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What will the next generation of medical coding look like?

A transformation is underway in medical coding as automation permeates revenue cycle management, raising questions such as: How will automation affect how medical coders work? How advanced is coding automation currently? What kind of skill sets will be needed for these new types of coding?

A transformation is underway in medical coding as automation permeates medical billing. It raises many questions, such as what kind of skill sets will be needed for this new generation of coding? Will it lead to massive layoffs? What kind of training will be available to prepare this new generation of coders? What are the implications for prior authorization and benefit determination? Those questions and more were the subject of a fascinating discussion in a new webinar, sponsored by Nym Health. The moderator is A. Jay Holmgren, assistant professor of medicine at UCSF in the department of medicine and the Center for Clinical Informatics and Improvement Research. Keith Olenik, chief member relations and service officer with
American Health Information Management Association (AHIMA), set the stage for the conversation, noting that the concept of administrative simplification that HIPAA was supposed to usher in never happened. “Our payers are dealing with archaic systems. They modified what was supposed to be a consistent language across the board, which then makes it even more difficult to automate when we’ve added all those variations. The cost of being able to manage those and create change is not insurmountable, but those are barriers and issues that we’re all going to have to deal with, and partnerships with vendors that are out there and having those dialogues and communications and supporting our staff is just the starting point.”
The shift is especially clear from the manual coding that many medical coders are familiar with to the adoption of automated formats such as computer-assisted coding. This involves predictive analytics and natural language processing and is increasingly being implemented in outpatient settings, for example, to improve productivity and accuracy. Beyond computer-assisted coding, Nym is ushering in autonomous coding —an approach to medical coding that relies on technology to fully and autonomously code patient charts. Leveraging clinical expertise, computational linguistics and explainable AI, the Nym engine instantly interprets provider notes within patient charts and translates them into accurate, compliant ICD-10-CM and CPT reimbursement codes.  Julien Dubuis, chief commercial officer at Nym, described autonomous coding this way. “[It’s] assigning the medical codes accurately within seconds and absolutely zero human intervention. When I say accurately, I mean that we can achieve 96% accuracy code-over-code for outpatient specialties, which is at par with some of the best human coders.” Further simplifying medical coding, the Nym engine is automatically updated as new guidelines are released and produces audit-ready, traceable documentation for every billing code it generates. Despite the visions automation conjures up, the panelists emphasized in different ways that people will continue to play an important role in the new generation of coding.  “I would say that it’s a matter of current coders thinking about elevating their skill,” observed Natasha Lafayette-Jones, enterprise director of clinical documentation and coding with Harmony Healthcare. “We talk about analytics, we talk about providing reports, we talk about truly being able to analyze the data… ‘Look at your cases, how many pneumonias are we having that have bacterial infection?’ Or if we’re talking about hierarchical risk category and in-stage renal disease, where are we seeing that and how often is that appended to our records and what are the complications and complexities with these types of cases?  They [coders] will be able to be that resource to the organization that can provide that data-driven analytical response.” Sherine Koshy, senior director of health information management at Penn Medicine, agreed, noting: “There are so many things that [a] coder has to remember today… And so having technology helps ease some of that, so that we won’t lose revenue. We’re here going to make sure that you are becoming more of an auditor in this job, more than just a coder.” The webinar also explored training and what will be needed for the next generation of coders, particularly as automation moves into in-patient care. Koshy described how Penn Medicine is addressing this with its investment in a coding academy to create more inpatient coders and sharpen the skill sets of current coders. “Penn has really done a great job with investing, creating jobs for those who are coming out of school… We’re going to make sure our coders have the right training for that technology… to make sure we’re going to invest in helping them have that skillset, working with AHIMA.” To hear more insights from the panelists, access the webinar Coding for the Future: Lessons Learned, Emerging Technologies & Future Opportunities by filling in the form below.
Photo: Filograph, Getty Images