This article is co-authored by Jeff Atkinson, National Practice Leader, and Susan Carrier, RN, BSN, MBA, CPC, CCDS, CCDS-O, Consultant
The use of Artificial Intelligence (AI) in medicine is already widespread, with various solutions enhancing productivity, decision-making, patient experience, and innovation. In the areas of documentation and reimbursement, AI has significantly improved healthcare coding, particularly within Medicare and Value-Based Care programs. By facilitating the accurate capture of codes that map to Hierarchical Condition Categories (HCC), AI can help reduce cost burdens and enhance the broader application of healthcare resources.
However, relying solely on AI for coding reviews presents risks. Here are some things you need to look out for when using AI for coding at your healthcare organization.
The Negative Effects of AI in Healthcare Coding
AI lacks the nuanced judgment and contextual understanding that skilled human coders provide. AI algorithms can misinterpret complex medical terminology and overlook subtleties in patient histories. These misinterpretations may lead to coding errors, missed comorbidities, and ultimately, inaccurate health records. Such errors can impact risk adjustment, reimbursement accuracy, and the quality of patient care. Additionally, AI systems are still evolving and require regular updates to keep pace with changes in coding regulations and other healthcare standards.
AI is a Supportive Tool, Not the Standalone Solution
A hybrid approach, combining AI with manual coding reviews, offers the best of both worlds. Healthcare providers can leverage the speed and efficiency of AI while ensuring accuracy through human expertise. This combined approach ensures more precise and compliant HCC capture, ultimately improving patient outcomes and financial results for healthcare organizations. AI-driven reviews should serve as a support tool, not a replacement for human oversight. Overall, security measures must be prioritized to control access and protect patient information. Governance frameworks need to be established to ensure the proper use of AI, specifically regarding who has access and which applications are being utilized. Most importantly, oversight and stringent quality control processes must be developed and consistently applied.
AI is here to stay, but human involvement will remain essential.
Need Medical Coders?
To create the hybrid approach to coding, you need human expertise combined with AI. Harmony Healthcare can help support you when building out this process by placing expert coders on your team. Contact us to get started.
