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Will Advancements in AI Take Over my Job as a Medical Biller or Coder?

April 25, 2024

Originally written for Billing & Coding Magazine, March/April 2024 (link to full issue)
By Adam Phillips, CEO
American Business Systems
www.ABSystems.com


By now, you may be sick of hearing about “AI”. It’s everywhere. According to a recent Grand
View Research Survey, “The global artificial intelligence market size was valued at USD 196.63
billion in 2023″* and shows no signs of slowing down. The technology has made its way into
virtually every industry imaginable. That’s exactly what AI is, “technology”, which is simply
defined as tangible or intangible tools that assist humankind. Tools alone, without humans to
wield them, don’t produce great results. It is up to humans to use tools to get something done,
perhaps faster, or in the case of medical billing and coding, more accurately.

What AI excels at is data analyzation and pattern detection. A large segment of Practice
Management/Billing/EHR systems are now integrating these AI features into their software.
Another really great use for AI is the ability to “listen” to a doctor talking to a patient and then
“write down” the encounter SOAP notes as with AI ally, the new NextGen Ambient Assistant.
This feature produces 90% accuracy, saving doctors roughly 2 hours per day. Is it totally
replacing a transcriptionist? Not necessarily. The charts still need to be reviewed and finalized by
a human. Same with billing and coding functions.

As with the case of medical billing and coding, this critical function of most medical practices
requires impeccable accuracy. What AI can now do is quickly look at chart notes and determine
what codes should be used for each patient encounter, with limitations based on complexity of
each case, and the fact that there are still numerous note-taking formats. So what AI is able to do,
is make your job as a biller/coder, in effect, easier.

You see, the human element remains crucial for complex decision-making, understanding
nuanced medical cases, and ensuring accuracy in coding. Instead of replacing jobs, AI may
transform them, creating opportunities for collaboration between humans and machines.
For now, charting and coding that has been analyzed or adjusted by AI, still requires a human to
do final review and authorization before processing.

Learn as much about AI as you can. Staying updated on industry trends and technological
advancements can help professionals in the medical billing and coding field stay relevant in the
face of evolving technologies.

While AI may bring changes to the tasks involved in medical billing and coding, it is unlikely to
completely replace human professionals. The collaboration between AI and human expertise has
the potential to enhance the overall efficiency and accuracy of healthcare processes, creating a
symbiotic relationship between technology and skilled professionals in the field.
References:

https://www.grandviewresearch.com/industry-analysis/artificial-intelligence-ai-market

Adam Phillips is the author of 9 Ways Doctors Let Money Slip Through Their Fingers – and how
a few simple ideas can guarantee a private practice will thrive in today’s post-pandemic world.
He is the CEO of American Business Systems, a training and support company for individuals
wishing to start their own medical billing business. He hosts bi-weekly educational webinars at
www.ABSystems.com.

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How to Sell Medical Billing Services to Doctors

May 6, 2016

If you’ve guessed it’s a challenge to learn how to sell medical billing services to doctors, you’d be right. They are busy and they are approached by various representatives trying to sell them something on almost a daily basis.

By Patrick Phillips, Founder and CEO
American Business Systems

Originally Published in BC Magazine June 2014

How to Sell Medical Billing Services to Doctors

One of the reasons they are hard to engage is that they are simply practicing what they know: triage. As you know, this is used in medicine to help determine the priority of patients’ treatment, based on the severity of their condition.

In determining who to speak to or what to concentrate on in their practice, physicians prioritize based on their perceived need at the moment. If they feel they need to speak to a financial advisor they will set an appointment to do so.  If they are looking at new equipment, they will agree to meet with a medical device rep.

But if they are presently doing their own insurance claims filing in-house, using their own staff, they may not see a need to meet with someone who is offering an outsourced solution.

And even if they are presently having their billing done by an outside company, they may feel that their billing and cash-flow are under control and, again, have no need to research other solutions.

However, as the founder of the nation’s largest network of independent medical billing companies, I see doctors signing up with our Licensees continually. The question remains: how to sell medical billing services to doctors if they are happy with their present billing situation?

One word: positioning. If you want to gain the trust and business of a doctor, you must learn how to position yourself in such a way that they want to do business with you.

For example, they may think their revenue cycle is what it should be because they get checks every week from payers and patients. So why talk to anyone about their cash-flow when it seems to be fine?

What they don’t realize is that their revenue may only be a fraction of what it could be. Maybe they do get checks on a regular basis (after all, they must have some cash-flow or they would not be able to stay in practice); but is their revenue maximized?

Are they collecting every penny that is due them from their payers and their patients? And would they know this with their present billers?

Are their billers using technology that is dated and does not have all the features that allows them to maximize their revenue?

Are their billers trained professionals whose sole focus every day is collecting the absolute most for the practice?

Here’s where positioning comes in: you, as a professional biller, must place yourself and your company in front of the practice as the “expert” in medical revenue management. You must be the individual and the company they think of when they have doubts about whether they are collecting the maximum amount from payers and patients.

And this is why it is important to realize the physicians’ tendency to triage.  They obviously do not think that their revenue is hurting or they would focus on fixing it. Their entire life is focused on helping patients get well. Their training, their education, their internship were all focused on patient treatment.  And most of them had very little, if any, training in business and managing their practice and reading financials. So the revenue cycle is not at the top of their list of things to focus on today.

So how do you position yourself as the “expert” who can increase their revenue and/or cut their costs? How do you keep your name at the “top-of-mind” for this practice so that when they do decide they need to make a change in the way they handle their billing, they think of you and your company?

We’ve have been teaching people how to sell medical billing services to doctors over the 20+ years we have been in business.  A dozen or so methods that have been tested and perfected over the years. These are proven ways to position you and your company with medical practices so that you are the one they look to for solutions to their cash-flow challenges.

First, you must position yourself as the Educator. This means that you must provide ongoing education to the practice in the way of newsletters, handouts and direct mail pieces.

Any news item you find on the Internet relating to healthcare can be copied and pasted or forwarded via a link to the web page.

Here are some websites that you should visit often to find relevant materials for your educational materials:

medicaleconomics.modernmedicine.com

jwatch.org

medicalnewstoday.com

physiciansnews.com

news-medical.net

medpagetoday.com

familypracticenews.com

physiciansnewsnetwork.com

On Facebook, search for “physicians news network” and “Medical Revenue Managers Association of America (MRMAA)”

And, of course, this publication’s website:

 billing-coding.com

Many of these sites have email newsletters you can sign up for and whitepapers you can download.

Anything can be shared nowadays as long as you give credit and provide a link to the website, as this provides more traffic for the author of the article or the publication.

Next, you must continually touch base with the practice/physician via email, direct mail and personal contact. Giving something of value with your name and contact information is crucial to keeping your name at the top of their mind.

These could be emailed newsletters, reprinted articles, marketing postcards, educational flyers and ebooks you have created using your word processor and saving as a PDF file.

And don’t forget the wide variety of customized promotional materials available that are specifically for the medical industry.

Try these websites, but be sure to compare prices as some items are available on several sites and are the exact same items:

anypromo.com

discountmugs.com

4imprint.com

epromos.com

graywolfpromotions.com

mypromoplanet.com

Remember, people don’t buy anything when you are ready to sell… they buy when they are ready to buy.  And they are not ready to buy until they feel a need for what you are offering.

Just as the doctor won’t recommend a medication or therapy until they have determined exactly what is wrong with you, you must find out where the gaps are in their revenue before offering a solution.  You can do this by asking a series of questions that will give you the data you need to make a proposal.

Questions you can ask could include:

  • How many hours each week are devoted by all staff members to doing your billing?
  • How many insurance claims are you filing per week?
  • What is the total dollar amount billed each month to insurance companies?
  • How much, on average, is collected per month from insurance companies?
  • What is your average percentage of claims filed that are rejected for one reason or another (national average is 34%)?
  • How many days, on average, does it take for payments to be received from payers?

 

By gathering information from the office manager or physician, you will be able to see where their gaps are in their revenue and propose solutions based on what you know you can do for them in improve their situation.

Another way you can position yourself in the medical community is to find a medical association in your area and join it as a “supporting member”.  You don’t have to be a medical doctor to join many medical societies.  They have a special membership just for individuals and companies that want to support the organization.  People like financial advisors, attorneys, CPAs, medical equipment salespeople and others who provide products and services to the medical community, like you!

The membership fee will vary, but it could be the best investment you could make in your marketing to physicians.  Imagine being at a conference or a dinner and rubbing elbows with doctors and their spouses. How to sell medical billing services to doctors? You get to know them as people.  You will be on the “inside” and, yes, at one point, they will ask about you and you will be able to share with them what you do for doctors.  They love people who support their association or society and the medical community, and they will consider you a part of their inner circle.

Don’t ignore the power of being a part of a tribe. I have seen some of my students get billing clients just by joining and attending these functions.  Clients that they have had for years, with continuing revenue for their company.

In summary, you need to start thinking of yourself, and your company, as a solution to the challenges that doctors are facing in the era of Obamacare.  They are scared and many of them are being absorbed by large hospitals.

This is not what they want.  They want to be independent owners of their own private practice. But the reality of lower Medicare reimbursements, higher rejection rates on their insurance claims and higher operating costs cause many of them to fall for the lure of being an “employee” for some large medical group.

You are in a unique position.  You can be the savior of the private practice in your area.  All you need to do is look at your higher calling and position yourself as the knight on the white horse that can save them from the changes coming in healthcare in the next few years. You can be the Expert they want to do business with.

 

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About ABS

Traditional jobs take up too much time and pay too little, and conventional franchise opportunities can be risky and expensive.

American Business Systems offers aspiring individuals another option – business ownership with minimal downside and maximum training and support, so that hard-working people can achieve success on their terms.