To harness the full power of ambient AI, revenue cycle leaders must drive the conversation or risk rising coding errors, ballooning denials, and lost revenue.
RCM decision-makers report a 90% usage rate of AI (versus 63% of IT decision-makers) and are also much more likely to see value in using AI in RCM (86% vs 52% of IT and 44% of executive/financial leaders). Despite these numbers, RCM leaders are rarely involved in steering technology choices from day one.
If enterprise health systems truly want to harness the full power of ambient AI, revenue cycle leaders must drive the conversation or risk rising coding errors, ballooning denials, and lost revenue.
Commure’s Chief Strategy Officer, Ian Shakil, joined a panel of ambient speech technology leaders at the 2024 Revenue Cycle Summit to discuss this critical aspect of ambient AI adoption.
Why RCM Leaders Must Be at the Forefront of Ambient AI Adoption
Revenue cycle leaders stand at the intersection of patient care and financial viability, yet too often they’re left out of early conversations about ambient AI solutions. When these tools are selected purely to reduce clinician “pajama time,” crucial requirements for coding, compliance, and reimbursement may be overlooked. Inadequate or imprecise documentation means additional work on the back end for RCM teams, higher rates of denials, and missed revenue opportunities.
By having RCM leaders participate in solution vetting from the outset, health systems can ensure that coding awareness, denial prevention, and payer criteria are woven into the product’s workflow. Clinicians can then focus on accurate documentation with the help of subtle nudges from ambient AI at the point of care, and allow revenue cycle teams to focus on optimizing reimbursement rather than retroactively fixing issues. This proactive collaboration ultimately positions RCM leaders as strategic partners who help unlock the full value of ambient AI technology.
Key Criteria for Evaluating Ambient AI Solutions
Selecting an ambient AI platform isn’t just about automating note-taking; it’s about building a foundation that supports efficient clinical documentation and robust revenue cycle outcomes. Here are three non-negotiable factors RCM leaders should demand from any potential vendor:
Intelligence & Contextual Awareness
A truly “intelligent” system goes beyond transcribing conversation. It should ingest past patient history, relevant diagnoses, and contextual cues in real time, ensuring each note is precise and complete. By nudging clinicians to document specific details—like HCC codes or modifiers—combining ambient AI with RCM preempts downstream queries and boosts coding accuracy.
Metrics & ROI
Time savings for clinicians may spark initial excitement, but RCM leaders need solid evidence of financial gains. Evaluate solutions by how they impact CDI query rates, decrease denials, and increase average reimbursement per visit. The more granular these metrics, the easier it is to pinpoint exactly where the AI is driving revenue capture and where adjustments may be needed.
Scalability & Flexibility
From multiple specialties to multiple languages, modern health systems are complex. A solution must adapt to varied care settings and be versatile enough to accommodate hospital inpatient needs, outpatient clinics, and everything in between. When growing or shifting payment models health systems require a platform that can scale rather than a rigid point solution that only works for a single slice of operations.
Measuring Success and Tracking ROI
Ambient AI solutions can transform clinician workflows—but without clear metrics, it’s tough to pinpoint precisely how much value they add. Here are three key areas to focus on and ensure all stakeholders are bought into before moving forward with a solution:
Clinical & Financial Data
Time savings, while important for reducing burnout, must be linked to clear revenue cycle improvements. Some health systems track metrics like average additional reimbursement per visit, while others focus on the uptick in the number of patients scheduled per week. Tying productivity gains to financial outcomes—rather than just survey data—is crucial for securing ongoing support and expansion of ambient AI initiatives.
Service Line–Specific Measurements
Every specialty has different coding, documentation, and quality requirements. In primary care, it may be about capturing HCC codes and add-on services. In the ED, a major focus could be critical care capture. Meanwhile, value-based care programs hinge on proper HCC re-capture and closing care gaps. RCM leaders should expect vendors to offer specialized metrics that reflect each department’s unique workflows and financial goals.
Clinician Burnout & Patient Experience
Ambient AI’s impact goes well beyond any single encounter. One of the largest contributors to clinician burnout is excessive documentation. By easing the after-hours charting burden, ambient AI enables providers to stay focused on patient care rather than note-taking. At the same time, patients benefit from more engaged face-to-face interactions. Tracking improvements in staff satisfaction, lower turnover rates, and positive patient feedback confirms that the technology not only boosts revenue capture but also enhances the overall care experience.
Looking Ahead: The Future of RCM in a Post-AI World
Ambient AI has moved beyond simple note-taking. The next phase of innovation will blend documentation, coding, and even payer interactions into seamless workflows, making RCM activities more automated and less burdensome. Over time, health systems may see real-time prior authorizations, near-instant claim adjudication, and more accurate risk adjustment—all fueled by increasingly “invisible” yet powerful AI-driven assistance. Rather than merely amplifying the status quo, leaders must challenge their technology vendors to reimagine care delivery and reimbursement in a way that unlocks new levels of efficiency and precision.
For revenue cycle leaders, this future points to a strategic pivot. Ambient AI solutions that were initially championed for clinician well-being are now demonstrating measurable business impact, with the potential to reshape how financial risk is managed. Yet these tools will only fulfill their promise if RCM teams drive the conversation, insist on measurable ROI, and ensure that solution providers are fully aligned with both clinical and financial objectives.
Discover the future of healthcare, powered by Commure. Trusted by some of the largest health systems including Tenet, Adventist, and Sutter Health, the Commure platform not only has deeply integrated RCM and ambient AI solutions, but a whole host of other products including staff duress, patient engagement, and RPM. Speak with one of our product experts today to learn more.
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