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E-Newsletter • October 2025 |
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Editor's E-Note
Health care continues to be one of the most enthusiastic fields of AI adoption. With staffs stretched perpetually thin, AI and automation are welcome developments for overburdened medical providers. This month, we’re highlighting a report on how AI is being incorporated into medical billing processes.
In addition to reading our e-newsletter, be sure to visit For The Record’s website at www.fortherecordmag.com. We welcome your feedback at edit@gvpub.com. Follow For The Record on Facebook and X, formerly known as Twitter, too.
— Dave Yeager, editor |
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Demand Drives AI Growth in Medical Billing
The AI in Medical Billing Market has emerged as one of the most transformative sectors in health care technology, reshaping how providers, insurers, and patients interact with financial processes. The market is characterized by intense competition as health care organizations prioritize efficiency, accuracy, and regulatory adherence. AI technologies are streamlining workflows by automating claim submissions, coding, eligibility verification, and payment posting—functions that were previously time-intensive and prone to human error.
The US AI in the Medical Billing Market size reached $1.29 billion in 2024 and is expected to reach $7.41 billion in 2032 at a compound annual growth rate (CAGR) of 24.46% from 2025 to 2032.
The United States remains a major hub, fueled by robust health care infrastructure, strict billing regulations, and high AI adoption rates. Hospitals and clinics continue to drive demand, while telehealth growth, regulatory compliance, and the emphasis on revenue cycle optimization provide fertile ground for further expansion.
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Medicare Telehealth Provisions Expire as Government Shuts Down
Losing reimbursement for telehealth visits and hospital-at-home programs may cause the services to no longer be an option for Medicare patients, reports Mobi Health News.
AI Solutions Are Reshaping Medical Billing
Automation and AI are transforming medical billing by streamlining time-consuming processes and helping billing teams catch coding errors and avoid denials, according to Healthcare Tech Outlook. |
Have a coding or documentation question? Get an expert answer by sending an email to edit@gvpub.com.
This month’s selection:
Dementia is often the documented diagnosis in the emergency department; dementia can no longer be a principal. When the cause of the dementia is not known and is not documented, how are we supposed to code this without getting an insurance company denial for diagnosis?
Dianne Barriere
Nuvance Health, Connecticut
Response:
CMS now requires a more specific underlying condition to justify use of these codes. Using F03.90 or F03.91 as principal will always result in a denial without the documented cause as primary. Therefore, if the provider cannot confirm the exact type to use as primary, such as in this case when the patient presents to the emergency department and access to their records to confirm the cause might not be available, they must use symptom-based codes, such as R41.0 (Disorientation, unspecified) or R41.82 (Altered mental status, unspecified). They could also use codes for agitation, psychosis, mood disturbance, anxiety, etc, to support complexity of care. If imaging is done, they might be able to document something more specific, such as "vascular changes" as well.
— Dawn Carter, MHA, CPC, CRC, CPMA, CDEO, CPCO, AAPC Fellow, is an AAPC National Advisory Board member. |
DeepScribe Ambient AI Platform
DeepScribe leverages ambient AI to automate documentation, transforming patient conversations into fully customizable, detailed clinical notes. The AI syncs with the existing workflow and allows clinicians to reduce time spent on documentation. Learn more »
Epic Unveils Comet
Epic has introduced Comet, a health care intelligence platform that anticipates potential patient journeys and suggests plausible scenarios of what’s likely to occur based on data such as diagnoses, labs, medications, and encounters, allowing providers to plan ahead and make more informed decisions. Learn more » |
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COVER STORY
No Longer in Denial
Denial management is costly and time consuming. Increasingly, health care organizations are turning to AI for help.
FEATURE
Strategic Initiative
Health care data security is mandated, but lack of clarity in existing laws leaves providers wondering what the least required level of security is. However, the current threat landscape and potential consequences of a breach indicate that they should be asking whether they are doing enough.
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