AiRo Helps Healthcare Providers Lower Medical Coding Operations Cost And Speed Up Claim Processing
Industry: Healthcare Provider
Client Overview:
The hospital is based in Minneapolis, US, and employs nearly 2,000 healthcare professionals, specializing in Cancer, Cardiac, Neurosurgery, Surgery, Electrophysiology, Orthopedics, Primary care, and urgent care.
Industry Overview:
The healthcare industry and providers use ICD10 codes with procedure codes to record diseases on health records, track epidemiological trends, help in medical reimbursement decisions, and justify why medical procedures are necessary.
Healthcare Providers hire certified coders to audit the patient chart and analyze the physician notes about the provided services to identify the accuracy of ICD-10 codes for billing. This process is entirely manual making it cost-heavy, and time-consuming.
ICD 10 coding process is complex and extremely prone to errors. This is mainly due to a lack of professional and manual coding training among medical code auditors. Moreover, the absence of standardized process compliances for auditing creates big hurdles for healthcare providers.
Manual Medical Code Auditing is a Slow and Expensive Process
Revenue cycle management is a vital part of all healthcare entities. Submitting patient claims to the insurance company and receiving payment is the primary source of income for healthcare providers. Delays and denials in the payment of these claims are a universal healthcare problem affecting the entire delivery of care process.
Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into codes for reimbursement. The diagnosis and procedure codes are extracted from medical record documentation. The codes are entered onto an insurance claim form that is subsequently sent to the insurance company.
Medical billing is the process of submitting and following up the claims with healthcare insurance companies to receive payment for services rendered. The professionals responsible for these tasks are called certified coders. These professionals are a high-cost and essential resource for healthcare providers.
Certified coders are asked to review the patient chart and analyze the physician notes about the provided services to identify the ICD-10 codes for billing. Moreover, this process is entirely manual making it time-consuming, and error-prone.
These errors occur when the coder uses incorrect ICD-10 codes, to describe the services or procedures patients receive during their treatment. This incorrect entry of diagnostic code is one of the most common reasons for delayed or denied payments in a medical claim.
Errors can also occur when the coder fails to identify all the codes that are included in the documentation. This non-submission of all the appropriate codes on the claim results in patients not receiving reimbursement because in effect the codes were not built.
AiRo Helps Healthcare Providers Boost Medical Coding Procedure With NLP-Based Bots
AiRo developed a Natural Language Processing-based Accelerator that collects medical terminologies from patient files and recommends ICD-10 diagnosis codes, as well as assisting in the quality assurance of already coded diagnoses.
This NLP-based accelerator can be used for three primary purposes:
Using Natural Language Processing (NLP) technology, providing ICD 10 code suggestions for billing based on patient chart material. The accelerator gathers clinical data and metadata from the source (usually an EMR/ EHR) and suggests ICD-10 codes for medical reimbursement using natural language processing (NLP).
Providing the percent probability (the tendency with which insurance companies would pay) of the ICD-10 code chosen is coherent with and complements the documented evidence.
Providing ICD10 code data such as code description, inclusions, ExclusionOne, and ExclusionTwo for search codes
This NLP-based application allows claims to be coded with increased accuracy and fewer errors. This unique Medical Coding Accelerator application can help healthcare providers to submit medical codes to insurance companies at a faster rate, reducing delays and denials due to incorrect coding. This can significantly help in increasing cash flow for the organization.
In such applications, an automated bot logs into the EMR and searches for the patient files. The bot is programmed to analyze the patient's chart and use a proprietary Natural Language processing (NLP) algorithm to extract and display the clinical data in a pop-up text box.
The NLP-based algorithm will recommend ICD-10 codes to the coder based on the analysis of the documentation or clinical notes associated with the visit. The clinical notes and the proposed ICD-10 codes are organized in the pop-up window so the coder can review them without having to toggle through multiple screens. At this point, the coder can review the codes and submit the data after verification.
NLP-based Bot Applications can reduce the average handling time of Coding Audits by 45%.
NLP-based robots can reduce claim denials due to coding errors by 45%. Moreover, these reductions in AHT and coding errors can enhance the cash flow of healthcare providers by 4%. With more efficient and productive Certified Coders healthcare providers can reduce the average handling time of certified coders by 35% and offer overall patient satisfaction.
The Medical Coder accelerator can help healthcare providers significantly reduce claim processing time and ICD-10 audit costs. Healthcare providers can expect the following benefits by implementing NLP-based bots in their claim processing system:
Increased Claimant Satisfaction
Lower Medical Coding operations cost
Faster Diagnostic coding
Quality check Faster time to settle Claims,
Decreased number of rejected claims
Validation of correct and complete coding
Innovation In The Medical Coding Process Across Healthcare Industry
Medical Coding is responsible for a large percentage of the operational effect, support, and overall compliance in healthcare services. Medical coding aids the healthcare industry in translating diagnoses, medical notes, and diverse healthcare services into a common language that assures the optimum end-to-end experience for patients, providers, and payers.
Thousands of medical coders across the world are responsible for conveying the clinical picture of patient health using claims data, including the severity of illness, comorbidities, and provider effort to manage treatment, among other things. While coding is a more traditional and well-established healthcare practice, it does not rule out the possibility of innovation.
Forward-thinking revenue cycle management solutions like the NLP-based Coding Audit Accelerator are necessary to ensure that medical coding is accurate, comprehensive of the quality of care being given, and guarantees proper compensation.
About AiRo
AiRo Digital Labs is an award-winning, global leader in AI and Hyper automation-led innovation for the healthcare ecosystem. We partner with Fortune 500 clients in the Healthcare, Pharma, and Life Sciences industry to address the challenge of applying AI technologies to augment and enable human effort, and to remove the inefficiencies in the care spectrum. We specialize in the emerging technology fields of Artificial Intelligence, Machine learning, Robotic process automation, Chatbots and Conversational AI, Natural Language Processing, Data Analytics, Premium Cloud Services, Industrial IoT, and other AI technologies.
Speak To Our Team Of Experts
Talk to us about how we can help healthcare providers lower medical coding operations cost and speed up claim processing
The AiRo Perspective
AiRo developed a Natural Language Processing-based Accelerator that collects medical terminologies from patient files and recommends ICD-10 diagnosis codes, as well as assisting in the quality assurance of already coded diagnoses.
