Will AI Affect Medical Bills?

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The use of artificial intelligence (AI) has exploded. Every day, news of what AI can do is touted by the networks’ talking heads. It seems every industry is affected by this newest technology. The health care industry isn’t immune to this latest innovation.

AI is already used in the operating room to a certain extent. But its use is now spreading. From coding to preventing fraud, AI is being adopted by hospitals and doctors. But will its use reduce costs? And how will AI affect patient care?

AI Fundamentals and Health Care

AI goes beyond your basic laptop computer software. It’s a computing platform capable of making intelligent decisions. Two AI applications are used in health care.

AI can learn. Its computational techniques learn from examples beyond operating from predefined rules. Machine learning uses algorithms that learn from data to improve, describe, and predict outcomes. Once AI is taught, it learns and evolves in the task at hand.

For example, in health care, a machine could be taught by humans to identify pictures of tumors from an magnetic resonance imaging (MRI) image. AI would learn other ways to identify tumors on its own. It could find tumors that people weren’t explicitly looking for.

Natural language processing (NLP) is the AI’s ability to understand human language. It then transforms the unstructured text into machine-readable structured data.

An example of NLP is translating the interaction between a doctor and a patient into a note.

The use of AI in health care is growing. In 2021, AI in the health care market was worth $11 billion. It’s now forecasted that worldwide, it will be worth $188 billion by 2030.

It’s anticipated that broad adoption of AI in the health care industry could result in between $200–360 billion annually. But where are these cost savings coming from, and what about the human element?

Medical Billing and Coding

There are over 70,000 codes that human coders use to process charts. And right now, it’s a time-consuming manual process. With the speed at which health care moves, the entire process is inefficient. Errors are made, which result in denied claims. And with the older population needing more health care, the workload keeps increasing.

Human coders work daily, but AI works 24/7, so billing will be prepared faster.

AI is accurate and doesn’t miss a code. This means you won’t be billed for a service you didn’t receive. It also means that a claim is less likely to be denied by your insurance carrier because the service was coded wrong.

Because AI will take on the coding role, fewer manual coders will be needed. Existing workers can be promoted to supervising positions, or they can handle tasks that require a human’s attention. Still, there is some pushback from current billers and coders who feel their jobs are threatened.

Anything dealing with patient data must be Health Insurance Portability and Accountability Act (HIPPA) compliant. All AI that processes this sensitive information must meet this standard.

The savings hospitals and providers have due to AI billing and coding efficiencies could help slow down increasing healthcare costs.

Preventing Health Care Fraud

Billions of dollars are lost each year due to health care fraud. AI can identify anomalies or suspicious claim activity. It can spot false billing data, payments, or organizational data.

Large volumes of data can be analyzed promptly, allowing fraud analysts to identify and address issues before they are large problems.

Because AI uses NLP, it can understand human language. It will be able to notice verbiage, claims being submitted from unusual locations, or incoherent data that humans may not see.

Electronic Health Records

You may have access to a portal that links all your doctors and the hospital you use. That’s AI. AI electronic health records (EHRs) can reduce costs and deliver comprehensive care management to the patient.

It lets patients receive care that is aligned with their health goals. The result is fewer tests, since providers can see what tests others have performed. It also could lower readmission rates since everyone is on the same page regarding care. Fewer tests and hospital stays not only help patients but save money.

Computer-Aided Radiology and Pathology

Computer-aided diagnosis (CAD) uses AI to analyze images. Both radiology and pathology use it to help diagnose diseases.

It’s been used since the 1980s, but is expected to improve with the addition of the latest AI. For example, there are less false positives with AI because it analyzes images more accurately.

Although currently done by humans, AI can automate the process of detecting disease. The result is fewer biopsies and more correct diagnoses.

AI Used in Health Care Is Here

AI may seem like something out of science fiction, but it’s working now in the health care industry. It’s on course to save billions of dollars through coding and fighting fraud.

The added benefit of EHRs is that they reduce costs and ultimately help patient care. Identifying anomalies correctly without biopsies is another benefit.

However, patient confidentiality is vital. AI must have the safeguards in place to be HIPPA compliant.

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