Medical billing is one of the most important administrative functions in any practice or hospital. While coding and submitting claims are essential to revenue cycle management (RCM), these tasks are labor-intensive and require significant staff time and meticulous attention to detail. Finding solutions to streamline the billing process can simplify RCM and free staff to focus more on patient care.
Introduction to AI in Medical Billing
Machine learning and artificial intelligence (AI) are transformative tools for industries that process large volumes of data, including the medical field. AI tools can support functions like clinical trial administration, public health reporting, and analyzing population-scale health trends.
These technologies also play a role in practice and hospital administration, particularly in simplifying key management functions such as medical coding and billing.
Any practice manager can confirm that coding and billing are essential to revenue cycle management. Automated medical billing with AI improves accuracy in initial claims filing. This helps reduce denials, bring in payments more quickly, and ease the administrative burden on staff.
Reducing Billing Errors and Claim Denials
Errors that lead to claim denials are a persistent challenge for medical practices of all sizes. A 2023 KFF review of ACA marketplace plans found that, on average, 20% of claims were denied, with 18% of those claim denials due to administrative errors such as duplicate claims or missing information.
The high number of denials based on administrative errors means medical practice staff have to devote considerable time correcting and resubmitting claims. This is an inefficient use of skilled staff time and causes payment delays.
AI-based billing tools automate the coding process by integrating with EHR platforms to generate codes from clinical documentation. Machine learning enables AI to accurately match billing codes to services and procedures, verify insurance eligibility and benefits, and ensure up-to-date provider network status.
AI tools can also identify errors in claims paperwork, identifying discrepancies between the claim and the patient’s most current information. Automated claim scrubbing helps prevent denials caused by minor mistakes, such as misspelled names or incorrect birthdates. According to a report by MedTech Intelligence, real-time error detection before claim submission can reduce denials and appeals by up to 20%.
Accelerating Claims Processing
One of the biggest benefits of AI-driven automation is its speed. AI billing and coding tools can process multiple claims in a fraction of the time it takes to do it using manual methods. This helps reduce staff hours required for accurate billing and adapt to fluctuations in patient loads without the need for additional staffing.
In addition to speeding up the process of generating claims, AI systems help expedite payments by preventing denials. Machine learning can identify patterns in payor denials and approvals. This type of pattern recognition allows the system to flag potential issues before the claim is filed, allowing staff to adjust claims proactively and prevent denials and payment delays.
Human oversight is the key to getting the full benefits of AI tools. Billing staff remains crucial to the process, but their role can elevate from largely data entry to problem-solving and triaging complex claims. AI tools can alert billing personnel to individual claims that may trigger denials or require additional information. Staff are able to address issues before submitting the claims, mitigating the risk of denials and labor-intensive appeals.
Enhancing Compliance and Reducing Administrative Burden
By design, automation takes over tasks that once required significant staff time and effort. AI is particularly well suited for repetitive tasks like entering coding information into claims. Unlike human staff, AI tools don’t experience fatigue or get called away from filing claims to help with other tasks. AI is also not susceptible to the inevitable human errors that occur with repetitive data entry. Using AI to compile data for medical claims frees up human staff to focus on other patient-centered responsibilities. This improves care and the patient experience while reducing the risk of future stress from denied claims.
Another advantage of AI is its ability to quickly assimilate new data. AI tools can adapt to annual CPT and ICD-10-CM diagnostic codes updates, minimizing the risk of coding errors. A simple data update to the AI platform can replace outdated information, allowing for the seamless implementation of new codes. AI tools can also integrate new payer-specific requirements, reducing errors that lead to claim denials.
Greater accuracy in filed claims leads to more timely reimbursements from payers. This provides practices with improved predictability in revenue cycle management. AI tools can offer confident revenue forecasting based on submitted claims, reducing concerns about revenue shortfalls caused by stalled payments.
The Future of AI in Medical Billing
Adopting AI in medical billing will become critical as payers increasingly use AI to assess claims. However, AI adoption on the payer side has coincided with a rise in claim denials. Industry leaders view billing AI as a valuable counterbalance to payer AI systems, giving providers dynamic billing tools that adapt to payer policies and procedures.
Equally important, AI billing systems alleviate pressure on medical practice staff without sacrificing billing accuracy. Clinicians spend less time matching diagnoses to codes in EHRs, and administrative staff handle fewer billing-related data entry tasks. Fewer claim denials reduce the hours spent on appeals and bring greater predictability to revenue cycles.
At PUREDI, we are committed to bringing the most advanced tools to our clients. Our automated medical billing technology ensures accurate, timely RCM for medical practices. Our comprehensive services include claims management, claims scrubbing, insurance eligibility verification, and advanced reporting and analytics. With our Error Checking & Denial Prevention Engine, we can track down delayed payments and give you valuable insights into how you can avoid future denials.
To learn more about PUREDI's full suite of medical billing and management tools, contact us today to schedule a consultation.
