Author: hmicorp

Artificial intelligence has solved countless human challenges – and medical coding might be next.
As organizations prepare for ICD-11, medical coding is about to become more complicated. Healthcare organizations in the United States already manage 140,000+ codes in ICD-10. With ICD-11, that number will rise.
Some propose artificial intelligence as a solution. AI could aid computer-based medical coding systems, identifying errors, enhancing patient care, and optimizing revenue cycles, among other benefits.
Today, we’re highlighting some of the ways in which artificial intelligence could change medical coding in the future.

How Artificial Intelligence Could Smooth the Launch of ICD-11

It’s impossible for humans to memorize the 140,000+ codes in ICD-10. With ICD-11, we’ll see more codes, making things even more complicated.
The coding of medical diagnosis and treatment has never been easy. In fact, it’s one area where many organizations struggle. Poor coding can lead to missed revenue opportunities. It can impact patient safety, increase insurance denials, and harm reputation.
Could artificial intelligence solve these problems? According to a report from Forbes, medical coding with artificial intelligence is closer than you think – and AI is already solving medical coding challenges for organizations around the world.

First, it helps to understand what ICD-11 is and why it’s important.
International medical organizations currently use the ICD-10 medical coding standard. It’s the tenth version of the International Classification of Disease codes. ICD-10 was created by the World Health Organization (WHO) and has 10,000+ codes available for diagnosis and treatment.
The next version of ICD has already been approved for implementation. WHO member states voted to implement ICD-11 in May 2019, and implementation will begin in WHO member states – including the United States – in January 2022.
ICD-11 is a significant change from ICD-10. It contains four times more diagnostic codes: instead of the 10,000+ codes in ICD-10, healthcare organizations will have 55,000 diagnostic codes from which to choose.
In America, medical coding is even more complicated. There is an enhanced version of ICD-10 specific to the United States. This version has over 140,000 classification codes, including roughly 70,000 codes for diagnosis and 70,000 codes for treatment. It’s possible the American version of ICD-11 could have several times that number.

Could Artificial Intelligence Help?

It’s already impossible for a human being to memorize the 140,000 codes in America’s ICD-10 medical coding system. In fact, it’s impossible for someone to memorize the 10,000 codes in the international version of ICD-10.
That’s why medical coders rely on code books. They thumb through a book or scan a database of codes to find the most appropriate code for the services performed.
Complicating things further is the fact that the same medical service can qualify for multiple codes. Depending on interpretation, there may be multiple ways to code a service.
Some suggest using artificial intelligence to help. As AI becomes smarter and more powerful, many healthcare organizations are turning to artificial intelligence.
Over the past 20 years, healthcare organizations have increasingly adopted computer-assisted coding systems. These systems recommend codes and identify coding errors.
By enhancing these systems with artificial intelligence, organizations can optimize revenue cycle management, avoid coding errors, and enhance patient care.
Artificial intelligence could:
• Identify inconsistent code usage within an organization
• Spot coding errors
• Identify the use of a rare or unique code
• Automatically recommend codes based on the services performed
• Provide actionable data on code usage, patient activity, and medical services performed
• Track codes within a patient’s history to avoid manual code entry with every visit
Overall, artificial intelligence could perform a role similar to contract medical coding specialists, helping healthcare organizations identify missed opportunities.

How Contract Medical Coding Specialists Help

Artificial intelligence will aid medical coding in the future. Today, however, healthcare organizations rely on medical coding specialists to help.
Contract medical coding specialists can implement better systems for inpatient, outpatient, same-day surgeries, ancillary departments, and physician E/M.
Unfortunately, not all medical coding services are alike. Some medical coding specialists have just a few months of training. Others have years or decades of experience.
By hiring the right medical coding specialist, healthcare organizations can optimize revenue cycle management, avoid coding issues, and enhance patient care.

Final Word: Hire a Medical Contract Coding Specialist Today

Like it or not, medical coding is becoming increasingly complex. With the launch of ICD-11, things could become more complex in the near future.
To help your organization prepare for future medical coding challenges, contact our medical coding specialists at HMI, LLC today. With decades of experience optimizing medical coding, HMI, LLC helps healthcare organizations capture missed revenue opportunities and avoid coding errors.

When some think of revenue cycle management, they think of larger healthcare organizations with complex needs. But healthcare organizations of any size can benefit from revenue cycle assessments.
Yes, smaller hospitals can benefit from revenue cycle assessments and healthcare consulting. In fact, these assessments could have a greater proportional impact on smaller, rural hospitals.
Rural hospitals need the help. In 2016, 41% of rural hospitals in the United States operated with negative margins. As populations age, this problem is getting worse – not better.
Today, we’re highlighting some of the ways that small, rural hospitals can benefit from a revenue cycle assessment.

Understand the Unique Challenges Facing Smaller, Rural Hospitals

The first and most important step is to understand the unique challenges smaller hospitals face. Smaller, rural hospitals face challenges that don’t exist with larger hospitals in big cities:
• 20% of the US population lives in rural regions, yet only 10% of physicians practice in rural regions, leading to a consistent physician shortage for smaller, rural hospitals
• Nearly half of all rural hospitals in the United States operate with negative margins
• Rural hospitals deal with different, more challenging patient demographics than larger hospitals in metro areas; rural areas tend to have older populations and higher rates of unemployment, creating problems for smaller hospitals seeking to optimize revenue cycles
• Hospitals in rural areas deal with more challenging patients than hospitals in urban areas; there are more patients over 65, higher rates of childhood poverty and premature death, and increased childhood mortality rates, among many other issues
Smaller, rural hospitals cannot change these factors: they’re inescapable parts of rural life in many parts of the United States. Instead of complaining about these challenges, good rural hospitals have learned to surmount these challenges by optimizing revenue cycles.

Get Creative When Attracting Physicians

Smaller, rural hospitals may already be operating with negative margins, making it harder for them to attract physicians. Typically, organizations that struggle to attract physicians can increase pay or other benefits. With smaller, rural hospitals, that may not be an option.
Instead, organizations seek other solutions.
Many rural hospitals implement team-based care models that depend on advanced practice clinicians, for example.
One 2016 study by the American Academy of Physicians Assistants found hospitals that used a higher physician assistant-to-physician ratio reduced care costs more than other teams in the same hospital using a traditional staffing model. These care teams had 3.5% lower costs, for example.
A separate study found that team-based care improved overall organization productivity. A recent MGMA survey, for example, found that implementing physician assistants into patient care led to a 34% boost in productivity compared to similar organizations.
While physicians may be the cornerstone of patient care, many rural hospitals are achieving success by switching to a team-based care model.

Get the Best ROI from Health IT Investments

Rural hospitals also face challenges on the IT side. While larger hospitals have the resources for full-featured IT departments, smaller hospitals do not. This can create technology headaches for patients and staff. It could impact patient data and organizational security.
A 2016 MGMA report found that a typical health IT implementation costs up to $32,500 per physician. That’s a 40% increase in costs over the last five years. That’s a challenging cost for rural hospitals to cover.
Some rural hospitals take a different approach, using paper-based systems even in 2020 andbeyond. These clunky systems reduce productivity and reduce patient security, among countless other downsides.
Thanks to technology, there’s a viable alternative: cloud-based systems. Cloud-based health IT systems allow rural hospitals to access the power of a full IT department without hiring a full IT department. They can use cloud-based health IT systems to boost productivity and enhance patient care – all at a comparable cost to what their larger, more metropolitan competitors are paying.
A good healthcare consultant can analyze organizational needs, then recommend and implement the best health IT system.

Reduce Uncompensated Care

Rural areas tend to have higher poverty rates than suburban areas. They also tend to have more adults 65 and older. That means more Medicaid and Medicare claims for rural healthcare providers.
Uncompensated care continues to be an issue for rural healthcare providers. One study found that 6% of rural hospital budgets go towards uncompensated ‘charity’ care, while urban hospitals pay just 5.1% towards uncompensated care. It’s a disproportionate burden for rural hospitals to bear.
Patients are expected to cover the cost of care out of pocket. However, patients in rural areas tend to have higher rates of poverty and unemployment. Even when patients owe money to the healthcare provider, the provider may never get it. Hospitals may setup extended payment plans, only to leave themselves with bad debt.
Healthcare consultants can implement payment systems that enhance a patient’s likelihood to pay, making it easier for rural hospitals to capture lost revenue. Many rural hospitals have achieved success with value-based reimbursement, for example.

Other Revenue Cycle Management Tips for Rural Hospitals

Rural hospitals seeking to compete with larger competitors should implement the following strategies, according to the National Rural Health Resource Center:
• Expand primary care services and hours
• Build a larger primary care network by aligning primary care physicians with other providers, fostering relationships between departments and staff, and creating affiliations with neighboring healthcare organizations, among other partnership opportunities
• Boost market care quality and patient satisfaction scores to get a competitive edge
• Invest in facilities and health IT
• Maximize fee-for-service revenue by building on existing services and customer loyalty (like marketing services to local providers for referrals).

Final Word

Rural hospitals face many unique revenue cycle management challenges. Unfortunately, much of the revenue cycle optimization guidance published today is catered towards larger organizations – not smaller providers.
Fortunately, a healthcare consultant can help. A good healthcare consulting team can analyze an organization’s needs, then recommend actionable solutions.
Even small changes are magnified at rural hospitals. That means minor improvements can lead to proportionally significant results. Optimizing a single medical coding system can have noticeable impacts on the bottom line.
For all of these reasons and more, consider hiring a revenue cycle management consultant for your smaller, rural hospital. Contact HMI, LLC today to get started.

Our consultant specialists will review and cdm audit single department or new service cdm line items for accuracy of the CPT©/HCPCS, UB revenue code, and modifier assignment for compliance with federal and MAC/FI rules and regulations, price comparison vs. allowable reimbursement levels, and review descriptions for meeting hospital’s internal standards. Line items will be noted for addition, modification, deletion, and/or allowable reimbursement levels. HMI perform new service/single department cdm review and Chargemaster Review Update. We can check your line items for accuracy and get your company the total reimbursement due in Nashville.

Our Comprehensive Charge Description Master CDM Review update includes analysis of inpatient and outpatient charges and all clinic charges maintained in the CDM and impacted by CMS PPS. HMI will review all CDM line items for accuracy of the CPT^®/HCPCS, UB revenue code, and modifier assignment for compliance with federal and MAC/FI rules and regulations, price comparison vs allowable reimbursement levels and descriptions for meeting hospital’s internal standards. HMI will identify all line items for addition, modification, and deactivation, as well as price comparison vs. allowable reimbursement levels. Concurrently, we will provide a coding and billing helpline by phone, fax, or email for the term of the contract. With HMI’s leading Hospital Chargemaster Review , Compliance Review and Audit Services and strategic pricing solutions, you can optimize charges and model the net revenue impact to maintain the bottom line.

Our medical coding auditor specialists will validate the CPT©/HCPCS and ICD-10-CM diagnosis coding assignment for outpatient services. The medical record documentation is reviewed against the hospital final billed claim to confirm reporting accuracy. The audit will include an assessment of documentation quality for supporting medical necessity. Supporting medical record documentation including the physician order, physician progress notes, results for diagnostic tests/studies, and/or procedural documentation is reviewed for completeness. HMI is the best Medical Coding Auditing Companies and Medical Coding Services Companies, Performs Outpatient Medical Coding Reviews and Medical Coding Audit Services. Medical Coding Auditor Performs the Auditing for Clinical, Physician, Inpatient and Outpatient.

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Our medical coding reviews specialists will validate the ICD-10-CM code sequencing of the principal diagnosis and the secondary diagnoses and ICD-10-PCS codes  for the assignment of the MS-DRG. A thorough review of the medical record documentation against the hospital final billed claim will confirm reporting accuracy. This reviews also addresses validating the coder assigned present on admission (POA) indicators and discharge status (disposition). HMI Performs Clinical Medical Coding Reviews, Physician Coding Reviews, Outpatient and Inpatient Medical Coding Reviews, Inpatient Medical Coder Companies and  Medical Coding Services Companies.

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