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AI in senior living: How organizations can use AI to scale smarter
AI is changing how businesses and organizations operate across sectors — and healthcare is no different. But while senior living leaders are curious about AI’s potential, many are unsure of how to convert that promise into meaningful results in areas like medication management, EHR analytics, personalized care and an all-around better experience for residents. However, the biggest roadblock here is often not technology, but mindset. Keep reading to learn more about how to solve that, plus more effectively implement AI within your senior living organization. What’s stopping senior living organizations from embracing AI? Faced with challenges like rising costs and Medicaid cuts that are already taking effect, many senior living organizations could benefit from finding efficiencies through AI. But this has proven easier said than done, in part because embracing AI demands a mindset shift. AI is a change management problem While integrating AI into your senior living organization does require implementing new tools and upskilling your team, it’s also largely an exercise in change management. Your team is used to operating one way, which can make building and sustaining the momentum you need to rebuild your systems or processes to take advantage of AI or automation tools feel a little bit like pushing a boulder up a hill. According to a survey of Wipfli clients, 91% of businesses or organizations report that non-technical obstacles are the biggest blockers to better leveraging new technologies like AI. Meanwhile, only 19% of executives actually feel comfortable leading an AI-transformation effort. In other words, because AI is still such a new and rapidly developing technology, organizations and leaders don’t feel comfortable with it. And that discomfort can make it harder to create results. Haphazard AI use can actually slow adoption and create chaos Is your senior living organization currently using AI? If your first instinct is to answer no, there’s a very good chance you’re wrong, because some of your individual team members are almost certainly using AI tools, regardless of whether they have buy-in from leadership. However, this risks creating a wild west scenario, where AI gets implemented piecemeal or haphazardly and without any overarching AI strategy. In this situation, you won’t have any governance standards, policies or processes to help ensure consistency, and can even risk HIPAA violations by exposing PHI to AI tools that don’t meet compliance requirements. Plus, such haphazard efforts will often flounder, blunting momentum for a more organized AI implementation plan. How should senior living organizations more effectively leverage AI? For senior living leaders looking to develop an effective, organization-wide approach to AI, the process matters. Specifically, you want to determine where you want to go, how you’re going to get there and what tools you’ll need to succeed. 1. Establish direction by identifying specific problems you want to solve A good AI strategy doesn’t mean buying your team a ChatGPT Pro subscription. Instead, identify specific problems within your organization where AI could make a difference. For example, if your organization is struggling to find skilled healthcare workers to fill key roles, consider whether AI could allow you to deploy your existing team more effectively by automating certain lower-level tasks so your staff can focus on more patient-centric work. Or can AI analyze data from your EHR to identify patient health trends you can use to improve care? Here, it can be good to lean on an advisory firm to help assess your current systems and processes and find gaps that AI could fill. You can also do this entirely in-house, so long as you keep the focus on looking for problems to solve. 2. Design your AI implementation strategy Once you’ve found problems that AI could help solve, you need to build a framework for implementation. This means designing an organization-wide AI strategy to help put new solutions into place. This includes laying out specific steps in the implementation process, identifying leaders or change champions to actually spearhead the rollout and establishing KPIs. It’s also essential to evaluate your existing data sources and prepare them for use by AI tools, a process that can include establishing a centralized data repository or warehouse. During this effort, you’ll need to consistently communicate with your whole team about why change is happening here and how they can help, as well as consider what training or upskilling opportunities you’ll need to provide. 3. Deliver by implementing specific tools that fit your strategy At this point, you can start implementing AI tools to solve the specific organizational problems you’ve chosen to target. However, this isn’t just a one-and-done event, but an ongoing process that involves both choosing the right tools and embracing the human, change management side of the equation. Your advisor can help you decide which AI solutions make sense for your needs, as the market has brought forth a dizzying array of options. Within your organization, communication remains essential, as you need to not just establish momentum, but maintain it. How can leaders prepare to oversee an organizational AI strategy? An effective AI strategy typically starts at the top, with commitment from leadership. So how should leaders prepare to oversee this effort with an eye towards more effective change management? Here are key leadership pillars to consider: Self-awareness: Before you ask your team to change by implementing AI, are you prepared to do the same? AI literacy: Your leadership team and organization need a shared understanding of what AI actually is and how you’ll be using it. Change leadership: Don’t just throw change at your team, but implement thoughtfully through planning, clear communication and celebrating wins or milestones. Effective use of resources: Throughout your AI implementation process, consider what work is being done, who will perform it, when it should happen and why it matters. Coaching and upskilling: Create training or coaching opportunities for your whole team to adapt to the changes within your organization. Read more Maximize new tax strategies for senior living providers 5 strategic planning imperatives for senior living organizations Embracing change in senior living: The path to innovation and growth
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Senior living providers are missing out on valuable revenue opportunities. Here’s how to change that.
Faced with growing financial pressures, more senior living providers are looking to generate new revenue growth. But what many providers don’t realize is that some of the most valuable revenue opportunities may not involve adding new patients, but simply running your existing business more effectively. What should you do to create more cash flow for your senior living business? Keep reading to find out. Low reimbursement rates and Medicaid cuts are pushing more senior living providers to search for new revenue Senior living providers across the country are feeling more financial urgency this year. In addition to rising costs and staffing constraints , one of the biggest drivers is that it’s simply harder to get paid enough for your work. Many providers are noticing lower reimbursement rates than in the past. Complex billing and reimbursement processes and procedures are also increasingly hard to navigate, demanding more people, better processes and help from AI to do so. Meanwhile, some senior living providers will also be affected by the roughly $1 trillion in Medicaid cuts that begin taking effect at the end of 2026. States with budget deficits, especially, may struggle to make up for the cutback in federal dollars and choose to move funding away from nursing homes. All of the above makes finding new revenue even more valuable for many senior living providers. But where should you look? What are the top missed revenue opportunities for senior living providers? Most senior living providers have clear revenue opportunities they are currently missing out on. Crucially, this hidden revenue doesn’t involve adding more patients, but improving revenue cycle management, billing processes, clinical management and other process-related improvements that may be fairly simple to implement. Key missed revenue opportunities include: Ineffective billing and revenue cycle management: Many senior living providers lack sufficient experience with billing and revenue cycle management, in part because there are no formal training programs that teach nursing home billing. This can result in slow collections due to ineffective internal processes or team members getting overwhelmed by trying to navigate complex insurance regulations without sufficient experience. Slow reporting: Nursing homes may also struggle with slow financial reporting, with financial statements frequently up to three months out of date. This makes it difficult to understand what’s happening inside your business and easier to miss that you’re leaving money on the table. Commingling adjustments and write-offs: Adjustments often get classified as write-offs, which means you miss out on any possibility of collecting on the adjustment balances. Any remaining payer balance needs to be evaluated to determine whether the payer made an error before adjusting off. Poor clinical documentation: Effective clinical management involves both accurately determining what a patient needs and fully documenting that care so you get paid for all of the services you provide. However, too many senior providers don’t properly document, which means not getting reimbursed for work that you’ve already done. Underbilling: Providers also may not always know what they are eligible to bill for, especially under Managed Medicare contracts and Medicaid. As a result, you could be paying out of pocket for costs like oxygen or transport that you should be getting reimbursed for. However, many of these revenue opportunities can be unlocked with relatively little effort, boosting your cash flow and softening the financial pressure on your business. Here’s how to start. How should senior living providers start taking advantage of more missed revenue opportunities? Senior living providers can often notably increase revenue by taking action to shore up holes in procedures, processes, systems or training. While some of this work takes time, there is often low-hanging fruit you can implement fairly quickly. Key actions include: 1. Train your team to use your systems more effectively Whether you run your business on new or legacy systems matters less than whether your team knows how to use them effectively. Even a simple change like training your team to no longer commingle adjustments and write-offs in your accounts receivable system can generate more revenue at very little cost to implement. 2. Strengthen team communication Make sure your team understands the billing opportunities that are available to you, as well as the importance of documenting everything for billing purposes. If you get everyone on the same page, less revenue will fall through the cracks. 3. Make targeted tech upgrades Use new tech tools where an investment makes sense from an ROI perspective . For example, could you implement an AI tool that helps you discover new revenue opportunities in your EMR, like areas where you’re not currently billing that you could be? 4. Explore automation Can you automate aspects of your billing process? This can exponentially reduce the amount of time you spend on billing work, while also speeding up your collections. 5. Increase your posted rates Managed Medicare contracts typically state that they will pay out the lower of either your posted rates or their reimbursement rates. This means if your posted rates are less than the managed care reimbursement rate, you can quickly generate new revenue simply by raising your posted rates to more than the reimbursement rate. 6. Build up your strategic financial capabilities Your accounting team may understand the day-to-day financial operations of your business, but many senior living providers lack higher-level financial awareness from a CFO or controller. You need someone on your team who understands the business of making money from a nursing home: Strategic planning, cost reporting, revenue cycle management, cash flow, KPIs and how it all fits together. 7. Seek advisory support An advisory firm that knows the senior living business can help you identify specific ways to generate more revenue. The right advisor will understand both operations and revenue cycle management and be able to point to areas of improvement within your business where a change could deliver results. 8. Consider outsourced billing or financial leadership An advisory firm can also deliver additional support in the form of an outsourced biller. This can be valuable because so few people really understand the ins and outs of nursing home billing, so an outsourced biller can often generate more cash simply by billing more effectively for the work you are already doing. Using an outsourced biller also eliminates the risk of making a significant investment in training an in-house biller, only to watch them quickly leave for a better offer. For higher-level financial leadership, you can also lean on an outsourced CFO or controller. Someone in this role will understand how your business works and be able to figure out how to more efficiently grow your revenue. Read more How demographic changes are impacting the senior living industry | Wipfli Innovation in the senior living industry — a key for growth | Wipfli 6 strategic planning imperatives for senior living organizations - Wipfli
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5 reimbursement strategies for rural health clinics
If rural health clinics (RHCs) want to successfully navigate a constantly evolving reimbursement landscape, they need to be proactive and adaptable. Understanding changing payment methodologies, regulations in your state and the latest updates from CMS will help your RHC stay viable and able to continue to provide essential healthcare services to rural communities. Here are five reimbursement strategies your RHC may want to consider: 1. Mobile rural health clinics Mobile rural health clinics are growing in popularity as a way for RHCs to reach a larger patient base. Their flexibility gives providers the ability to bridge the gap between rural communities and healthcare services while using existing RHC certifications and rates. Mobile rural health clinics do not have to be certified on their own — existing RHC-certified locations can add them to an existing Medicare enrollment — although they can be. Mobile rural health clinics, when a part of an already-certified RHC, are viewed as an extension of the already-certified location. Therefore, they are not required to meet the RHC conditions of participation on their own. For example, a mobile clinic would not need to provide the four basic lab test requirements or include advanced practice providers to qualify since the already-certified RHC meets those requirements. In addition, specialty services could even be the only services provided in these locations. A mobile RHC must operate with a consistent schedule and the location must have a current medically underserved area or a health professional shortage area designation. In addition, RHCs interested in using mobile clinics should check the specific state requirements that may be in place. To maximize reimbursement, consider completing an analysis to determine which RHC (if more than one exists) to attach the mobile RHC enrollment. Using this strategy, clinics will want to look at the existing Medicare and Medicaid rates and patient payor populations of the service area being considered. 2. Telehealth behavior health providers With the permanent ability for RHCs to provide distant-site mental health services and receive payment from Medicare under the all-inclusive encounter rate, RHCs may want to consider implementing this service line. And until December 31, 2027, the in-person requirement for these services has been waived. Clinics can contract with remote behavior health providers to offer telehealth visits while receiving the AIR for those services. As of 2024, CMS recognizes two additional RHC practitioners with services paid at the AIR: Marriage and family therapists and mental health counselors. 3. Hospital outpatient department status Changes to payments for provider-based RHCs may prompt grandfathered RHCs to analyze the services that they provide and bill as part of their certification. RHCs may want to consider moving certain specialty services out of the RHC and bill under a hospital outpatient department methodology. Or, since productivity standards are no longer applicable to RHCs, services that are currently provided in the hospital may want to be analyzed under an RHC billing methodology. The treatment of RHC and HOPD clinics varies drastically from state to state regarding Medicaid payment. Therefore, it is also important to understand how both of these types of entities are reimbursed in your state and analyze the payor type. 4. Change of address CMS allows clinics with grandfathered RHC status to keep their existing rates even if they move locations. For providers, this lets RHCs be strategic about which locations may be optimal as a certified RHC with a grandfathered rate as long as the RHC meets the location requirements and RHC conditions of participation. A hospital that has grandfathered RHC rates and other potential RHC locations may want to explore moving their existing certification to a clinic that has a higher Medicare and Medicaid population. That clinic location would receive the grandfathered rate, while the less utilized clinic could still apply for RHC status and receive the new federal capped rates. Again, analyzing the potential reimbursement gain and including the Medicaid reimbursement effect would be critical. Grandfathered RHCs need to be aware that they will lose their status if they expand beyond 50 beds . 5. Medicaid rate review Reviewing the RHC Medicaid rates in your state and being aware of opportunities that may exist to increase them helps to ensure that your clinic is optimizing reimbursement. The financial impact of RHC status will depend on factors such as your state's reimbursement rates and your clinic's payer mix. When reviewing the overall RHC reimbursement effect, you need to analyze the overall change in Medicare and Medicaid reimbursement. A change in scope of services request may also be available in your state, which could potentially increase the RHC Medicaid rate. In some states, the addition of a service line such as mental health could trigger a change in scope and could result in a readjustment of a clinic’s RHC rate. Read more: The tech infrastructure that can drive your rural health transformation State of rural healthcare 2025 executive summary Transforming healthcare access: CMS finalizes groundbreaking changes for rural health clinics and FQHCs
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