A new bill in the state Senate would regulate the increasing use of artificial intelligence in healthcare billing and insurance.
Sen. Amy Galey, R-Alamance, says costs can increase and insurance claims can get denied when AI is used to make coverage and billing decisions. She says a new version of House Bill 565 that she's sponsoring would address it.
"This bill seeks to put guardrails on the use of AI in billing and handling of insurance claims — guardrails both for the insurance company and for the provider," she said.
Her proposal would ban insurance companies from denying coverage for particular treatments or services based solely on an AI review. And it would ban healthcare providers from using AI to bill for more expensive services — a practice known as upcoding — without approval from a human medical provider.
"Hospitals can use technology to automatically increase bills without human oversight or intervention," Galey said. "The hospital controls the medical record from the very beginning. There are concerns that the AI can be programmed to intentionally create the record in a way that increases reimbursement.
"The increased billing does not lead to better outcomes for patients. It just leads to higher costs for public insurance like Medicaid and Medicare, for private insurance, and ultimately for taxpayers and patients." She worries the use of AI tools could be driving up the costs of healthcare overall, pointing to research showing an increase in billing for certain types of more expensive services.
But the state's hospitals are voicing concerns about the bill. Blair Borsuk represents the N.C. Healthcare Association.
"When AI can be appropriately utilized to streamline time-consuming and costly administrative burdens, practitioners spend more time actually practicing medicine and focusing on on their priority of serving patients," Borsuk told the Senate Health Committee, adding that her organization wants to work with lawmakers to tweak the bill.
The bill could get its first Senate committee approval next week after an initial hearing last week.
