Healthcare reimbursement is evolving, with payers increasingly using AI to manage claims, leading to more denials, delays, and appeals for providers. The lack of transparency in AI systems leaves hospitals at a disadvantage when contesting denials. Timely appeals are crucial to avoid revenue loss due to AI-driven denials. Some hospitals have tried to combat payer AI with their own AI tools, but this can result in more denials. To reduce the impact of AI on revenue, hospitals should leverage human expertise, understand AI algorithms, adapt to new systems, recognize patterns, and stay proactive in addressing denials. Balancing human expertise and technology is key to managing AI-driven claims denials effectively.
Source link
How Payers are Using AI to Deny Claims and Dent Provider Revenue
