> New analysis from the Blue Cross Blue Shield Association (BCBSA) finds that hospital systems are increasingly billing patient hospital stays as more medically complex, driving nearly $1 billion in additional healthcare costs in just two years. [...]
> More than 60% of hospital systems are now using AI-enabled technologies that can scan lab results and electronic records to identify secondary diagnoses, which could move a patient into a higher-severity, higher-reimbursement billing category.
Upcoding is a tale as old as time (and one of UHG's main tactics for making truckloads of money), but this does seem new and interesting.
Like, obviously only a doctor can diagnose. But, they can use technology to help them look at problems, including AI (literally the most versatile pattern matching software we have, just in natural language and with lower success rates). And they can make their own judgement call on if what the tool output is saying is correct.
However, if a Doctor were to see a bogus secondary diagnosis on their screen, and then dismiss it, they're opening themself up to medical malpractice liability, no? Like, it seems like the safest option would be to run (and bill for) the extra tests to confirm if the AI's story is true or untrue.
From your comment, I suspect you know much more about this topic than me.
But it doesn't seem from the link that they are running extra tests, just that they are charging for the secondary diagnosis. That's odd, if there's liability for not testing or treating it, isn't it?
That…doesn’t sound like a bad thing for patients? That sounds like an increase in the standard of care. I’m not surprised a health insurer is mad about it though
Adding false secondary diagnoses is one of the most prevalent forms of healthcare upcoding and makes hospitals and health providers a boatload of money.
It sounds like AI is making doing that a lot easier, and probably hard to contest what it finds without running extra tests.
> New analysis from the Blue Cross Blue Shield Association (BCBSA) finds that hospital systems are increasingly billing patient hospital stays as more medically complex, driving nearly $1 billion in additional healthcare costs in just two years. [...]
> More than 60% of hospital systems are now using AI-enabled technologies that can scan lab results and electronic records to identify secondary diagnoses, which could move a patient into a higher-severity, higher-reimbursement billing category.