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Payers and providers are locked in an “AI arms race” over coding and claims, but some industry leaders are acknowledging the battle may be a distraction from providing patient care.
“The bots battling the bots is a real thing,” Sachin Jain, MD, SCAN Group president and CEO, told Becker’s.
“We’re spending all this effort trying to figure out how to get paid and how to deny payment, instead of figuring out how to streamline the actual experience of care so that people who need help can get it,” he said. “We should all take a pause and say, ‘Can we end this madness?’ Because it is absolute madness.”
Centene and Elevance Health, among other insurers, have accused providers this year of “aggressive coding,” with AI-assisted clinical documentation tools heightening that scrutiny. One health system’s clinicians reported reduced rates of burnout while using ambient AI, but also thousands more in revenue per clinician.
While payers escalate their AI resources to authenticate claims and streamline prior authorization requests, some providers say insurers are outpacing them and creating an imbalance.
“We in the provider sector are chasing this a bit,” Dennis Laraway, executive vice president and CFO of Cleveland Clinic, said.