AI×Human for 'Claim Leakage' and 'Medical Office Staff Shortage': Dot-F Launches Proof of Concept of 'Receful AI' with Shioya Gastroenterology Clinic

Dot-F Co., Ltd. (Headquarters: Chuo-ku, Tokyo; Representative Director: Shogo Fujiwara; hereinafter 'the Company') has partnered with Medical Corporation Medino Shioya Gastroenterology Clinic (Chairman: Yushi Shioya; hereinafter 'the Clinic') to initiate a proof of concept of 'Receful AI', a service that fully outsources clinic receipt operations using AI and remote expert medical office staff.

The greatest feature of Receful AI is that it covers even 'daily billing operations' which have not been sufficiently addressed by conventional receipt outsourcing, through a combination of AI and human. AI checks billing in real-time after medical examinations, and remote expert medical office staff perform confirmation, correction, and billing – a new approach that integrates real-time AI billing support and remote medical office outsourcing.

In this proof of concept, the company will verify the effectiveness of the medical AI BPaaS model that 'takes over the operations themselves' rather than consulting, addressing two challenges faced by Japanese clinics: 'profit loss due to billing omissions' and 'structural shortage of medical office personnel'. *This proof of concept is not a clinical trial of medical devices, but aims to verify the suitability of medical office operations.

■ Background: Unseen Leakage of Clinic Profits

In clinic management, 'billing' of medical fees is a critical operation that directly affects revenue. However, many medical institutions are not aware whether billing is correctly performed and whether they are missing out on revenue that should be obtained. Billing knowledge tends to be specific to certain veteran medical office staff, and hiring and retaining such personnel is difficult. On the other hand, external outsourcing services are expensive, and many clinics hesitate to introduce them.

As a result, 'claim leakage' where medical fees that should be billed are not billed occurs daily, and clinic profits are lost invisibly. As the shortage of medical office staff becomes more severe in the future, this issue will become even larger.

■ What is Receful AI: AI×Human fully outsources even 'daily billing' not covered conventionally

Receipt operations consist of two processes: (1) 'billing operations' performed on-site after medical examinations, and (2) 'claim operations' at the end/beginning of the month to bill the government. Conventional receipt outsourcing mainly covers (2) end-of-month/beginning-of-month claim operations. In contrast, 'Receful AI' supports both (1) billing and (2) claim operations in a seamless manner: AI checks billing in real-time after examinations to detect omissions, and remote expert medical office staff perform confirmation, correction, and billing.

From the clinic's perspective, they can entrust daily billing to monthly claims as if they have 'hired another' experienced medical office staff. Without worrying about hiring and retaining specific veteran personnel, they aim to simultaneously prevent claim leakage and reduce the burden of claim operations.

■ AI Delivers Expert Billing Knowledge to the Field

Another feature of Receful AI is that it provides billing knowledge that previously only some veteran medical office staff could answer, to on-site staff in real-time via AI. It presents relevant sections from Ministry of Health, Labour and Welfare notifications with sources, and instantly judges the possibility of billing. It also follows fee revisions every two years through data updates. This aims to standardize the service without depending on the judgment of a limited number of skilled personnel.

■ About This Proof of Concept

In this proof of concept with the Clinic, through the operation of Receful AI, the following will be mainly verified:

- Improvement of billing accuracy through collaboration of AI and remote medical office staff
- Contribution to clinic revenue by preventing claim leakage
- Reduction of on-site burden for receipt operations

Results obtained from the verification will be announced separately.

Comment from Yushi Shioya, Chairman of Shioya Gastroenterology Clinic

'In clinic management, the time spent on billing operations and the impact on revenue due to claim leakage are far from negligible. Furthermore, considering the era of recruitment difficulty, the cost of hiring medical office staff and the time/cost of training, AI entering the operations seems very rational and rather becomes an inexpensive option.

Receful AI is a system that combines the power of AI and the expertise of experienced medical office staff to support daily billing to claims. Our clinic also has great expectations that this proof of concept will advance the creation of an environment where medical institutions can focus on medical care with peace of mind.'

■ Future Development: Supporting Medical Institutions to 'Create Profits'

The shortage of medical office staff is expected to become more severe in the future, and it will become increasingly difficult for clinics to maintain billing accuracy on their own.

While many business efficiency services aim to 'reduce costs', our company aims to help medical institutions recover the revenue they should be earning and 'create profits'. By combining technology and specialized personnel, we aim to become an infrastructure that supports the very management base of clinics.

Through Receful AI, we will contribute to creating an environment where healthcare professionals can focus on medical care with peace of mind.

▶ Service site: https://dot-f.jp/reseful/