The Role Of Integrated Financial Systems In Mitigating Surprise Medical Billing

Abstract

The problem of surprise medical billing has become quite ubiquitous in the American healthcare system, impacting the wallets of insured citizens adversely as they unknowingly seek the services of providers who are out of network. Although the No Surprises Act has created federal safeguards to prevent surprise bills, there are portions in the regulatory system that have not been addressed sufficiently, and a system-wide approach is needed for technical solutions. The approach is transformative as the Integrated Financial Systems (IFS) are increasingly offered on the basis of advanced interoperability standards like Fast Healthcare Interoperability Resources (FHIR) and promising emerging technologies such as blockchain and distributed ledger systems. These technologies bring more transparent, efficient, and secure healthcare billing ecosystems, which are beneficial to all stakeholders because patients achieve greater financial clarity and simplified billing procedures, providers realize a streamlined approach to revenue cycle management and fewer administrative tasks, and insurers achieve faster claims processing and fraud detection. The rise of IFS brings with it critical, ethically-driven concerns surrounding algorithmic decision-making and data privacy that would require the implementation of explainable AI, routine bias evaluation, and human judgment via Human-in-the-Loop frameworks to warrant fair results among various patient groups.