Reinventing the patient payment process with medical billing artificial intelligence

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Medical Billing AI

With ever changing healthcare regulations, how can you save time and resources while increasing your patient pay collection potential?

ImagineAI™ is the artificial intelligence you need to streamline the medical billing process. Automated within ImagineBilling, this rule-based solution helps identify appropriate patient coverage, evaluates the patient’s ability to pay and customizes your billing messaging and methods for patient payment. Reduce denials and number of patient statements sent with advanced Eligibility and Propensity to Pay logic.

Take the guesswork out of patient collections

  • Charge Capture: ImagineAI™ validates existing patient insurance, checks eligibility and completes ID verification.

  • Patient Billing: The AI engine then determines propensity to pay and financial aid options for the patient.

  • Patient Follow-up: Based on the patient billing evaluation, the final step in the engine is to configure the number of statements and write-off rules.

Charge Capture:
Validate existing patient insurance, eligibility and ID verification

Step 1 (Setup) — User sets up location rule to enable ImagineAI™ Eligibility services for their practice. The "EligibilityVisitCreatedThreshold" setting allows the ImagineAI Eligibility check to pull visit information for evaluation at a default of 6 months. This setting prevents the system from running unnecessary checks on outdated visits.

Step 2 — The Eligibility task will first look at the primary insurance listed on the visit, if any. If the patient visit does have a primary insurance listed, ImagineAI™ will validate eligibility for that specified payor. If the patient is eligible for the specified payor, ImagineAI will gather and return the relevant data. If the patient is not eligible for the specified payor, ImagineAI will run an ID Verification check.

Step 3 — If ImagineAI™ discovers that a patient is not eligible, it will then run an ID Verification check for the patient and will return the patient’s current demographic data.

Patient Billing:
Determine propensity to pay and financial aid options for patient

Step 1 — Set up "Financial Service – Propensity to Pay" task. This will assign a patient score based on his or her payment history recorded in ImagineBilling. Five grades are established in this section ranging from "A - Very High" to "D - Very Low" based on the patient’s payment history. The score will indicate how likely a patient is to pay his or her current balance based on his or her history of payments. If the patient has a current internal score of ‘B,’ ‘C,’ or ‘D,’ or if the patient does not have an internal score at all, then Imagine will check to see if the patient has Medicaid. If the patient does have Medicaid, the system will not run an ImagineAI Propensity to Pay check. If the patient does not have Medicaid, Imagine will flag the patient as needing a new score and will place the account on a statement billing delay. This check saves you from running unnecessary checks on patients who regularly pay bills in a timely manner.

Financial Aid:
If ImagineAI™ returns a patient score of ‘D’ or ‘E,’ it will run a Financial Aid check for the patient.

This check will return a percent of Federal Poverty Level (FPL) range in which the patient falls. This information is useful in determining whether you should expend resources following up on patients with scores of D or E.

Key Benefits of ImagineAI™

Streamlines patient collections by discovering the right coverage

Ensures appropriate demographic information is correct

Established statement strategies and patient pay assistance

Erases manual process and performs in a fraction of the time and cost

A Word From Our CEO

"The manually-intensive process of verifying coverage and working to obtain patient payments is no longer efficient. We have pioneered the technology behind ImagineAI™ to create a truly unique, market-leading product that produces results in a fraction of the time and cost."

— Sam Khashman, ImagineSoftware CEO & President

Download the White Paper

Artificial Intelligence (AI) is quickly becoming a reality that will alter the future of healthcare in all aspects — not just in the detection of disease. In this white paper, we take you through current applications of AI in medical billing to improve billing staff workflow, common medical billing mistakes and the patient collection process.


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