Provider Billing Auditor: Enhancing Accuracy and Efficiency
Challenge
In the high-stakes arena of healthcare billing, there is absolutely no margin for error. Billing inaccuracies can lead to significant financial losses or trigger extensive audits from regulatory bodies like Medicare, demanding a painstaking manual review process. Despite the adoption of electronic health records (EHRs), discrepancies between what is recorded in the billing system and actual healthcare services rendered persist, especially in large-scale operations such as nursing homes. To mitigate these risks, healthcare providers often employ a labor-intensive triple-check process before finalizing bills. However, this best practice, while effective, consumes valuable time and resources.
Approach
To address these challenges, we developed an AI-powered auditing tool designed to streamline and enhance the accuracy of the healthcare billing process. Our tool automates the triple-check protocol, significantly reducing the manual effort involved. By processing two disparate data inputs—for instance, comparing facility's service notes against draft billing reports—the AI tool identifies and normalizes minor discrepancies, flagging any significant mismatches for human review. This innovative approach not only expedites the billing process but also uncovers subtle discrepancies that might escape manual checks, ensuring a higher level of accuracy and compliance.
Impact
Automating the time-consuming triple-check procedure saved countless hours of manual work each week. More importantly, the tool has enhanced billing accuracy across the organization by identifying and allowing for the correction of discrepancies prior to billing. This not only safeguards against financial loss and regulatory scrutiny but also standardizes billing practices across facilities, ensuring consistent and reliable billing operations. Through this technological advancement, healthcare providers can now focus more on delivering quality care rather than being bogged down by the intricacies of billing processes.
