Generative AI in Your Desk Drawer: Revenue Management

This article starts to look at healthcare generative AI use cases. Is it any surprise that new technologies in health care pop up quickly in the area of reimbursements? Payments are the constant obsession of every manager. Claims Abhishek Sharma, principal of business transformation at Sagility, says that payers question why a doctor ordered an MRI instead of a less costly CT scan, and that precise details in the patient’s medical record and clinical demographic history have to be culled to justify the decision. Dushyant Mishra, co-founder and CEO of RapidClaims, says that five to ten percent of costs in clinical institutions goes to billing and revenue management. The international ICD classification of diseases and conditions went from about 13,000 codes in ICD-9 to 68,000 in ICD-10. ICD-11 has already been formalized but is not in widespread use. It’s really too much to expect a human coder to find the most appropriate code (translate: the code most likely to maximize reimbursement). Doing so requires checking historical records for symptoms, test results, and other data that the payer needs to validate a code. Moreover, codes are routinely being added and deleted, and payers change their criteria for approving them. Mishra says that payers handle codes differently, some separating conditions and others preferring them to be combined. Ongoing training is required for human coders. It’s a textbook use case for AI. Anna Twomey, senior director of healthca...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Administration AI/Machine Learning C-Suite Leadership Health IT Company Healthcare IT Revenue Cycle Management Abhishek Sharma Administrative Burden AI Advantage Akshay Sharma Anna Twomey Artificial Intelligence Automated Medical C Source Type: blogs