St. Joseph’s Health, a leading health system in New Jersey, provides world-class care through a combination of medical expertise, innovative technology, and compassion. Its more than 5,000 skilled providers and 1,000 expert physicians provide nationally recognized award-winning inpatient and outpatient care through a network of hospitals, physician practices, urgent care centers, and outpatient centers.
St. Joseph’s Health and AGS Health formed a strategic relationship to deploy a blended solution of computer-assisted professional coding (CAPC) and outsourced services. The goal was to rapidly transition coding duties from St. Joseph’s clinical resources to a dedicated team of coders while achieving technology-enhanced productivity, efficiency, and accuracy
Challenges
- Medical coding responsibilities combined with clinical labor shortages were distracting physicians from patient care and contributing to clinician burnout.
- It was a challenge for physicians to keep pace with increasingly complex and rapidly evolving coding guidelines.
- Tasking physicians with self-coding caused back-end delays in billing and reimbursement and higher rates of coding-related denials.
Outcomes
- Coder productivity increased by about 40-60%, saving nearly $200,000 annually in full-time coding resources.
- The CAPC now processes more than 320,000 charts annually with 78% evaluation and management (E/M) coding accuracy.
- Pediatrics coding denial rates decreased from 34% to 8% and primary care denials decreased from 26% to 9%.
- Monthly collections on the current month of billing in pediatrics rose from 36% to 87%.
- Clean claim rates improved from 55% to 66%, or up to 90% if registration and eligibility issues were not a factor.
Change Management Wins Over Key Stakeholders
Clinical Sponsorship and Level Setting Expectations
Unexpected CPT Category II Benefits
“I really like the fact that AGS Health’s approach leverages a combination of technology and human input. What really attracted me was the partnership that AGS said they would give us – and they’ve proven repeatedly that this is a partnership. It’s the ability to enhance the CAPC program while knowing that, at the end, there is still a human to verify, to do the eyeball check. That is an undervalued thing in healthcare, and it’s so incredibly important for what we do.”
