5 major innovations to expect for Artificial Intelligence in Medical Billing

“Artificial Intelligence will rule the world”. This sounds straight from a science fiction movie. But it will be indeed true especially in the healthcare sector. There is always a thought that AI will replace human workforce. But in reality, technology development has increased new avenues of employment.

When computers were introduced, people were scared of losing their jobs. Going by history, computers has led to the development of software programs and internet. IT industry contributes a major portion to country’s national revenue. Before we go deep into the major innovations that can take place in Healthcare sector, let us first see some interesting statistics on Artificial Intelligence.

What is Artificial Intelligence(AI)?

Artificial Intelligence is a method of getting tasks done through machines with lesser or no human intervention.This happens through logical reasoning or through repeated tasks being taught to the machines. Machines are trained in such a way that it can respond based on earlier scenarios . Virtual assistants like Siri and Alexa are good examples of Artificial Intelligence.

AI can be applied in almost all fields including manufacturing, education, transport, healthcare, sports, media, communication, social networks, gaming, agriculture, online business, electronics, hospitality, entertainment, real estate, retail space, banking & finance, home, events, government, cyber security, aerospace, defence and so on.

Some important statistics on Artificial Intelligence

  • Key clinical health AI applications has the potential to save $150 billion annually for US healthcare economy by 2026.(Source:Accenture)
  • Global artificial intelligence (AI) in healthcare market is expected to reach approximately USD 17.8 billion by 2025, at a CAGR of 43.8% between 2019 and 2025. (Source: Zion Market Research report)
  • Global spending on cognitive and AI systems is expected to reach $57.6 billion in 2021. (Source: IDC)
  • The share of jobs requiring AI skills has grown 4.5 times since 2013. (Source: Forbes)
  • By 2020, AI will eliminate 1.8 million jobs and create 2.3 million. (Source: Venture Harbour)
  • AI will boost profitability by 38 percent and generate $14 trillion of additional revenue by 2035. (Source: Accenture)

Impact of Artificial Intelligence in Healthcare Industry

  • Virtual doctors
  • Customized treatment for patients based on their medical history
  • Identification of Medicines based on disease
  • Identification of candidates for clinical trials
  • Identification of disease and diagnosis
  • Wearable health trackers
  • Prediction of Epidemic outbreak
  • Routine tasks automation
  • Surgical robots

5 Major innovations of Artificial Intelligence in Medical Billing

Medical billing is a process where the patient takes a treatment from a hospital and the medical biller creates the bill based on the inputs given by the medical coder and sends it to the insurance company to claim the charges incurred by the patient.

The amount that can be claimed from the insurance company depends on the patient’s policy terms and conditions. Whatever could not be covered by insurance will be recovered from the patient directly.

Even though Medical billing looks simple, it does has its own set of challenges. Medical billing involves lot of codes, processes, data entry work, paper work and so on. So there is always a greater possibility of human errors.

This is where automation of tasks can reduce the error percentage. We can definitely expect the following 5 major innovations in the medical billing industry through artificial intelligence.

Innovation 1: Auto correction of codes

If you take Medical codes in general there are thousands of codes. Almost every year we get to see a new set of codes getting listed. So it makes the job of the medical coder all the more difficult to keep a track of it.

In spite of having all the codes entered in the system, there are still errors being made. Errors costs money and time. This is one major area of concern for Hospitals, EHR companies and Medical billing companies.

Software companies are working on ways to reduce coding errors through Artificial Intelligence. We will be witnessing things like auto correction of codes while typing or suggestion to correct the codes when the system detects an error. This will be something like a Microsoft word showing a red line and green line for grammar and spelling errors.

In recent times, we can see the auto correction / suggestion happens in our mobile phones. Similar kind of AI solutions are possible in the near future. This kind of AI solutions can be made through pre-programmed inputs given to the system.They are also capable of learning and reacting based on past experience. It has the intelligence to address even complex problems.

Innovation 2: Automation of repetitive tasks

Another innovation which we could see in the medical billing industry is automation of tasks. If you take medical billing business lot of tasks gets repeated. This takes away lot of productive time of the billers. AI can help the medical billers to improve their efficiency as well as to reduce the monotony in their work.

By saving time, billers can focus on other critical areas like patient care, report analysis and so on. This will make them more active and productive.Wherever the process involves set of standard procedures or in other words rule based business processes, automation can come into play. Some of the examples could be data recording and insurance verification.

Innovation 3: Automation of Pre-authorization

Pre-authorization is a process in which the insurer(patient) needs to get prior approval or authorization from the insurance company before taking a medical treatment. Pre-authorization is not required for all medical treatments. It is applicable for only few kinds of medical conditions, which will be clearly listed in the insurance policy.

Hospitals and patients will generally have a bit of confusion whether a particular condition falls under pre-authorization or not. Due to this we could see lot of payment delays and denials. This is another major area where we can witness the introduction of artificial intelligence.

Since pre-authorization involves follows given set of rules, it is easier to automate this process. This again falls under the category of rule based business process AI can be utilized here to reduce denials.

In the current scenario, patient takes the treatment and only during the claim process they get to know that the treatment comes under pre-authorization. By using AI the patient will know instantly whether the planned treatment is covered under the insurance policy or not. So having AI for this process will give more clarity about the claim at the initial stage itself.

Innovation 4: Training for new recruits

This is another area where artificial intelligence can be deployed. Every now and then there will be new set of medical coders joining a medical billing company. Any organization will conduct training programs for the new recruits.

Generally in a medical billing company, the trainer will fix a particular date and all the new comers will come for the training. In reality, each recruit will join the company on different dates. So the training gets postponed till a batch is formed. As a result the actual work starts very late.

If AI is introduced in the training part it makes the new recruit to learn and start working on a early. Through AI they can create a LMS (learning management system) which will take the learner to a self learning system with the help of text and audio visual content. The LMS will automatically take them to a set of modules and also test the learner’s capability and proficiency.

Once the learner completes all the modules, they will have to take an online test and score the required marks to get qualified. In some cases, the knowledge level of the learner is tested at the end of every module. By doing so, time and money will be saved and the learner becomes an expert at a reasonably shorter time.If required trainer can evaluate the qualified learner.

Innovation 5: Chat-bots for Patient service

Chat-bots is another AI tool which is widely used in businesses. We can use AI based chat bots to answer Patient queries. A chat application can be given for the patients to know their medical history, reports, insurance claims, next visit alert, appointment and so on.

Apart from that this AI based chat bot will be able to handle general queries from the patients. The same tool can be used to update the patient on the insurance status and other claim related information.

AI Applications for Medical Billing and Coding:

  • The majority of artificial intelligence use the emerging and advanced applications for billing and coding companies specifically those machine learning and Natural Language Processing in order to recognize the documents.
  • Many healthcare billing companies admit that Artificial Intelligence in medical billing drives it’s automated text extraction and document classification software products.
  • Large amounts of trained medical keywords and phrases are helpful to understand and recognize various document formats to feed them into computer assisted coding system.
  • All the documents of patients are scanned as image files including medical records and billing documents.
  • Artificial intelligence applications assist in extracting data from over 15 categories of medical, clinical documents on daily basis.

All the above mentioned innovations will only help the existing workforce. This will not affect the jobs in the health care industry. The innovations discussed above will help the people to speed up few of the process. In real terms, these innovations will only increase the productivity of the people.

Types of AI relevant to healthcare industry:

  • Machine learning or deep learning is a technique to learn training models with data.
  • It’s one of the most essential and common forms of artificial intelligence.
  • Natural language processing is another form that includes applications like analysing text, speech recognition and others related to languages.
  • NLP is approached by basically two models, Statistical and Semantic.
  • Expert systems based on rules and collections stands as dominant technology and also widely spread back then.
  • It requires human intelligence and experts to build set of rules in knowledgeable domain.
  • Physical robots are well known and also have been installed around the globe in larger basis.
  • Physical robots are especially used to perform tasks such as lifting, repositioning, welding as well as assembling objects in ware houses and factories.

Artificial Intelligence in Medical Billing will replace Humans- True or False?

While the world is still debating on this question, this statement is far from the truth when it comes to the healthcare industry.

  • In the case of the healthcare billing industry, tools backed with AI are great assistants to the humans already at work.
  • The human workforce is capable of making much more complex decisions. But they do not get to spend much time on these tasks since they are always caught up in doing mundane and repetitive work.
  • Filing up forms and posting payments manually not only takes up their time but also leads to several errors.
  • These intricate issues in the daily workflow lead up to inefficient use of the workforce. Artificial Intelligence can take charge of these repetitive tasks and free up the staff’s time to a great extent.
  • The reason why many healthcare organizations are not investing in AI is that they think it will eat up a lot of jobs.
  • On the contrary, AI tools will assist humans in doing their work in a much more efficient manner.

· So, if you want to shoot up your team efficiency, then you should definitely consider incorporating AI tools into your workflow.

As everyone knows, Artificial Intelligence is going to take the world to the next level. So its time the world embrace this technology. If you think some more innovations  are possible in the medical billing industry, do add it as a comment, we will definitely add it, if it meets our standard requirements. You can also share this blog post to people who really need it. For more news on technology in healthcare you can read articles here.

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