May 31, 2023

What Impact Will Artificial Intelligence Have on Medical Billing and Coding

What Impact Will Artificial Intelligence Have on Medical Billing and Coding

Many experts find it challenging to envision revenue cycle management (RCM) in the age of artificial intelligence (AI). What influence will this technology have on the revenue cycle and the day-to-day operations of the healthcare back-office? Of course, no one knows when AI will become the industry standard, but there is some buzz about the potential benefits AI could provide in the near future.

AI will Streamline Medical Billing Workflows

Deep learning of users’ interactions with EHR and billing software may have the most substantial impact on a medical biller’s day-to-day. For nearly all of the significant health IT companies, utilizing artificial intelligence to learn a user’s habits, predict their requirements, and display the correct data at the right time is a major emphasis.

Automatically retrieving and manipulating data has the ability to substantially reduce the amount of time spent on human billing activities while also allowing staff to make more informed decisions regarding the next stages in the denial resolution process.

Enhanced Medical Coding Accuracy

The potential of AI to analyze text and speech will be a key feature. Systems will be able to learn the language of processes and diagnoses in order to issue precise codes. This capability might have a significant impact after code set updates, ensuring that the correct codes are utilized, and documentation is compliant, minimizing the time it takes to move from one code set to the next. Consider how much easier the transition from ICD-9 to ICD-10 would have been if artificial intelligence had been implemented.

Prompt Pre-authorizations

The ability of AI to draw conclusions and make predictions will be one of its most essential features. Getting a pre-authorization from a payer today might take hours, even days. Future technologies may be able to assess a patient’s health data in a matter of seconds and determine whether a procedure is medically necessary. The good news for medical billers is that an automated process will ensure that authorization is received and associated data is captured, considerably decreasing (or eliminating) pre-authorization denials owing to a lack of an authorization number.

Enhanced Patient Customer Service

AI will be employed in a variety of industries, not just healthcare. Customer service advancements, such as bots that are used for patient interactions such as appointment scheduling and payment collection, could significantly impact on how patient communications are handled. One of the key advantages for providers and billers is that the process can be standardized, which reduces the number of difficult patient billing interactions and perhaps improves the relationship patients have with billing personnel.

Deeper Denial Analysis

In the future, artificial intelligence will undoubtedly improve efficiency and profitability. However, AI’s ability to evaluate data and make learned decisions may present an even greater chance to enhance revenue. A situation where denials are increasing due to a lack of medical necessity, a lack of documentation, or coding errors is an example. AI would evaluate the denials to determine the root problem, then create prompts in the EHR/PM to deal with the issues, gather all information for proper coding, and ensure that the provider’s notes are comprehensive.

Wrapping Up

AI breakthroughs have the potential to help not only healthcare providers and medical billing employees, but also payers. According to CMS, the overall improper payment rate in the fiscal year 2018 was 8.12 percent, or $31.62 billion. Significant savings from ‘smart’ AI systems have the potential to save payers money, lowering the overall cost of healthcare for patients.

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