Healthcarercm

  It is no surprise that denials continue to be a significant challenge for many healthcare organizations. Recent statistics indicate that the  rate of denied claims is on the rise , with studies showing  denial rates climbing above the historic 10% 'benchmark' and reaching as high as 15% for certain provider types . This growing denial rate not only impacts revenue but also places an enormous burden on healthcare staff, adversely affecting both morale and productivity. These factors contribute to reimbursement delays and slower cash flow, compounding the financial strain on healthcare organizations and making it even more essential for healthcare organizations to optimize their denial management processes. Financial Impact of Denied Claims Claims denials of 10% or more result in significant financial losses for healthcare organizations and directly impact their overall revenue. The combination of increasing denial rates and operational inefficiencies often results in cri...

  As healthcare organizations work to improve efficiency in their revenue cycle operations, it is crucial for leaders to thoroughly evaluate medical coding automation technology solutions. This evaluation helps manage expectations regarding the most effective strategies. Implementing the right automation approach can enhance accuracy, streamline workflows, and ease the challenges posed by rising volumes, staffing shortages, and complex reimbursement processes. Understanding key milestones to a future state is critical, but the road to building an automation strategy will be different based on the individual needs of the organization. Evaluating Medical Coding Automation Technologies Traditional medical coding methods are labor-intensive and prone to errors, and automation can help alleviate challenges in the three key areas where healthcare organizations struggle, including volume, staffing, and denials management. Rising volume:  McKinsey & Company estimates a  5% to...

  The advancement of artificial intelligence (AI) is driving greater accuracy and efficiency in medical coding to maximize reimbursement. As healthcare organizations examine the path forward, it requires technology solutions that are inclusive and responsive to the needs of the continuum, from experienced health systems exploring autonomous coding to those new to AI-driven  clinical documentation improvement (CDI) ,  computer assisted coding (CAC) , and  computer assisted professional coding (CAPC)  solutions. Driving Advancement in Coding AI Successfully enhancing coding AI requires agility and adaptability. Framing technology advancements as a collection of “focus areas” rather than a rigid plan provides flexibility in addressing shifting customer priorities while still emphasizing emerging trends. Four key strategic areas of focus to drive advancement in medical coding AI include: Strategic Innovation.  Staying ahead of breakthroughs in generative AI and...