Kimberly Smith MSHI, RHIA, CCDS, CCDS-O, CPC’s Post

Recent bipartisan initiative urging the Biden administration to ensure fair and accurate use of AI tools in Medicare Advantage. Lawmakers have called for a thorough review of these tools to prevent the denial of care, especially for our elderly and sick patients. This important step is crucial for safeguarding the health and well-being of those who rely on Medicare Advantage. AI tools often make generalized decisions that fail to account for individual patient needs. This approach is contrary to the mission of Medicare, which aims for person-centered care. Human/agent oversight is essential to ensure AI decisions are accurate and fair. Let's work together to ensure technology serves our patients with integrity and fairness. #MedicareAdvantage #Healthcare #AIOversight #PatientCare #HealthcareInnovation

The use of artificial intelligence (AI) in healthcare, particularly within Medicare Advantage (MA) plans, is sparking legal challenges and prompting regulatory action. Lawsuits Against MA Plans: - Two recent class-action lawsuits allege that Humana and UnitedHealthcare used AI to improperly deny coverage for services in MA plans. - Plaintiffs claim the AI tools made "premature" decisions based on "unrealistic recovery predictions," leading to denied care. - Insurers argue these claims fall under the Medicare Act and require exhausting administrative remedies before lawsuits. - They also claim state law claims are preempted by the Medicare Act's regulatory framework. Learn more: https://hubs.ly/Q02t8k0B0

 𝐓𝐫𝐚𝐜𝐤𝐢𝐧𝐠 𝐟𝐞𝐝𝐞𝐫𝐚𝐥 𝐞𝐟𝐟𝐨𝐫𝐭𝐬 𝐭𝐨 𝐚𝐝𝐝𝐫𝐞𝐬𝐬 𝐭𝐡𝐞 𝐮𝐬𝐞 𝐨𝐟 𝐚𝐫𝐭𝐢𝐟𝐢𝐜𝐢𝐚𝐥 𝐢𝐧𝐭𝐞𝐥𝐥𝐢𝐠𝐞𝐧𝐜𝐞 𝐢𝐧 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞? Here are a few initiatives to be aware of: 👉  Executive Order on Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence 👉 OCR / CMS final §1557 rule which prohibits discrimination through the use of “patient care decision support tools” (AI) 👉 Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Rule from the Office of the National Coordinator for Health IT (ONC) https://lnkd.in/gfM6x_53

Interested in AI in Healthcare Quality measures? Check out these two documents that Medicare & Medicaid Services & Coalition for Health AI published. Artificial Intelligence (AI) in Quality Measurement https://lnkd.in/gaKGYvtJ BLUEPRINT FOR TRUSTWORTHY AI IMPLEMENTATION GUIDANCE AND ASSURANCE FOR HEALTHCARE https://lnkd.in/gbKY_u-e

The incoming Trump administration is stepping into a complex landscape of healthcare regulation, particularly as AI technology becomes more integrated into medical practices. One major challenge lies in managing AI-generated misinformation, which can quickly spread and pose serious risks to public health. As AI models create increasingly human-like text, distinguishing fact from fiction is becoming tougher. This not only threatens public trust in health institutions but also risks exacerbating health crises, as seen during the COVID-19 pandemic. Meanwhile, the proposed expansion of Medicare Advantage and Part D coverage for weight-loss medications brings potential benefits for millions. However, it also raises critical questions about prior authorization standards and marketing regulations. As the administration contemplates Medicaid changes, including budget cuts and stricter eligibility, the stakes for low-income Americans and people with disabilities are exceedingly high. Navigating these challenges will require strategic, thoughtful regulation that balances innovation and public health safety. Read the full article below! 👇 #HealthcareRegulation #AITechnology #PublicHealth #Medicaid

🚨 New AI Guidelines for Digital Healthcare Practitioners. 🚨 AHPRA has released new guidelines on the use of AI in healthcare; focusing on patient safety, transparency and ethical obligations. Importantly, digital healthcare practitioners must ensure their insurance covers the specific and unique risks associated with AI-driven care. This move highlights growing regulatory scrutiny on digital healthcare, making compliance and insurance more critical than ever. #digitalhealth #AIinHealthcare

Exciting news in healthcare policy! Bipartisan lawmakers are calling for increased oversight of AI in Medicare Advantage coverage. This initiative aims to ensure that AI technologies are used ethically and effectively, protecting patients' interests and enhancing care quality. As AI continues to revolutionize healthcare, it's crucial to strike a balance between innovation and regulation. #Healthcare #AI #MedicareAdvantage #HealthPolicy

Generative AI is revolutionizing healthcare by making processes more efficient and enhancing knowledge. However, as with any powerful technology, it comes with its own set of challenges, including the risk of fraud, waste, and abuse. Check out our latest WhitePaper with my great colleague Jason DiNovi. The latest insights from SAS explore how healthcare organizations can leverage GenAI to improve patient care while staying vigilant against potential fraud. #FraudWeek #HealthcareInnovation #GenerativeAI #FraudPrevention #AI #PublicSector #FWA

We've already seen lawsuits against certain health insurers over denials of prior authorizations based on AI predictive analytics. However, this settlement marks a first-of-its-kind legal action involving #generative_AI used in healthcare decision-making. 🏥🤖 In this case, a Texas-based health AI company was accused of making false claims about the accuracy of its AI products. These AI tools were deployed in hospitals to summarize patient data in real-time, but they were inaccurately marketed with claims of a #hallucination rate of "<1 per 100,000." Now, as part of the settlement, the company must disclose the true accuracy of its products and ensure hospital staff are fully informed about the technology’s limitations. 🚨 Key Takeaways: 1️⃣ Don’t take AI vendor claims for granted: Providers and payers deploying health AI tech should leverage internal or third-party audits and monitoring to verify accuracy and safety. 2️⃣ New regulatory requirements are coming: The federal government has made its stance clear - starting January 1, 2025, predictive DSI developers must report 31 source attributes under the Assistant Secretary for Technology Policy HTI-1 rule. This is the beginning of heightened scrutiny for AI in healthcare. 3️⃣ Demonstrating good faith with compliance: While the regulatory landscape for healthcare AI is still evolving, legal and compliance teams can get ahead by adopting the seven elements of a successful compliance program from the HHS Office of Inspector General (link in comments). The future of AI in healthcare is promising but requires responsible deployment and continuous oversight. #HealthTech #AIRegulation #AIGovernance #GenerativeAI #HealthcareAI #EthicsInAI #AICompliance #PatientSafety #AIinHealthcare #ArtificialIntelligence #DigitalHealth 🔗 Follow CHARGE for the latest updates on AI regulation and governance in healthcare.

🌐 Harnessing Generative AI in Healthcare: Opportunities and Challenges 🌐 Generative AI is revolutionizing healthcare by making processes more efficient and enhancing knowledge. However, as with any powerful technology, it comes with its own set of challenges, including the risk of fraud, waste, and abuse. Check out my latest White Paper with my great colleague Jason DiNovi The latest insights from SAS explore how healthcare organizations can leverage GenAI to improve patient care while staying vigilant against potential fraud. Discover how to navigate these opportunities and challenges: https://lnkd.in/e67q7sVN #FraudWeek #HealthcareInnovation #GenerativeAI #FraudPrevention #AI #PublicSector