Medical billing is not a simple process. It requires precision and correct timing. Even one small mistake can lead to a claim rejection, which no healthcare provider wants. Claim rejections are expensive because they affect accounts receivable (A/R) and also create extra pressure on working capital, staff time, and other internal resources.
When a healthcare provider submits a claim to an insurance company for the care provided to a patient, there is usually a 5–10% chance that the claim will be denied. A more recent study shows that almost 41% of providers report a claim rejection rate of around 10%, which means 1 out of every 10 claims submitted gets rejected for different reasons.
Over the years, with the use of systems like EHR, PMS, and RCM, there has been improvement in billing workflows and a reduction in manual errors. However, the statistics mentioned above are recent, which clearly shows that even with these modern systems, errors and issues that lead to claim rejections still exist and have not been fully solved.
But things are changing now. AI is being used in medical coding and claim submission to catch mistakes early. With AI-based billing software, providers are able to submit cleaner claims with fewer errors from the start.
AI Medical Billing Software
As AI is changing many industries, it is also doing the same in the healthcare industry, from diagnosis and drug research to medical billing. We at Talisman Solutions realised this trend early on. When AI started changing and disrupting industries, and with our two decades of experience in medical billing, we decided to create our own AI-powered medical billing software, and we successfully did.
AI works best when it is used with human experience. Technology handles the heavy and repetitive work, while billing experts use their judgment. This makes the overall billing process faster and easier to manage. We have noticed that clients using our software saw a 20–30% improvement in their A/R within 3–6 months of use.
Our AI Billing Software Features
So, our AI medical billing software has multiple modules or features that give it the ability to simplify the coding and claim submission process.
- Billing Intelligence: Different providers use different codes, and the system understands that. It also understands the rules and processes of different payers. Because of this, the right codes are added and the claims submitted have fewer mistakes. This helps reduce errors during submission and also saves time in overall claim processing.
- Coding Assistance: The system creates context for coding by reading clinical notes and patient information. This gives the system a clearer picture of the work done for the patient. It checks whether the added codes fit payer rules. If something looks off, it marks it. It can also suggest better codes and point out mistakes. This saves time during coding.
- Denial Pattern Analysis: If something is slowing down the A/R cycle due to claim denials, the system identifies it. The AI in the medical billing software system checks older denied claims and notes what caused the issue. It also shows problems that appear again.
- Review: Before a claim is sent, the system checks it. It looks for typing errors or missing details. This helps avoid simple rejections.
- AR Follow-Up Prioritisation: The system identifies high-value and time-sensitive claims that need follow-up. This makes it easier for the billing team to decide where to start.
- Human + AI Copilot: In this software, AI helps the billing team with routine checks and calculations. When something looks unclear, a billing expert reviews it and makes changes. AI may also point out things that were missed. This helps keep the work moving.
How Our AI Billing Software Simplifies Coding and Claims
Below is a simple view of how coding and claim submission usually happen.
- System Connectivity: The software uses data from the existing EHR or PMS and avoids entering the same details again.
- Patient Visit: The patient comes to the clinic or hospital.
- Clinical Notes and Patient Details: Doctors and other staff add patient data and clinical notes.
- AI Reads the Information: The system reads the notes to understand the care given.
- Coding Assistance: The system helps choose codes, flags missing or wrong entries, and checks payer rules.
- Billing Intelligence: The system follows provider and payer rules to keep claims clean.
- Automated Charge Review: Before sending the claim, the system checks for mistakes like typos or missing details.
- Human and AI Review: AI does routine checks, and billing staff review and fix issues if needed.
- Claim Submission: Claims are sent only after all checks are done.
- AR Follow-Up Prioritisation: The system highlights claims that need faster follow-up, so the billing team knows where to focus first.
- Fewer Errors and Rejections: With fewer mistakes, fewer claims get rejected.
- Faster Claim Processing: Claims move ahead without long delays.
- Improved A/R Cycle: Providers see better A/R results in 3–6 months.
Conclusion
This is how AI is being used in medical billing today. It helps reduce delays and errors in coding and claim submission. AI does not replace billing staff. It helps reduce manual work in daily billing tasks. If billing delays or repeated denials are happening often, AI billing tools can be looked at.
