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The Future of Medical Coding and the Vital Role of Autonomous Coding Technology

By AGS Health

December 22, 2023

With the advent of autonomous coding technology, the future of medical coding is undergoing a significant transformation. Autonomous coding technology is having a profound impact on the revenue cycle, including improving cashflow, maximizing revenue, and enhancing patients’ financial experience.

The Current State of Medical Coding

Medical coding is integral to healthcare administration, billing, and reimbursement processes. It involves assigning specific alphanumeric codes to describe patients' medical conditions, diagnoses, procedures, and treatments. These codes help ensure accurate claim submissions, appropriate reimbursement, and streamlined communications between coders, CDI specialists, and physicians.

Manual medical coding processes are prone to human error, inconsistencies, and inefficiencies, which leads to coding inaccuracies, delays in claim processing, and potential revenue loss for healthcare organizations due to underpayments and potential fines due to poor compliance and audits. Moreover, incomplete or inaccurate coding can negatively impact patients’ financial experience due to delayed or inaccurate billing.

The Rise of Autonomous Coding Technology

Autonomous coding technology, powered by artificial intelligence (AI), uses advanced algorithms to analyze vast amounts of medical data, including electronic health records (EHRs), clinical notes, and diagnostic imaging reports. The technology can then accurately assign the appropriate codes to medical procedures and diagnoses – and the benefits go beyond reimbursement. Today, autonomous coding is well-suited for high-volume outpatient settings, such as radiology, pathology, and emergency medicine. However, with time and proper training, the technology is poised to revolutionize medical coding throughout the healthcare ecosystem.

Improving Patient Financial Experience

Because autonomous coding can analyze vast amounts of healthcare data quickly, coding processes can be performed in a fraction of the time required of manual processes. By capturing and categorizing data consistently and accurately, autonomous coding also reduces opportunities for error and the potential for coding-related denials. As a result, patients are provided with a streamlined billing process that greatly reduces the likelihood of improper billing and helps prevent frustrations caused by delayed payment requests.

Reducing Healthcare Costs

  • Efficient Claims Processing
    By automating the coding workflow, healthcare organizations can improve revenue cycle management, expedite claim processing, and reduce administrative burdens. This streamlined process contributes to cost savings and operational efficiency.
  • Accurate Reimbursement
    Inaccurate coding can result in underpayment or overpayment for healthcare services, leading to financial challenges for providers and patients. Autonomous coding technology ensures accurate code assignment, minimizing coding errors and reducing the risk of improper reimbursement.

Human Validation

While autonomous coding may sound like a completely “hands-free” solution, human feedback plays a crucial role in validating code accuracy when confidence levels don’t meet the minimum threshold. This creates a feedback loop that is essential to the continuous learning and improvement of the technology. For more complex coding environments, today’s autonomous coding solution may also incur “fall-out charts” where confidence scores are too low for the system to handle autonomously. As a result, humans play a critical role in handling complex code assignments, while autonomous coding technology manages the more simple and routine charts.

The integration of autonomous coding technology into the healthcare ecosystem offers transformative benefits that extend beyond administrative efficiency. By enhancing accuracy, streamlining workflows, and improving compliance, autonomous coding positively impacts revenue and patients’ financial experience. As the healthcare industry embraces this advanced technology, the potential for improved operational efficiency and cost savings is substantial.

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AGS Health

Author

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.

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