Transforming the Healthcare Revenue Cycle with Artificial Intelligence: A Guide to Building Impactful AI Using Electronic Claims and Electronic Heath
暫譯: 利用人工智慧轉型醫療收入循環：建立影響力AI的指南，使用電子索賠與電子健康記錄

Reid, Korin

Transforming the Healthcare Revenue Cycle with Artificial Intelligence: A Guide to Building Impactful AI Using Electronic Claims and Electronic Heath
  • 出版商: Productivity Press
  • 出版日期: 2025-08-08
  • 售價: $2,470
  • 貴賓價: 9.5 折 $2,347
  • 語言: 英文
  • 頁數: 180
  • 裝訂: Quality Paper - also called trade paper
  • ISBN: 1032639482
  • ISBN-13: 9781032639482
  • 相關分類: 人工智慧

    • 海外代購書籍(需單獨結帳)

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商品描述

Revenue cycle management (RCM) refers to an institution's financial management process that helps track, identify, collect, and manage incoming payments. This process helps businesses foster financial transparency within the company and charge patients the correct amount for the services they receive. But because of the unique healthcare payment system in the United States, relatively few of these dollars change hands directly between providers and their patients. Instead, there is a complex reimbursement system, mostly driven by third-party payment transactions between government programs and insurance companies, on the one hand, and healthcare providers, on the other.

Artificial intelligence (AI) can help predict claim denials by analyzing past denial trends and alerting health information management (HIM) professionals of potential denials in advance of billing. This affords an opportunity to review and correct claims pre-bill. One major benefit of AI in RCM is increased efficiency. By automating routine tasks, healthcare organizations can free up staff to focus on more important and value-added work. This can lead to improved productivity and faster turnaround times, ultimately resulting in improved patient care.

This book provides an informative blueprint to help hospital and healthcare revenue cycle administration personnel along their AI journey by using the most commonly available administrative datasets, electronic claims, and electronic health records. Peppered throughout the book are hilarious anecdotes and cautionary tales from the author's experience in building AI solutions in the healthcare space.

The book begins with an overview of key concepts such as data science, machine learning, AI, language models (e.g., ChatGPT), and more. The author expands on the defined process in the context of common revenue cycle use cases that leverage electronic claims and electronic health records. Finally, the book provides guidance on how to evaluate AI solutions at each point of the development process, including third-party vendor AI solutions.

商品描述(中文翻譯)

收入週期管理（Revenue Cycle Management, RCM）是指機構的財務管理過程，幫助追蹤、識別、收集和管理進來的付款。這個過程幫助企業在公司內促進財務透明度，並向病人收取正確的服務費用。然而，由於美國獨特的醫療支付系統，這些資金中相對較少的部分是直接在提供者和病人之間轉移的。相反，存在一個複雜的報銷系統，主要由政府計劃和保險公司之間的第三方支付交易驅動，與醫療提供者之間的關係相互交織。

人工智慧（Artificial Intelligence, AI）可以通過分析過去的拒絕趨勢來預測索賠拒絕，並提前提醒健康資訊管理（Health Information Management, HIM）專業人員潛在的拒絕情況，這為在開帳單之前審查和修正索賠提供了機會。AI在RCM中的一個主要好處是提高效率。通過自動化例行任務，醫療機構可以釋放員工的時間，讓他們專注於更重要和增值的工作。這可以提高生產力和更快的周轉時間，最終改善病人護理。

本書提供了一個資訊豐富的藍圖，幫助醫院和醫療收入週期管理人員在其AI旅程中，利用最常見的行政數據集、電子索賠和電子健康紀錄。書中穿插了作者在醫療領域構建AI解決方案的經驗中的幽默軼事和警示故事。

本書以關鍵概念的概述開始，例如數據科學、機器學習、人工智慧、語言模型（例如，ChatGPT）等。作者在利用電子索賠和電子健康紀錄的常見收入週期用例的背景下擴展了定義的過程。最後，本書提供了如何在開發過程的每個階段評估AI解決方案的指導，包括第三方供應商的AI解決方案。

作者簡介

Korin Reid earned a PhD in chemical engineering at Georgia Institute of Technology, where she leveraged AI and operations research (OR) to determine the most cost-effective means of producing biodiesel from switchgrass in the southeastern United States. Since then, Dr. Reid has held numerous roles in the healthcare information technology space, including serving as vice president of data science and innovation at a mid-market healthcare revenue cycle information technology firm. Dr. Reid is also known for developing the first AI model at a leading Fortune 5 healthcare company. The solution impacted more than 160 million patients. For this effort, she was named to Forbes 30 under 30 in 2017. She frequently speaks on the topic of AI in the healthcare space, sharing her unique framework for data scientists, technologists, and healthcare providers alike to collaboratively develop transformative initiatives. She has a knack for conveying technical information in an easily understandable manner, often leveraging humor and entertaining personal anecdotes to do so.

Dr. Reid is Chief Executive Officer of Ellison Laboratories, a healthcare information technology company that leverages AI and OR to improve the quality and efficiency of healthcare delivery. She also teaches in the master's in data science program at UC Berkeley. Dr. Reid has contributed as a writer, podcaster, and on-air talent for multiple media platforms and has been featured in the Wall Street Journal and Forbes magazine.

作者簡介(中文翻譯)

Korin Reid 在喬治亞理工學院獲得化學工程博士學位，期間她利用人工智慧 (AI) 和運籌學 (OR) 確定在美國東南部從開關草生產生物柴油的最具成本效益的方法。自那時起，Reid 博士在醫療資訊科技領域擔任了多個職位，包括在一家中型醫療收入循環資訊科技公司擔任數據科學與創新副總裁。Reid 博士還因在一家領先的《財富》500 強醫療公司開發首個 AI 模型而聞名。該解決方案影響了超過 1.6 億名患者。因為這項努力，她在 2017 年被評選為《福布斯》30 位 30 歲以下精英之一。她經常在醫療領域的 AI 主題上發表演講，分享她獨特的框架，讓數據科學家、技術專家和醫療提供者能夠共同開發變革性計劃。她擅長以易於理解的方式傳達技術資訊，經常利用幽默和有趣的個人故事來達成這一點。

Reid 博士是 Ellison Laboratories 的首席執行官，這是一家利用 AI 和 OR 改善醫療服務質量和效率的醫療資訊科技公司。她還在加州大學伯克利分校的數據科學碩士課程中授課。Reid 博士作為作家、播客主持人和媒體平台的在場人才，為多個媒體平台做出了貢獻，並曾在《華爾街日報》和《福布斯》雜誌中被報導。

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