**Presented at the 2023 CMSA Annual Conference**
*** RN and CCM credits ***
Medical necessity documentation must be accurate, timely, efficient, and effective, ensuring patients receive the right care at the right time and in the appropriate setting. Good documentation can improve patient safety, patient and provider satisfaction, quality care, and communication, whereas poor documentation leads to less desirable outcomes. In addition, the burden is not limited to providers but is shared with patients who do not have transparency into utilization management processes. To this end, Artificial Intelligence (AI) in healthcare is evolving rapidly where it had not previously done so. Improved medical necessity clinical documentation, powered by AI, has the potential to release physicians, payers, patients, and administrative staff from the significant burden prior authorization causes in healthcare today.
OBJECTIVES:
- Identify two ways AI can assist with medical necessity documentation.
- Discuss the importance of machine learning and natural language processing in medical necessity documentation.
- Demonstrate improved outcomes for patient and provider satisfaction.
