AI That Pays: Lessons from Revenue Cycle
summary
Healthcare revenue cycle drives severe losses — 40% of hospitals operate at a negative margin — and much waste comes from avoidable denials and manual prior authorizations. Ensemble builds an end-to-end RCM stack (EIQ platform) that stitches longitudinal structured and unstructured data, deploys multimodal LLM agents and a GenAI-powered clinical denials pipeline to assemble appeal packets, and automates prior-auth corrections. Measured outcomes include a 40% reduction in appeal preparation time, higher overturn rates, tracked ROI, and growing throughput across hundreds of hospitals.
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chapters (10)
- 0:00The state of healthcare
- 0:51From big tech to health tech
- 3:56AI's role in healthcare
- 4:48The burden of administration
- 6:42The cost of complexity
- 7:57Addressing claim denials
- 9:44Case study: clinical appeals
- 15:37Overcoming industry hurdles
- 16:40Moving beyond automation
- 17:49Future outlook
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