AI has immense potential to streamline the existing medical billing and coding procedures.
FREMONT, CA: Medical billing and coding is a crucial aspect of healthcare. According to a report, the medical billing outsourcing market is projected to touch $16.9 billion by 2021. The coding and billing functionality translates patient record information into standardized codes that can be used for billing patients or third-party players such as insurance companies and Medicare. Despite the essence of the process, errors in billing and coding resulted in $36.21 billion in improper payments in the year 2017. Firms are testing alternative technologies such as artificial intelligence (AI) to improve the efficiency and accuracy of the billing and coding process.
Most of the advancements in AI applications for medical billing and coding come under the category of Computer Assisted Coding. Firms are leveraging machine learning (ML) and natural language processing (NLP) to recognize and extract data from medical documents automatically. The extracted data can then be used for proper coding and billing. However, the most significant impact on a biller’s everyday operations can happen from deep learning of users’ interaction with billing software. All the major IT vendors have realized the above potential and are using AI to record a user’s habits, anticipate their requirements, and display appropriate data at the right time.
The ability of AI to analyze text and speech will be a key feature in medical coding and billing, as well. With such a capability, systems can be fed with the language for diagnosis and procedures and assign accurate codes. Such a capability can have a major impact after code set gets updated, ensuring correct codes are used while the documentation is compliant as well. Further, the ability of AI to make predictions and conclusions will aid in pre-authorizations. Currently, it can take hours to get a pre-authorization from a payer. AI-enabled systems will be able to assess a patient’s health data and decide the necessity of a procedure almost immediately. Additionally, an automated process will confirm that authorization has been obtained, thereby offsetting pre-authorization denials due to the lack of an authorization code.
Further advancements in AI and related technology will enable the firms to optimize medical billing and coding procedures to a vast extent.
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