This guide helps health information management (HIM) leaders understand how autonomous medical coding technology integrates with existing workflows and addresses key challenges facing HIM and coding departments today. The following sections outline coding capabilities, workflow considerations, performance metrics, and organizational impacts.

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NAVIGATE GUIDE CONTENT

Today's HIM & Coding Challenges

Workflows with Autonomous Coding

Specialty-Specific Performance

Proven Impact on Coding Teams

Implementation Success Factors

TODAY'S HIM & CODING CHALLENGES

HIM and coding departments face unprecedented challenges in today's healthcare environment that impact both operations and staff well-being. Understanding these challenges is crucial for developing effective strategies to modernize coding workflows and improve departmental performance.

Burnout & Retention Challenges

• Administrative Burden driven by staffing challenges and increasingly complex regulatory guidelines
• High Turnover costing departments thousands in recruitment and training

Workflow Challenges

• Complex Workflows forcing coders to continuously shift their focus and adapt to different code classification systems
• Resource Management Challenges including training offshore/contracted resources and managing quality and compliance issues

WORKFLOWS WITH AUTONOMOUS CODING

Autonomous coding technology seamlessly integrates with existing healthcare systems to create more efficient and consistent coding processes. The following workflow diagram provides a simple, high-level representation of coding workflows once an autonomous coding solution has been implemented.

Comprehensive Coding Capabilities

• Intelligent Code Assignment – Automatically assigns CPT, ICD-10-CM, and Modifiers
• Comprehensive Coverage – Including Evaluation & Management codes
• Precision & Compliance – Ensuring accurate billing & reimbursement

Built for Any Setting

• • Inpatient and Outpatient Facility
  • Provider-Based Services
  • Single Path Workflow

Note: Coding scope and supported code sets may vary by autonomous medical coding vendor

SPECIALTY-SPECIFIC PERFORMANCE

Different medical specialties present unique coding challenges and opportunities for automation based on documentation patterns and case complexity. Understanding specialty-specific automation rates (the percentage of total encounters coded by the autonomous medical coding solution) helps HIM and coding leaders set realistic expectations and identify the highest-impact areas for implementation.

These rate typically increases over time as machine learning algorithms process more data. Autonomous medical coding solutions may route encounters to manual coding teams in certain cases, such as:

• Incomplete or missing documentation in patient records
• Ambiguities in physician notes
• Complex case requirements

Note: Automation metrics represent industry averages and may vary by vendor, implementation approach, and documentation quality.

PROVEN IMPACT ON HIM & CODING TEAMS

Autonomous coding solutions deliver measurable benefits that address the core challenges facing HIM and coding departments today. Real-world implementations demonstrate significant improvements in staff satisfaction, workflow efficiency, and financial performance metrics.

Address Burnout & Retention Challenges

• Eliminate mandatory overtime and paid time off (PTO) restrictions - autonomous coding reduces backlogs, enables flexible scheduling, and improves work-life balance
• Improve staff satisfaction and retention - automated routine coding creates advancement opportunities and reduces turnover-related costs

Real-World Example: After implementing Nym's autonomous medical coding engine for ED facility coding, Inova, a top health system, eliminated all overtime requirements for ED coders, removed PTO limitations, and promoted four ED coders to higher complexity areas. Read the Inova Case Study.

• Streamline coding operations - by automating the coding of routine encounters, autonomous coding solutions create consistent, predictable workflows and eliminate the need for offshore or contract coders
• Improve DNFC (Discharged Not Final Coded) metrics -  most autonomous coding solutions can code thousands of charts per hour, a huge gain in processing speed compared to traditional manual coding (anywhere from 10-40 charts per hour per coder) – this improvement in coding turnaround time significantly reduces the volume and age of encounters awaiting coding, accelerating the revenue cycle and improving cash flow
  
• Reduce coding costs - autonomous coding solutions deliver substantial cost savings through labor arbitrage, typically offering lower cost-per-claim than traditional in-house coding teams or Business Process Outsourcing (BPO) alternatives

Real-World Example: After implementing Nym's autonomous coding engine for ED facility coding, Inova eliminated their need for contract coders, reduced annual ED coding costs by $500K, and reduced the revenue sitting in weekly DNFB by 50%. Read the Inova Case Study.

Implementation success factors

• Communicate early-on that the aim of autonomous coding is the automation of routine cases to reduce backlogs and reduce administrative burdens, not coder replacement
• Involve coders in testing and validation to build trust and ownership
• Create career pathways that leverage coders' expertise for complex cases and auditing
• Share success metrics regularly to build confidence in the technology
• Curate facility-specific guidance to share with automation technologists

Questions to Ask Vendors

• What percentage of encounters can be coded autonomously for our specific specialties?
• How does the system handle edge cases and exceptions?
• What is the accuracy rate compared to expert human coders, and how does the vendor measure accuracy? (Look for 95%+ accuracy)
• How will implementation impact our existing workflows and systems?
• What training and support do you provide during and after implementation?
• How will we work together to automate our facility-specific policies and procedures?

Next Steps: Schedule a discovery call to discuss your specific coding challenges and explore how autonomous coding can transform your department.

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