Significant Artificial Intelligence Innovations in HME Billing

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Intelligence Innovations in HME Billing

HME billing is the process by which a patient receives care from a hospital, and the HME biller prepares the bill based on the inputs provided by the HME coder and delivers it to the insurance company to collect the charges incurred by the patient. The amount that can be claimed from the insurance firm is determined by the terms and circumstances of the patient’s policy. Whatever is not covered by insurance will be collected directly from the patient.

Computers, according to history, have resulted in the development of software applications and the internet. The IT industry contributes significantly to the country’s national revenue. Before delving into the significant advances that can occur in the Healthcare sector, let us first look at some fascinating data about Artificial Intelligence.

Artificial Intelligence’s Impact on the Healthcare Industry

  • Doctors on the internet
  • Patients’ treatment is tailored to their HME history
  • Identification of Medicines based on disease
  • Candidate selection for clinical trials
  • Disease identification and diagnosis
  • Wearable health monitors
  • Epidemic outbreak prediction
  • Automation of routine activities
  • Robotic surgery

Even while HME billing appears to be easy, it has its own set of obstacles. HME billing entails a plethora of codes, protocols, data entry, paperwork, and so on. As a result, the probability of human error is always larger.

This is where task automation can help to lower the percentage of errors. Through artificial intelligence, we may predict the following 5 important improvements in the HME billing business.

Auto-correction of codes

There are thousands of codes in the HME field in general. Almost every year, a new set of codes is added to the list. As a result, keeping track of it becomes much more challenging for the HME coder.

Despite having all of the codes entered into the system, issues continue to occur. Errors are costly in terms of both money and time. This is a key source of concern for hospitals, EHR providers, and HME billing firms. Artificial intelligence is being used by software companies to eliminate coding errors.

Things like auto-correction of codes while typing or suggestions to correct codes when the system detects an issue will be seen. This will be similar to a Microsoft Word document, with a red and green line for grammatical and spelling mistakes.

In recent years, we’ve seen auto correction/suggestion occur in our mobile phones. Similar AI technologies may be available soon. This type of AI solution can be created by providing the system with pre-programmed inputs. They can also learn and react depending on previous experience.

Repetitive task automation

Another type of innovation that we might see in the HME billing sector is task automation. A lot of tasks are repeated in the HME billing sector. This consumes a significant amount of billers’ productive time. AI can assist HME billers in increasing their efficiency and reducing monotony in their work.

Billers can focus on other vital areas such as patient care, report analysis, and so on by saving time. This will increase their activity and productivity. Automation can be used in any process that incorporates a set of standard procedures, or in other words, rule-based business processes. Data recording and insurance are two examples.

Pre-authorization Automation

Pre-authorization is the process through which an insurer (patient) obtains prior approval or authorization from an insurance company before undergoing HME treatment. Pre-approval is not required for all HME procedures. It is only applicable to a limited number of HME issues, which will be specified in the insurance policy. Hospitals and patients will generally be perplexed as to whether a specific issue comes under pre-authorization or not. As a result, we may see a significant increase in payment delays and denials. This is another significant area where we might expect to see the adoption of artificial intelligence. Because pre-authorization entails following a set of rules, it is simpler to automate this process. This is another example of a rule-based business process where AI can be used to reduce denials.

Fresh recruits’ training

This is yet another use for artificial intelligence. Now and again, a fresh group of HME coders will join an HME billing organization. Training programs for recruits will be conducted by any organization.

Typically, in an HME billing organization, the trainer will set a day for all new employees to attend training. In reality, each new hire will start at a different time. As a result, the training is postponed until a batch is created and the actual job begins much later.

Patient service chatbots

Another AI tool that is extensively employed in enterprises is chat-bots. To answer Patient questions, we can employ AI-powered chat bots. Patients can be offered a chat application to learn about their HME history, reports, insurance claims, next visit alert, appointments, and so on.

Aside from that, an AI-powered chatbot will be able to address general patient inquiries. The same technology can be used to keep the patient up to speed on the status of his or her insurance and other claim-related information.

Role of Sunknowledge in HME Billing

Sunknowledge Services Inc is a pioneer in the HME billing and process outsourcing industry. Our highly skilled medical billers and coders have transformed revenue and decreased operational costs by 70% over the years.

Sunknowledge Services Inc caters to all of your problems better than anybody else. Our unique approach and capabilities across all practice management platforms make us an excellent RCM destination for the country’s premier names. We provide personalized service and may match or beat any price. You can now transform all of your pre and post DME/HME billing obligations with us. Contact us for complete process management solutions.