How AI can Help Resolve the Issues in Medical Billing and Coding?

How AI can Help Resolve the Issues in Medical Billing and Coding?

Do you know what the key is to a smooth RCM? Which thing assures successful reimbursement promptly? If you’re thinking about medical billing and coding services, then you’re guessing right. We especially emphasize the role of medical billing outsourcing companies in making it possible. From the very beginning, the healthcare sector suffered from complexities in its bills. And suppose if everything goes fine with bills, the prolonged time of revenue recovery is an issue. Anyhow, thanks to computer-assisted medical billing services for replacing the old paper system.

All-in-all, it is through the latest advancements in healthcare IT that we can address the potential issue. Along with this, the hospitals now provide medical coverage and facilities to larger populations. So, we have a lot of data for medical billing and coding. Likewise, medical billing companies have immense billing work to do. Thus, the new advancements bring new challenges for medical billers and coders. But the good thing is that healthcare IT has started working on more advanced versions of billing systems. That’s why we will be able to tackle the situation on time.

In this blog, we will see what new challenges occur in current medical billing and coding. Also, the healthcare sector has planned to deal with them using AI.

Novel Challenges for Medical Billing and Coding Companies

In FY202, the CMS stated that billing mistakes led to $1.36 billion in incorrect payments or 1.54 percent of all expenditures. It is such a huge amount. Therefore, the U.S. needs to address the issues in medical billing and coding.

Mentioned below are some challenges medical billing companies are facing these days.

Complex Billable Codes

You know, the medical coders have one distinct code for every service or treatment rendered. The codes may vary for the same symptoms from one condition to another. So, these medical billing and coding companies have more than 70,000 billable codes. They have to apply the right and relevant code at a certain place. Otherwise, the clearing house can deny the claim for false documentation.

For such a huge amount of code, one person can’t be efficient enough to learn and handle it all. Thus, we need more and more medical coders who have authentic certifications. The coders must have expertise in translating the Electronic Medical Records (EMR) software and EHR data. But currently, we lack such expertise to some extent.

Employee Burnout; Low Incomes

It is quite clear that coding tasks are not easy. Professional coders burn the midnight oil to complete their coding courses and get field experience. However, they usually do not get handsome salaries for the services they perform. This simple fact is very disappointing.

Different Medical Billing and Coding Systems

Currently, medical billing companies have three main coding systems. The most recent one is the ICD. However, it is also true that these systems get modified from time to time. For instance, after ICD-9-CM, now we have ICD-10-CM. Every system has to follow the updated codes now. Thus, the medical coding service providers have to be updated with all of them.

Erroneous Claim Generation Due to Manual Tasks

It takes a lot of work to code medical records. Further, they manually match each medical visit and procedure with a corresponding code. So the coders are prone to making mistakes.

For the creation of patient statements and accounting, the data must be input into several systems. Scalability issues prevent the laborious hand-coding method. Overall, medical billing and coding is an exhausting operation that cannot be done error-free.

How to Combat the Challenges in Medical Billing?

Machine learning and natural language processing (NLP), two AI-driven technologies, can comprehend and combine enormous volumes of disorganized data effectively and quickly. From the software used to create EHRs, AI can recognize and extract data. Afterward, it can quickly match the right codes.

Benefits of using AI in medical billing and coding

Healthcare organizations are using artificial intelligence to streamline operations and cut down on mistakes in medical billing. The following are some advantages of using artificial intelligence for medical billing:

  • AI makes sure that accurate patient statements are given promptly, which helps increase cash flow.
  • Simplify administrative duties for employees to increase productivity and decrease burnout risk.
  • Eliminate human mistakes, which may cost healthcare organizations a lot of money.
  • Automation of the coding procedure will provide a scalable system that is less dependent on billing specialists.
  • Audits may be done in real-time, eliminating the problem of identifying an error before it’s too late.
  • Integrated patient statements may be produced to speed up the payment process and even nudge clients toward prompt payment.


An efficient medical billing and coding system is necessary to ensure a steady flow of money in healthcare. It is the major financial goal of every organization which is now possible with AI. AI-driven technology has the potential to combat all billing problems with its perfect algorithms. We can now automate the manual task with great ease. For further information on AI-driven solutions in medical billing, keep visiting P3 Care. We will give you the most interesting and useful sort of information every time.

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