1. Introduction: The Challenge Faced by the RCM Company

The US-based Revenue Cycle Management company primarily provides medical billing, coding, and other services to various healthcare facilities such as Home Health, Hospice, and Physicians.

One of the major challenges that the company faced was the increasing backlog of medical cases and the complexity of medical coding, particularly given the diverse specialties within the healthcare industry. This complexity made it difficult to maintain both accuracy and productivity in medical coding.

Managing a high volume of medical records and claims efficiently, without compromising accuracy, had become a significant hurdle for the company. In their efforts to identify and address revenue leakage, the team discovered that inaccurate or incomplete coding often resulted in denied claims, delayed reimbursements, and ultimately, lost revenue.

To ensure coding accuracy and maximize revenue, the company sought a reliable, feature-rich, AI-powered medical coding tool. During their search for a dynamic automated medical coding solution, the team was introduced to MediCodio.

Established in 2021, MediCodio specializes in delivering AI medical coding tools for healthcare and RCM companies across the globe.

2. CODIO’s Intelligent Code Suggestions: Enhancing Accuracy and Compliance

CODIO is an advanced medical coding tool powered by AI/ML and RPA. Unlike other code reference tools that are complicated for medical coders to navigate, CODIO is designed keeping user simplicity in mind.

With the help of RPA/API technologies, CODIO analyzes the patient chart from the electronic health records, reviews all the treatments and medical services of the patient, and suggests relevant codes to the medical coders. Once the coder reviews the codes and verifies them, the report is sent to the billing system.

This automation process saves a significant amount of time for medical coders allowing them to process more patient charts.

For the US-based RCM company, CODIO acts as a revenue-generating engine. It not only improves coder productivity but also reduces the chances of errors.

Previously, the RCM company’s medical coder was spending a lot of time to review and assign codes as they had to manually do the research. But, with CODIO, the medical coder has to simply review the code suggested by the AI engine. The patient data is automatically retrieved by CODIO from the EHR system, and the illness and medical services provided to the patient is analyzed, and appropriate medical codes are suggested.

3. Seamless Integration with EHR Systems: Streamlining Data Management

By Deploying CODIO, the US-based revenue cycle management company is able to eliminate the inconsistencies that arise from interpreting Electronic Health Record (EHR) data.

CODIO reads data from all types of Electronic Health Records (EHR) systems facilitating a more streamlined and efficient data management process. It uses OCR to read patient charts from PDFs. The user-friendly interface of the CODIO app has allowed medical coders to navigate to different screens quickly and easily.

CODIO is the future of streamlined and precise medical coding, delivering accuracy and efficiency like never before.

Read More: What are the common challenges in Medical Coding?

MediCodio’s Solution

MediCodio approached the problem with a comprehensive AI-powered medical coding tool designed to address the specific needs of the US-based revenue cycle management company. Here’s how MediCodio helped overcome the challenges:

1. 1. AI-Driven Code Suggestions: MediCodio’s tool provided intelligent code suggestions based on the latest coding standards and practices. This feature significantly reduced the time required for manual coding and increased accuracy.
   2. NCCI Edit Checks: The tool performed NCCI (National Correct Coding Initiative) edit checks to ensure compliance and accuracy, minimizing the risk of denied claims due to coding errors.
   3. Specialty-Specific Coding: MediCodio’s AI could predict medical codes for all medical specialties, making it easier for coders to handle diverse cases without compromising accuracy.
   4. Claim Charge Capture Reports: The tool generated detailed Claim Charge Capture reports, ensuring all services rendered were accurately billed, thus reducing revenue leakage.
   5. Scalability and Efficiency: MediCodio was capable of handling heavy coding workloads, coding millions of charts per day effortlessly, which helped in clearing the backlog and managing new cases efficiently.

Implementation and Results

Upon implementing MediCodio’s AI-powered medical coding tool, the RCM company observed immediate improvements:

• • Reduced Backlog: The intelligent code suggestions and efficient handling of large volumes of medical records helped in significantly reducing the backlog of cases.

• • Increased Accuracy: With specialty-specific coding, the accuracy of medical coding improved, leading to fewer denied claims.

• • Enhanced Productivity: The automation of routine coding tasks allowed coders to focus on more complex cases, improving overall productivity.

• • Revenue Optimization: Accurate coding and comprehensive Claim Charge Capture reports ensured that the company maximized its revenue by minimizing denied claims and capturing all billable services.

Conclusion:  Reliable AI tool for medical coding

MediCodio’s AI-powered medical coding tool proved to be a game-changer for the US-based revenue cycle management company. By addressing the critical challenges of backlog, complexity, accuracy, and revenue leakage, MediCodio enabled the company to streamline its coding processes, enhance productivity, and optimize revenue. This case study highlights the significant impact of adopting advanced AI technologies in the healthcare industry, showcasing how MediCodio can be a valuable partner in achieving operational excellence and financial success.