With the continuing increase in capability and decrease in costs, AI technology in healthcare payments is the wave of the future. The healthcare payment field presents technological, regulatory, and procedural challenges that represent hurdles for implementation of artificial intelligence technologies, but AI is also uniquely capable of solving many of these challenges.
Let’s look at how AI technology will impact the healthcare payments field for the better, now and in the future.
Artificial Intelligence: What is it Good For?
Artificial intelligence is an umbrella term for a variety of technologies, such as machine learning and natural-language processing, that can perform tasks normally requiring human intelligence such as decision-making, pattern recognition, and data analysis.
There’s no substitute for human creativity and ingenuity, but AI serves as a powerful force multiplier, automating repetitive tasks and processes. AI is most efficient when integrated into processes with the following three traits:
AI technologies can handle functions like data handling and analysis, accounting and auditing, basic customer service, and archiving in an infinitely scalable and automated way. If implemented and programmed correctly, they can accomplish specific tasks more accurately and consistently than humans, 24 hours per day,
Healthcare Payments: How Can AI Help?
The American healthcare billing system is incredibly complex. Almost every doctor visit, hospital stay, and medical treatment has multiple stakeholders involved and generates tremendous amounts of data.
The clinical side of the healthcare field has embraced the AI field. Clinicians and researchers have leveraged AI for astonishing medical breakthroughs in recent years. Advances made possible by AI technology:
- Early detection of cancer and other diseases – AI-powered solutions spot warning signs of cancer and some blood diseases earlier and more accurately than humans.
- Development of new medications – AI systems can scan genomes and existing research and identify potential candidates for new medications, as well as potential new uses for existing medications.
- Personalized treatment plans and chronic illness management – AI can help chronically ill people manage their conditions on their own, with the guidance of their doctor. For example, an AI-based app provides diabetic patients with predictions on their glucose readings based on their own history and general data sources and makes recommendations based on the patient’s behavior.
- Automated symptom assessment – An AI-powered chatbot guides patients through a symptom assessment and provides likely causes, allowing them to make a more educated decision on treatment.
While AI is being used extensively in treatment, adoption of AI for healthcare administration and payment has been slower. 70% of providers still use manual processes for check-in, and 90% still use manual processes for collections. With AI-powered solutions being introduced to solve many pain points in the healthcare payment sector, this is expected to change over the next few years.
Leveraging the unparalleled data analysis capabilities of AI provides opportunities to improve efficiency and increase revenue for providers, as well as a smoother, more user-friendly experience for patients. How? Let’s find out.
Personalized / Smart Medical Bills
9 out of 10 consumers have been surprised by an unexpected or unexpectedly large medical bill in the last year. This not only reduces patient satisfaction, but sometimes results in patients giving up and ignoring the bill. AI can leverage patient data to provide personalized smart bills that offer multiple options for payment, tailored to each patient’s preference.
Chatbots for Digital Payments
Banks and financial institutions have been finding success with using AI-based chatbots on Facebook Messenger to offer personalized payment options and accept digital payments. Unpaid medical bills are a sizable drag on the bottom line of many healthcare providers and reducing the amount of those unpaid bills is important for providers to have the resources necessary for patient care.
Medical Billing Workflow
Medical billing and coding specialists must produce fast, accurate bills and paperwork using thousands of unique codes, sometimes with only minor differences between them or ambiguous language separating one from another. With so many opportunities for miscoding or clerical errors, it’s no surprise that over 80% of medical bills have at least one inaccuracy.
AI-based software can learn from each user’s interaction with billing and coding software and provide algorithm-based suggestions and real-time error correction. This increases efficiency and reduces the rate of errors.
Payment Integrity: Eliminating Fraud, Waste, and Abuse
Experts estimate that fraud, waste, and abuse charges cost healthcare payers $300 billion each year. Payers only prevent or recover a small percentage of these charges; the sheer volume of data makes it difficult to review more than a fraction of claims. AI technology as a force multiplier, though, is a game changer in the payment integrity space.
Alaffia Health uses machine learning and natural-language processing to automatically review incoming claims, flag suspicious or improper items, and request corroborating paperwork from the provider. Their team of medical billing and coding experts review high-cost claims identified as most likely to contain overbilled or improper charges, and prevent or recover any overbilled amounts..
The result? Thanks to the force multiplier of AI technology, Alaffia’s team saves healthcare payers an estimated $150 per member each year in overbilled charges. If your healthcare plan has 100,000 members, that’s $15 million saved every year.
AI Drives Better Outcomes
AI technology drives better outcomes for patients, providers, and payers when thoughtfully implemented as part of healthcare payment processes. While AI-driven medical treatments rightfully get the lion’s share of press coverage, AI technology in healthcare payments is also crucial to providing positive patient outcomes.
While implementing AI on your own can be challenging, a proven, established partner puts the power of AI at your org’s disposal. Alaffia Health’s platform, for example, seamlessly integrates with your own systems and provides a turnkey AI-driven payment integrity solution. Fraud, waste, and abuse charges are the bane of every healthcare payer. To get them under control, book a call with Alaffia today.