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AI-driven coding can streamline processes, providing patients with an improved experience and allowing physicians to optimally capture revenue.

Many industries find that their use of artificial intelligence (AI) is growing at lightning speed, and the healthcare industry is part of that trend. AI might be the answer to combating a dearth in coding employees, chart backlogs, and regulation alterations that often result in denied claims and subsequent loss of revenue. According to Austin Ward, head of Growth at autonomous medical coding company Fathom, the medical coding process is adversely effected largely by a deeply ingrained issue of fixed mindset within the healthcare community. In other words, physicians are simply accepting the way things operate without exploring any alternatives. Ward suggests that, rather than accepting the burden of coding as a necessary evil, physicians should employ AI to transform coding into a more streamlined process. Automated coding will ultimately provide physicians and administrators with a significant number of recaptured work hours, allowing them to focus on more high-priority items.

Ward suggests many ways in which employing AI for coding helps to capture reimbursement. For example, AI catches many inadvertent physician or administrator-induced errors, often caused by overburdened work schedules. Coding automation points out documentation errors early in the process and allows for correction at a timely point. With the help of AI, fewer missed procedures, inaccurate test readings, and wrong Evaluation and Management (E&M) code levels will occur.

Employing AI for coding can also alleviate workforce shortage dilemmas. According to the American Medical Association (AMA), there is an ongoing shortage of coders in the U.S., which raises costs and ends up diminishing revenue. It also puts a significant burden on coding staff, potentially leading to more mistakes and chart backlogs. Ward notes that AI helps to generally boost accuracy by thoroughly pointing out correct procedures, most fitting treatments, and best-suited codes. What’s more, AI has the ability to identify nuances in a patient’s condition by delving into clinical narratives, thereby achieving coding accuracy that humans might find challenging to nail down.

Another benefit of AI is that it allows real-time feedback through hybrid coding models, which offer a blended model wherein AI gives human coders real-time feedback on their work, allowing them to amend wrong information right away. Ward notes that hybrid coding models can also help offer advice to physicians, like the need to write a more thorough narrative or to provide unaccounted for information. Employing AI for coding also allows for cross-referencing codes with patients’ electronic health records (EHRs), thereby analyzing the accuracy of an assigned code. Ward adds that physicians can then fix any coding errors that come to light, ensuring appropriate reimbursement. Many guidelines have been altered in 2024, and AI offers protection against typical 2023 E&M errors by immediately acknowledging changes, thus ensuring appropriate reimbursement for physicians.

According to Ward, automated coding’s benefits extend even beyond ensuring appropriate reimbursement in that it improves patient care. By alleviating administrative burdens for physicians, AI coding allows them to devote more time to patient care, while simultaneously lessening the chance of a patient receiving care from an over-tired, over-stressed doctor. This is of paramount importance, as a Journal of the American Medical Informatics Association article found that burned out physicians put patients at an increased risk for having to endure unneeded tests or medical errors. In turn, Ward adds that overall patient experiences improve when physicians use automated coding, with additional benefits like quicker bill processing, which provides patients with the luxury of being able to better budget for healthcare expenses. Bottom line, automated coding provides patients with an improved experience and allows physicians to optimally capture revenue.