This is How AI Can Manage Your Medical Billing Process

AI in Healthcare

With the assistance of AI medical billers and coders can work efficiently and accurately, flagging down most of the human errors and mistakes.

Recent studies show that the error rates in medical billing are reportedly pretty high. According to studies conducted by the American Medical Association and Nerdwallet, the error rates are 7.1 percent and 49 percent for medical billing and medicare claims respectively. This can be adhered to factors such as upcoding, duplicate billing, digit transposing of ICD and CPT codes, etc. among others. Most of such errors can be said to be human errors, which can be avoided if taken care

A unique and new approach in the healthcare industry is improving patient collections through artificial intelligence (AI. With the assistance of AI medical billers and coders can work efficiently and accurately, flagging down most of the human errors and mistakes. The automated process can make the work efficient and faster. AI can also verify or complete clerical tasks, insurance appeals, and claims process.


The first stage of patient treatment starts from physician or specialist appointment. Each visit of the patient has to be verified and validated by the system when it comes to automating the billing system. AI solutions analyze details such as the previous visits, patient demographic, insurance eligibility, billings, drug prescriptions, and payment details. Both the patient and the hospital are informed of the eligibility and capability for the next visit based on this data.

One of the emerging technologies in AI is based on Computer Assisted Coding (CAC). It utilizes Machine Learning (ML) and Natural Language Processing (NLP). The CAC automatically identify and extract data from documents and inserts into the system. The automated AI solutions analyze physician documentation for the text/treatment and automatically recognize relevant medical codes. Apart from the processing of codes and high data volumes, AI can also decrease the standard work hours and human error.


As mentioned earlier, the latest AI solutions collect the data from each stage of the patient visit and record the data. The latest price parameters are updated to the online system, which automatically generate the bills as per the procedures completed. The system also takes into consideration the insurance capabilities and eligibilities of the concerned person. It keeps the insurance firms and the hospital in the loop notifying the concerned parties if any issues are found during the process. The AI can also calculate and assign patient grades based on a patient’s past and current financial status.


AI solutions can automate certain tasks that are repetitive. It takes the work of the staff by increasing their productive timing. Activities can be set previously set with the combination of ML, NLP, and AI. One of the advantages for using AI in the medical billing is the feature of pre-authorization. AI helps the patient know instantly whether the planned treatment is covered under the insurance policy or not. So having AI for this process will give more clarity about the claim at the initial stage itself, avoiding multiple financial or approval delays during the process.

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