AI is Delivering Measurable Value Across Healthcare Revenue Cycle, ISG Expert Says

ISG describes how healthcare providers are using AI across revenue cycle workflows and promotes its standardized framework to support measurable RCM transformation.

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ISG presentation at Becker’s IT + Revenue Cycle Conference focuses on leveraging AI and automation to address revenue and cost pressures

STAMFORD, Conn.--(BUSINESS WIRE)-- Healthcare organizations are achieving measurable financial and operational results by applying AI to longstanding revenue cycle challenges, says an expert with global AI-centered technology research and advisory firm Information Services Group (ISG) (Nasdaq: III).

Speaking today on the “Navigating the Next Wave of Revenue Cycle Pressures” panel at the Becker’s IT + Revenue Cycle Conference in Chicago, ISG Partner and Healthcare Lead James Burke said AI is delivering immediate financial returns for hospitals and health systems—easing front-end patient access, reducing preventable denials, strengthening coding accuracy and optimizing patient financial engagement.

“Organizations are turning to AI not simply to automate tasks, but to build more resilient and scalable revenue cycle operations that can adapt to rising denial rates, growing prior authorization requirements, workforce shortages and increasing payer complexity,” Burke said. “The greatest revenue cycle value from AI is coming from solving longstanding operational problems at scale. AI is modernizing workflows across the entire RCM value chain, improving workforce productivity and accelerating cash.”

AI solutions can identify claims likely to be denied before submission, flag missing documentation and prioritize work queues based on the likelihood of reimbursement, Burke said. Health systems are reporting denial rate reductions of 10 to 20 percent.

AI is also helping to automate patient access and authorization processes, including prior authorization workflows, eligibility verification, benefit checks and medical necessity reviews. Organizations are reducing manual touch points by 30 to 50 percent and shortening authorization turnaround times from days to hours, resulting in more claims being auto-adjudicated and better care outcomes.

In clinical documentation and coding, generative AI and machine learning are helping to improve coding accuracy, automate chart reviews and identify missed charges and documentation gaps. Organizations are seeing productivity improvements of 20 to 40 percent in targeted workflows while reducing coding-related denials and strengthening revenue integrity.

AI-powered digital assistants also are improving patient financial engagement by expanding self-service capabilities for billing questions, payment plans and financial assistance screening. Engaging patients earlier and providing greater transparency can improve patient satisfaction, reduce call center volumes and increase collections, Burke said. Successful initiatives are tied directly to measurable revenue cycle metrics such as denial rates, net collections, cash acceleration, labor productivity, cost to collect and patient satisfaction.

“To maximize the value of AI, organizations must integrate and prepare the data in a healthcare provider ecosystem – which is dispersed across on-premise, cloud and specialty departments,” Burke said. “Rather than treating AI as a standalone investment, the technology should be enabled by process redesign, workflow automation, analytics and managed services.”

ISG offers a standardized revenue cycle management transformation framework with AI to help U.S. healthcare organizations make RCM services contractable, measurable and governable. The solution combines market benchmarks, standardized contract terms, KPI and SLA catalogs and ongoing governance with AI-enabled platforms and services to help healthcare providers reduce costs, improve financial performance and accelerate revenue cycle transformation.

The Becker’s 11th Annual IT + Revenue Cycle Conference brings together healthcare executives and industry experts to examine technology, revenue cycle management and other issues affecting hospitals and health systems. Additional information is available on the event website.

About ISG

ISG (Nasdaq: III) is a global AI-centered technology research and advisory firm. A trusted partner to more than 900 clients, including 75 of the world’s top 100 enterprises, ISG is a long-time leader in technology and business services that is now at the forefront of leveraging AI to help organizations achieve operational excellence and faster growth. The firm, founded in 2006, is known for its proprietary market data and research, in-depth knowledge and governance of provider ecosystems, and the expertise of its 1,500 professionals worldwide working together to help clients maximize the value of their technology investments.

View source version on businesswire.com: https://www.businesswire.com/news/home/20260915986660/en/

Press Contacts:

Laura Hupprich, ISG
+1 203 517 3132
laura.hupprich@isg-one.com

Erik Arvidson, Matter Communications for ISG
+1 978 518 4542
isg@matternow.com

Source: Information Services Group, Inc.

Key Terms

revenue cycle management financial

Revenue cycle management is the set of processes a healthcare provider or medical business uses to turn patient care into cash, including registering patients, billing insurers, submitting claims, collecting payments and handling denials. Think of it as the organization’s checkout system and follow-up team; efficient management shortens the time to get paid, reduces lost revenue and lowers financial risk, which directly affects cash flow and profitability that investors watch closely.

prior authorization medical

Prior authorization is a process where a health insurance company requires approval before covering certain medical services or medications. It functions like a pre-approval step, ensuring that the treatment is necessary and appropriate before expenses are paid. For investors, understanding prior authorization is important because delays or denials can impact healthcare costs, provider operations, and the financial stability of related companies.

auto-adjudicated technical

A process or decision that is completed automatically by software or a rules engine without human review. For investors, it signals that outcomes such as claims, transaction matches, clinical trial endpoint confirmations, or compliance checks are handled by programmed criteria, which can speed processing and reduce labor but also concentrate reliance on the correctness of the underlying rules and data—like a self-checkout that tallies and approves items based on barcode scans.

generative AI technical

Generative AI is a type of computer technology that can create new content, like text, images, or music, on its own. It’s important because it can produce realistic and useful material quickly, which could change how we create art, write stories, or even develop new products. Think of it as a smart robot that can invent and produce things almost like a human.

medical necessity reviews medical

A medical necessity review is the process used by health plans, insurers, or their reviewers to decide whether a proposed treatment, test, procedure, or drug is clinically appropriate and eligible for payment under a patient’s coverage. Think of it as a gatekeeper check that compares the requested care to clinical guidelines and policy rules; its outcomes affect how often services are approved, how providers get paid, and how quickly new therapies are adopted, so it can influence revenue and reimbursement risk for healthcare companies.