Revenue Cycle Automation

Core Introduction

AGS Health is transforming the role of automation in the revenue cycle with Agentic AI—a new class of intelligent digital agents designed to collaborate, adapt, and deliver real business outcomes. These AI agents go beyond simple task automation, bringing the power of decision-support and human-like reasoning to complex healthcare workflows. Whether needing single-purpose digital agents or multi-agent systems, AGS Health can help orchestrate a digital workforce and unlock the full potential of the revenue cycle.

Main Features

• Collaborative Team Empowerment: AI RCM agents work alongside staff, understanding natural language, learning from instructions, and offering suggestions so the team can focus on strategic oversight and quality assurance.
• Workforce Adaptability at Scale: AGS digital agents allow RCM operations to scale without proportional headcount increases by adapting to evolving rules and workflows, reducing IT burdens, and enabling rapid onboarding of new facilities, specialties, and payer types.
• Outcome-based Autonomous Decisions: Agentic automation solutions focus on outcomes by dynamically analyzing context, providing data-driven recommendations, and prioritizing the next best actions based on unique goals and strategies.
• Secure Governance: Ensure compliance, data integrity, and controlled access across all activities.
• Seamless Synchronization: Keep systems, agents, and people aligned in real-time for smooth operations.

Key Digital Agent Applications & Benefits Delivered

• Authorization Agent: Automates prior authorization by identifying payer-specific requirements, gathering supporting documentation, and submitting requests electronically. Benefits: 50% of production performed by digital agents, 90-95% accuracy in IV and authorization determination.
• Eligibility Agent: Verifies insurance coverage and benefits, flags inactive coverage or COB conflicts. Benefits: Reallocation of labor to complex tasks, reduced touches and faster processing, annual savings ranging from $72K to $194K.
• Denials Agent: Automates denial intake, classification, and routing based on payer-specific rules and remittance data. Benefits: 98.1% automated success rate, 100% TAT adherence, over $18M recovered annually, more than 40% reduction in AHT, 15% increase in productivity.
• Appeals Agent: Automates appeal packet creation and submission by compiling denial details, EOB, clinical documentation, and payer-specific templates. Benefits: Over 10K automated appeals prepared/submitted per month, replaced need for over 50 FTEs, 98% accuracy.
• Other Common Applications: Patient Access Agents (Pre-certification/adjudication, demographic/address validation), HIM and Clinical Agents (validation/classification/indexing of faxed medical records, release of information, chart requests, mail processing), Patient Financial Service Agents (payment posting/reconciliation, claim status check/updates, remittance processing, transition to collect).

Deployment Process

1. Research: Automation engineers conduct research interviews with key stakeholders to understand current needs and challenges.
2. Analyze: Perform a gap analysis and feasibility assessment for deploying digital agents, including documentation and integrations with key systems.
3. Propose: Develop a proposal detailing development timelines, projected ROI, and contractual agreements.
4. Implement: Upon contract completion, engineers rapidly develop and deploy digital agents.
5. Monitor: AGS Health maintains the digital agents and provides updated data based on feedback and results.

Support & Analytics

• Flexible Support Models: Fully Managed Services (build using in-house technologies, optional performance monitoring/upkeep) and Self-Managed Services (leverage AGS development resources ad-hoc while handling monitoring/upkeep in-house).
• Analytics and Reporting: Intuitive and customizable dashboards to maintain, monitor, and report on digital workforce performance. Includes simple cloud-based implementation, customizable dashboards, real-time reporting, and seamless data integration with EMR, ERP, and practice management systems.

FAQs

• Difference from traditional RPA: Agentic automation is more dynamic and intelligent. Key differences include: Autonomy (makes decisions without predefined rules), Contextual awareness (understands intent/context), Goal-oriented (pursues specific business outcomes), Multi-step reasoning (plans, learns, adjusts), Inter-agent collaboration (multiple agents coordinate like human teams).
• Implementation Time: Typically follows a phased approach, with MVP use cases going live in 4–8 weeks and full deployment scaling in 3-6 months.
• Implementation Preparation: Identify high-friction workflows; engage stakeholders (operations, IT, compliance, revenue integrity) early; define clear goals (e.g., faster denial resolution, improved DSO); start small and scale.
• Exception Handling: Employs a hybrid human-in-the-loop model. When a denial requires clinical judgment or policy escalation, the agent flags the task for human review, routes it to the appropriate team, and learns from human input over time.
• Compliance: AGS Health’s agentic AI is HIPAA-compliant. Solutions are hosted in secure, HITRUST-certified environments, encrypt data at rest and in transit, and operate within strict access controls and audit trails.
• Internal Resources Required: IT for access provisioning and data mapping, Operations to define workflows and validate use cases, Compliance/security to review controls. AGS provides a dedicated implementation team to minimize internal impact.

Pricing Information

No specific pricing information is provided on the page; requires contacting the official team.