5 Major Innovations which will transform the Medical Billing Industry

By: exdionrcm


Healthcare providers and recipients can face many challenges when it comes to medical billing. Medical billing hasn’t been known to be a seamless process and the paperwork involved can often be long, error-prone and eventually frustrating for the recipients.

Whether you are dealing with claims, payments, billing codes, or the software being used to operate the company’s revenue cycle, there are challenges that always come up.

In these unprecedented times, a streamlined, organized, and error-free billing process is the need of the hour. This is where technology, with the emergence of Artificial Intelligence (AI), can play a key role in transforming the medical billing industry, in turn improving the overall customer experience.

Innovations through AI 

AI has proven to be a great asset in healthcare, helping get rid of all the errors which creep in with manual processing and increasing productivity in the long run.

Let us look at five key innovations through AI that will transform the medical billing and coding industry in the coming years.

Auto-correction of codes

There are thousands of medical codes that medical billing professionals need to remember and have access to. There is a new set of codes which gets listed almost every year. Though these codes have already been entered in the system, the sheer volume of codes makes maintaining complete accuracy a challenge. This has become a major area of concern for hospitals, EHR companies and medical billing companies.

This is where AI will intervene and nullify those errors. The system will either auto-correct the code while it is being typed or suggest the correct code when it detects an error. This works very similar to the auto-correct suggestions that we see on our mobile phones. 

Automation of repetitive tasks

Medical billing has a lot of repetitive tasks which eat away at the productivity of billers. By automating the billing workflow, billers can improve their efficiency, reduce the monotony of their work and save a whole lot of time.

The time saved by automation will let them focus on other critical tasks such as patient care, analysis of medical reports and more. Automation can be used wherever there are rule based processes involved, such as recording of patient’s data or insurance verification, for instance.

Automation of Pre-authorization 

In the case of pre-authorization, the insurer needs to get prior approval from the insurance company before taking a medical treatment. Pre-authorization is only valid for certain medical conditions, but hospitals and patients are often unaware of which conditions they can use pre-authorization for.

This lack of awareness can lead to further confusion about claims and the possibility of claim denial at a later stage as well. AI can clear out this confusion as well. 

As it stands, a patient comes to know that he was eligible for pre-authorization only after going through treatment. Using AI, he will know if he is eligible for pre-authorization at the initial stage itself, before he opts to go in for treatment. Taking this proactive step saves him from any kind of confusion at a later stage.

Identification of claim denial patterns through RPA

With insurance claims, there is always a fear of claims being denied, sometimes on very flimsy grounds. Robotic Process Automation (RPA) can allay these fears, by identifying those claims which don’t meet the stipulated requirements, finding certain common patterns, and reducing the occurrence of those patterns. RPA can also facilitate the claims review process by preventing claim denials and correcting them for payment which will end up saving a lot of time, effort, and money. 

Chat bots for patient service 

Chat bots are no longer a novelty, but an integral aspect of customer service in almost every industry. The medical billing industry is no exception to this. Chatbots can be used to answer most customer queries related to billing and also keep them updated on their insurance status and other claim related information. These bots are built with extended learning and NLP capabilities which can gauge human emotion and also give them the most suitable answers, much like a human would.

Patients don’t have to wait indefinitely for a customer support executive to resolve their queries and waste their time. 

ExdionRCM leverages AI in healthcare, to make sure that they deliver a superior patient experience. 


Exdion RCM uses cutting-edge technology to help healthcare providers stop revenue leakages and collect payments.

With Exdion RCM you will get:

  • RPA tools to automate the billing workflow and integrate disparate systems
  • Improved billing transparency to reduce patient frustration
  • Standardized workflow
  • Reduced manual processes and error-prone systems
  • Processing all through the day and week, improving the payer and patient experience

Discover Exdion RCM and completely transform your billing experience.

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