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By Kacie Geretz, Director of Growth Enablement
January 22, 2026
The original version of this blog appears on Libman Education’s website here and was published on January 21, 2026.
You've decided to explore autonomous medical coding. Great! Now what?
Most guidance jumps straight to comparing vendor features, but organizations that truly want a successful implementation start somewhere else: understanding their own operations first.
In our previous article (“Cutting Through AI Vendor Hype: Understanding the 3 Tiers of Medical Coding Automation” LINK: https://libmaneducation.com/cutting-through-ai-vendor-hype-understanding-the-3-tiers-of-medical-coding-automation/), we walked through the spectrum of options from computer-assisted coding to autonomous coding. Now let's figure out where your organization stands and what you're actually trying to solve.
Before looking externally at any vendor, look internally at your own teams and the challenges your organization is facing. What areas are driving costs? Where are denial rates high? Where do you suspect you're missing revenue? Is there a merger on the horizon or a new service line opening? Is your outsourced vendor delivering the coding quality you require?
Getting clear on these questions helps you identify your primary driver: cost, quality, or innovation. That driver shapes everything that follows. Different drivers lead to different evaluation criteria and different vendor questions.
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What is the Challenge the Organization is Facing? |
Primary Driver |
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High costs from contracted coders, current staffing models, or outsourcing |
Cost |
|
High denial rates due to 1) overly aggressive denials by payers that require extensive and costly resources to respond, and/or 2) potential internal coding accuracy concerns |
Quality |
|
Preparing for a merger or opening a new service line, office, or hospital |
Cost and Quality |
|
E&M calculators in the Electronic Medical Record requiring maintenance, causing under-coding or over-coding when not mapped correctly |
Quality |
|
Lack of skilled coding or revenue integrity staff to review all exception encounters |
Quality and Cost |
|
Outpatient surgeries where professional fee CPT codes and facility CPT codes differ, leading to denials |
Quality |
|
Overlapping charge and coding functions across multiple staff positions (FTEs) that a single automation engine could perform |
Cost |
|
Outsourced vendor delivering inconsistent quality requiring continuous monitoring |
Quality |
|
Leadership pushing for AI technology adoption with demonstrable return on investment (ROI) |
Innovation |
Your driver shapes which questions matter most during vendor conversations. Here's where to focus your attention.
Understand coverage and automation rate. Ask how the vendor defines their coverage or automation rate, and whether they expect it to increase over time. This matters for workforce modeling, ROI projections, and figuring out how much coding volume you can reallocate from current staff or vendors.
Pay attention to red flags here. If a vendor claims they can cover 100% of encounters, they likely have humans working in the background. It's not a pure technology solution. Even rates in the 80-90% range for certain encounter types should prompt questions about accuracy.
Clarify pricing and ROI. Understand the hard ROI (FTE cost savings) versus the soft ROI (denial reduction, revenue uplift). Most vendors at this point are competitive and less expensive than human coders or outsourcing, but you need the specifics for your own analysis.
Ask about guideline maintenance. Who keeps the engine current with CMS, AMA, NCCI edits, and AHA Coding Clinics? What about state-level rules? This is a compliance must-know, but it also tells you who bears the ongoing maintenance burden: the vendor or your team.
Understand their onboarding philosophy. Does the vendor have a standard coding approach, or do they configure their system to your organization's coding philosophy and standards (SOPs)? Medical coding in U.S. healthcare has a lot of gray areas. It's important to know upfront whether you're expected to adapt to the engine or the engine adapts to you.
Clarify error handling. How are errors found and fixed? What safeguards are in place, and who owns them: the vendor, your organization, or is it shared?
Don't forget charge routing. HIM and Revenue Integrity have become so intertwined that it's hard to talk about coding without charging. Ask how the engine handles charges and whether Charge Description Master (CDM) mapping is part of implementation.
Assess workflow integration. Will this solution disrupt your coders and charge analysts, or does it fit into existing workflows? No organization can afford for its coding and charging productivity rates to go down. You're always looking for efficiencies, not new friction.
Review their innovation roadmap. What improvements are on the vendor's short-term and long-term roadmap? Does it align with where your organization needs to go? If not, could you strategically shift resources to bridge the gap?
Ask about reporting and dashboards. If leadership is pushing for this innovation, they're going to want to see how it's working once it's implemented. Understanding how the vendor helps you display Key Performance Indicators (KPIs) is vital to the partnership and to your ability to demonstrate success internally.
Operational clarity isn't about creating a 50-page internal report. It's about walking into vendor conversations knowing what you're trying to solve and which questions actually matter for the challenges your organization is facing.
Keep in mind that autonomous coding evaluation isn't an HIM-only project. It's an IT project with Revenue Cycle oversight, Revenue Integrity impact, and implications across both facility and professional sides of the organization. Understanding who needs to be at the table, what value they bring to the analysis, and what will help them feel confident, sets you up for smoother conversations down the line.
With this foundation in place, you're ready to evaluate vendors more effectively.
In our next article, we'll focus on the people side: how to engage your coders, address concerns, and build the cross-functional support that a project like this requires.
Kacie Geretz, RHIA, CPMA, CPC, CCA is the Director of Growth Enablement at Nym, where she aligns Nym’s product roadmap with the evolving needs of health system partners and serves as the externally-facing expert on Nym’s autonomous medical coding engine. A graduate of The Ohio State University’s Health Information Management program, Kacie brings deep expertise across the revenue cycle—having led revenue integrity programs, built managed care contracting and credentialing infrastructure, and driven denials and A/R process improvement initiatives. She is passionate about advancing healthcare automation and regularly shares insights on coding innovation and RCM transformation.
