By Lauren Johnson
This year is the fifth consecutive year that Medicare has cut physician reimbursement rates with a 2.83 percent cut that started in January.
“Medicare, in particular, has always wanted to cut five percent reimbursement for years and years, and they’re doing that now through what they call sequestration,” said Kevin Bonner, president of Systemedx. “Basically, they give you things that you have to track, like blood pressure. You have to track all these things or they’re going to penalize you anywhere from two to eight percent so they’re getting a lot of money back. A sequestration code is like a take-back code.”
Sequestration and cutting reimbursements mean doctors get paid less, and because of this, some doctors won’t accept new Medicare patients.
“That affects the health of the patient when the good doctors don’t see them because Medicare doesn’t pay as well as the other insurance companies,” Bonner said.
Systemedx, a healthcare technology company based in Cullman, is using AI technology to improve billing and increase reimbursement rates. Three automated systems the company has implemented include AI Coding, AI Office Visit, and AI Overwatch.
“We like to say Medicare has an automated bot that tries to lower or deny claims. Systemedx has a bot that fights for you,” Bonner said. “Our bot watches the historical data of how Medicare is paid to all our clinics. We monitor how Medicare pays and then show you how you can get the maximum reimbursement.”
This AI tool watches denials and compares denials to others in the same field, showing why a claim was denied. The bot watches for rejections and provides information about what needs to be improved and what areas need more attention to get better reimbursement rates.
“Your objective in billing is to get it paid the first time you send it to the insurance,” Bonner said. Systemedx also utilizes software that listens to the doctor and patient conversations and generates notes with CPT codes (Current Procedural Terminology) and ICD codes (International Classification of Diseases). After listening to the conversation, the bot puts the charges and the problems into the system.
Within the last three years, Systemedx has been on the cutting edge of an automated tool that reads surgery notes. After a surgery is completed, the bot will read the office notes from the hospital and generate the CPT.
“If you use the AI to do your coding, it’s constantly adjusting to get the maximum reimbursement,” Bonner said. “It also does a thing called process automation where it actually goes in and scrubs the claim. In other words, if the claims get entered through some kind of manual process, it’ll check them to make sure you’re getting it paid the first time. Then auto sends to clean claims. Auto receives the check amounts back. They’re called remits when you’re doing billing. It automatically gets the remits back and posts to the correct patient accounts.”
The claim will be zeroed out and the automated system will provide a worksheet of claims that needs to be reviewed by human eyes. It pinpoints areas that might have caused the claim to be denied, like missing office notes or missing modifiers.
Another system, called AI Overwatch, keeps an eye on all critical areas in billing like the days in accounts receivable. It shows how the billing process is doing as a whole and monitors deadlines, like timely filing requirements.
“All of this has brought incredible improvements. I did the surgery readings for a practice in Huntsville that is now at $8.7 million in savings. That is a large practice – 30 surgeons and 180 providers – but they’ve made $8.7 million with the AI bot, and that was just reading their surgeries and coding them,” Bonner said.
In addition to new tools like reading surgery notes and listening to patient conversations, Text to Pay, a feature Systemedx started this year, is another improvement that helps clinics collect money faster and gives patients an easy option to pay through their smartphone within 24 hours of their visit. It’s also cutting costs on postage and saving time.
As AI technology continues to become more advanced, Bonner expects it to help improve the general health of the public. These AI programs will assist doctors who are already busy and aren’t able to provide as much attention to each individual patient as they’d like to.
