How Payers are Using AI to Deny Claims and Dent Provider Revenue

MedCity News November 24, 2024
Chandler Barron

While AI has the potential to streamline processes, its current use in the revenue cycle is resulting in more claim denials, payment delays, and a greater need for appeals, particularly because payers often use AI to retroactively review medical necessity determinations.

As healthcare reimbursement evolves, hospitals are facing a new challenge: payers are increasingly using artificial intelligence (AI) to manage claims. Many providers may not realize AI tools are being used to review their claims, and these systems are not built with provider interests in mind. While AI has the potential to streamline processes, its current use in the revenue cycle is resulting in more claim denials, payment delays, and a greater need for appeals, particularly because payers often use...

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