Tech & Innovation in Healthcare

Artificial Intelligence:

Augment Your Auditing Process in 5 Ways With AI

Find out where the technology can improve your workflows.

Artificial intelligence (AI) is a rapidly evolving technology that has shown several benefits in healthcare and the revenue cycle. One space where AI can transform healthcare practices is by using its assistance during your auditing process.

Read on to learn five areas where AI can help auditors and healthcare providers.

Quickly Review Documentation With AI

Deploying AI to dig through documentation during the auditing process can be a substantial timesaver. In this step, the technology assists you by reviewing the documentation and can automatically flag possible coding errors or gaps in the documentation.

“This is going to allow us to streamline that process and allocate our human resources more effectively,” said Jacob Swartzwelder, CPC, CRC, CIC, CPMA, CEMC, AAPC Approved Instructor, managing director of Compliant Approach Partners LLC, during his session, “Enhancing Compliance with AI-Powered Audit Tools and Techniques,” at AAPC’s AUDITCON 2023.

He explains that the computer can quickly scan a large amount of documentation. “[The technology] can go through multi-targeted focus areas very quickly. We can set it up to check 20 things on all 100,000 records, and it can do that and prioritize which records would be most beneficial to receive a human review,” Swartzwelder added.

Uncover Under-Documented Conditions

Due to the human element of healthcare and medical coding, medical conditions may be under documented in the patient record or claim. Under-documented conditions contribute to inaccurate coding and even loss of revenue for the practice. In the auditing process, you can use AI to hunt through medical documentation to locate these conditions.

“We can use that AI to analyze clinical documentation to identify if there are keywords or concepts that might be missing, or that should be included to get the most accurate patient profile, and we can identify those under-documented conditions,” Swartzwelder said.

Clinicians can then use the AI’s analysis to improve their documentation quality, which will help coders more precisely code the encounters and providers can have an accurate picture of the patient’s health to help improve the patient’s outcome.

Improve Coding Accuracy

“We all know that coding accuracy is essential for reimbursement for one, reimbursement, security, and risk for two. We want to make sure that we’re not having money taken back, and that we can build stable financial forecasts. Coding accuracy is very important for accurate patient profiles and reporting to your payer system,” Swartzwelder said.

When you use AI to assist you in your auditing process, the technology can automatically flag certain records for potential errors, such as incorrect codes and incomplete documentation. Then, you’ll know to prioritize those records to communicate with your providers, either via a query or an educational session.

Deliver Real-Time Feedback to Providers

Doctors, nurses, and other clinicians can receive helpful advice for improving their documentation as they perform the task. AI technology can deliver automatic alerts for areas where refinements may be needed. These instant insights include:

  • Highlighting missing information
  • Suggesting related diagnoses based on lab results
  • Imaging analysis

However, these alerts can be alarming for healthcare providers if they’re documenting during the evaluation and management (E/M) visit.

“If you’re in the space of looking at vendors for this or if you’re in the development side of these things, please pay attention to what that provider is going to be interfacing with,” Swartzwelder said. He continued, “Some providers today are working on even small laptop screens, and we do need to pay attention to what that is going to look like in terms of not taking away from patient care, and not taking away from some of the positives that already exist there.”

Achieve Efficient Workflows

Streamlining your audit workflow is a huge step toward optimizing your resources and improving the process for both you and the providers you work with. Adding AI to your process can also enhance your auditing by:

  • Automatically reviewing large volumes of records
  • Flagging sections for additional review
  • Delivering helpful feedback to clinicians

The last two items might not take a lot of time but will add up over thousands of records each year. AI can assist auditors to ensure audits are conducted timely and efficiently to help produce:

  • Greater coding accuracy
  • Maximized reimbursement
  • Reduced risk to the organization
  • Improved patient outcomes

Stay tuned to Tech & Innovation in Healthcare for more information as AI continues to evolve in healthcare.