Key Use Cases: How AI Automates Healthcare Administration
A 2025 survey from AHA and the Assistant Secretary for Technology Policy found billing and scheduling were the two fastest-growing use cases for AI in healthcare. Below is a closer look at how health systems bring AI-driven automation to these key administrative functions, along with a few others. Research from Gartner co-authored by Potts helps provide definitions and examples.
Billing, Claims Processing and RCM Automation
Automated coding tools can analyze data in the EHR and other clinical systems and assign the appropriate diagnostic or procedural codes. This cuts down on the time it takes to properly code a patient visit. Claims can be submitted faster, which means organizations get reimbursed faster.
Keeping humans in the loop is an important part of this process, according to Gartner. If software determines a code for a medical service that doesn’t meet a predetermined level of confidence, the code will be flagged for a manual review.
Prior Authorization Automation
Here, AI tools similarly analyze patient records, as well as clinical guidelines and preloaded payer requirements, to decide if a procedure or medication will require prior authorization. From there, Gartner notes, software can create documentation it deems a payer will need to conclude a service is medically necessary.
This use case takes on added importance amid the push for electronic prior authorization from the Centers for Medicare & Medicaid Services. It’s also an area where AHA advocates for having a clinician in the loop — especially on the payer side, Holloman says. If hospitals and health systems are forced to review and appeal denials, they face an undue administrative burden.
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Scheduling and Patient Communication
AI is well positioned to help organizations optimize schedules by analyzing patient demand, projecting the resources needed to meet that demand and recommending necessary staffing levels, Holloman says. This is particularly helpful for managing capacity in the operating room, where careful orchestration of surgeons, physical space and equipment is necessary to schedule procedures.
Meanwhile, different AI tools can help hospitals communicate with patients who have procedures scheduled. Gartner notes that use cases can include providing patients with tailored educational materials, generating treatment plans, offering pre-visit instructions and reminders, summarizing the clinical encounter, and creating post-visit instructions. While Gartner describes the financial and operational gains of these use cases as largely marginal, the consultancy does note a positive impact on patient satisfaction.
EHR Management and Documentation
Ambient listening and documentation is one of the most promising uses of AI in healthcare administration, Holloman says. Supporting transcription and creating structured clinical notes reduces the burden on staff to accomplish those tasks — especially during much-maligned after-hours “pajama time.”
Potts agrees: “This solves several issues at once.” Gartner’s research calls ambient scribes a “likely win” for a health system, noting that it can improve coding and reimbursement, save time, mitigate legal and regulatory risk, improve job satisfaction, and even aid clinician recruitment efforts.
Supply Chain Management
As with scheduling, using AI to manage hospital supply chains begins with assessing demand for medical equipment, medications, and any general supplies used in procedures or to support everyday patient care. Analyzing patterns in supply use can help reduce overstocking, Potts notes. It also lets organizations standardize orders so they can purchase items in bulk, reducing costs as well as variability of items available.
