Republican lawmakers in North Carolina have put forth a proposal that would limit AI’s use in healthcare, primarily in relation to how it is used in billing and claims denials, WRAL News reported May 21.
House Bill 565 would prohibit payers from using AI as the sole basis for denying healthcare claims or prior authorization requests. It would also crack down on hospitals and other care sites that use AI to upcode procedures — even non-intentionally. The legislators argue thata AI could unknowingly push billing systems towards more expensive codes if there are not safeguards and human oversight.
“We know that AI can amplify what already exists,” Alessandra Bazzano, PhD, a professor at UNC Gillings School of Public Health, told the publication. “If there’s a reimbursement algorithm that rewards severity or intensity, those AI tools might accelerate pressure toward doing that kind of higher coding .”
Under the legislation, providers and vendors would be restricted from using AI to recommend or generate billing codes that result in upcoding unless a treating provider reviews the documentation and confirms it is supported by the patient’s medical record.
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