Healthcare providers are under significant pressure due to chronic diseases becoming more prevalent among aging populations and a growing general population. As patient needs evolve and technology trends and tools become more accessible, healthcare providers are adopting them to improve patient care.

If reports are to be believed, the telehealth market is projected to expand at a compound annual growth rate (CAGR) of 24.0% from 2023 to 2030. With this substantial increase, technology-driven solutions have become increasingly important in the healthcare industry, especially in the context of home care.

But what are the opportunities in home care processes, and how can automation become a part of them? Let’s explore more about the home care processes and how automation can accelerate patient care experience.

How can AI and Automation Reduce the Administrative Burden From Homecare?

As per the report, Home Healthcare Market is expected to grow at a CAGR of 7.96% from 2023 to 2030.

With higher adoption of Home healthcare services, home healthcare teams currently grapple with unnecessary inefficiencies. Hindered by outdated technology and disjointed systems that have persisted for decades, it’s imperative to reconsider how these teams handle the overwhelming administrative workload.

Excessive and laborious hours devoted to monotonous tasks are not only leading to staff burnout but also resulting in subpar patient outcomes, diminished revenue recognition, and notable operational drawbacks. But here, AI and Automation can be saviors to home healthcare teams and help them automate administrative tasks and offer on-time patient care.

Let’s have a look at some of the home care processes to automate using AI and Automation.

How can AI and Automation Reduce the Administrative Burden From Homecare?

  1. Electronic Visit Verification Process

    An electronic visit verification system requires tracking a variety of information, including the type of service performed, the location of the service, the medical notes generated, the location and date of the service, who provided the service, who received it, and when the service began and ended. Caregivers often miss to clock in/clock out and enter the service provided to patients, and with missing information, it gets challenging for home care providers to create billing and initiate payments.

    Here, instead of the administrative team following up with caregivers and patients, the AI bot can connect with them via SMS/Call to record input and update the system. This helps homecare agencies improve compliance, get paid and improve the cash flow cycle.

  2. Referral Management

    In-home care agencies, the referrals are received by home care agencies through different channels including portals and online directories, healthcare providers, insurance providers, community organizations, agency websites, etc. Right from intake automation, patient information collection, and referral triage, home care agencies go through a lot of tasks.

    Here AI and automation solutions can be easily integrated with referral portals, perform data extraction from referral faxes using intelligent document processing, check the eligibility on the insurance portal, integrate with the EMR system, prioritization, and perform automated matching and episode creation with minimal or no human intervention. This leads to improved care quality and faster response time to referrals.

  3. Prior Authorization

    The process of prior authorization involves seeking approval from a payer before delivering specific services to a client. This encompasses the identification of services that necessitate authorization, the submission of authorization requests, and the subsequent tracking of the outcome of the authorization.

    Here AI bots can seamlessly integrate with payer systems, accelerating the electronic submission of requests, and expediting the review and approval process for authorized services. These prior authorization bots also provide real-time tracking and updates on submitted requests, minimizing uncertainty and enabling proactive follow-up with payers. Furthermore, they verify client eligibility for specific services in real time, ensuring accurate service requests and mitigating denied claims.

  4. AI Staffing

    Every day, home care agencies encounter the complex challenge of aligning the most suitable caregivers with their respective clients. This intricate puzzle demands thoughtful evaluation of skills and requirements, coupled with smooth communication and coordination. The AI Staffing Agent excels in skill-based matching, taking into account caregiver availability, preferred hours, and workload preferences. Simultaneously, it considers client needs and schedules to ensure a harmonious alignment between caregivers and clients. Also, AI bots can quickly identify and resolve scheduling conflicts in real time and offer continuity of care.

  5. Client Engagement

    Communication is the most important when it comes to offering quality care to home care providers. Leveraging automation in client engagement, whether through chatbots or SMS, empowers clients with self-service options, a user-friendly interface, and an approval mechanism. This not only enhances the client experience but also delivers substantial advantages for both clients and home care agencies. Using AI bots, home care agencies facilitate communication with ready FAQs, push notifications, self-service assistance, and automated reminders. This empowers clients to manage their care more actively.

  6. OASIS Assessment Upload

    The process of uploading the OASIS assessment to iQIES involves gathering information about a patient’s health status, functional capabilities, and service requirements. The upload frequency may range from weekly for highly unstable clients to approximately every 60 days for stable clients with minimal changes in their needs.

    OASIS assessment upload bot with AI and automation streamline the transfer of assessment data from your Electronic Health Record (EHR) or clinical documentation system to iQIES swiftly, eliminating the need for manual data entry. This not only saves processing time but also reduces errors typically associated with manual typing. Additionally, AI facilitates rapid data transfer and submission, expediting reimbursement processing and payment cycles compliant with regulatory standards.

  7. Client Signature Matching

    Client signatures and authorizations are essential for care plan approval, service consent, and information release. AI bots excel in swiftly handling extensive signature volumes, drastically cutting down authorization turnaround times compared to manual verification. Automated solutions effectively decrease administrative overhead and mitigate potential errors linked to manual verification, enabling agency administration staff to concentrate on crucial tasks. Additionally, the bots are adept at detecting subtle inconsistencies, thwarting unauthorized transactions, and safeguarding client information.

  8. Eligibility Check

    The eligibility checks entail assessing whether a client qualifies for diverse home care services and funding channels. This involves collecting client information, identifying funding sources, confirming eligibility for each source, and establishing service levels and coverage. Automating both manual data entry and verification substantially decreases the administrative workload, allowing staff to focus on critical tasks like client care and service planning.

    Additionally, eligibility check bots eradicate human errors linked to manual data handling, enhancing the precision of eligibility determinations and mitigating compliance risks. The integration of automation and AI solutions also diminishes administrative costs tied to manual verification and paperwork, thereby enhancing overall operational efficiency.

  9. Claims Processing

    Claims submission involves electronically reporting provided services to a client’s insurance plan or government program for reimbursement. Home care agencies can automate this process using automation and AI solutions. In the automation of claims submission, a bot accesses the EMR system, retrieves processed claims, and uploads them to the insurance payer portal or clearinghouse for reimbursement. This way automation serves to alleviate administrative burdens, boost cash flow, and elevate accuracy and compliance for home care agencies.

  10. Denial Management

    Denial management involves the systematic procedure of recognizing, comprehending, and resolving claim denials from payers regarding services rendered to clients. A well-executed denial management process is essential for organizations to optimize their revenue, guarantee correct reimbursement for services, and deliver quality care without financial burden.

    Automating denial management process streamlines the monitoring of submitted claims, identification of denied claims, automatic retrieval of denial notifications and Explanation of Benefits (EOBs), filtering, updating Electronic Health Records (EHR), and directing claims to staff for correction. This way administrative burdens get reduced and allow home care agencies to focus on quality care.

  11. Caregiver Engagement

    Caregiver experience matter the most when it comes to client retention for home care agencies. In daily working hours a caregiver has a lot of tasks that need to be taken care of. Home care agencies can create automated assistance for caregivers. Caregiver Engagement Automation offers a comprehensive solution, including a Chatbot, assistance with Electronic Visit Verification (EVV) updates, self-service automation for payroll requests, scheduling tools, and personalized dashboards tailored for home care agencies.

  12. Voice Note

    Voice notes prove invaluable to caregivers by relieving them of the burdensome task of manual note-taking. Through a voice bot, caregivers can effortlessly create and update notes in the EMR system by dictating information. By simply calling a designated phone number, caregivers have the option to edit their dictation if necessary, providing a hands-free documentation experience. This method offers flexibility, allowing notes to be recorded in the caregiver’s preferred language, and ultimately contributes to more precise and improved documentation.

  13. Virtual Caregiver

    The shortage of high-quality caregivers underscores the need for their efficient utilization. Virtual caregivers, equipped with voice, chat, and SMS text capabilities, offer clients regular check-ins, reducing reliance solely on in-person visits. Moreover, these virtual caregivers empower clients to proactively communicate changes in their condition, facilitating early interventions and better outcomes.

    Also, the bots efficiently collect and log client data, including symptoms, vital signs, and medication adherence, ensuring continuous monitoring and early issue identification. Additionally, virtual caregivers enable home care agencies to remotely monitor clients, potentially reducing the necessity for in-person visits and travel time, thereby saving valuable time and resources. The insights derived from virtual caregiving contribute to enhanced care planning and resource allocation, ultimately improving overall outcomes.

  14. ICD Coding

    ICD coding refers to the utilization of the International Classification of Diseases (ICD) system for coding and classifying various health conditions, diseases, and medical procedures. Also, the ICD coding serves multiple purposes like diagnosis documentation, billing, treatment planning, data analysis, and EHR integration. Leveraging automation and AI in ICD coding process identifies pertinent ICD codes and recommends the most specific codes based on contextual understanding. This innovative tool empowers ICD coders by providing options to select, reject, or update the ICD codes identified by the AI system. Furthermore, it seamlessly integrates these codes with the Electronic Medical Record (EMR) system, streamlining the coding process and ensuring accuracy in medical documentation.

  15. Caregiver Point System Dashboard

    Implementing an automated point system through an AI bot serves as an effective strategy to recognize and incentivize caregivers. This system rewards positive behavior, ultimately contributing to the retention and longevity of caregivers within the organization. This AI bot seamlessly integrates with various data sources, offering live dashboards that enable providers to monitor performance in real time.

    The automated point system enhances provider outcomes by improving hiring rates, enhancing reporting capabilities, and facilitating precise tracking of caregiver performance. Additionally, it empowers providers with insights into top-performing caregivers and offers a multitude of other benefits for optimizing caregiver management and overall healthcare service delivery.


Automating routine and manual tasks is an absolute necessity in today’s competitive healthcare market. Hospitals and other health agencies that engage in in-home care need to embrace this phase of their digital transformation. With reasonable effort and investment, your medical facility can become significantly more agile and resilient, ready to weather any new storm that may come your way.

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