How Much Is AI Upcoding Costing Employers?

Healthcare providers have adopted AI faster than almost any other industry, and most of that investment has gone toward billing and revenue software rather than patient care. Of the $1.4 billion spent on healthcare AI in the past year, 89% went to back-office tools that help providers get paid more for the same services. Garner's research estimates these tools are now adding 1.7% to employer healthcare spend every year.

This webinar will walk through the data behind that estimate and explain what it means for benefits leaders. Garner's team will cover how AI-assisted coding software encourages tactics like severity inflation, unbundled procedures, and extra diagnosis codes on claims, and how those tactics show up in real claims data. Office visit and emergency room coding intensity have both risen about 5% since 2021, and 80% of payers expect the number of codes per claim to keep growing.

You'll also learn why carriers are struggling to keep up. Denial rates have increased 13% over the past three years, but provider billing tools are improving faster than payer defenses. Waiting for your carrier to solve this problem is not a realistic strategy.

Finally, we'll discuss what employers can actually do: how to identify providers who deliver high-quality care without inflated billing, and how to design incentives that steer employees toward them.

If you manage a self-funded health plan, this session will help you understand a cost trend that is easy to miss and getting more expensive each year.