Shereese Maynard, MS, MBA She/Her’s Post

The power of a dual strategy integrating both deep technology and human expertise drives meaningful outcomes.

Revolutionizing #MedicareAdvantage Discover how AI, powered by Emedlogix's generative AI for HCC code extraction, is reshaping the landscape. Overcome compliance challenges, streamline document verification, and boost accuracy for a robust and cost-effective healthcare future! #AIInHealthcare #EmedlogixAdvantage #Healthcare #Emedlogix #MedicareAdvantage #CAC #MedicalCoding #computerassistedcoding #artificialintelligence #computercoding #medicare #generativeAI #hcccoding #riskadjustmentcoding #riskadjustment #medicalcoding #medicalbilling https://wix.to/7xUerHo

CMS PUMPS THE BRAKES ON AI FOR MA PLANS CMS is cracking down on AI use in Medicare Advantage. Click the link below to read the the full article.

Navigating the complexities of high-cost in-network claims in healthcare requires more than the use of AI. Learn why an approach that combines AI and human clinical expertise enables payers to efficiently manage the volume, complexity, and nuance of reviewing high-cost claims. Hear from Brian Rubio, Vice President of Products and Emily Ehle, PharmD, Vice President of Operations for Expert Claims Review from Zelis in this HealthPayerIntelligence article: https://lnkd.in/esVG79nc   #AI #Zelis #ClaimsManagement

When Technology Treats: The Critical Challenge of AI Liability in Healthcare Hospitals are integrating AI into patient care but face significant liability concerns, illustrated by a case where AI failed to consider a patient's critical family history, leading to a fatal outcome. Michelle Mello from Stanford highlights the need for hospitals to evaluate the risks and benefits of AI tools carefully, recommending strategies for managing potential liabilities. Key strategies include: - Rigorous testing of AI tools, akin to FDA approval processes for drugs. - Transparent documentation of AI tool specifics, such as model versions and software packages. - Smart contracting with developers to ensure a fair distribution of liability. - Considering patient disclosure about the use of AI tools in their care. The current lack of clear regulations and the general public's discomfort with AI in healthcare add to the complexity of deploying AI tools responsibly. The discussion extends beyond legal concerns, touching on how the uncertainty affects the healthcare technology market, innovation pace, and patient access to new treatments. I believe until liability is clearly regulated, a hybrid approach of human and artificial intelligence remains a key necessity. Read more in the topic in this Stanford Institute for Human-Centered Artificial Intelligence (HAI) article: https://lnkd.in/eapSkiyt

🧠 AI in #Healthcare: Complementing, not replacing. To successfully harness the power of #AI, human-in-the-loop (HITL) approach is one of the keys to increase adoption in clinical practice. #HITL ensures that the AI systems are guided, validated, and supervised by clinicians’ expertise. Ultimately, leading to improved service quality, patient outcomes, and a more efficient healthcare system. 🤖 #Healthtech #innovation #safety #organisationaldevelopment #organisationalchange #changemanagement

If AI steers a doctor wrong, who pays ? This is an important conversation in #healthcareAI and need an urgent discussion. In our recent article we discussed "Shared Accountability" and "Human Warranty" for AI applications in healthcare. (Ref: https://lnkd.in/gUD7ieqp) In 2024, we all should work on making #HealthcareAI truly compatible Link: https://lnkd.in/g7kzZrVs

The use of artificial intelligence (AI) in healthcare, particularly within Medicare Advantage (MA) plans, is sparking legal challenges and prompting regulatory action. Lawsuits Against MA Plans: - Two recent class-action lawsuits allege that Humana and UnitedHealthcare used AI to improperly deny coverage for services in MA plans. - Plaintiffs claim the AI tools made "premature" decisions based on "unrealistic recovery predictions," leading to denied care. - Insurers argue these claims fall under the Medicare Act and require exhausting administrative remedies before lawsuits. - They also claim state law claims are preempted by the Medicare Act's regulatory framework. Learn more: https://hubs.ly/Q02t8k0B0

Given the complex challenges and regulatory safeguards in the #healthcare industry, AI is unlikely to replace physicians soon. While AI shows promise in tasks like diagnosing illnesses and streamlining paperwork, it still requires supervision and validation by experienced physicians. Furthermore, while AI could potentially increase access to medical advice in lower to middle-income countries, this advice still needs to be validated by human physicians to ensure proper advice is given, according to Andrew Beam, a professor at Harvard. Even if AI were to be desired, organizations like HIPAA and other privacy standards require any new tech to be intensely scrutinized and reviewed before entering the mainstream medical sphere. Integrating AI in healthcare may shift roles, allowing professionals to focus on higher-level decision-making, ultimately improving patient care with careful implementation and necessary precautions. #AIinHealthcare #MedicalInnovation

Hospitals and insurers are leveraging advanced AI tools to optimize billing and administrative processes, aiming to achieve greater efficiency and revenue. As the healthcare industry embraces AI technologies, significant financial implications arise for providers, insurers, and the government. Providers strive to accurately code bills and optimize reimbursement using AI, while insurers seek comparable tools to scrutinize bills and mitigate fraud. The rapid development of robust generative AI has sparked an intense competition between providers and insurers. Both sides also aim to reduce costs by streamlining administrative workforces through AI-assisted systems. Policymakers express concerns about the impact of AI on issues such as prior authorization and surprise billing, yet regulatory efforts in the realm of health AI are in their early stages. Congressional hearings are underway, but the current legislative focus primarily revolves around transparency rather than substantive rules, as the industry rapidly adopts new tools. The widespread adoption of health AI poses a potential risk of escalating tensions over billing between providers, insurers, and patients who may become entangled in disputes. https://lnkd.in/eJCVWCzp