Key Takeaway: Ensuring compliance in revenue cycle management (RCM) requires transparency in medical coding rationale, but current processes often lack this clarity. Nym's autonomous coding solution addresses this challenge by providing transparent, traceable audit trails for every code it assigns. These audit trails include supporting documentation, industry guideline references, and other components that make it easier for healthcare organizations to facilitate audits, refute denials, and ensure continuous compliance.
When RCM teams rely on medical coders to manually code patient encounters, it can be a challenge to quickly get insight into the coding rationale behind a claim. As a result, compliance processes such as appeals facilitation or denials management can end up being an extremely time-consuming, resource-intensive process.
Consider that your organization is conducting an internal audit of a large volume of claims. In an ideal world, you’d be able to show each patient chart to whoever originally coded the encounter, and that person would explain the rationale applied.
In reality, however, coders process hundreds of new charts a month. It’s highly unlikely that any coder will quickly and accurately recall the coding rationale for a single patient chart after a significant amount of time passes. In practice, most coders would need to review each and every coded chart, as though they are coding the chart for the first time. Without such due diligence, a coder cannot accurately provide the required rationale, which could put the quality of the internal audit at risk.
The challenge is similar when it comes to refuting a denial. Coders will often need to look back at the full patient encounter associated with the denied claim before providing any type of coding rationale.
At the end of the day, when relying on manual coding processes, there is no easy, quick way to access the rationale behind a code assignment. That said, the medical coding industry is changing by the day. With Nym’s autonomous medical coding solution, healthcare organizations now have access to in-depth audit trails that provide the rationale behind every coding decision and thereby drive better efficiency across countless different compliance processes.
At Nym, we’ve taken an innovative approach to autonomous coding. While other autonomous coding solutions rely largely on machine learning to automatically code charts, Nym’s engine leverages both AI and a rules-based approach to ensure that all codes assigned by our engine are accurate and compliant.
At a high level, Nym uses linguistics, multiple subfields of AI (such as machine learning and natural language processing), and a robust medical ontology to translate unstructured information in medical records into structured clinical narratives.
As soon as Nym generates a structured clinical narrative, the rules-based component of our engine assigns medical codes to the patient encounter, taking into account the most up-to-date coding and documentation guidelines. It is this rules-based component that really enables Nym’s engine to produce such in-depth, transparent audit trails to explain the rationale for every code assigned.
The term “audit trail” is somewhat new in medical coding and may have a different definition depending on the autonomous coding vendor you’re working with. At Nym, we’ve developed audit trails that go beyond providing a quick sentence describing the coding rationale.
Components of Nym’s audit trail:
Supporting documentation from the patient encounter, provided side-by-side with every diagnosis code assigned
Links to the specific guidelines referenced by the engine to provide transparency into coding decisions
Justification for every Evaluation and Management (E/M) level assigned
Audit trail provided for both professional fee (profee) and facility coding results (i.e. single-path coded charts)
By including each of these components, Nym’s audit trails create a truly comprehensive, actionable source that RCM staff can turn to in the event of an audit, denial, or other matters related to compliance.
Nym’s audit trails have helped our customers significantly improve audit facilitation and denials management, and have even helped certain customers enhance their coding and documentation education. Healthcare organizations that use the Nym engine can simply access the associated audit trail in a few clicks. This ease of access, combined with the level of detail and evidence provided for every coding decision, has removed the resource-intensive compliance process associated with manual coding and is bringing greater efficiency to audit facilitation, denials management, and other compliance-related activities for Nym customers across the country.
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