Author: PayerWatch & AppealMasters
9/16/24
At PayerWatch, we’ve been closely monitoring the rise of artificial intelligence (AI) in healthcare, especially in relation to claims denials. There’s no denying AI’s potential to streamline processes, but as highlighted in this recent article, AI is now linked to a troubling surge in Medicare Advantage and commercial claims denials. Providers are bearing the brunt of it.
AI may promise efficiency, but without the expertise of seasoned clinicians and legal experts, it’s becoming a tool for payers to increase denials, not reduce them. From the outset, we at PayerWatch were skeptical about AI’s ability to assess and appeal unjust denials as effectively as a human. Unfortunately, this is exactly what we are now witnessing — AI being used to push more denials through, creating new headaches for hospitals.
At PayerWatch, we believe technology should enhance, not replace, human expertise. Our Veracity™ software leverages industry-recognized tools like robotic process automation (RPA) to assist our team, but it’s our experienced clinicians and legal professionals who drive real results for hospitals. We will continue standing firm for providers, pushing back against this denial surge with the right mix of advanced tools and human expertise.
