CHICAGO - New research from the Blue Cross Blue Shield Association (BCBSA) and its data analytics partner Blue Health Intelligence® (BHI®) suggests that the growing use of AI in hospital billing is driving higher health care costs by increasing the number and severity of diagnoses billed without any record of the expected treatment.
Analyzing de-identified claims data from tens of thousands of maternity admissions nationwide, researchers found a sharp increase in cases coded for acute posthemorrhagic anemia, a serious condition that typically requires interventions such as blood transfusions. However, many patients coded with the diagnosis never received those treatments.
“Something is disconnected,” said Dr. Razia Hashmi, BCBSA’s vice president of Clinical Affairs. “Among hospitals showing the fastest rise in diagnoses of post-partum anemia, the rise in patients coded with this condition wasn’t paired with the level of care we would have expected, and the patterns we’re seeing point to AI‑enabled coding.”
The cost impact is significant, reaching approximately $2.3 billion in spending:
- Researchers estimate that roughly $663 million in inpatient spending and at least $1.67 billion in outpatient spending may be tied to more aggressive, AI-enabled coding practices nationwide.
While AI has the potential to reduce administrative burden when used appropriately, the findings underscore the need for greater oversight. BCBSA and BCBS companies are working at both the national and local levels to use data to identify upcoding trends, establish clear expectations for hospitals using AI tools and better align payment with the accurate representation of care delivered.
About Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans.