The benefits and hidden costs of AI scribes

Ambient AI scribes have typically been marketed as tools to reduce providers’ administrative burden by speeding up the clinical documentation process. They may also be useful in boosting health system revenues.

Multiple studies show that scribe usage is leading to more billing codes being included in clinical notes, which in turn leads to higher reimbursement from insurers and higher revenues for hospitals. That may be a slight boon for health systems, experts said. But, they cautioned that it could also increase overall medical costs and insurance premiums, particularly when scribes are used in inpatient settings, which involve billing for much higher-cost services. Whether they also result in improvements in care is unclear.

“It leads us to a more interesting question, which is around who’s going to capture the benefits of AI as it disseminates throughout the healthcare system?” A Jay Holmgren, assistant professor at the University of California, San Francisco (UCSF), said.

If health systems can use AI to lower costs while reimbursement rates stay the same, large medical systems may be able to boost their margins rather than pass benefits directly to patients, he added.

Chris Bond, spokesperson for AHIP, the industry trade group representing insurers, said in a written statement that “provider upcoding is adding billions of dollars in wasteful spending and raising healthcare costs for everyone,” and that insurers are “doing everything in their power to protect consumers and keep coverage and care as affordable as possible.”

A closer look

Riverside Health, a nine-hospital health system based in Newport News, Virginia, reported an 11% rise in physician relative value units (RVUs), which measure the time, skill, and intensity of providing a service, since the system began using Abridge’s ambient scribe. RVUs are also used to help determine how much physicians are paid.

Charles Frazier, SVP and chief medical information and innovation officer at Riverside, told Healthcare Brew the health system began using the scribe in May 2024. Today, roughly 450 out of the health system’s more than 800 clinicians, including physicians, advanced practice providers, therapists, and clinical social workers, use the scribe in primary care settings, emergency departments, and more recently, in inpatient settings.

Riverside Health has seen higher coding intensity as a result of using Abridge because the clinical documentation “is more complete,” according to Frazier.

Clinicians often finish up their documentation long after an appointment, as they quickly move from patient to patient, he said. They must then rely on memory, which means they may not recall everything that was discussed in an appointment, and therefore not bill for it. With scribes doing the remembering for them, clinicians’ notes are much more thorough, and more codes are included, according to Frazier.

He declined to specify how much Riverside pays Abridge.

Abridge declined to comment on how much it charges hospitals for its scribe and the effects its platform may have on medical costs.

Not only are the scribes leading to more codes, they’re also sometimes leading to patient visits being classified as a higher level of care, experts said. For billing purposes, outpatient visits are ranked by level of complexity, with more complex visits ranked at five, and the lowest ranked at one. Higher-complexity visits typically translate to higher reimbursements.

Without a scribe, a clinician may forget to document that, during a patient visit, they discussed the patient’s history of COPD, for example, Frazier said. Including details like that can boost the level of complexity.

According to Riverside’s analysis, since using Abridge, the health system’s proportion of level-four patient encounters for returning patients increased by 4 percentage points, and the proportion of level-five patient encounters for returning patients increased by 1 percentage point.

“That right there more than pays for what we’re paying for [Abridge],” Frazier said. “It’s been a great investment.”

Value varies by setting

Using AI scribes in inpatient settings may be more lucrative for health systems compared to outpatient services, which tend to have lower reimbursement rates.

A study from UCSF, published in January 2026, found that AI scribes led to increased RVUs and patient encounters on a weekly basis, with no change in the amount of claims denials, at UCSF Health, where the scribes were used for ambulatory visits. That increase translated to an additional $3,044 annually per physician when measured on the 2025 Medicare physician fee schedule, according to the study.

“The reason that the numbers are really not that high is because this is ambulatory, office-based billing, which is not the moneymaker for any of these large health systems,” Holmgren, who was lead author of the study, said. “When we talk about the really high-cost items in the US healthcare setting, that is often hospital and facility fees, inpatient, the really complex procedural specialties, and prescription drugs, in many cases for high-cost new drugs, like GLP-1s, obviously.”

As more health systems like Riverside start incorporating scribes more deeply into inpatient settings, “it’ll be interesting to see if there are real revenue impacts” for the hospitals using them, Holmgren said.

What about overall healthcare costs?

A June analysis from PwC, one of the Big 4 accounting firms, found that the commercial healthcare cost trend is expected to increase by up to 9% in 2027, with AI documentation and coding tools being one of the main contributors of the growth.

That may translate into higher premiums for consumers, experts said.

“Now for every visit, you have this AI recording, AI-generated summary and notes, and AI-generated billing codes that eventually translate to higher charges for payers,” said Tinglong Dai, Bernard T. Ferrari professor at the Johns Hopkins University Carey Business School. Dai’s work focuses on integrating AI into clinician workflows. “The high premiums eventually will be used to fund the higher service charges.”

More billing codes per visit may also mean uninsured patients and those with high-deductible health plans are stuck footing a larger bill.

“If some of the access challenges that are constraining healthcare utilization today are resolved because physicians are spending less time charting and more time seeing patients, that drives utilization of the health system and total costs there as well,” Derek Skoog, principal and health actuarial and economics practice leader at PwC, told Healthcare Brew.

The study from UCSF found that clinicians using AI scribes see slightly more patients per week compared to those not using the technology. However, at Riverside, Frazier said scribes haven’t led to more patient visits, but instead has helped doctors stay on schedule, so patients are spending less time waiting.

Whether or not the use of AI scribes improves the quality of care patients receive is yet to be determined. Some data suggests patient experience might be better because clinicians can spend more time focused on their patients during appointments rather than note-taking. But there are also concerns over AI misinterpreting or omitting information from notes.

Frazier said that, at Riverside, they’ve occasionally seen their scribes struggle to understand medication names, for example.

“Those are the reasons why you really need to review those notes, because sometimes they get a little confused,” he said. “That’s rare, though.”