AMA calls for AI oversight
By HME News Staff
Updated 9:38 AM CDT, Tue June 20, 2023
CHICAGO – The American Medical Association has adopted a new policy calling for greater regulatory oversight of health insurers using artificial intelligence (AI) to review patient claims and prior authorization requests. The newly adopted policy calls for health insurers using AI to implement a thorough and fair process that is based on clinical criteria and reviews by physicians and other health care professionals with expertise for services under review, and that has no incentive to deny care. "The use of AI in prior authorization can be a positive step toward reducing the use of valuable practice resources to conduct these manual, time-consuming processes, but AI is not a silver bullet,” said AMA Board Member Marilyn Heine, MD. “As health insurance companies increasingly rely on AI as a more economical way to conduct prior authorization reviews, the sheer volume of prior authorization requirements continues to be a massive burden for physicians and creates significant barriers to care for patients. The bottom line remains the same: We must reduce the number of things that are subject to prior authorization.” The AMA highlighted data from ProPublica showing that, over a period of two months in 2022, Cigna doctors denied more than 300,000 claims as part of a review process that used AI, with Cigna doctors spending an average of 1.2 seconds on each case.
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