Medical Coding Automation: An Introduction For Administrators

Medical Coding Automation: An Introduction For Administrators

If you operate a medical practice, you may already use some form of medical coding automation. Your Electronic Medical Record (EMR) or Practice Management (PM) software may generate claim forms, complete with rudimentary auto-coding.

But every one of those forms requires human review, which limits the time savings that comes with more robust automation.

Besides, EMR and PM systems can’t guarantee that you’re billing for everything you’re owed—or ensure that payments from Medicare, Medicaid, or private insurers arrive in a timely manner.

To achieve all these goals and more, you need to fully automate your revenue cycle using Robotic Process Automation (RPA), enhanced with Artificial Intelligence (AI) and managed through a digital Business Process Management (BPM) system.

If that all sounds too complicated to you, you are not alone. Fortunately, the team at Nividous has a ton of great experience building automated revenue cycle management solutions just like this.

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Nividous’ AI-enhanced RPA bots use Natural Language Processing (NLP) to translate the provider’s notes into codes. Then, they create claim submission documents based on those codes, all without human intervention.

These steps can be performed in conjunction with your existing EMR, PM, or billing systems, if desired. The bots can even log into insurance portals, file claims, and reconcile those claims. All of that starts with quick, accurate coding—and medical coding automation is quickly becoming a necessity for growth.

Why Medical Coding Automation Is Becoming Essential

The U.S. medical coding system includes more than 70,000 discrete codes—ideally, one for every possible diagnosis, treatment, and supply. As medicine advances, these codes change, and even an experienced medical coder is bound to make a few mistakes. Those mistakes can add up to significant underbilling, as well as cash flow delays lasting weeks or longer.

In other words, accuracy in coding is essential for medical practices. Medical coding automation provides this accuracy—but with an intelligent automation platform like Nividous, accuracy is just one of the benefits. Nividous AI for medical coding—and more—can automate the entire medical revenue cycle, including:

  • Insurance verification and pre-authorization
  • Identifying and recording the correct codes
  • Submitting claims through insurer web portals
  • Reconciling claims
  • Resolving insurer disputes for faster payment

From the point of patient engagement to the instant the payor’s check hits your bank account, the Nividous platform provides full user control and visibility.

This end-to-end process automation regularly reduces manual work by 80%—and even more in some instances, one of which we’ll describe shortly. Just as valuable, Nividous’ medical coding automation tools speed up cash flow considerably, cutting time-to-cash in half.

Will medical coding become automated in every instance?

No. Human decision-makers remain necessary for revenue cycle management in the healthcare industry.

The goal is to automate rote, rule-based tasks while allowing medical coders to work on exceptional cases—and then use those cases as training data to make the automation bots smarter.

That’s why the Nividous platform includes an adjustable Confidence Score for every automated task.

If you set the Confidence Score at 80%, the system will trigger a notification for human review anytime the AI determines that the chance it’s not making the right call exceeds your risk tolerance, as set by the Confidence Score.

When experienced medical coders have the time to pursue solutions to their toughest challenges, they can use their innovations as new training data for bot models.

This use of machine learning creates a continual feedback loop; automation that never stops improving, working in conjunction with human experts who never stop innovating.

Competition is fierce, and companies that automate have a significant advantage.

While medical coding automation is a major driver of practice profitability and cash flow, it’s not here to replace human employees.

It is here to help them work more efficiently, carving out more time to focus on the complex decisions that require human wisdom (see sidebar).

To illustrate, here’s an example of the power of intelligent automation for medical coding and broader revenue cycle management for practitioners.

Medical Coding Automation With Nividous: A Real-World Success Story

Kane Wound Care is a medical specialist group that brings wound care services to more than 1,500 patients across three states every week.

The company’s management spotted the hazards of coding errors, including delayed payments and even undercollection. Their goals were to achieve 100% accuracy and improved speed on all billing and coding tasks.

Nividous RPA bots with AI capabilities helped Kane Wound Care reach these goals—and more. The bots analyzed patient documentation, identified correct billing codes, and added those codes to invoices.

As a further step toward hyperautomation—sophisticated process automation that incorporates AI decision-making and human/bot workflow orchestration—the Nividous platform also allowed Kane Wound Care to file patient reports into customer EMR systems within 24 hours of service.

Altogether, this example of medical coding automation, and the broader process automation to which it led, provided powerful measurable benefits: a 95% reduction in manual work, a 90% improvement in coding accuracy, and process turnaround time that’s 85% faster.

Interested in attaining similar benefits for your medical office? Contact us to discuss medical coding automation today.

On Demand Webinar Kane Wound Care Automates Medical Coding with Nividous’ AI-Powered Bots

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