Medical coding mistakes isn’t just an administrative burden anymore, they are a constant monetary drain for many healthcare organizations. With over 70,000 ICD codes to navigate and the influx of patient records, medical coders are finding it nearly impossible to manually code and process large volume of patient records. Also, healthcare organizations have begun to identify the true enterprise-wide costs associated with coding inaccuracies. Apart from delaying the revenue cycle, medical coding mistakes prevent proper reimbursement and increases administrative costs, and disrupts cash flow.

To address these issues, healthcare organizations are looking for a reliable automated medical coding software powered by Artificial Intelligence (AI).  AI has been a game changer for this pursuit helping clinicians reduce errors, enhance accuracy, and improve financial outcomes.

In this article, MediCodio’s SME, Jessica Miller, explores how automated medical coding can significantly reduce medical coding mistakes, enhance accuracy, and improve financial outcomes.

Revealing the Costs of Medical Coding Mistakes

Medical coding mistakes can have wide-ranging impacts, affecting healthcare providers in three main ways: increasing administrative burdens, causing revenue losses, and disrupting cash flow.

Administrative Burden

The administrative costs tied to medical coding mistakes are staggering. In 2022, the healthcare sector spent $82.7 billion on administrative tasks alone, according to RevCycle Intelligence. When coding errors arise, they add to these costs in several ways, including time spent on reviews, denial management, staff training, and clinician strain. Correcting medical coding mistakes requires extensive review by coders and administrative staff, and managing denials related to coding errors is another costly process. In fact, a Premier survey revealed that providers waste $10.6 billion annually fighting denials, contributing to rising administrative costs.

In addition to denial management, providers must invest in continuous training for coding teams to ensure they keep up with evolving guidelines. For clinicians, these burdens can create burnout and high turnover rates, negatively affecting the quality of patient care. The added strain from medical coding mistakes diverts focus away from patient care, leading to a decline in service quality and increased financial strain.

Lost Revenue

Medical coding mistakes are a major factor in claim denials, resulting in lost revenue. The American Medical Association found that 11% of all claims in 2022 were denied, equating to 110,000 unpaid claims for a typical health system. Undercoding, a common issue, often leads to revenue shortfalls, as providers may not fully capture the reimbursable services they perform.

For instance, if a physician conducts a thorough examination in the emergency room and manages several complex conditions, but only a low-acuity evaluation code is billed, it underrepresents the services provided. Such medical coding mistakes lead to revenue losses since the claims fail to reflect the actual services delivered.

Cash Flow Disruption

Inaccurate coding also leads to cash flow disruptions, making it harder for healthcare providers to manage their finances effectively. Frequent claim denials or resubmissions due to medical coding mistakes delay reimbursements, which strains the organization’s liquidity. Rising working capital costs due to high interest rates further compound this pressure on finance teams, impacting operational stability and cash flow. In essence, medical coding mistakes can ripple through an organization’s finances, creating significant cash flow challenges.

Boosting Accuracy Through Automated Medical Coding

The widespread financial impacts of medical coding mistakes are driving healthcare leaders to adopt advanced technologies, such as AI, to improve coding accuracy. A Bain and KLAS survey indicated that 80% of healthcare providers are either implementing or planning to adopt AI strategies, with revenue cycle management identified as a key area of focus.

Automated medical coding technology, powered by AI, offers several key benefits to address medical coding mistakes and enhance financial performance:

• Reduced Costs: AI-driven coding is more cost-effective than traditional manual coding, typically saving 30-50% per encounter. Higher accuracy minimizes time spent on complex corrections, further reducing administrative overhead.
• Improved Revenue Capture: AI ensures accurate coding for Evaluation and Management (E/M) services, capturing all billable services accurately. Autonomous coding identifies procedures that human coders might miss, leading to higher revenue units and better compensation for physicians.
• Reduced Denials: By improving accuracy and compliance, AI-driven coding reduces denials associated with medical coding mistakes, making the claims process smoother. It also provides insights into frequent denial causes, helping providers address coding issues proactively.
• Enhanced Consistency and Adaptability: AI coding applies uniform guidelines, providing consistent results and reducing the impact of medical coding mistakes. Autonomous coding systems can quickly adapt to updates in coding guidelines, maintaining compliance without the need for lengthy training periods.

A real-world example is MediCodio’s client, a renowned Ambulatory Surgery centre that leverages CODIO, an AI-powered medical coding software to boost accuracy, reduce administrative costs, and alleviate clinician burdens. Many healthcare organizations are pursuing similar initiatives across specialties to reduce the costs associated with medical coding mistakes and to establish long-term financial resilience.

Check out: How MediCodio Helped a US-based RCM Company Increase Revenue?

Reframing Coding Challenges as Opportunities for Innovation

Medical coding mistakes carry substantial costs across the board, contributing to staff administrative burdens, revenue losses, and cash flow issues. Focusing on improving coding accuracy to meet or exceed a 95% target can yield organizational-wide benefits.

With the latest generation of coding automation technologies, providers can effectively tackle the root causes of medical coding mistakes, leading to reduced costs, better revenue capture, and fewer denials. By adopting AI, healthcare providers can transform the challenges posed by coding errors into growth opportunities, ensuring a more stable financial future.

By leveraging advanced algorithms and machine learning techniques, AI systems can analyze vast amounts of medical data with remarkable accuracy, identifying patterns and discrepancies that human coders might overlook. This technology enables automated coding processes, ensuring that diagnoses and procedures are accurately matched to the appropriate codes, thus minimizing the risk of errors.

MediCodio plays a critical role in this transformation. With its AI-powered coding solution, CODIO helps healthcare organizations reduce medical coding mistakes, enhance revenue cycle efficiency, and enable sustainable financial growth. Embracing solutions like CODIO can empower billing and coding leaders to overcome coding challenges and secure a stronger financial foundation.

All in all, AI empowers coders to enhance their accuracy and productivity, leading to faster claim processing and reduced rework. Ultimately, the integration of AI in medical coding not only alleviates administrative burdens but also transforms coding practices into a more reliable and efficient system, safeguarding the financial health of healthcare organizations.

FAQs

1. What are the common causes of medical coding mistakes?

Medical coding mistakes often arise from manual errors, lack of coder expertise, or misinterpretation of clinical documentation.

2. How do medical coding mistakes affect healthcare organizations financially?

Mistakes lead to claim denials, delayed reimbursements, and potential penalties, significantly impacting an organization’s revenue cycle and financial health.

3. How can AI help prevent medical coding mistakes?

AI tools analyze clinical data with precision, ensure accurate code assignments, and flag inconsistencies, reducing the likelihood of costly errors.

4. Are there specific coding standards AI solutions adhere to?

Yes, AI systems are designed to align with coding standards like ICD-10, CPT, and HCPCS, ensuring compliance and accuracy in all coding practices.

5. Can AI completely eliminate medical coding mistakes?

While AI dramatically reduces errors, human oversight remains essential for complex cases or unique scenarios that require nuanced decision-making.