A health system in the Midwest had a Discharged, Not Final Billed (DNFB) problem. Manual medical coding processes limited coder productivity, resulting in a DNFB backlog that climbed to nearly 40 days—a costly and unsustainable problem that posed a serious threat to cash flow and the revenue cycle.
"We had minimal efficiencies in place…Updating charges, pulling documentation, matching documentation to accounts, and creating encounters were all manual, and we spent a significant amount of time on reporting," said a senior manager of coding.
The nationally recognized nonprofit health system in northeastern Ohio has more than 1,000 beds and over 850 physicians across its regional network. With nearly 129,570 patient days, more than 873,350 outpatient visits, over 25,350 surgeries, and 139,140 ER visits annually, it was clear that the health system had outgrown its manual approach to coding and billing professional fees. The decision was made to leverage automation to tackle the backlog and modernize coding processes.
Specifically, the organization looked to coding automation to eliminate:
- The 35–40-day coding backlog and associated downstream billing and coding issues caused by manual coding processes and staff shortages.
- Inefficient siloed departments and spreadsheet-based reporting that made it difficult to provide physicians and coders with timely feedback.
- Reliance on code books for coding reviews exacerbated billing delays.
Professional Coding Automation
The first attempt involved using an existing computer-assisted coding (CAC) solution designed for facility coding. However, it quickly became evident that it fell short of professional fee coding needs.
"We tried to bend the cookie-cutter facility solution to fit our professional fee needs. It kind of did, but not really, so our results were just a drop in the bucket of efficiencies that the facility side was realizing," said the coding leader. "So, we got the green light from leadership to see what options were out there."
After evaluating several options that ultimately did not meet their needs, particularly in terms of E&M coding, the organization selected AGS Health and its computer-assisted professional coding (CAPC) solution.
Featuring integrated workflows to simplify coding tasks and efficiently abstract multiple parameters, CAPC is powered by an industry-leading clinical natural language processing (NLP) engine built specifically for professional-fee coding to ensure precise coding across all professional specialties, encompassing ICD-10 CM, CPT, HCPCS, modifiers, and professional E&M levels.
"Seeing what AGS could provide was big, but I also very distinctly remember both of the conversations we had with AGS and feeling like they were willing to work with us to build a tool that works for us, rather than molding us to fit their tool," said the coding leader. "Knowing they were willing to be so flexible really made me feel comfortable."
Rapid Outcomes and Measurable Value
AGS Health configured its CAPC platform to meet the organization’s professional coding needs, rather than expecting the coding team to alter their established workflows to the solution. This led to CAPC's quick embrace by the coding staff. In just seven months, the team eliminated the backlog. Other results include:
- Average charts per coder per hour improved to nearly 18, an increase of 5-6 charts per hour.
- The value of claims coded per month increased from $2 million to $4 million
- DNFB dropped from approximately 38 days to just 10
The organization highlights CAPC’s custom productivity and other reporting tools as particularly beneficial. They allow team leaders to rapidly access and drill down into data at a very granular level to identify trends and productivity or coding issues and present the information in ways that are meaningful to both coders and physicians—a capability that has enhanced end-user satisfaction with CAPC.
"The ability to compare the charges the provider dropped to what was actually billed or what the coder approved… and present bell curves to show how E&Ms are new versus established or trending month-over-month is huge," the coding leader said.
The director of revenue cycle at the organization adds that the ability to quickly identify and address trends has been invaluable to driving change among coders and physicians.
"Now, with AGS reporting, we’re able to identify a trend and take it back to the physician in real time. It eliminates the manual aspects and reassures the physician that there really is a problem, and they have to improve their documentation. We have substantial data because AGS tracks every single case our coders are coding, and it’s easy to filter down to anything that we need and provide that data back to those stakeholders to drive change."
Exceeding Expectations
Innovation, agility, and flexibility came together to ensure CAPC's success. Even when another vendor’s failure to deliver expected coding workflow automations hampered implementation progress, AGS Health’s deployment team leveraged its automation expertise to quickly address the issue and get things back on track.
"Once we realized that we were down the wrong path with the other vendor, AGS stepped in and helped us quickly develop a solution. They saved the day," the revenue cycle executive said.
The coding leader added, "AGS Health’s CAPC has truly exceeded our expectations. We came into this just wanting a tool to help us code more efficiently, but what we’ve gotten is a tool that has helped us automate and streamline coding processes, and, for a large majority of our revenue cycle pre-billing, we’ve made a lot of strides forward."
Download the case study to read more about this professional coding automation story.
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