AI linked to surge in Medicare Advantage, commercial claims denials: AHA
Becker's Healthcare September 10, 2024
Administrative costs now account for more than 40% of hospitals’ total expenses for delivering patient care, with a significant portion driven by the rising number of care denials stemming from the growing use of artificial intelligence tools by insurers.
Between 2022 and 2023, claims denials surged by an average of 20.2% for commercial plans and 55.7% for Medicare Advantage plans, according to a Sept. 10 brief from the American Hospital Association shared with Becker’s.
“One factor driving this growth is the increased use of machine learning algorithms and other artificial intelligence tools,” the AHA wrote. “Poor applications of these technologies can result in automatic denials of care without consideration of a patient’s individual clinical circumstances or review from a clinician...