Medical coding is an essential step of revenue cycle management. However, current processes rely largely on human coders, which is error-prone and time-consuming due to the sheer number of codes and the length of medical documents.
In recent years, to overcome these challenges, autonomous medical coding has gained traction for its ability to reduce denials and bolster critical decision-making capabilities. According to a study by Towards Healthcare, the global AI in the medical coding market is projected to hit a whopping $7,150 million by 2032.
For healthcare providers looking to take this AI-driven leap from traditional Computer-Assisted Coding (CAC) systems, going for the right autonomous coding software is the right way forward. This buyer’s guide aims to equip you with all the valuable insights needed to decide which software you should invest in.
But first…
What is autonomous medical coding?
Autonomous medical coding is a technology-driven process of analyzing electronic patient data to generate a complete, ready-to-use code set for billing. It combines the capabilities of machine learning algorithms, natural language processing (NLP), and advanced data analytics to streamline the coding process.
Autonomous medical coding solutions run in the background, taking a first pass at coding all patient encounters and sending all successfully coded charts to billing. They do it with minimal human intervention—a significant improvement over other solutions like CAC, which require medical coders to validate the coding output before an encounter can be sent to billing.
Why is there a need for autonomous medical coding software?
As healthcare organizations grow and handle increasing volumes of patient data, manual coding systems can easily become overwhelmed and prone to inconsistencies. This is one of the primary reasons why they need autonomous medical coding software.
AI algorithms can quickly analyze and interpret the vast amount of healthcare data, extracting key information and assigning appropriate codes. Thus reducing the burden on human coders who otherwise would have to painstakingly review and assign codes to every medical record.
Another important aspect is that autonomous coding software can continuously learn and adapt. By training them on large sets of data and incorporating feedback from human coders, these systems can improve their accuracy with time. They can not only recognize patterns and identify trends but also make connections between different medical concepts.
Furthermore, a recent report by Virtue Market Research suggests that autonomous medical coding can reduce up to 60% of the time spent on coding. This means that medical coders can use that freed-up valuable time to handle other critical tasks.
Key features of autonomous medical coding software
Here are the top 7 features to look for in an autonomous medical coding software that can optimize RCM, enhance coding accuracy, and improve compliance:
- Accurate coding: The main purpose of the software is to accurately convert clinical documentation into universally recognized codes. A top-notch solution should show a high level of accuracy in code assignment, with minimum errors and discrepancies.Look for AI systems armed with advanced algorithms and ML capabilities that continually improve coding through feedback mechanisms.
- Compliance with coding standards: The software that you choose to go with must stay up-to-date with the changing coding standards such as ICD-10, CPT, and HCPCS. These standards, set by the World Health Organization (WHO), the American Medical Association (AMA), and the Centers for Medicare & Medicaid Services (CMS), keep updating regularly to reflect the advances in medical knowledge.One major benefit of this feature is that it ensures that coding aligns with the latest regulations, which in turn helps you avoid penalties and claim rejections.
- Compatibility with EHR systems: When looking for the perfect autonomous medical coding software, it is crucial to go for one that integrates seamlessly with Electronic Health Record (EHR) systems. EHR integration allows patient documentation and coding data to be synchronized.Such a feature reduces the need for manual data entry and improves coding accuracy by automatically transferring relevant clinical information into the coding platform.
- Real-time accuracy checks: Effective visibility and auditability of the decision-making processes are vital for trust in any AI platform. This can be achieved with the help of transparent algorithms and timely reporting of revised decisions when data or circumstances change.With Aideo’s AI coding platform Gemini, you have full visibility and control over essential clinical information on its real-time analytics dashboard. Gemini lets you monitor coding operations proactively and make corrections quickly.
- Security and privacy: Make sure that the autonomous medical coding software vendor that you go for adheres to strict security and privacy policies to safeguard patient data. It should comply with HIPAA (Health Insurance Portability and Accountability Act), SOC2, GDPR, and ISO/IEC 27001 regulations.
- Training and support: Before making the final decision, inquire if your AI medical coding software vendor offers detailed onboarding training for healthcare providers and coding teams. This includes tutorials on understanding the interface and how to interpret the AI-generated coding suggestions. Also, responsive customer support to assist with any technical issues or queries that may arise is a must-have.
- Specialty coverage: When choosing the vendor, ensure the solution is tested and proven in the areas you need. Autonomous coding is well-established in primary care, radiology, urgent care, path/lab, etc. To make the right decision, check which specialties are covered by the vendor and ask how many similar customers they support.While most autonomous coding solutions excel in outpatient and specialty care, inpatient facility coding remains a challenge due to its complexity.
By carefully considering these features and conducting thorough evaluations, you can make an informed decision on which software aligns the best with your specific requirements. Though you don’t have to look any further for your ideal vendor…
Aideo﹘ your one-stop solution for autonomous coding
At Aideo, our mission is to leverage modern technology to reduce denials and lower healthcare costs. Our coding platform, Gemini, is a streamlined workflow tool that uses advanced AI and ML algorithms to continuously assemble, catalog, and codify certified coder expertise. Gemini analyzes patient information from EHR systems and physician notes to automatically suggest the most accurate code.
Additionally, an AAPC Evaluation and Management (E/M) Coding Calculator is embedded into the Gemini coder platform to assist in standardizing the coding of complex E/M medical claims. This integration provides Aideo’s customers access to the latest E/M codes, MDM definitions, time-based coding guidelines, shared or split services details, and more.
Healthcare organizations can leverage Aideo’s expertise to reduce denials and improve decision-making capabilities. As automation technology revolutionizes the industry, Aideo’s innovative solutions lead to a more efficient and effective healthcare system.
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