The American Medical Association (AMA) has adopted a policy regarding use of augmented intelligence (AI) to review patient claims and prior authorizations.
In a June 14 announcement, the AMA said its House of Delegates has adopted a policy during its annual meeting “calling for greater regulatory oversight of insurers’ use of AI in reviewing patient claims and prior authorization requests.
“While the AMA supports automation to speed up the prior authorization process and cut down on the burdensome paperwork required by physicians, the fact remains that prior authorization is overused, costly, inefficient, and responsible for patient care delays.”
The new AMA policy calls for insurance payers who use AI “to implement a thorough and fair process that is based on clinical criteria and includes reviews by physicians and other healthcare professionals with expertise for the service under review and no incentive to deny care.”
The announcement referenced a ProPublica report that said over a period of two months last year, “Cigna doctors denied more than 300,000 claims as part of a review process that used artificial intelligence, with Cigna doctors spending an average of 1.2 seconds on each case.
“The new AMA policy calls for insurers to require a human examination of patient records prior to a care denial.”
AMA Board Member Marilyn Heine, M.D., said in the announcement, “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. 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.”
Augmented intelligence, as described by Health IT Analytics, “is like artificial intelligence in the way they both use machine learning to enhance care quality. However, instead of replacing human intelligence, augmented intelligence works to build upon it.” Health IT Analytics said augmented intelligence “keeps human intelligence elements in its procedure” and that augmented intelligence “acts as a tool to assist the physician in the task.”