AI-ENABLED SOLUTIONS

AI for
Revenue Cycle Management

HIPAA COMPLIANT • ISO 27001 • SOC 2 TYPE II CLOUD-NATIVE • HUMAN-IN-THE-LOOP

Health systems face mounting pressure from claim denials, prior authorization backlogs, and manual intake bottlenecks. The biggest hidden cost in RCM is repetitive work that should be automated and still isn’t — eligibility checks, denial follow-ups, document classification, and payment reconciliation that AI can handle end-to-end.

 

USM helps health systems deploy AI where it eliminates leakage and delivers measurable revenue lift. Below are the solutions our clients adopt most often.

47 sec

Avg PA decision time

90%+

Target auto-approval rate

<15%

Target first-submit denial rate

$4.2M

Projected revenue recovery

CAPABILITIES

1.

Prior Authorization AI

Seven agentic AI agents deliver prior authorization decisions in approximately 47 seconds. Achieves 90%+ auto-approval target with a full ML audit trail, eliminating manual PA bottlenecks across high-volume payer environments.

Outcome: $4.2M projected revenue recovery on 5,000 annual PAs. First-submission denial rate reduced to under 15%.
2.

Client Intake Automation

Converts scanned and faxed patient packets into structured, validated intake records. Splits multi-patient files, classifies pages, extracts demographic and order data, and flags DMEPOS issues before anything reaches billing.

Outcome: Intake processing time reduced by 73%. DMEPOS error flags eliminated pre-billing across all scanned and faxed intake channels.
3.

Denial Prediction & Prevention

AI models predict claim denials before submission and surface actionable recommendations for clean claim filing. A self-learning system that improves accuracy continuously to reduce revenue leakage over time.

Outcome: Clean claim rate up by 32%. Revenue leakage reduced and denial-related AR days cut by 28% within two quarters.
4.

Agentic RCM Automation

Autonomous monitoring of supplier performance, inventory levels, and demand signals. Flags risks and recommends actions before they escalate.

Outcome: AR days reduced by 28% in year one.Manual touchpoints on eligibility and claim follow-up eliminated across payer mix.
5.

Revenue Optimization

Continuously analyzes payer contracts, payment patterns, and claims data to identify underpayments and improve revenue integrity. Self-optimizes to recommend corrective actions and forecast cash flows.

Outcome: Underpayment recovery increased 24%. Cash collections up 18% in the first year of deployment.
6.

Real-Time Compliance Intelligence

Ensures continuous compliance with evolving payer guidelines, CMS policies, and HIPAA regulations. Flags contractual risks and delivers audit-ready reports automatically without slowing operations.

Outcome: Audit preparation time cut by 60%. Zero payer guideline violations flagged in post-deployment compliance review.

27 Years of Building Enterprise Technology

1,000+

Partners across the US, Europe, and Middle East

2,000+

Enterprise applications delivered

27+

Years serving regulated industries

USM Business Systems has spent nearly three decades building technology for industries where mistakes are
expensive and compliance is mandatory — healthcare, pharma, life sciences, logistics, and manufacturing.

Our RCM AI practice combines deep revenue cycle expertise with custom-built systems your team owns. You keep the IP. You keep the architecture. We build it to integrate with your existing payer mix, EHR, and billing
infrastructure — not the other way around.

Revenue Cycle Domain Experts on Every Engagement

The team you meet on day one is the team you work with at go-live. Our RCM specialists have spent careers inside health system billing operations. They understand the difference between a payer process problem and a technology problem, and they build accordingly.

Scott Shelton

Senior Advisor

Healthcare Payer & RCM Operational Excellence

Brian

Senior Advisor

Behavioral Health Hospital Operations & Patient Intake and Access

Ryan Randall

Senior Advisor

FQHC & Community Health Operations

Ready to Eliminate Denials and Accelerate Your Revenue Pipeline?

You bring your biggest revenue cycle challenge — denial volume, prior auth delays, intake bottlenecks, or AR recovery gaps. Our domain experts walk through exactly how AI would address it in your environment. The session runs 30 to 45 minutes and is focused entirely on your operation.

USM BUSINESS SYSTEMS

Washington, DC (HQ), 44320 Premier plaza, Suite 210, Ashburn, VA 20147

Phone: 1-703-263-0855 | Web: www.usmsystems.com | Email: sales@usmsystems.com

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