The Labor Department recently sued UnitedHealth Group subsidiary UMR, alleging that it wrongfully denied claims for emergency room services and urinary drug screenings since 2015. UMR did not determine the medical necessity of the claims, denying them “based solely on diagnosis codes and not applying a prudent layperson standard," according to the complaint.
The revenue cycle is incredibly complex due to shifting payer requirements, continuous regulatory compliance and coding updates, and emerging and evolving payment models. That complexity increases the administrative burden and drives up cost for providers.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
In this complex and rapidly changing claims denial environment, providers must take a proactive approach to stay ahead of the game. Here's what providers can do to successfully navigate the audit landscape.
The companies will build their claims processing platform on Google Cloud's infrastructure, leveraging artificial intelligence and machine learning capabilities. The goal of the collaboration is to improve patient and provider experience and reduce spending on administrative processes.