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AI could be used in medical billing to improve efficiency

Administrative expenses account for about 15% to 25% of total national health care expenditures, according to 2021 research.
AI could be used in medical data, billing to improve efficiency
Posted at 3:37 PM, May 25, 2023

Artificial intelligence is entering the realm of medical data, with the hopes of making medical billing more accurate and efficient.

The A.I. would use data such as labs, vital signs, and orders to deduce what was managed in a clinical setting. This means administrators would be less dependent on a doctor’s notes.

"I think this is a field where, as a society, there's pretty broad agreement that we have to be very thoughtful in how we deploy these technologies," said Dr. Michael Gao, the CEO and co-founder of SmarterDx.

SmarterDx is a company focused on using A.I. with clinical data to make billing more accurate. Dr. Gao says this would, in turn, save hospitals money on administrative tasks.

"What we really care about at SmarterDx is not just depending on physician notes, on what the doctor is able to write while their primary purpose is thinking about the care they should be delivering and the care plan they're building, is not being solely dependent on that to figure out what happened between the doctor and the patient," he said.

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"If hospitals are misrepresenting or not fully representing the complexity of their patients, the quality of care might look different than what it actually is," Dr. Gao said.

Administrative expenses account for about 15 to 25 percent of total national health care expenditures, according to 2021 research published in the Journal of the American Medical Association.

The pros?

Dr. Gao said this could help with cleaner data for hospitals and more accurate billing, meaning more accurate reimbursement for hospitals and less back and forth between hospitals and insurance companies. In the long term, it could help with better health care research and outcomes as well.

"Improving the accuracy of  this reporting ... sort of improves the allocation of resources and the ability to know which hospitals are doing well and which hospitals could be doing better," he said.

So what about administrative jobs?

"What would be great is if A.I. can help with the mundane parts of a person’s job and in turn, let them focus on the parts that require the most judgment, the most insight, and the most creativity," Dr. Gao said.

The software is provided to hospitals and connected to their medical records to generate insights, Dr. Gao said. Data is not repackaged or reused for any other purposes. A human expert is still responsible for what actually gets added to a patient’s chart.  

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