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MUTUNGAMIRIRO weSosaiti
AI Upcoding uye Coding Compliance Njodzi
AI upcoding inoitika kana software yekukodha, komputa-inobatsirwa coding injini kana AI zvinyorwa zvematurusi zvinoratidzira kana kupa macode ekubhadharisa epamusoro nhanho yesevhisi kana kuomarara kupfuura kutsigirwa kwerekodhi yekurapa.
Pa peji ino4 min verenga
Pfupiso
Izvo zvine basa nekuti mupi anoendesa chikumbiro, kwete mutengesi, saka makodhi asina kutsigirwa anogamuchirwa kubva kuAI chishandiso anogona kubhadharwa zvakanyanya uye kugadzira mhosva pasi pemubatanidzwa weFalse Claims Act.
Kudzika Kwakadzika
Upcoding haisi itsva, asi AI inoshandura chiyero chayo uye kuti zvinoitika sei. Munhu anokwidza macode anokanganisa zvirevo zvavanobata. Modhi yekukodha inorerekera kumakodhi epamusoro inobata zvese zvazvinoita. Kuonda ikoko kunogona kubva mukudzidziswa kwenhoroondo yekubhadharisa data yagara iine upcoding, kubva kuchigadzirwa chakagadzirirwa kuwedzera 'kutorwa kwemari', kana kubva kuzvinyorwa zvinotorwa neturusi, senge manotsi akaumbwa uye rondedzero refu yezvinetso inoteererwa mberi. Generative zvinyorwa zvinyorwa zvinowedzera nzira yechipiri. Munyori ambient anogona kutaura kuongororwa zvakanyanya kana zvakanyanya zvakanyanya kupfuura zvairehwa nachiremba, uye iwo mazwi anobva afambisa kodhi. Kufumurwa zviri pamutemo kunowanzobva kuFalse Claims Act. Pasi peMutemo, kuendesa zvirevo zvemanyepo kuzvirongwa zvemubatanidzwa zvakaita seMedicare neMedicaid zvinogona kutungamira kukuvadzwa katatu pamwe nechirango chehurumende chechero chega, uye chirango chinogadziriswa kukwira kwemitengo. Humbowo hwekuda kubiridzira hahudiwe. Mutemo unotsanangura 'kuziva' kusanganisira kusaziva nemaune uye kusakoshesa kusakoshesa chokwadi. Kugamuchira mazano eAI muhuwandu pasina ongororo, kana kufuratira zvakawanikwa zvekuongorora zvemukati, zvinogona kuita nharo kuzadzisa chiyero ichocho. Izvo qui tam zvigadziro zvinorega vanoridza muridzo vega, kazhinji makodhi, maodhita kana vaimbove vashandi, faira sutu uye vagovane mune chero kupora. Zvakaparadzana, mutemo wemubatanidzwa unoda kuti vanopa rubatsiro vataure uye vadzose kubhadharwa kweMedicare neMedicaid mukati memazuva makumi matanhatu, saka ongororo inowana zvikanganiso zvinofambiswa neAI inogadzira chisungo chekudzorera. Pfungwa nhatu dzisiridzo dzinouya kazhinji. Chekutanga ndechekuti mutengesi anotakura njodzi. Kondirakiti inogona kusanganisira kubhadharwa, asi mupi wekubhadhara anosimbisa chikumbiro. Chechipiri ndechekuti chero chinhu chakanyorwa neAI chinoverengwa semagwaro. Makodhi anofanirwa kutsigirwa nezvakanyorerwa uye zvakabvumiranwa nemurapi. Chechitatu ndechekuti undercoding ndiyo yakachengeteka sarudzo. Yakarongeka undercoding zvakare haina kurongeka. Chinangwa makodhi anofanana nerekodhi, kwete macode anosundirwa mune chero nzira.
Strategic Impact
Ngozi uye kuchengeteka
Njodzi uye yemazuva ese AI kukuvadza zvese zvinoenderana nekuti ndiani anonzwisisa njodzi uye ndiani anogona kuita.
Sarudzo dzakajeka
Ruzhinji nehunyanzvi kuverenga nekunyora kunoumba kana mutemo wakasimba wekuchengetedza uchigoneka mune zvematongerwo enyika.
Kucheka kuburikidza nehype
Tsananguro dzakajeka dzinoderedza kubatwa nehype, lab PR, uye isina kujeka tsika theatre.
Ramangwana reAI Upcoding uye Coding Compliance Njodzi
Kutariswa kwealgorithm-inotyairwa kukodha kungangowedzera kutariswa, sezvo vaongorori vehurumende vakatoongorora kuti kuongororwa kunoendeswa sei kuMedicare Advantage kugadzirisa njodzi uye vanobhadhara vanoshandisa yavo analytics kutsvaga vanobhadhara kunze. Masangano anogona kutarisira mibvunzo pamusoro pekuti maturusi avo ekukodha akasimbiswa sei, kuti mazano anoongororwa sei uye kuti vakatariswa kudonha. Uchapupu-hunobatanidzwa mazano uye nguva dzose yekuongorora yekuongorora inogona kuve yekutanga tarisiro muzvibvumirano zvevatengesi. Mabatiro achaita remangwana rekuita neAI-assisted coding ichiri isina kugadzikana, saka zvakanyorwa ongororo maitiro ndiyo inonyanya kudzivirirwa chinzvimbo nhasi.
Real-World Implementation
Injini yekupanze E/M inokurudzira 99215 kushanya kwekutevera nekuti inoverenga zvese zvinopinda mune yakakopwa-mberi dambudziko runyorwa, kunyangwe sarudzo yekurapa yakanyorwa zuva iro inotsigira 99213 chete.
Munyori ambient anoshandura chirevo chemurwere nezve kupeperetswa pamasitepisi kuita 'acute pane chisingaperi systolic moyo kutadza' mune chinyorwa chinyorwa. Chiremba anoisaina pasina kuiongorora, uye kodhi inowedzera kuomarara kuti hapana chinhu mukiriniki rekodhi chinotsigira.
A Medicare Advantage chart-review tool inokweva kuongororwa kubva pane zvinyorwa zvakanyorwa makore apfuura uye inovakurudzira seyazvino njodzi-yekugadzirisa macode, kunyangwe kusangana kwazvino kusingaratidzi humbowo kuti mamiriro akatariswa, akaongororwa, akaongororwa kana kurapwa.
Chikwata chekuteerera chinocherekedza kuti chiremba mumwe anogashira ingangoita zana muzana yeAI kodhi mazano uye ane yakanyanya kushanya kwepamusoro-soro kupfuura vezera mune imwe hunyanzvi. Iyo inoraira yakatarisana nekuongorora yakadzokororwa, yobva yapa dzidzo uye inodzosera mari yakawandisa.
Njodzi & Guardrails
Kurapa njodzi iripo seSci-fi nepo kugona kunobatanidza.
Kuvhiringidza kuchengetedzwa kwechigadzirwa chepamusoro nekuenderana pasi pekuzvimiririra kwepamusoro.
Kusiya vateereri vasiri veChirungu uye vasiri nyanzvi vaine zvinyorwa zvemhando yakaderera chete.
Implementation Roadmap
Kuparadzana kwechigadzirwa kukuvadza, kushandisa zvisizvo, uye kurasikirwa-kwe-kudzora / kusarongeka njodzi.
Bvunza kuti ndeupi humbowo hunogona kushandura maonero ako panguva uye kuomarara.
Sarudzo yekutanga masosi uye kongiri evals pamusoro pezvikumbiro zvekushambadzira.
Ziva imwe nzira yekuita: basa, mutemo, mari, kana hunyanzvi - kwete kuziva chete.
Ramba Uchiongorora
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Mibvunzo inowanzo bvunzwa
Chii chinonzi AI Upcoding uye Coding Compliance Njodzi?
AI upcoding inoitika kana software yekukodha, komputa-inobatsirwa coding injini kana AI zvinyorwa zvematurusi zvinoratidzira kana kupa macode ekubhadharisa epamusoro nhanho yesevhisi kana kuomarara kupfuura kutsigirwa kwerekodhi yekurapa. Izvo zvine basa nekuti mupi anoendesa chikumbiro, kwete mutengesi, saka makodhi asina kutsigirwa anogamuchirwa kubva kuAI chishandiso anogona kubhadharwa zvakanyanya uye kugadzira mhosva pasi pemubatanidzwa weFalse Claims Act.
Sei iyo yakarerekera AI coding modhi ichigona kukonzeresa kukuvadzwa kwekuteerera kupfuura munhu mumwechete anokwidza?
Mumwe munhu anokanganisa zvirevo zvavanobata. Modhi ine yakarongeka yakatsamira inodzokorora kukanganisa kumwechete pachikero pane zvese zvayakabata.
Pasi pemutemo weFalse Claims Act, imamiriro api epfungwa anogona kuita kuti mubatsiri abhadharwe kunyangwe pasina chinangwa chekubiridzira?
Mutemo unotsanangura 'nekuziva' kusanganisira kusaziva nemaune uye kusakoshesa kusaremekedza, saka kubvuma kubuda kweAI muhuwandu pasina ongororo kunogona kugadzira kuratidzwa.
Chibvumirano chechipatara chinoti mutengesi wekodha achazvidzivirira. Nei chipatara chichiri kufumurwa kana AI-yakakurudzirwa macode asina kutsigirwa?
Chero zvingataurwa nekondirakiti, mupi anoendesa uye nekusimbisa chikumbiro, saka mutoro kuhurumende unotanga nemupi.
Mushure mekuongorora kwemukati kwaona kuti AI-inogamuchirwa makodhi yakatungamira kuMedicare overpayments, mutemo wemubatanidzwa unodei?
Vanopa rubatsiro vanofanirwa kuzivisa uye kudzosa kubhadharwa kweMedicare neMedicaid mukati memazuva makumi matanhatu, saka zvakawanikwa zvekuongorora zvinogadzira chisungo chekubhadhara.
Ndechipi chiratidzo cheyambiro icho gwara rinobatanidza kune otomatiki kusarura?
Kugamuchira dzinenge zano rega rega kunoreva kuti vanoongorora vakamira kutarisa, kwete kuti modhi inogara yakanaka.
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