Managing the financial journey of patient care is no easy feat for today’s healthcare providers. Hospitals and health systems frequently encounter challenges such as staffing shortages, intricate payment regulations and a high volume of denied claims.
These issues typically result in significant administrative overhead and reduced revenue. However, a promising solution is emerging in the form of agentic artificial intelligence (AI).
Agentic AI offers a transformative approach by autonomously managing and automating challenging RCM tasks. Distinct from conventional automation tools, agentic AI possesses the capability to make decisions, integrate new information and adapt its operations in real time.
Agentic AI goes beyond simple automation to perform complex, multi-step tasks with very little human help. While it shares some features with other AI technologies, like generative AI, agentic AI stands out because it can act independently.
John Landy, Chief Technology Officer at FinThrive, explains in a TechTarget interview that while agentic AI has similarities with other workflow technologies, its ability to work on its own makes it different.
"When we talk about agentic AI overall, it’s similar to other workflow technology in the past, but it’s autonomous," said Landy. "It allows for decision-making, and it's integrated. So, by nature of it being in the AI realm, which is broad in general, it’s integrated with data systems."
Agentic AI autonomously achieves objectives by analyzing data, acquiring new information and initiating actions. For example, it can independently resolve denied claims and dispatch appeals. The system continuously adapts based on outcomes and streamlines workflows by coordinating tasks across disparate systems and teams, enhancing overall efficiency.
This combination of independence, learning and coordination allows agentic AI to tackle the ongoing challenges of the revenue cycle in ways that previous technologies could not.
Agentic AI can be used throughout the revenue cycle to automate tasks, make things more accurate and reduce administrative work.
Submitting correct claims is vital for a healthy revenue cycle. Agentic AI automates this by analyzing payer contracts to learn the specific rules for each. It then gathers the necessary information from the electronic health record (EHR) and other systems to ensure each claim is complete and accurate before submission.
This includes pointing out missing documents and correcting codes in real-time, which helps reduce initial claim denials.
The prior authorization process takes a lot of time. Agentic AI simplifies this by automatically collecting clinical documents and patient data from the EHR. It reviews payer policies, fills out and submits authorization forms and tracks the status of each request. This full automation speeds up the process and allows staff to focus on more complex cases.
When claims are denied, agentic AI can analyze denial codes to find patterns and root causes. It gets the data needed to fix errors, prioritizes denials based on how much revenue they impact and writes and submits appeals, helping organizations get paid faster and lower their overall denial rate.
"We believe that the denials appeal process is another really good use case," explained Landy to TechTarget. "If you could think about today, humans are essentially handling denials, calling payers to get the details of what happened, packaging together an appeals packet and resubmitting the claim to payers. To perform that work at scale for large organizations requires a lot of people."
Using Agentic AI in healthcare revenue cycle management offers big advantages:
Like any new technology, using agentic AI comes with potential risks.
Protecting patient data is crucial, especially as AI agents access information across an organization and from other providers. Landy stressed the importance of IT security reviews when choosing vendor solutions.
“Vendors also have to make sure they're investing in the plumbing that allows you to really leverage AI," Landy explained. "So, for example, investing in the whole data platform, which some vendors are going to try to find a shortcut for."
Landy also warned vendors may exaggerate their AI capabilities. He encourages a thorough vendor evaluation to confirm that a tool can deliver real results
The ability of Agentic AI is poised to transform RCM. Its ability to independently manage complex, end-to-end processes opens the door to a future where healthcare organizations operate more efficiently, recover revenue faster and adapt more easily. By automating routine tasks, agentic AI allows human teams to focus on high-value work that requires critical thinking and specialized skills.
As the technology advances, its role will continue to grow. Continuous innovation is essential, and partnering with a trusted technology leader is critical to managing this evolution successfully. For organizations ready to move beyond traditional automation, adopting agentic AI is a natural next step toward a more stable and efficient financial future.
FinThrive is leading the way in modernizing RCM through agentic AI. Powered by FinThrive Fusion™, an intelligent data platform that integrates, cleanses and governs data, FinThrive enables smart, compliant decision-making across the entire revenue lifecycle. Every AI interaction is designed to meet strict standards for privacy, security and regulatory compliance, helping healthcare organizations achieve operational excellence.
Interested in learning more about Agentic AI and how it can help your organization? Don’t hesitate to reach out by filling out the form below.