Billing in healthcare administration is considered among the most challenging jobs within the field. This task calls for exactitude, comprehensive knowledge of payer guidelines, and lots of repetitive tasks completed while being under pressure of time, like insurance verification or claim submission. In the recent past, technology has been of help to billing professionals to some extent.
Nonetheless, the technologies in use are always put in the same category even though there are essentially two distinct types of technology in operation here: automation and artificial intelligence.
The Benefits of Automation
Automation in medical billing can therefore be considered as an activity which involves doing repetitive activities in a consistent manner, following a certain predetermined routine. The automation will involve doing these activities systematically without becoming tired. Repetitive tasks, which always have to be performed in the exact same way, require exactly the kind of assistance offered by automation.
An example of repetitive task that requires automation would be checking the insurance eligibility of patients. With regard to a hospital with a lot of patients, checking the status of their insurance eligibility and also any change of status would be something that used to be done through manual checking of the individual patient’s information in the payment system. With automated eligibility checking software, this process becomes automatic and changes are noted before they become a problem.
Other rule-based tasks can also be automated. It is possible to screen claims for compliance with payer rules prior to filing the claim so that any unnecessary mistakes are identified beforehand. Automated tracking of the status of the filed claims and automated data entry can also be carried out. These tasks do not involve judgment but only accuracy and consistency, which are best performed by automation.
Growing Role of AI
The process of artificial intelligence works differently. Instead of executing specific pre-programmed steps, it utilizes vast quantities of previously collected data and makes its own conclusions, which were not pre-set in the algorithm. Therefore, automation executes specific actions whereas AI is employed for analyzing the collected data and making recommendations in case there is no clear-cut answer.
For example, AI can be used for predicting the likelihood of claim denial and help the biller to review the claims before sending them. This can also be helpful for the coding process since it helps select the correct codes based on the available documents. Moreover, it can be used for analyzing the clinical notes that were written in regular language and find out what was important for the coding process. It would take an enormous amount of time to do the same thing without using the AI.
However, it must be said that the use of AI does not eliminate the necessity of conducting the review process itself. It is the suggestions provided by AI which are of much help and can only be valuable when verified by a qualified individual. The point of using this technology is to point out where it is really necessary.
How the Two Work Together
Automation and artificial intelligence are very much related to each other and are even used together in practice. While automation collects and verifies the information needed, artificial intelligence analyzes the collected information and identifies which claims should be analyzed in more detail. For instance, a claim could be created and verified automatically and after that analyzed by an AI-based solution as a potential denial.
With such a combination, the process becomes much more efficient due to automatic handling of routine tasks and analysis of complicated claims, which can be then analyzed by a human.
The Biller Role
One would be wrong to assume that the purpose of these technologies was to replace medical billers. Quite the contrary. By assuming routine tasks and highlighting the cases that really need attention, the use of these technologies makes it possible for the billers to devote their time to cases that require their skills and experience – appeals, the coordination of more than one payer and the cases of a peculiar nature which no rule or pattern can account for.
This is of high importance now, when the pool of experienced billers is getting smaller. It takes some time to gather the necessary information to perform billing correctly and it cannot be replaced overnight. Reduction of routine work enables this.
However, there is also the question of accuracy and of data security. Personal and medical information is involved in billing process, and this means that the system should handle it properly and according to all the standards of privacy. Automated systems and AI can help in doing that by minimizing the number of mistakes which occur during manual processing of the information.
Looking Ahead
Usage of these technologies for medical billing is going to be increasing in the coming years. Automation is going to shoulder more tasks in the area of predictable tasks, while the artificial intelligence will be able to assist in more interpretation-based tasks. It is certain that the primary aim will remain the same, which is making medical billing accurate and efficient.
When health care organizations are thinking about using these technologies, then they must know the uses of each one of them. They should be aware of where automation helps and where artificial intelligence can help.
