AI in Claims Processing | Webinar
This webinar from VMG Health examines how AI tools are reshaping medical coding and claims auditing operations, and the compliance risks that come with them. Presenters Pam D’Apuzzon and Frank Cohen cover the shift from coder-as-generator to coder-as-curator, the “human-in-the-loop paradox” where biased human oversight can train AI to be biased more efficiently, and the regulatory exposure created under the 60-Day Rule and False Claims Act. The session closes with a four-pillar governance framework and concrete operational guardrails organizations can implement to keep AI-assisted coding defensible rather than a liability.
Learning Objectives
- Distinguish between artificial intelligence and augmented intelligence in healthcare coding, and explain why augmentation—not automation—is the appropriate model for claims auditing.
- Identify the sources of bias that enter AI-assisted coding systems (data, algorithmic, human, and operational) and describe diagnostic indicators, such as declining override rates, that signal a loss of meaningful human review.
- Apply the four-pillar governance framework (transparency, accountability, fairness, explainability) and the eight pre-deployment questions to evaluate AI coding/auditing tools and reduce regulatory and litigation exposure under the 60-Day Rule and False Claims Act.
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