RCM Automation for Telehealth: Rules vs AI — Why the Best Systems Use Both
Every week, we hear the same question from telehealth providers: "Should we use rules-based automation or AI for our revenue cycle?"
It's the wrong question.
Here's why: A Parkinson's disease telehealth visit generates a predictable pattern. The provider is licensed in Texas. The patient is at home in Texas. The visit is synchronous via video. These facts don't require AI to verify—they're deterministic. If patient location = Texas AND provider license state = Texas AND visit type = video, then apply POS 10 (patient's home) + Modifier 95 (synchronous telemedicine). This rule will fire correctly 100% of the time.
But that same visit also has a 32-minute consultation note with unstructured clinical documentation. Extracting "G20.A1 - Parkinson's disease without dyskinesia" from narrative text like "Patient presents with pill-rolling tremor at rest, bradykinesia noted during finger tapping, cogwheel rigidity in upper extremities" absolutely requires AI. No rule can map that clinical description to the correct ICD-10 code with sub-classification.
The insight that drives modern RCM automation: These aren't competing approaches. They're complementary capabilities that solve fundamentally different problems.
RCM Automation for Telehealth: How Foresight does it
There’s no prize for picking a side. There is a prize for getting paid on the first try.
Telehealth unlocked access. It also exploded the number of billing edge cases: home vs. clinic, audio‑only vs. audio‑video, multi‑state licensure, plan quirks, and denial codes that read like alphabet soup. If you’ve tried to automate revenue cycle management (RCM) with only rigid edits or only AI, you’ve met the limits: brittle rules that break on real‑world variability, or “smart” systems that can’t show their work when an auditor asks why.
The highest‑performing teams do something simpler and smarter: they pair deterministic rules for the black‑and‑white, machine intelligence for the gray, and human review where the stakes are high. That’s how we designed Foresight RCM. Here’s the playbook.
Comparing Top RCM & Prior Authorization Solutions
Revenue Cycle Management (RCM) and prior authorizations (PA) are critical yet challenging areas for healthcare providers. From the perspective of a CFO, practice manager, or revenue cycle director, choosing the right solution can greatly impact financial health and efficiency. In this post, we compare our unified RCM + electronic prior auth platform against leading alternatives in the market. We’ll look at both broad end-to-end RCM systems and specialized PA/automation solutions, highlighting their strengths, limitations, and ideal use cases – and why our platform offers a compelling choice for many provider organizations.