Streamlining Revenue Cycle with AI Workflow: Linking Documentation and Coding
As healthcare organizations across the U.S. face rising costs, growing patient volumes, reduced reimbursements, and increasing denials, leaders are turning to AI-powered revenue cycle management (RCM) and ease financial pressures, particularly in regard to denials.
Yet AI on its own isn’t enough. Many healthcare organizations continue to address clinical documentation and coding as two separate entities, which leads to inefficiencies and a lack of visibility and drives costs.
New solutions that combine clinical documentation and coding into one, unified workflow and are powered by AI, can be the backbone for better accuracy, compliance, optimal revenue, and financial sustainability in today’s market.
$12B a Year Lost to Denials
Denials have been on the rise for nearly a decade. In the last three years, they have held steady at 12%, according to Optum, and show no signs of slowing down. Given the time to rework and appeal them, it’s no surprise that denials are the most time-consuming task in the revenue cycle, a survey by AKASA found. Of course, the amount of time and resources required for denials management is also costly. In fact, denials cost hospitals nearly $20B a year, according to research by Premier.
What many organizations overlook is that the quality and depth of documentation have a direct impact on coding accuracy and denials. Plus, clinical documentation and coding often operate in silos across organizations. This is often a result of a reliance on point solution vendors as well as vendors that handle multiple functions of the revenue cycle.
This fragmented approach and the lack of visibility and collaboration commonly lead to inefficiencies, errors, compliance risks, and revenue leakage. Aside from prior authorizations, the most common cause of denials is coding errors, including incorrect or missing documentation, overcoding, and undercoding, according to Experian Health.
Documentation also has an impact on care and the patient experience. When clinicians are so focused on their laptops and their notes, patients are less likely to be seen and heard. All of these challenges taken together are risks for organizations looking to stay financially viable.
Providers spend $19.7 billion a year to adjudicate claims
With growing patient and payer complexity, regulatory changes, and persistent staffing shortages, organizations must look to new solutions that drive efficiency.
34% of providers say coders are the most difficult revenue cycle role to fill
Driving Accurate Claims Through a Unified Workflow
Solutions that offer one, end-to-end workflow encompassing clinical documentation at the point of care and coding ensure accurate physician notes and audit-ready charts—reducing denials, driving efficiency, and improving revenue integrity. These solutions break down siloes that are typical of point solution vendors, enabling consolidation, visibility, accountability, and cost savings.
Our care enablement platform combines clinical documentation via ambient AI scribe, autonomous coding, and human expertise to ensure accurate coding and appropriate revenue, drive better outcomes, and curb costs.
Through our Scribble Suite of solutions, organizations capture care in real time, enabling complete and compliant notes from the start. Scribble feeds into our medical coding solution, allowing for clean claims before submission and reducing denials and rework. Our solutions have been shown to deliver 95% coding accuracy, lower denial rates, and reduce coding costs by 35%.
A Validated Platform
We were recently recognized by Black Book Research as a leader in Clinical Documentation and Managed Medical Coding—designations we have held for 12 and three years, respectively. The awards come on the heels of also landing the top spot in the first-ever AI-driven Revenue Cycle Management (RCM) category.
In its Clinical Documentation, Virtual Medical Scribes & Transcription Services report, we earned the top spot with the highest number one criteria ratings, leading the way in the following areas:
Client relationships and cultural fit
Demonstrates our commitment to delivering quality, efficiency, effectiveness, and a simple process.
Deployment and AI solution implementation & system-wide standardization
Speaks to our ability to successfully put into play new solutions without excessive supervision and also address challenges quickly.
Best of breed technology and process improvement
Speaks to our ability to provide exceptional vendor management and technology services and amplify existing operations.
Viability and managerial stability
Points to our commitment to strong leadership and fiscal management.
Data security and backup services
Demonstrates our ability to ensure the highest level of cybersecurity and protections, and instill confidence in our services.
Reliability
Shows that we meet agreed-upon terms and provide a high level of service and support.
In Black Book Research’s Managed Medical Coding Inpatient and Ambulatory Solutions report, we also landed the top spot as the number one vendor, taking the lead in seven key areas:
- Strategic alignment of client goals: ONC, MACRA, MIPS, VBC, growth initiatives. This demonstrates our ability to meet our clients’ needs and prioritize their satisfaction.
- Innovation points to our commitment to make customized enhancements to our solutions to meet our clients’ expectations.
- Scalability, client adaptability, flexible pricing speak to our ability to scale our solutions and provide a pricing structure that meets our clients’ needs.
- Vendor staff expertise, compensation, and employee performance indicate our commitment to attract and retain top talent, provide professional development, and allow employees to take the lead on projects.
- Marginal value adds demonstrate our ability to show appropriate cost savings that ensure client satisfaction and costs, as well as identify new opportunities.
- Support and customer care points to our commitment to deliver effective account management, customer service, and satisfaction.
- Best of breed technology and process improvement show that we are leaders in vendor management and technology, and our solutions amplify our customers’ current level of operations.
We believe smarter healthcare drives better outcomes at a lower cost, and allows clinicians to focus on the core of medicine rather than the chores. Our solutions are trusted by over 600+ healthcare enterprises and 150,000 clinicians across leading health systems.
Ready to unify your clinical documentation and coding workflows? Connect with our team to see how we’re helping health systems improve accuracy and reduce denials.
