. But the data told a different story—over 60% of their manual touches were related to underpayment analysis.”
Without MedEvolve, they would have continued down the pathway to evaluate authorization automation solutions, missing the fact that their team was wasting time on underpayments—many of which stemmed from inconsistent training on contract management variances. Since then the clients has centralized the payment compliance process allowing the majority of AR representatives to focus on other high priority denials.
Instead of guessing, MedEvolve shows you where you’re losing margin, why it’s happening, and who is accountable. That allows teams to take targeted action. The healthcare industry doesn’t need more automation. It needs intelligent prioritization.
“Don’t waste your time and money on technology that solves what you think is your biggest problem. Use data to know your real problem,” Seefeld advises.
Before investing in the latest AI-powered platform, ask yourself: Do I know what’s really broken in my revenue cycle? The bottom line is you can’t fight bots with more bots. Not until you know exactly where your process break downs are occurring. Not until you understand what work is being done manually, why, and by whom. Otherwise, you’re just layering automation over chaos.
Start with Effective Intelligence®—and let your data tell the truth.
Matt Seefeld, Chief Executive Officer at MedEvolve, brings over 24 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence solution and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014. Matt ran global sales for NantHealth and provided consulting services for healthcare technology and service businesses nationwide, prior to joining MedEvolve full-time.
Effective Intelligence combines Patient Financial Clearance Automation, Medical Billing Workflow Automation, and Real-Time RCM Analytics in a cloud-based platform designed to integration with your current EMR/PM technology to measure the effectiveness of your RCM staff.
Review and assess your practice’s financial status in 5 min or less and know exact where you are losing money and why. Measure the work effort of every revenue cycle employee, incentivize and retain your top performers, and help employees that need improvement.
You can prevent most common denials, rejections and write-offs during the scheduling and pre-registration process in advance of the appointment. Configure checkpoints and use central task management to quickly clear patients and keep your front office staffing needs at a minimum.
As team members log in to the web-based application and record each “touch” of a claim, outcome, and next task, key data points are recorded like who completed the task and when, outcome, task notes, internal / external messages sent, collection success and other data points that feed into our real-time analytics.
Reduce RCM labor dependence with financial clearance, insurance A/R, & patient A/R automation modules with real-time analytics.
Increase productivity and simplify front & back office processes while keeping your staff focused with our flagship PM system.
Before investing in the latest AI-powered platform, ask yourself: Do I know what’s really broken in my revenue cycle? The bottom line is you can’t fight bots with more bots.
The creator of the Effective Intelligence® suite for revenue cycle optimization will lead the next phase of innovation & growth at MedEvolve.
As healthcare leaders look for the low-hanging fruit for AI and automation investments in the revenue cycle, there are three things that should be considered to achieve maximum impact on
Where are mistakes happening & what are the proven strategies to fix them? View the infographic and take product tours of Ei Suite.
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