The times are certainly changing. Payers are now starting to use Artificial Intelligence (AI) and machine learning to determine who and how to pay, and that can be a tough thing to navigate as a neighborhood dentist. Your industry is moving away from traditional billing practices and toward real-time reimbursement, and you need to know what that entails for your office. Well, we’re here to help you work in an efficient way, which means understanding how payers are using AI.
At Dental Auditing Solutions, we know that the landscape is evolving. AI technology is definitely altering the work environment for dentists and specialists, even if they try to avoid it. Now, insurance companies are no longer viewing individual claims on their own. Instead, they are choosing to use predictive risk scoring, and they have an opinion of your office before they even take a look. So, when you need to know a little bit more about artificial intelligence use by insurance payers, we’re here for you.
Are you ready for a new world of billing? Find out more about predictive risk scoring with Dental Auditing Solutions.
What Is Predictive Risk Scoring?
You are probably familiar with our credit scoring system in the US, as you need to navigate it to find a place to live or purchase a car. But now, insurance companies are using artificial intelligence to do a similar thing for dental offices. Obviously, this could potentially create real problems for practices who aren’t paying attention.
This is called predictive risk scoring, and it’s being used by some of the most popular dental insurance companies in the world, including Delta Dental. Insurance payers are tracking your behavior, and they want to know that you are operating in good faith. If your risk exceeds a certain level, it could mean that your claims need to be manually reviewed, or they might be tougher on your pre-authorizations.
Documentation Is More Important Than Ever
If your team is a little sloppy when it comes to gathering clinical notes or images for the claims process, it’s time to make a change. Now, with artificial intelligence and machine learning in play, documentation is an absolute must. Payers are using AI to audit all incoming claims as they come in.
Now, not only do you have to have clinical notes, but they need to be able to be read by machines. For example, brief notes may be problematic, as there might not be enough context. AI wants to know the location, extent, and reasons for your actions.
Plan Your Practice With Dental Auditing Solutions
Be prepared for changes to billing and coding with a team that understands them. If you’ve got questions, ask Dental Auditing Solutions at (972) 459-1508 today.