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Latest CASE STUDIES
By AGS Health
July 13, 2022
In today’s value-based healthcare landscape, where hospitals and healthcare institutions are compensated based on the quality of care, even the most minor deviation in documentation can leave gaping holes in the revenue stream. Clinical Documentation Improvement (CDI) becomes even more crucial as Medicare continues to be the biggest payer for U.S. hospitals. With an expected 72 million people falling under its bracket by 2025, the exponential growth in this sector will only place a further burden on patient documentation in the years ahead.
Care providers must continuously realign their healthcare revenue cycle management (RCM) through comprehensive and quantifiable performance metrics or Key Performance Indicators (KPIs) to accurately capture care quality and ensure proper reimbursement. Overlooking even a single criterion could lead hospitals and clinics to suffer significant reimbursement losses. A robust set of KPIs helps hospitals track performance and prevent dire circumstances. It also provides organization-wide visibility of the hospital’s revenue cycle success.
Healthcare organizations struggle to optimize their KPIs despite meticulous adherence to the revenue cycle, especially for outpatient procedures where volumes and scope for errors are high. As a result, they suffer millions of dollars in lost revenue through claim denials and reworks. Research shows hospitals lose about 2% to 5% of their net patient revenue in unpaid claims.
The ability to effectively use KPIs is the deciding factor in reducing claims denials and maintaining a healthy revenue cycle. When looking at KPIs in a value-based healthcare model, the efficiency of the medical coding and documentation process is most important. Two key factors govern these:
While these factors form a solid basis for medical coding and documentation, there are several KPIs that can help track the revenue cycle health of outpatient procedures, including:
The introduction of Natural Language Processing-enabled (NLP) computer-assisted coding (CAC) software has bolstered professional medical coding in new and innovative ways. Having been trained for years on longitudinal clinical charts, the ability of AI-powered CAC systems to visualize KPIs in a more organized manner allows for decision-making geared toward higher revenue generation and improved healthcare quality.
With this in mind, AGS Health’s computer-assisted coding allows providers to simplify the coding workflow. By using, industry-leading, clinical NLP technology, AGS’s CAC tool provides:
Computer-assisted coding and NLP-based tools significantly improve coding accuracy and other outpatient KPIs. For example, Auburn Community Hospital used AGS’s CAC to optimize its coding workflow and revenue cycle, which led to:
Once in effect, the AGS CAC solution offers considerable benefits for medical coding workflows. With the NLP-driven solution in place, hospitals can expect to see the following metrics:
Revenue management and integrity are governed by KPIs that effectively identify areas where payments are low but compliance risks are high. When CAC software is NLP-driven and applied effectively, it creates new avenues for medical coding to successfully progress and meet the needs of a value-based healthcare ecosystem.
AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.