Preventing Billing Omissions and Returns with AI: Using Receipt Checking in Internal Medicine Clinics

Internal medicine clinics are a field with very many billing items—the Lifestyle-Related Disease Management Fee, the Specific Disease Treatment Management Fee, various prescription management add-ons, tests, and more. The more items there are, the higher the risk of revenue loss from billing omissions and returns from mismatches between disease names and billing. In particular, since the 2024 revision reviewed the lifestyle-disease management fees, internal medicine billing has become even more complex. This article explains how to perform receipt billing checks in an internal medicine clinic's electronic chart with AI to prevent billing omissions and returns. Note that billing requirements are set in notices and notifications, so always confirm them in the primary sources.

Why billing omissions and returns are prone to occur in internal medicine

Because internal medicine handles a wide range of diseases, the factors involved in billing are diverse. Here we organize the main reasons omissions and returns easily occur.

• The complexity of management fees: Rules are detailed, such as the prohibition on billing the Lifestyle-Related Disease Management Fee and the Specific Disease Treatment Management Fee together.
• Missed add-ons: There are many items, such as prescription management add-ons and various guidance fees, that can be billed but are missed.
• Mismatch between disease names and billing: A shortage of disease names corresponding to tests or medications leads to returns and assessments.
• Keeping up with revisions: Since the 2024 revision, billing rules have changed, making manual management difficult.

These are areas where oversights are unavoidable with human visual checking alone.

The basics of receipt checking and the benefits of AI

Receipt checking is the work of inspecting receipts (statements of medical fees) before submission and correcting billing omissions, errors, and shortages of disease names in advance. Traditionally, medical clerical staff performed this by hand or with rule-based software, but using AI greatly improves accuracy and efficiency.

The main benefits of AI receipt checking are as follows.

1. Detecting billing omissions: It suggests items that can be billed but have not been recorded, preventing revenue loss.
2. Preventing returns and assessments: It points out mismatches between disease names and billing in advance, reducing returns and point deductions.
3. Keeping up with revised rules: With checking in line with the latest billing rules, it curbs confusion right after a revision.
4. Eliminating dependence on individuals: The system provides standard support for checking that tends to depend on veterans' experience.

The strength of checking with an integrated chart

Receipt checking becomes more effective when integrated with the electronic chart and receipt computer. If the chart content and billing are connected on the same system, you can notice billing omissions and shortages of disease names at the time of the consultation, without deferring the burden to end-of-month receipt work. Compared with a separate-type operation that links data, it has an advantage in the immediacy and accuracy of checking.

Internal medicine receipt checking with AI Karte

"AI Karte," developed by Pottech, is an integrated receipt-computer cloud electronic chart equipped with an AI receipt checking function as standard. Because chart entries and billing are connected on the same system, it can detect billing omissions and shortages of disease names in real time within the flow of the consultation. It also handles internal-medicine-specific rules such as the prohibition on billing the Lifestyle-Related Disease Management Fee and the Specific Disease Treatment Management Fee together, curbing the risk of returns and assessments in advance.

Furthermore, because AI Karte's system is automatically updated in line with medical fee revisions, it automatically keeps up with post-revision billing rules. Together with support for creating treatment plans via document AI drafts, it streamlines internal medicine billing work in an integrated way.

In closing

Internal medicine clinics have many billing items and are a field with a high risk of billing omissions and returns. Checking that relies on human effort alone cannot avoid oversights, and keeping up with revisions is a burden. By using integrated-chart AI receipt checking, you can curb revenue loss from billing omissions and the risk of returns and assessments, and reduce the burden on medical clerical staff. While always confirming specific billing requirements in official materials, incorporating constant support by the system is effective.

Through the provision of AI Karte, Pottech serves as the optimal business partner for clinics—supporting not only better working conditions for physicians, nurses, and medical clerical staff, but also helping clinics achieve to the fullest what they want to accomplish.

For details, please do not hesitate to contact us.

References / Sources

• About the FY2024 Medical Fee Revision (MHLW)
• Special Medical Fees B000 Specific Disease Treatment Management Fee (MHLW)
• Information on receipts (medical fee claims) | Social Insurance Medical Fee Payment Fund

The billing requirements, points, and criteria for returns/assessments change by fiscal year and notification. This article does not assert them; please always confirm the latest information in the official sources above.