Work

Real-time automated billing for tobacco treatment: developing and validating a scalable machine learning approach

Year: 2025

Type: article

Abstract: Objectives: To develop CigStopper, a real-time, automated medical billing prototype designed to identify eligible tobacco cessation care codes, thereby reducing administrative workload while improving billing accuracy. Materials and Methods: ChatGPT prompt engineering generated a synthetic corpus of physician-style clinical notes categorized for CPT codes 99406/99407. Practicing clinicians annotated the dataset to train multiple machine learning (ML) models focused on accurately predicting billing code eligibility. Results: Decision tree and random forest models performed best. Mean performance across all models: PRC AUC = 0.857, F1 score = 0.835. Generalizability testing on deidentified notes confirmed that tree-based models performed best. Discussion: CigStopper shows promise for streamlining manual billing inefficiencies that hinder tobacco cessation care. ML methods lay the groundwork for clinical implementation based on good performance using synthetic data. Automating high-volume, low-value tasks simplify complexities in a multi-payer system and promote financial sustainability for healthcare practices. Conclusion: CigStopper validates foundational methods for automating the discernment of appropriate billing codes for eligible smoking cessation counseling care.

Source: JAMIA Open

DOI: 10.1093/jamiaopen/ooaf039