AI Fans Revenue Cycle Fire

I hate to say I told you so, but I told you so. Artificial intelligence (AI) and revenue cycle management (RCM) are a match made in net revenue and profit margin heaven for hospitals, health systems and medical practices. Actually, I love to say I told you so. Just maybe not as much as providers love AI to collect more money for doing pretty much the same thing.

Two new reports are out that support what I told you was going to happen and what is happening.

The first report is from the BlueCross BlueShield Association (BCBSA). Analyzing Blues plans’ claims from the first quarter of 2023 through the fourth quarter of 2025, BCBSA said hospitals are billing inpatient stays as more medically complex without evidence that patients are any sicker than they were before based on the treatment they received.

Hospitals are doing it by adding more secondary diagnoses codes to claims for secondary conditions or comorbidities for the same type of patients. And they’re doing it by using AI-powered technologies that scan patients’ medical records and clinical documentation for things to support additional diagnoses.

“Many of these diagnoses can be derived from single laboratory values or routine observations, making them particularly well-suited for detection by modern RCM technology,” the report said. “Technologies including ambient listening for observation codes and laboratory data mining appear to be contributing to this coding growth.”

I told you that in this monthly column based on my own experience: “Motive, Means and Opportunity: Billing Codes Are Murdering Healthcare.”

The second report is from Bain and Co. and KLAS Research. The report is based on a survey of 303 U.S. executives at provider and payer organizations.

Asked what their top technology investment was, the number one answer among provider respondents was RCM. Sixty-four percent cited it as one of their top three priorities for outpatient care, and 43% cited it as one of their top three priorities for inpatient care.

Further, 75% of the provider respondents said they were “optimistic” or “highly optimistic” about AI specifically improving their ambient documentation, chart summarization and clinical documentation.

I told you that in this monthly column based on other surveys, reports and research: “Following the Healthcare AI Money Leads to One Inescapable Conclusion.”

I have no problem with hospitals, health systems and medical practices billing insurance companies and patients for everything they’re allowed to bill for and for all billable services supported by accurate and timely clinical documentation. I have no problem with insurance companies and patients refusing to pay for things that providers are not allowed to bill for or for services not supported by accurate and timely clinical documentation.

The problem is that each side is turning to AI to make their cases for them. It’s an arms race between providers and payers with patients becoming collateral damage. You think we’re in an affordable crisis now? Just wait.

We need AI to help us build better healthcare. We don’t need AI to make entrenched incumbent industry stakeholders even more difficult to dislodge.