Revenue Cycle Management (RCM) is an essential, and growing, segment of the healthcare field, offering a standardized format for determining the costs of procedures and treatments. The procedures for billing and coding are necessary, and they’re used to translate patient records into standardized codes that are used for billing third-party payers and patients. Unfortunately, the ongoing challenge is coding accuracy. In the fiscal year of 2017, the Centers for Medicare & Medicaid Services (CMS) reported that errors resulted in over $36 billion in improper payments. Some companies are beginning to develop and test artificial intelligence applications to help improve the efficiency and accuracy of billing and coding processes.

Understanding Artificial Intelligence 

Artificial intelligence (AI) is the ability of software to mimic human cognitive functions, and it has the ability to perform many different jobs traditionally done by professionals. Although you may immediately think of robots, AI is actually far more helpful than robots and machines. While some types of artificial intelligence seem to learn over time, the process is still generally controlled by a human. The ultimate goal of AI is to take specific processes and automate them, something that can prove significantly useful within the medical billing and coding field. 

The Problem with Inaccuracies in Revenue Cycle Management 

Just a single misfiled code can result in claim denials and contribute to the increasing costs of insurance and treatment. Unfortunately, errors are pervasive, with one study finding that over 90% of hospital bills contained errors. False claims, whether done intentionally or by mistake, are a massive problem in the healthcare field, with healthcare fraud costing Americans billions of dollars each year. Inaccuracies in billing and coding cost everyone, and artificial intelligence offers.

Benefits of Artificial Intelligence Use in Healthcare

Artificial intelligence has already worked its way in multiple industries, and its ability to analyze large amounts of data and make decisions and predictions that become increasingly accurate is undoubtedly valuable to the medical billing and coding industry. Since medical billing and coding involves so much data input, generation, and analysis, there’s incredible potential for AI. Just a few of the benefits of AI for medical billing and coding include:

• Benefit #1 – Text Processing– Many of the AIs currently being developed in this field are those with the capabilities to analyze texts. AIs able to identify keywords within medical reports can determine which codes should be used for treatments provided. This has the ability to reduce the margin of error related to inputting and choosing codes.

• Benefit #2 – Improving Accuracy– One of the significant benefits AI has to offer is the ability to improve accuracy. Inaccurate billing codes are one of the main reasons for declined claims, and even a single error can result in a reduced claim or a denial. Improved accuracy is one of the key benefits of adding AI to the medical billing and coding industry. Out of all the many ICD and PCT codes, they don’t all refer to individual services or treatments. Certain codes are used when multiple procedures are administered at one time. These bundled codes are designed to improve ease of use. AI could be used to easily recognized when these codes show up, updating them to the correct single code. Not only would this improve accuracy, but it could benefit processing times. 

• Benefit #3 – Easier Adaptation to Changes– For 2019 alone, there will be 216 deleted codes and 392 new codes. As was seen with the change from ICD-9 to ICD-10, complete revisions to the coding standards can take place, resulting in big adjustments. The medical industry has successfully made these adjustments in the past, but it takes some time, and the learning curve often results in more errors as codes get used to new procedures and codes. AI could be used in the future to make these adjustments easier, reminding uses or changes to codes and preventing coders from entering codes that have been deleted. 

• Benefit #4 – Reduced Processing Times– Another challenge in the medical billing and coding industry is processing time. It takes a significant amount of time for a procedure to be billed, for the payer to accept the bill, and then for payment to be received. Backed-up payments prevent a problem for providers, insurance companies, and patients. Improving processing times must begin with billing and coding professionals. AI can improve accuracy while saving professionals time as they compile procedure and billing information. When coders save time, it speeds up the rest of the processes. 

The Future of AI in Healthcare

Many different companies are working to develop AIs explicitly designed for medical billing and coding, including M-Scribe, 3M, Popul8, and A2iA. As more medical facilities begin to bring AI into their medical billing and coding departments, it’s very likely that more companies will start to enter this field. While AI already has the potential to address some of the big challenges faced in the medical billing and coding industry, it’s very likely that more research and development will result in new innovations for billing and coding AIs. 

M-Scribe is on the cutting edge of billing and coding technology and also offers payer contract review, provider credentialing, and more. Contact us today to learn more about how we can help your practice improve billing and coding efficiency, reduce denials, and improve revenue. 

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