Most Popular
The medical billing pressure is mounting in 2025. Most billers aren’t getting ROI from AI tools, and 83% worry about cyberattacks, according to Tebra’s 2024 survey of medical billing professionals. And Medicare Advantage audits just got serious. These threats aren’t hypothetical — they’re already reshaping medical billing workflows.
In Tebra’s free webinar, “AI, audits, and attacks: How billers stay resilient,” billing experts Jeff Hillam (CEO, Red House Medical Billing) and Aimee Heckman (RCM and Compliance Consultant) shared actionable strategies from the trenches, where they’re tackling these challenges daily.
Moderated by Jesse Noyes, Tebra’s VP of Marketing, the session offered practical guidance to help billing teams build resilience and protect revenue. Watch the webinar recording below, and access our accompanying guide to maximize your company's success in today's landscape.
The AI reality check: What actually works
Everyone’s talking about AI in medical billing, but according to Tebra’s survey, most billers aren’t reporting meaningful results yet — and many haven’t started experimenting with it at all.
- Just 29% report any improvement in efficiency
- 42% haven’t implemented AI or automation in any form
- And in complex areas like denials management, adoption is in the single digits at only 8%
Why the disconnect? There’s often confusion between automated tasks and true AI.
Know the difference: Automation vs. AI
Much of what’s called AI today is really just automation — and that’s not a bad thing. The key is knowing what each tool does best.
Automation excels at rules-based tasks like:
- Eligibility verification
- Auto-posting payments
- Flagging/routing denials
AI is built for learning patterns, making predictions, and adapting over time:
- Crafting detailed appeal letters
- Converting paper superbills to digital
- Predicting denials before they hit
- Following up with payers via AI voice messages
Use automation to streamline the repeatable and AI to tackle the unpredictable. Knowing the difference helps you invest wisely — and avoid the hype.
Make AI work for you
Before adopting AI, ask these questions:
- How is this AI trained? Who reviews its outputs?
- What measurable results can the AI prove?
- What HIPAA compliance controls are in place?
Quick wins to try today:
- Let AI spot underpayments
- Use AI to draft appeal letters (but always review them)
- Automate data entry to free up your team
Pro tip: Never input real patient data into public tools like ChatGPT; doing so would be a HIPAA violation. Create a prompt library for consistency — and always double-check results. AI is your assistant, not your replacement.
Cybersecurity: Your business depends on it
Let’s be blunt: if you handle medical billing data, you have a target on your back.
- 83% of billers worry about data breaches
- Only 35% have intrusion detection in place
- Just 45% train staff to recognize phishing attempts
That gap between concern and action? That’s where businesses are most at risk.
Your cybersecurity action plan
Heckman shared these budget-friendly steps you can implement this week to improve your cybersecurity:
- Run phishing tests quarterly using free tools from CISA or NIST
- Enable the basics, such as multi-factor authentication, email filtering, and antivirus software
- Find an affordable MSSP (managed security service provider) if you lack in-house expertise
- Document your breach response plan before you need it
Download your free resource now
Access it instantly — just complete the form
Compliance: Get ahead of the audit curve
Medicare Advantage audits are intensifying and HIPAA enforcement is stricter than ever, yet our research shows:
- Only 41% of billing companies have documented billing processes
- 13% offer zero compliance training
Your compliance checklist
Start here to get audit-ready:
- Complete annual security risk assessments (HHS offers a free tool)
- Update your business associate agreements (BAAs) regularly — these define how third parties handle protected health information (PHI) under HIPAA
- Appoint a compliance lead, even if it’s part-time
- Review standard operating procedures (SOPs) quarterly, especially for denials and appeals
Think of compliance as insurance — invest now so you don’t have to pay for it later.
How to build a resilient billing team
Today’s most successful billing operations aren’t just hiring task-doers — they’re investing in people who can manage systems, adapt to change, and take ownership of critical workflows.
But there are still major hurdles:
- Repetitive manual tasks consume 25% or more of staff time
- 44% cite cost as a barrier to adopting new technology
As Hillam noted, “We’ve been hiring people to do tasks. We now need people to oversee systems.” That shift requires intentional upskilling and clear ownership of essential processes.
To build long-term resilience, focus on:
- Building strong operational foundations that reduce risk and improve revenue: This includes documenting your workflows, auditing results, and making thoughtful tech investments that allow your teams to focus on higher value tasks.
- Establishing ownership for key areas: Ensure there are team members that oversee major areas such as PHI access, appeals submission, and automated workflows. That way if issues arise, your team can know how to catch and address them.
“We can’t afford to look at these trends in silos anymore. They’re converging and merging, and the only way forward is to really integrate our thinking.”
Your action plan: Start small, think big
Feeling overwhelmed? Start here:
This week
- Audit your current automation (what’s working, what’s not?)
- Schedule a phishing simulation
- Review one critical SOP
This month
- Test one AI tool for a specific pain point
- Update your breach response plan
- Assign compliance ownership
This quarter
- Complete a security risk assessment
- Document your top 5 billing processes
- Invest in team training for one new technology
The bottom line
Medical billing in 2025 demands smart systems, proactive planning, and strong teams. AI, cybersecurity, and compliance aren’t trends — they’re table stakes for the next era of billing success.
Want to dive deeper? Watch the webinar replay for examples, tactical advice, and more insights from our expert panel. You can also check out the post-webinar discussion for a deeper dive about navigating AI and compliance.
Download the slides
Download the webinar slides here to further improve compliance, reduce risk, and future-proof your tech stack.
Learn more about the medical billing landscape:
- Navigate AI, cybersecurity, and compliance — without getting overwhelmed: Meet the moment with smarter systems, stronger safeguards, and real-world tactics you can use now.
- A medical biller’s guide to essential AI terms: Learn essential AI terms for medical billing to evaluate software, improve claim accuracy, and boost revenue cycle efficiency.
- The true cost of medical billing: From unexpected fees to AI adoption, learn what’s changing in the world of medical billing.
- Current Version – Aug 27, 2025Written by: Jean LeeChanges: This article was updated to include the most relevant and up-to-date information available.
- Aug 04, 2025Written by: Jean LeeChanges: This article was updated to include the most relevant and up-to-date information available.
Stay Ahead with Expert Healthcare & Billing Insights
Get the latest industry updates, financial tips, and expert strategies — delivered straight to your inbox.
Stay Ahead with Expert Healthcare & Billing Insights
Get the latest industry updates, financial tips, and expert strategies — delivered straight to your inbox.
