Healthcare Providers Struggle with AI Adoption Amid Rising Claim Denials

What's Happening?

Healthcare providers are facing increasing challenges with claim denials and data errors, as highlighted by the Experian Health 2025 State of Claims survey. The survey, which included 250 healthcare professionals, revealed that 41% of providers experience denial rates of 10% or higher, a trend that has been worsening since 2022. Despite the belief among 67% of providers that AI could improve the claims process, only 14% are currently utilizing AI technology. Among those using AI, 69% report success in reducing denials and improving resubmissions. The survey also noted that claim errors are rising, with 54% of providers reporting increased errors, and 68% finding it more challenging to submit clean claims compared to the previous year. Staffing shortages and manual rework of claim denials further complicate the situation.

Why It's Important?

The slow adoption of AI in healthcare revenue cycle management is significant because it highlights the gap between potential technological solutions and their practical implementation. With claim denials and data errors on the rise, healthcare providers are under pressure to improve efficiency and accuracy in their billing processes. AI offers a promising solution to these challenges, yet concerns about accuracy, HIPAA compliance, and the ability to understand payer-specific rules hinder its widespread adoption. The reluctance to embrace AI could result in continued financial strain for healthcare organizations, affecting their ability to deliver quality care and manage operational costs effectively.

What's Next?

Healthcare providers may need to address the barriers to AI adoption by investing in training and development to ensure their teams are equipped to handle AI technologies. Additionally, collaboration with AI developers to enhance the accuracy and compliance of AI systems could facilitate broader adoption. As the knowledge of AI grows, with 62% of respondents feeling well-versed in the technology, there is potential for increased integration of AI in healthcare processes, provided the concerns are adequately addressed.