The Ethics of Automation in Medical Billing

15 May 2024

Manual medical billing is full of long-standing problems that cause delays and errors. While automation seems like the ideal solution, it could do more harm than good if healthcare institutions don’t carefully consider integration-related ethical concerns. Fortunately, there are ways to ethically leverage the benefits of automation in health care.

Automation’s Role in the Medical Billing Process

Despite several ethical concerns, the healthcare industry leverages automation because it’s cost-effective and it improves productivity. These benefits are more than welcome amid shortages of medical professionals and rising operating expenses. Administrative costs account for 15%-25% of health expenditures in the United States — and billing and coding are the leading drivers.

Another significant benefit of this technology is the elimination of human error. For example, autonomous coding software can assign codes to patients’ charts with 96% code-over-code accuracy for most outpatient specialties. These accuracy and efficiency improvements could improve patient outcomes and satisfaction.

This technology automates repetitive processes, meaning it can automatically assign billing codes, identify record inconsistencies, detect unusual billing patterns, and remind patients of upcoming payments. Hospitals could substantially accelerate workflows with it. They can also save money by integrating this technology into their existing administrative processes.

Examples of Medical Billing Automation Technology

While the healthcare sector uses various automation technologies, the most common are:

Robot Process Automation (RPA)

Unlike the name suggests, RPA has nothing to do with robots. Rather, it’s a software technology following a predefined workflow. It completes its task repetitively or in response to specific triggers. It can handle various administrative tasks independently.

Revenue Cycle Management (RCM)

RCM is the process hospitals use to track patient-related financials. Seventy-five percent of hospitals and health systems in the U.S. deployed RCM technology during the COVID-19 pandemic. This technology automates everything from coding to collections.

Artificial Intelligence (AI)

AI is more versatile than RPA or RCM, as hospitals can tailor it to their needs. They can use it for backend administrative processes, deploy chatbots to answer frequently asked payment questions, or leverage machine learning (ML) for predictive forecasting.

5 Ethical Concerns of Automating Health Care Finance

While automation technology could benefit hospitals, it may negatively affect patients. Healthcare institutions should examine several ethical considerations:

System Apathy

Automated tools replace humans in sensitive medical billing roles. Concerningly, they’re incapable of emotion and don’t care about context but interact with vulnerable people — those who have just had a medical scare, lost a loved one, or can’t afford to pay for their medication.

Considering empathy contributes toward rebuilding patients’ trust and protecting companies’ reputations, automation technology may negatively affect hospitals just as much as patients. People generally dislike dealing with apathetic machines over humans.

Algorithmic Bias

Bias is a massive issue with AI systems since unconscious prejudices are often incorporated into training. Even if it’s unintentional, bias has long-lasting adverse impacts. For example, an ML model might disproportionately deny one demographic’s claims if it primarily trains on another.

System Transparency

As automation technology advances, tracing the logical framework it follows to reach conclusions becomes increasingly challenging. For instance, the black box issue with AI revolves around its inability to display a decision-making process, meaning every step before its output is essentially a mystery. A lack of transparency can worsen patient satisfaction and trust.

Patient Privacy

Industry experts worry automation will inadvertently expose patients’ personally identifiable information (PII), medical records, or financial details to bad actors. Considering that 30% of healthcare institutions automating with RCM use at least two third-party vendors, their fears aren’t unfounded. Outsourcing to run and maintain software can open them to data breach risks.

Job Losses

Medical billing professionals update patient information, generate invoices, process insurance claims, collect payments, and resolve disputes. Unfortunately, automation technology can take over their jobs almost entirely — meaning most face unemployment in the face of widespread adoption.

How to Ensure Medical Billing Automation Is Ethical

While medical billing automation aims to streamline administrative processes and improve interactions, it could inadvertently harm relationships and outcomes. You’d need to navigate ethical concerns carefully to increase accuracy and efficiency without compromising the equitable treatment of patients and workers.

You can overcome automation’s ethical concerns with strategic integration and oversight. For example, you could develop an AI governance framework to ensure deployment and utilization stays transparent and moral. After all, ongoing management is vital to long-term success.

Automated technology should also have a human element, whether someone is on standby for escalation or a professional audits the system’s output. This way, you can connect with patients and recognize how context may affect their ability to pay. Working with people can increase revenue while preserving reputation.

Notably, even those not in charge of the technologies should have some training to ensure their occasional usage is equitable, safe, and secure. After all, you can only preserve patient privacy and help guarantee optimal outcomes if you fully understand how to navigate and manage the tools you leverage.

The Moral Implications of Automated Medical Billing

While you could increase accuracy and productivity with automation, it could also lower patient satisfaction and result in more disputes. Navigating the complex ethics around integration is time-consuming, but it is worth the effort to improve patient outcomes and preserve facilities’ reputations.