Automation in Revenue Cycle Management: Healthcare Providers Share Their Experiences with Autonomous Medical Coding

By Or Peles, Chief Executive Officer and Julien Dubuis, Chief Commercial Officer

If you said the term “autonomous medical coding” to a healthcare provider or revenue cycle professional as recently as two years ago, it’s likely that you’d be met with a blank stare, skepticism, or a combination of the two. Today, both the term and the solution itself are gaining widespread adoption across hospitals, health systems, physician groups, and many other healthcare settings in the U.S. The technology, which leverages artificial intelligence to assign medical codes to patient records with no human intervention, has moved past the proof-of-concept stage. Today, we can confidently say that over 15 percent of the top 100 health systems in the country are leveraging autonomous medical coding to accelerate payment cycles, increase revenue, and help alleviate the pressures caused by staffing shortages. Click here to learn more about the evolution of medical coding and the key differences between autonomous coding and CAC.

With this in mind, KLAS Research, a leading healthcare IT data and insights company at the forefront of the revenue cycle management (RCM) market, organized its first-ever KLAS Revenue Cycle Summit. This year’s summit was focused on autonomous coding, bringing together both vendors and representatives from leading healthcare organizations for two days of insightful presentations, breakout sessions, and panels.

As a leading autonomous coding vendor, we at Nym wanted to share some key themes that we heard from providers regarding the current state of autonomous coding, best practices, obstacles, and future areas of opportunity. We would also like to thank KLAS for organizing such an impactful event - please stay tuned for KLAS’s own summary brief of the event in the coming weeks.

Click here to view KLAS’s Emerging Solutions Spotlight on Nym’s Medical Coding Engine

Key Themes from KLAS Research's Revenue Cycle Summit

Healthcare providers need autonomous coding

There are many reasons that autonomous coding has gained significant traction from healthcare providers. Staffing shortages, thin operating margins, and lengthy turnaround times continue to plague revenue cycle leaders, putting their organizations at risk of backlogs, lost revenue, compliance issues, and other serious issues.

This has providers looking for a solution that can provide high coding quality and speed with as little human intervention as possible, and autonomous medical coding aims to provide those exact benefits. While there are differences between vendors in terms of the quality, speed, and level of human intervention required by their autonomous coding solution, the overall goal is to provide a  solution that requires no human validation before charts are sent to billing and which accurately codes charts in a matter of seconds. Click here to learn about the value that Nym’s engine delivers to leading healthcare providers

Success depends on clear business goals and level-setting expectations

One of the challenges when implementing a new technology solution in healthcare is that business goals and expectations are not always crystal clear. At the summit, both KLAS and the healthcare providers in attendance stressed the importance of having providers clearly define the goals they want to achieve with autonomous coding. A key recommendation was to “define the hard benefits; be careful with soft metrics,” or in other words, don’t leave wiggle room in terms of the return on investment (ROI) that you expect from your autonomous coding vendor. Not only will this help your vendor understand your priorities, but it will also force your internal team to align with one another and be strategic in your autonomous coding journey.

For vendors, it was emphasized they must be transparent about the capabilities of their autonomous coding solutions and level-set expectations for providers from the get-go. “Capabilities” may refer to things like coding quality and coverage (the percentage of charts autonomously coded by the solution), to provide a few examples. Too often, software vendors make “pie-in-the-sky” claims about what their solution can do without being able to back it up after go-live (remember computer-assisted coding, anyone?). By requiring autonomous coding vendors to be up-front with the value that providers can expect from their solution (and when that value should be expected), providers can make better-informed decisions when it comes to setting their goals and timelines around autonomous coding adoption.

Find an autonomous coding vendor that is willing to grow with you and understands your specific needs

The third theme focuses on how important it is for providers to select an autonomous coding vendor whom they are willing to grow and expand with over time. Because autonomous coding is not available for all specialties currently, providers often partner with a vendor for one or a few specific areas, emergency medicine and radiology for example, with the intention of progressing into additional specialties in the future. 

There are many benefits to this approach. Providers talked about this type of partnership from a data standpoint, commenting that “once a vendor has your data, it is much easier to grow with them versus finding a [new] vendor for each use case.” This should come as no surprise, as data exchange in healthcare can be a complex process requiring many resources to ensure the safety and security of patient information.

Providers also stressed the importance of having a vendor that “understands your coding ‘philosophy’.” As we know at Nym, every health system, hospital, or physician group has a unique set of standard operating procedures (SOPs) and guidelines related to medical coding. It is imperative that vendors develop a detailed, comprehensive understanding of the provider’s specific coding “philosophy” from the get-go so that the autonomous coding solution produces the coding quality and output expected by the provider. Having a vendor that truly understands your coding SOPs and guidelines may also help accelerate progression into additional specialties down the line.

Putting these themes into context with Nym’s medical coding engine

Many of the themes we heard at the summit are things that our team thinks about every day as we work to ensure that Nym’s medical coding engine delivers the best value to our customers.

In terms of level-setting expectations, we pride ourselves on being transparent about the value that our engine delivers. This involves aligning on timelines related to coverage, coding accuracy, and other key metrics that drive value for our customers. We also understand the importance of transparency around implementation, which is why we provide a detailed breakdown of the implementation process with Nym’s engine for any prospective customers.

The theme of providers and vendors growing together is close to our hearts here at Nym. Many of our current customers began automating coding with Nym for one specific specialty, but have since expanded into additional areas as they see the increased efficiency and cost-savings that our medical coding engine delivers. When it comes to our customer’s coding “philosophy,” not only do we take the time to fully understand their unique coding SOPs and guidelines, but we go a step further and configure our medical coding engine for each specific customer. We are also able to quickly reconfigure the engine in the event that customers make any updates or changes to their internal guidelines, providing the flexibility that many providers require.

However, you don’t need to take it from us. Check out Nym’s Emerging Solutions Spotlight, published by KLAS Research, to hear directly from executives at leading health systems about the benefits of automating medical coding with Nym, best practices to ensure success with Nym's engine, and other key insights.

Again, thank you to KLAS Research for organizing such an insightful event and to all the providers and vendors in attendance for their thoughtful contributions to all things autonomous medical coding.

Interested in learning more about autonomous medical coding with Nym? Check out these helpful resources!

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