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Latest CASE STUDIES
By AGS Health
June 22, 2022
Looking back across 50 years of coding technologies as we did in our recent white paper reveals a pattern to the catalysts for change. The lion’s share of technology advances traced in the paper emerged from an urgent need to accelerate the coding process, improve accuracy, mitigate risk of denials and audits, and boost productivity – despite the still-ongoing shortage of coding professionals.
While advanced technologies, such as predictive analytics, artificial intelligence, machine learning, natural language processing, and Clinical Language Understanding (CLU), can help minimize the impact of labor shortages, they cannot overcome this issue on their own. However, they do up the ante in terms of identifying the right outsourcing and solutions partner to fill staffing gaps and ensure a healthcare organization has access to – and is properly using – the latest coding technologies to stay on top of rapidly evolving code classifications, regulatory mandates, and advances in medicine.
Partnering with an outsourced coding service provider remains a top strategy for healthcare organizations dealing with a shortage of qualified professionals and/or a spike in coding volume. Supplementing internal coding teams with outsourced experts can optimize productivity and avoid coder burnout.
The right outsourcing partner provides access to a highly trained and experienced workforce that stays current on technology, regulatory and coding changes, and best practices. Outsourcing partners are in a better position to identify and resolve coding problems that are contributing to a healthcare organization’s higher denials rates. They also offer scalable processes that shift with patient volumes and workloads, eliminating bottlenecks so internal staff can focus on core, mission-critical tasks.
A growing number of providers and coding outsource vendors are leveraging the cloud to integrate CAC, CDI, and auditing tools into a single cohesive AI platform. The addition of NLP and AI technologies also automates key processes, including analyzing chart contents and prioritizing for CDI specialists those with the highest likelihood of requiring clinician queries. Further, embedding these tools into encoder and CAC software allows coders to focus on validating or adjusting recommendations based on their review of appropriate chart elements.
The result is a powerful technology-enabled coder-CDI collaboration that generates a higher degree of efficiency, quality, accuracy and, subsequently, reimbursement. It also allows healthcare organizations to address improper documentation and coding that currently cost the U.S. healthcare system about $54 billion annually.
The right solutions provider can also lay the groundwork for what’s to come, such as “coding alert” technology that works in the background of CAC software and, ultimately, true autonomous coding which couples CLU with AI/ML and NLP. Bots, or Robotic Process Automation (RPA), also hold great promise for automating the more mundane processes and freeing auditors to focus on the more complex cases requiring deeper quality assurance before being released as claims.
As coding and coding technologies have evolved, the process of identifying the right outsourcing and/or solution partner has become more complex. The stakes are far higher, and the wrong engagement can result in disaster. (See Overcoming Labor Shortages Through Automation and Outsourced Services: Part Three.)
The best service and/or technology partners will be trustworthy, highly experienced, and have longevity and a proven track record. They will be willing and able to provide high-level, high-touch customer service and 24/7 support. Versatility and flexibility are also important, as is a deep bench of qualified coders and technology professionals to dedicate singularly to the client organization’s workload.
Finding the right partner is worth the time it takes to conduct an exhaustive and thorough assessment. The right match will more than make up for the time and resources dedicated to the search.
Gain a better understanding of where we are today with coding and coding technologies, how we got here, and the direction that new innovations are taking us in the future by downloading the full white paper today.
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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.