How AI Technology Eases the Audit Process for Healthcare Providers

We’ve all heard the news stories about billing errors in the healthcare system, whether it’s a patient being charged for 13 colonoscopies in a single month and Medicare paying each bill until an auditor catches it or a patient being oversubscribed a medication in a fraud or abuse case.

The healthcare auditing process, in all these cases, provides a way to confidently reduce any potential risk of fraud or waste within the healthcare system for any of their insurance-provided procedures and prescriptions.

But when audits are performed manually, they’re notoriously tedious, time-consuming, and come with a risk of costly human error. And it’s no wonder since these auditing activities demand that employees maintain a high degree of focus and attention so they can consistently make high-quality decisions, which isn’t easy.

How AI Can Ease the Healthcare Auditing Process

Fortunately, this problem is becoming a thing of the past for many healthcare providers, thanks to tools like Hindsait. By using AI insights, Hindsait’s AI-enabled audit platform helps human employees perform clinical audits more efficiently. This leads to:

• Better, more consistent, and error-free decisions in just 2/3s of the time, with decision wait times reducing from days to minutes.
• Healthcare providers saving millions of dollars on clinical review costs alone.
• The platform delivering 30%+ efficiency over manual review processes.
• Healthcare providers enjoying 35% fewer appeals and reconsideration decisions.

How AI-Enabled Auditing Works

Let’s get a closer look into how these results are produced, from one step to the next.

Step 1. Data Ingestion and Processing

First, medical records and unstructured data are ingested through API from your workflow platform, be it OnBase or another solution. Then, it processes the data in real time, only allowing clean, high-quality data to enter to pipeline to minimize the risk of downstream issues.

Step 2. Automation and Data Extraction

It then extracts relevant data from various document formats using Robotic Process Automation (RPA), which combines the capabilities of Optical Character Recognition (OCR), Computer Vision, Optical Mark Recognition (OMR) and Hindsait’s signature and date detection. Clinical natural language processing then converts the unstructured data into structured formats for analysis. Then, Hindsait’s adaptive algorithms further enhance accuracy by optimizing extraction tools based on document type and historical performance.

Step 3. AI-Driven Decision Engine

In this step, Hindsait’s AI-driven decision engine evaluates your medical records against clinical guidelines. The AI assigns confidence scores based on machine learning. If the AI sees the decision as clear-cut, it’ll give it a higher confidence score. And when the confidence score exceeds dynamic, data-driven thresholds, the decisions are automatically made with zero need for human intervention.

Step 4. Human-AI Collaboration

When the confidence score falls below the threshold, your employees collaborate with Hindsait via the AI audit platform. This collaboration lets your employees focus their time and attention on the cases with the highest need, instead of distributing their energy across lower-priority cases on top of that. As a result, the decision-making process is accelerated, producing the staggering results we explored in the bulleted list earlier in this blog.

Step 5. Continuous Learning and Feedback

In this final stage, the technology uses continuous learning and feedback to improve all outputs. It stores all final decisions and data in a centralized repository and continuously learns from human intervention and feedback, refining its model in real time to “retrain” itself. It even offers notes functions for seamless collaboration and future audit trails.

Launch Your AI Journey Today with Healthcare Auditing

Now more than ever, healthcare providers are being demanded to reduce expenses and improve compliance and accuracy, all while improving the patient experience. So, it’s no wonder that AI is becoming an increasingly hot topic of conversation in the healthcare space. This technology is designed to impact all of these desired outcomes, and has proven itself more than capable, too.

Want to learn more about how to launch your AI journey? Leave a comment in the chat below, we’d love to hear from you.