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Chief Healthcare Executive December 21, 2024
What AI Can and Can’t Yet Do in Payment Integrity
ICD10monitor June 20, 2022
It’s important to be realistic about what AI can and can’t do currently.
Artificial intelligence (AI) has been a buzzword in payment integrity for years. Companies are increasingly using AI and data mining to identify healthcare savings. This technology can be helpful in the right scenarios.
Data versus Nuance
AI, which includes technologies like machine learning, works well in certain settings involving relatively straightforward claims data. It is good at analyzing data, recognizing patterns and outliers, compiling statistics, and making calculations in scenarios where the appropriate code assignment is obvious and there are no gray areas. But not every scenario is strictly data-driven. Some situations need to be evaluated and interpreted, and that means they require human experience and intelligence.
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