Speeding Payments and Reducing Denials for Hospitals with AI-Powered Utilization Management with Dr. Heather Bassett Xsolis

Dr. Heather Bassett, Chief Medical Officer at Xsolis, is using AI to reduce friction between healthcare providers and payers in the utilization management and mid-revenue cycle space. Their Care Level Score is a data-driven metric derived from patient data to reduce manual processes, denials, and administrative costs for both hospitals and insurance companies. The system enables automated approvals for clear-cut cases, reduces repetitive administrative work, and reduces delays in patient diagnoses and treatment initiation.   Heather explains, "We're an AI company at heart. We work with acute care hospitals across the US. We live in what's called the utilization management and mid-revenue cycle space, which, to put that in layman's terms, is we make sure that hospitals get paid appropriately for the care they provide their patients."   "We recognized fairly quickly that there was just a tremendous amount of complexity in manual processes and saw an opportunity to layer in automation and AI to help decrease a lot of the friction, get rid of the manual processes. And then a larger opportunity we saw was to ease much of the friction between hospitals and providers and payers. And that's really where we've helped our clients solve that problem and move the needle forward." "Unfortunately, there is an increase in the number of denials, and that requires a lot of rework and submission on the hospital side. And also, when you look at what's happening, when the hospital is submitting information to get authorization for that inpatient hospital-level of care, they're doing a manual review and sending information to the payer. Well, there's a UR, utilization review, nurse on the payer side who is doing exactly the same thing, and a good percentage of the time they're coming to the same conclusion."  #Xsolis #HealthcareAI #UtilizationManagement #RevenueCycle #PriorAuth #PayerProvider #ClinicalAI #HealthIT  xsolis.com Download the transcript here