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AGS Health: Ramping-up RCM Leveraging ‘AI with a Human Touch’

Labor shortages are one of the many adversities magnified during the COVID-19 pandemic. When combined with recent inflation, rising claim denial rates, increased regulatory scrutiny, and technology disruption, revenue cycle leaders are facing a perfect storm. AGS Health believes that a hybrid of their services with intelligent automation and high-touch support is the way forward in RCM. “From a clinical standpoint, labor shortages result in idle operating rooms or the postponement of non-surgical appointments, reducing patient volumes and revenue-generating opportunities. Meanwhile, understaffed back offices lead to diminished quality, extended claim submission times, and rising denial rates,” apprises Patrice Wolfe, CEO of AGS Health.

Patrice has 35 years of experience in the healthcare industry and considers RCM to be the most complex process and her favorite part. To counter lower revenue, slimmer profit margins, reduced collections, and unpredictable cash flow, she advocates investment in AI capabilities and automation that can drastically improve operations across all parameters. “By automating tedious and repetitive tasks, such as data entry, manipulation, and extraction, RCM leaders can redeploy their skilled team members to focus on more challenging and complex tasks that add greater value to the overall revenue cycle performance,” she explains. AGS Health has made substantial investments in developing technology-enabled services, which they refer to as ‘AI with a human touch.’

AGS Health’s RCM service suite caters to customers’ requirements throughout the RCM lifecycle. It starts with listening to customers by understanding their objectives and challenges and involving a team of seasoned experts for an in-depth analysis of the customer’s existing RCM processes. This is followed by designing a configured solution to help them achieve their goals. “Finally, as a committed partner, our team provides continual performance updates and actionable intelligence to support the long-term growth of our customers’ revenue cycle,” Patrice adds.

Overview of AGS Health’s RCM Services

AGS Health’s patient access services provide financial clearance for patients, including demographic, insurance benefits, and prior authorization verifications. The AGS Health team works directly with customers to identify and implement technology platforms that best suit their specific needs.

In the mid-revenue cycle, the company offers services to support professional fee and facility coding, risk adjustment coding, clinical documentation integrity (CDI), code auditing, and coding denial edits and appeals. These are complemented by a suite of technology offerings that include computer-assisted coding (CAC), computer-assisted CDI, auditing, and enterprise analytics. Combined, AGS Health attests that these solutions can maximize the accuracy, performance, and productivity of customers’ HIM functions.

On the back end of the revenue cycle, the company’s patient financial services provide support to ensure complete, accurate, and timely payment. These services include A/R account follow-up, denial avoidance and management, payment variance and under-payment identification, transaction services, billing and claim scrubbing, and complex claims management.

With the new AGS AI Platform, the company asserts that tedious and repetitive tasks can be managed autonomously throughout the revenue cycle. Cognitive digital workers can perform tasks and operationalize the next best actions based on data, heuristics, and machine learning. The platform’s built-in data fabric, intelligence engine, and actionable worklists allow it to learn and adapt to each customer’s processes and environment.

From eligibility and verification to coding, payment posting, and collections, the platform incorporates a full suite of RCM solutions that can be configured to meet the needs of any organization. AGS Health reports that any healthcare organization facing labor shortages, interoperability challenges, or difficulties scaling their operations to meet RCM workflow requirements can benefit from implementing these capabilities.

A true partner will demonstrate a personal investment in the success of their customer’s organization, instill confidence, support change management, and deliver results on schedule.

A Trusted Growth Partner for Healthcare Clients

AGS Health’s services and support define the core of the company’s value proposition. Since its inception in 2011, the company has evolved globally with a diverse 11,000 team members who are qualified and trained professionals with stellar performance records in their respective fields. Each team member is trained with award-winning programs and stays abreast of the latest best practices, code updates, and regulatory guidelines.

“Together, we are customer-centric problem solvers, serving more than 100 leading healthcare organizations across the United States, and technology has been central to creating the services and enterprise analytics we provide,” Patrice says, shedding light on the company’s cloud-based AI platform and custom automation development services. “A true partner will demonstrate a personal investment in the success of their customer’s organization, instill confidence, support change management, and deliver results on schedule. While the technology itself must be capable of meeting the needs, it’s that trusted partnership that will ensure our clients can mitigate risk and adapt to change.”

AGS Health supports its claims by touting a 95 percent customer retention rate, which it attributes to the team’s ability to drive outcomes, performance, and trusted relationships. One of the company’s notable customer success stories includes a large physician group with a substantial volume of aged A/R and high overhead costs. AGS Health ramped up services quickly with a comprehensive transition plan and analytics-based process improvement. In just three months, the customer collected more than $120,000, which provided a three-fold return on investment.

Another use case is with one of the largest academic medical centers in the Northeast that commissioned the company to provide coding denial management services. They had a large inventory building up rapidly, so they needed a partner to scale operations quickly and help them identify the root cause. The AGS Health team assisted them in decreasing their denial inventory by 72 percent in just six months, leading to $1.4 million in collections with a 40 percent OPEX savings.

Recently, AGS Health collaborated with a Florida hospital to automate patient collection notifications, which increased their collection rates from roughly 19 percent to about 43 percent. Similarly, they implemented automation into a 470-bed healthcare facility which decreased their DNFC days from 7.6 days to 4.7 days, enhancing their cash flow by $2,270,356. Their rejected claims decreased by approximately 30 percent with complex denials reducing by about 13 percent.

Creative Problem Solvers with a Solution-agnostic Mindset

Looking back at 2022, AGS Health has had nurturing relationships with customers, and expanded its service offerings for financial clearance, HCC coding, and patient financial services. To embrace change in the volatile state of the industry, the company exemplifies how working with the right partner can help mitigate the risks associated with new technology adoption and altering existing RCM processes. “Strategic growth partner” is the description that best resonates with the crux of AGS Health in terms of understanding the complexity of modern RCM. “No two revenue cycles are the same, including wide-ranging variations in people, processes, and technology.

With over a decade of industry presence, our cumulative experience is unrivaled,” Patrice describes. “We approach each new challenge with a solution-agnostic mindset. Our goal is simple—help healthcare leaders proactively solve problems, identify opportunities, and execute flawlessly so they can achieve the financial freedom to invest in their core mission of high-quality care delivery.”

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