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By Suhas Nair
November 16, 2023
Advancements in artificial intelligence (AI) have revolutionized the healthcare industry. One area that has seen significant development is medical coding, a crucial process in healthcare revenue cycle management (RCM). Traditionally, medical coding has been a labor-intensive task, requiring human coders to manually review patient charts, interpret clinical data, and assign the appropriate codes for billing and reimbursement purposes. However, the landscape of medical coding is rapidly changing, with the emergence of autonomous coding as the most recent transformation.
Autonomous coding refers to AI-driven systems capable of automatically assigning medical codes to patient charts without the need for human intervention. These cutting-edge technologies have the potential to streamline coding processes, reduce costs, and improve accuracy.
Unlike traditional Computer-Assisted Coding (CAC) systems, autonomous coding systems can independently assign relevant codes with full confidence, considerably reducing the need for human supervision. The system reads the chart, assigns codes, and automatically sends them back to the Electronic Health Record (EHR). Coders are left with only a small percentage of charts that the autonomous coding system cannot process due to low confidence scores, dramatically reducing the time spent on administrative tasks and focusing primarily on reviewing and coding more challenging cases or focusing on other initiatives such as quality or even documentation improvement. This transition has drastically improved coding efficiency and accuracy, allowing coders to dedicate more time to complex cases rather than routine administrative tasks.
Key supporting technologies enabling autonomous coding include Natural Language Processing (NLP), Natural Language Understanding (NLU), or Clinical Language Understanding (CLU), which allow the software to read and comprehend clinical charts like a human coder. Additionally, knowledge graphs and a variety of system learning techniques are utilized to apply domain-specific clinical knowledge, administer coding guidelines, and learn from past coding experiences. This combination of technology empowers the technology to autonomously process charts, assign accurate codes, and continually improve through ongoing feedback.
Autonomous coding solutions offer substantial benefits that can positively impact the bottom line for healthcare organizations, improve efficiency, and increase coding accuracy. Since the system operates without minimal to zero human intervention, a significant percentage of the total coding workload can be directly billed, reducing the number of coders needed and the time required for coding. This is particularly advantageous in scenarios where physicians themselves assign codes, such as in specialties like radiology. With autonomous coding handling the coding burden, physicians have more time to see patients and focus on their primary responsibilities.
While the potential benefits of autonomous coding are considerable, there are also limitations to consider. These include the high initial cost of implementation, the need for high-quality data, and the importance of ensuring that the system aligns with current coding guidelines. Additionally, the absence of a consistent feedback loop can inhibit the AI system's learning and improvement and limit the AI’s coding accuracy or ability to expand to broader specialties or charts. True autonomous coding requires the right partner to develop systems that can handle all aspects of coding to deliver on the promise of complete autonomy.
When evaluating an autonomous coding solution, healthcare organizations must carefully consider how this technology will fit into their existing coding processes and how it will affect the accuracy and efficiency of their coding results. It is crucial to understand the level of support and service offered by an autonomous coding vendor, which includes implementation assistance, training, ongoing maintenance, and customer support, to ensure a successful integration.
The future of autonomous coding will thrive through a continuous feedback loop that involves a collaborative effort between human coders and AI systems on a single platform. The process includes the integration of abstraction, quality-related measures, and audits. In this advanced system, the AI adjusts its coding approach continuously, eventually increasing its ability to handle a wider range of specialties and charts. By receiving data from various sources, such as human coders coding fallout charts, audits, claims data, denials data, the AI can incorporate real-world coding outcomes into its learning process. The system processes vast amounts of data at a rapid pace, allowing it to improve its accuracy, coding capabilities and confidence over time.
Autonomous coding technology has the potential to revolutionize the industry, and it is critical that healthcare organizations evaluate autonomous coding solutions carefully. By selecting and implementing the right solution, healthcare organizations can streamline coding processes, reduce costs, and improve accuracy while freeing up coders to focus on complex cases and other areas of impact.
Suhas Nair is a product enthusiast who is passionate about transforming real-world challenges into opportunities for product innovation. With over 15 years of experience in healthcare and technology, Suhas has delivered several SaaS products from concept to market. Suhas leverages his passion for AI by using technologies like Natural Language Processing to optimize healthcare processes and outcomes. A keen space enthusiast, he often fantasizes about the countless possibilities that exist over the horizon when he is not working.
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