Revenue cycle leaders need coding and billing to be compliant, accurate and fast. What are hospitals to do as the health care staffing crisis extends to coders, and bringing new coders fully up to speed can take six months to a year?
To learn more about how coding automation augments the work of coders and increases coder productivity today, and what an autonomous experience will help mitigate in the future, Becker's Hospital Review recently spoke with Nathan Carver, acute care coding growth leader at 3M.
Note: Responses edited for length and clarity.
Question: Can you paint a picture of the opportunity and the promise of automation in coding?
Nathan Carver: Today, translating a physician's documentation to a record coded for reimbursement requires an army of approximately 90,000-plus medical coders across the U.S. Medical coding automation is not an easy task because of the complexity of changing regulations, the diversity of payer rules, and the many coding approaches and unique IT tasks. More than 80 percent of facilities in the U.S. already have access to computer-assisted coding technology, but the movement to a fully autonomous coding experience is only just beginning. Advances in artificial intelligence and increased connectivity with the cloud are paving the way for a more autonomous future and are elevating the role of highly specialized coders as a result.
The promise of automation is to improve the accuracy and efficiency of coding and to supplement coders so they can be more effective. But coders need to feel confident that what the machine is doing is correct or they won't trust it. And trust is key. When automation surfaces the correct information and takes simple tasks off of coders' plates, coders are free to focus on more complex records and tasks.
Regulatory events are a reality and the key to stay ahead of them is to have all the pieces in place — both from a technological and process perspective. The sudden addition of new codes in response to COVID-19 is a great example of unpredictable events. Technology companies with the clinical expertise, technology, processes and human capital in place to quickly react to these events are in a good position to be able to help health systems not miss a beat.
It is important to recognize that coding automation cannot just be turned on with a switch. It involves a combination of machine learning and human coding expertise that work together and evolve over time. The opportunity for automation is to improve accuracy, compliance and efficiency by enabling medical record coders to work in tandem with technology. This is the promise of automation in coding.
Q: What are some examples of coding processes that 3M HIS has automated?
NC: In the beginning, 3M introduced software that provided prompts, digitized reference materials and automated coding pathways. We then launched a computer-assisted coding solution that auto-suggested codes. Documents are automatically arranged and organized on the screen, with annotations and evidence highlighted to support the recommended codes. We have effectively streamlined the coding process to make it very easy for coders to find what they need to complete their coding tasks.
In ambulatory settings, where there aren’t coders on site, providers rely on picklists, manual reference guides or memory to assign codes. This approach is inefficient and is prone to errors and denials. In this setting today, 3M helps providers review codes and compare them to what our system would suggest. Using a rules-based approach, codes that pass the threshold can then be sent directly to the billing system without coder intervention.
Q: In a perfect world, how would a coding team interact with an autonomous system? What are the gaps and hurdles to get to this ideal state?
NC: In a perfect world, automation would take care of most cases, leaving highly specialized coders to focus on the complex cases. Human coding experts and AI will ultimately work in tandem with occasional auditing from technical and clinical experts to ensure ongoing accuracy. This partnership is critical to withstand ever changing coding regulations.
Consolidation in the health care sector is the norm, as physician practices merge or are acquired by hospitals. This creates a challenge since different organizations often have different technology platforms at varying stages of automation maturity. The end goal is to have either one single system or multiple systems that are integrated and talk to one another. That will set hospital systems up for success.
Q: In the next five to 10 years, how will the tasks of a coder change based on automation improvements?
NC: In the future, as automation is more broadly adopted and as the technology continues to improve, coders should be able to shift their time to focus even more on the really challenging cases, where they can use their very sought-after skills, rather than spending time on simpler tasks.
As procedures continue to become more complex, you will probably see additional specialization of coders in different clinical areas. As coders become more well-versed with particular procedures, they would then be able to code those procedures more quickly and effectively. In addition, coders can become more adept at auditing and validating different records.
3M has the utmost respect for the medical record coding community. Our automation technology is designed to enable coders to dive into roles that will best serve the hospital and the patient. By automating medical records, 3M strives to empower coders to work at the top of their licenses while solving ongoing staffing burdens. Most importantly, we want to ensure those complex cases get coded right the first time so that health organizations can achieve revenue cycle excellence to help improve patient care.