The headline was inevitable. Hospital AI pumps out bigger better invoices. Health insurer AI rolls up its sleeves and pumps out denials.
The story in the NYT is here. It's based on a new report issued by the BCBS Association here, here.
Here's a short quote from NYT:
- Using codes for various medical conditions, hospitals submitted claims for tens of thousands of patients that described their illnesses as more complex in 2024 and 2025 than in 2023.
- Despite the added conditions, there was no evidence that the patients had received different treatment from the hospitals, according to the analysis by the Blue Cross Blue Shield Association, which represents state Blue Cross plans.
- Using A.I. tools, hospitals are collecting more information about their patients, and submitting bigger claims, the association said.
- “Coding is changing because of this technology,” said Luke Chalker, a senior vice president at the association. By describing patients as having more complicated conditions and adding a secondary diagnosis, like anemia or low sodium, the hospitals were paid an average of nearly $12,000 more per case.
Here's similar text from BCBS:
- Our analysis of over 55,000 excess complex cases found that hospitals are systematically adding secondary diagnoses that bump claims into higher-severity, higher-reimbursement diagnosis-related groups (DRGs) without a corresponding increase in clinical care.
- These shifts account for 70% of the incremental inpatient coding intensity costs to the Blue System.
