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Nanonets RCM Deck

The document outlines a transformative approach to Revenue Cycle Management (RCM) using AI technology, resulting in significant improvements such as a 67% reduction in avoidable denials and faster billing processes. It details a step-by-step workflow for patient intake, pre-authorization, claim submission, and denial analysis, emphasizing automation and real-time insights to enhance efficiency and cash flow. Nanonets aims to create an autonomous AI RCM team to maximize revenue collections and reduce costs.

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Omer Ahmad
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6 views16 pages

Nanonets RCM Deck

The document outlines a transformative approach to Revenue Cycle Management (RCM) using AI technology, resulting in significant improvements such as a 67% reduction in avoidable denials and faster billing processes. It details a step-by-step workflow for patient intake, pre-authorization, claim submission, and denial analysis, emphasizing automation and real-time insights to enhance efficiency and cash flow. Nanonets aims to create an autonomous AI RCM team to maximize revenue collections and reduce costs.

Uploaded by

Omer Ahmad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Higher Reimbursements disbursed faster

Transform your
Revenue Cycle
Management
Continuous Improvement

ROI on RCM Transformation

● 67% Reduction in avoidable denials

● Reduce A/R Days < 30

● 50% increase in copay collections

● Over 30% reduction in cost to collect

● 100% control on Agents for CIOs


(build in house Agentic Capability)
Product Proposition

Product Capability

Faster Registration:
AI-agents get patients in faster, through automated reading of
documents, insurance and verification
Address Upfront:
AI-agents handle high risk cases with insurance discovery, eligibility
checks, pre-authorization, and scrubbing

Bill Faster:
AI-agents will help the billing department ensure all claims
follow Payor contracts to get paid faster and reduce denials
Recover More:
Reconcile Faster, identify variance, reduce underpayments, file
appeals and get paid the expected amount

Continuous Improvement
Integrated dashboards to allow hotspot identification for
improving denied claims
Summary Offering

Nanonets is building an AI RCM team that will work autonomously as


the to maximise revenue collections and help save costs
Pre-submission workflow

Step 1: Patient Intake Agent (Predictive + Assistive AI)

PROCESS
1. Processes referrals and creates a new order
2. Validates insurance details in real-time and talks to the patient for
updated details
3. For invalid verification, Discovery agent hits alternate payors /
medicare / medicaid to get relevant information

EXAMPLE
AI flags that a patient's insurance coverage will expire before the service
date and alerts staff to confirm eligibility or collect updated insurance
details.

OUTCOME
Prevents rejections due to ineligible patients.
Pre-submission workflow

Step 2: Pre-Authorization Assistance (Assistive AI)

PROCESS
1. Assistive AI identifies which procedures or services typically require
pre-authorization based on payor data.
2. Assistive AI gathers necessary documents to establish necessity.
3. Communicates with payers over call or electronically to get
authorisations approved

EXAMPLE
AI identifies that an upcoming MRI requires pre-authorization and lists
the required forms and payor contact details.

OUTCOME
Avoids denials due to missing pre-authorizations.
Pre-submission workflow

Step 3: Real-Time Claim Scrubbing (Assistive AI)

PROCESS
Assistive AI validates claims as they are being created, flagging errors
like mismatched diagnosis and procedure codes, missing modifiers, or
incomplete fields.

EXAMPLE
While submitting a claim, the system detects that the ICD-10 code does
not justify the CPT code and suggests an alternative.

OUTCOME
Produces clean claims ready for submission, reducing rejections.
Submission workflow

Step 4: Payor-Specific Rule Validation (Assistive AI)

PROCESS
AI cross-references claims against payor-specific rules for coverage,
formatting, and bundling requirements as per the payor contract

EXAMPLE
AI detects that a payor requires an attachment (e.g., lab report) for a
specific procedure and prompts staff to include it before submission.

OUTCOME
Ensures claims meet all payor requirements, increasing first-pass
acceptance.
Submission workflow

Step 5: Claim Submission and Monitoring (Billing Agent)

PROCESS
Agent reviews the procedure codes, and creates a bill within the
Practice suite management system before the bill is approved to be
sent to the clearing house

EXAMPLE
AI predicts that claims to a specific payor experience frequent delays
for certain procedures and suggests proactive follow-up.

OUTCOME
Reduces delays and improves cash flow.
Post-submission workflow

Step 6: Automated Denial Analysis (Predictive AI)

PROCESS
Predictive AI categorizes denied claims by reason and payor trends,
identifying common patterns.

EXAMPLE
AI identifies that most denials are due to a specific modifier error and
highlights corrective action for future claims.

OUTCOME
Enables targeted process improvements.
Post-submission workflow

Step 7: Appeal Letter Generation (Generative AI)

PROCESS
Generative AI drafts appeal letters tailored to denial reasons, including
relevant codes and documentation.

EXAMPLE
A denial for "insufficient medical necessity" triggers AI to create a letter
citing supporting clinical notes and guidelines.

OUTCOME
Faster appeal resolution and reduced administrative burden.
Continuous Improvement

Step 8: Denial Trend Reporting (Predictive AI)

PROCESS
AI generates detailed reports on denial trends, payor performance,
and staff accuracy.

EXAMPLE
A report shows that 15% of claims denied by a payor are due to incorrect
documentation, prompting targeted training for staff.

OUTCOME
Continuous process improvement through actionable insights.
Continuous Improvement

Step 9: Staff Training Assistance (Assistive AI)

PROCESS
AI delivers real-time guidance and training based on recent denial
cases and updated payor policies.

EXAMPLE
After identifying a pattern of modifier-related denials, AI provides
step-by-step instructions to coders on correct usage.

OUTCOME
Improves staff accuracy and compliance.
Continuous Improvement

Step 10: Integrated AI Dashboard (Predictive + Assistive + Generative)

PROCESS
A centralized AI-powered dashboard provides real-time insights into
claim statuses, denial rates, and process bottlenecks.

EXAMPLE
The dashboard highlights claims pending pre-authorization, tracks
appeal progress, and identifies high-risk claims.

OUTCOME
Provides end-to-end visibility, reducing silos and enabling
proactive management.
Continuous Improvement

Transforming RCM
Typical

● Manual Data Entry & Reconciliation


○ Billing teams often key in payment data from Explanation of Benefits (EOBs) or Electronic Remittance Advices (ERAs)
manually, leading to transcription errors and high labor costs.
○ Slow processes keep Days in A/R (Accounts Receivable) elevated and delay cash flow.
● Fragmented Systems & Workflows
○ EOBs, clearinghouses, and practice management systems don’t always sync seamlessly, causing missed or misposted claims.
● Limited Real-Time Visibility
○ Providers lack immediate insight into payment variances, making it harder to spot anomalies or correct errors before
month-end close.

AI-Driven Solution

● Intelligent Data Extraction & Matching


○ AI-agents automatically parse ERAs/EOBs and match payments to specific line items.
○ Real-time alerts highlight any discrepancies (e.g., missing line items, incorrect contractual adjustments).
● Automated Posting & Reconciliation
○ The system updates the billing platform automatically, reducing manual touches and improving payment velocity.
Let’s build the future of RCM
together!

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