The Blue Cross Blue Shield Association released a new analysis last week blaming hospitals' AI coding tools for inappropriately adding nearly $1 billion dollars in costs to its member plans over two years.
The fact pattern BCBSA points to, higher coding for the same care, can easily be explained by something far more likely to be true than the conspiratorial intent they suggest: providers finally getting credit for the care they’ve always delivered and never got paid for.
It's true that AI is changing coding, and a host of other similarly broken and expensive processes in healthcare. Good. It should. It has the power to remove administrative burden and save money. BCBSA knows this, because their member carriers and payment integrity vendors are integrating it into their processes at scale as well.
This paper also conveniently disregards the insurers’ culpability in this “bot war.” Looking just at coding, we see payers, Blue plans included, aggressively denying and delaying payment for “additional information,” over the same time period of this study. Our data shows a median 63% increase in this tactic over last year, with an average of well over 100% when Medicare Advantage plans are included.
And we're not the only ones noticing. Days after BCBSA published its analysis, the Texas attorney general opened an investigation into Blue Cross Blue Shield of Texas over alleged denials and delays of urgent, medically necessary care.
Hospitals are using AI to document, code, and bill more accurately. Payers are using their own automation at every stage, from pre-pay audits to post-pay retractions. This bot vs. bot argument follows a familiar pattern of new technology applied to old motivations and processes. History is rife with examples, but suffice to say we’re fighting yesterday’s war.
At Anomaly, we’re looking to the future. We believe the promise of this powerful technology isn’t to automate the worst of our broken healthcare processes, but to eliminate them. We’re focused on going straight to the heart of the issue and using data to fundamentally change how care is negotiated and paid for, not how it's coded and billed.
Patients deserve transparency. Providers deserve to get paid for their work. We all deserve a payment system that works without a trillion dollars worth of processes and bots chasing it.
Our team is driving toward that future by designing the technologies required to run it. We’ve started by reverse engineering how payment actually works, by analyzing billions of claims and remittances, compared against contracts, payer policies, and correspondence to drive transparency into revenue leakage and how contracts are actually performing. With that visibility, health systems can manage their payer relationships and hold them accountable to their contracts.
If payers really want to reduce costs as they say, both parties can use this capability to negotiate and administer contracts with far less friction, expense, and confusion for patients.
BCBSA says more of these studies are coming. If they look like this one, save the paper. We know what they’ll say. The bot wars will continue and employers, patients, and taxpayers will keep paying through the nose. The bots are having their day today, but we’re trying to make it a short one.
Artificial intelligence can either be wildly deflationary for healthcare as we believe, or just be used to pour gas on the dumpster fire of today’s system that has failed. We’re choosing to bet on the future, and look forward to building it with you.
