From integration to payer interactions: How leaders are shaping AI’s role in RCM
AI has been firmly integrated into revenue cycle management (RCM) as organizations look to boost efficiency, enhance patient experience and prepare for a rapidly evolving future. In a recent discussion hosted by Becker’s Healthcare and Zotec Partners, leaders shared strategies for balancing cutting-edge innovation with operational realities.
The conversation featured insights from Steve Sevy and Mike Mihalczo, both national vice presidents of enterprise solutions at Zotec Partners, alongside revenue cycle leaders from health systems nationwide.
Here are four key takeaways from the conversation.
1. Seamless integration is essential
Health system executives emphasized that while new AI tools offer promise, their long-term value depends on smooth integration with existing EHR systems. Mr. Sevy highlighted that health systems are looking for strategies to incorporate new AI technologies in a way that enhances their RCM efficiency but is built for long-term productivity.
Participants described weighing the benefits of “best-of-breed” external solutions against the operational ease of staying within the EHR ecosystem. Some noted that while APIs and bolt-on tools can be effective, deep integration reduces workflow disruptions and enables scalability.
“It’s really the patient I am worried about,” the CEO of a community hospital on the East Coast said. “Then that next step is to reduce the burden on staff. If it’s not integrated, it’s going to cause more issues.”
2. Payer Interactions
Several leaders identified real-time claims adjudication, submitting a claim and receiving payment during the patient’s visit, as the industry’s north star. While it remains aspirational, interim advances such as automated denial management and payer policy integration are moving health systems closer to this goal.
The chief revenue cycle officer for a non-profit hospital system on the West Coach said her team is piloting AI-generated appeal letters for complex denials and exploring partnerships to embed payer policies directly into authorization workflows.
“We need our payers to come front and center and to come together,” she said. “They have AI, they’re ahead of us in this space and for our patient as well as for financial sustainability, we’ve got to be able to come together and work on this.”
3. Augment, not replace
Automation can improve efficiency, but panelists stressed that AI should augment, not replace, staff expertise. Mr. Mihalczo underscored the importance of maintaining a state-of-the-art consumer experience that is digitally enhanced but retains the human touch.
Leaders also addressed workforce concerns, noting that automation should enable staff to focus on higher-value tasks rather than eliminate roles.
“There’s always fear when we talk about machine learning and automation that it just automatically means fewer people,” The CFO for a health network on the East Coast said. “What it really means is people doing what people need to do, being augmented by AI and other automation bots. How you approach it by reducing fear among your teams is going to be very important.”
4. Change management and ROI tracking
Panelists agreed that successful AI implementation requires strong change management, clear ROI targets and leadership alignment. This includes involving compliance, IT and operational teams early in the process and setting milestones for evaluating performance.
Some leaders advised a “fail fast” mindset — ending pilots quickly if they don’t meet expectations — while others preferred to wait until technologies are proven at peer organizations before investing. Across the board, participants stressed that any AI adoption must ultimately advance core goals: improved patient experience, stronger financial performance and streamlined operations. Leaders who can integrate new tools without losing sight of long-term strategy and the human relationships at the heart of healthcare will be best positioned to thrive in the next era of RCM.
“Understand what your strategy is, where you want to go, and what kind of partners are going to evolve with you as you go,” Mr. Sevy said. “Do you want to take a wait and see approach? Those cycles used to be a year or two to do that, and now it might be three or six months. It’s an exciting time and the discussion around integration is really key.”
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