An artificial intelligence arms race is afoot between medical providers and insurers seeking advantage in dividing the $4 trillion in health care expenses Americans accrue each year. “Everyone’s trying to maximize revenue while toeing the line on, effectively, fraud,” Nick Stepro told Daniel. He’s the chief product and technology officer at Arcadia, a company that works with health care organizations on both sides of the divide looking to build the technology. It’s true, he believes, that advanced AI will bring a host of positive impacts to the health system — but perhaps not before it further inflames the feuds over bills between your health plan and your medical provider. What’s up? For providers, the dream is an AI tool that can quickly and aggressively code procedures and file claims. Insurers — and the government agencies that pay for health care — want comparable technology to scrub those bills. The provider side: Leaders at several health systems told Daniel they want to reap savings by coding their bills more accurately, thus reducing their liability. Others highlight the benefits of reducing the labor needed to complete administrative tasks. And nearly all providers are keenly interested in making their staff happier by reducing burnout. Payers respond: Insurers say they’re making major investments in AI to cut their own administrative costs and weed out fraud in the bills they receive. “It feels like the perfect storm coming of the technology really becoming a more significant asset to the company if deployed correctly,” said Craig Richardville, chief information officer of Salt Lake City-based Intermountain Health, which does business as both a provider and payer. Government’s stake: Agencies already use AI to combat fraud, according to the National Health Care Anti-Fraud Association, an alliance of government agencies and private insurers. A spokesperson for the Centers for Medicare and Medicaid Services said that “CMS continually assesses opportunities to safely and responsibly leverage new, innovative strategies and technologies, including AI, to more effectively accomplish its mission.” At the same time, the agency has to answer to patients skeptical of strict anti-fraud measures that can result in denied care. Daniel has more on the race here.
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