Explore COVID-19 and its impact on medical coding and auditing at hospitals, and assess the importance of adopting AI assisted medical coding to improve the overall accuracy and efficiency of operations.

The COVID-19 pandemic has caused unprecedented challenges in hospitals around the world. As COVID-19 cases rise, challenges in medical coding and billing management continue to evolve, causing direct impacts to the healthcare revenue cycle. These problems highlight the need for innovative healthcare solutions to drive efficiencies and address short term and long term challenges. 

COVID-19 is challenging health information management professionals and hurting the revenue cycle

Health information management has become a major priority during the COVID-19 pandemic. Collected data points within Health Information Systems (HIS) are able to manage, identify, collect and translate COVID-19 data in a timely manner. The use of digitized and advanced HIS are vital to control the pandemic by capturing reliable and accurate health information. As a result, coded data is the key for health professionals to monitor and counteract challenges that the current pandemic presents.‍

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1. Medical codes are changing

Coding standards require accurate diagnoses of COVID-19 cases to be reflected in new ICD-10 codes. The issue of accuracy of coding information and consistency arises where the new coding direction creates larger room for error in coding and billing processes. Hospitals need to precisely update and keep track of ICD-10 codes in order to optimize for revenue cycle management and analytics. 

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2. Denial rates are increasing

Due to the increased prevalence of new COVID-19 cases/variants, medical coders and auditors are facing increasing and sometimes unsustainable demands. This has resulted in a decrease in the efficiency, accuracy, and completeness of coded data submitted for reimbursement, as seen, in the United States, by a nationwide claim denial rise of 11%. Denial management of codes through appropriate payment posting in medical coding requires particular caution to ensure an accurate reimbursement process. 

How we can limit COVID-19’s affect on medical coders and the bottom line?

To counteract the effects on COVID-19 on health information management, new-age artificial intelligence (AI) and machine learning (ML) powered systems can help complete automatic secondary reviews of coded and claims data with reference to clinical documentation. Auditors can accelerate their reviews of high-value opportunities to limit denials, optimize reimbursements, improve coding specificity, and identify clinical documentation improvement opportunities. 

By simplifying and doing much of the coding work up front, AI and ML technology can act as an innovative solution to ensure (1) new COVID-19 codes are accurately captured and (2) the increased workload is manageable. 

In turn, this will result in an efficient coding, billing, and auditing process through the RCM cycle. 

Where Semantic Auditor can help...

Semantic Auditor has proven to increase auditor efficiency by 3x while identifying 25% more data quality opportunities than the next market-leading software. The platform leverages the strength of AI and Machine Learning (ML) to take care of all the auditing needs of a hospital. The use of AI for coding audits can help prevent extensive backlogs as the platform helps hospitals improve the quality of data and make all-chart audits a reality. It will also help reduce the number of denials arising from clinical documentation issues. 

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The COVID-19 pandemic should be a call to action for hospitals to start adopting AI for coding and auditing as the pandemic exposed the vulnerability of the current system. The importance of medical coding and auditing cannot be overstated. It's time for the healthcare system to make the best out of the available data in order to code and audit faster and more accurately.