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Text Content

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 * RCM Solutions
   * [Custom]
     
     Patient Access
     
     Start your revenue cycle strong by ensuring that critical, and accurate,
     patient information is in place before patient visits begin.
   
   * [Custom]
     
     Health Information Management
     
     Our team of coding experts, with a deep understanding of the healthcare
     industry and its specialties, paired with smart technology creates a
     tangible, positive impact on cash flow.
   
   * [Custom]
     
     Extended Business Office
     
     AGS Health provides a comprehensive suite of RCM services that are
     customized for each customer. Our experienced team of experts serves as an
     extension of your business office.
   
   * [Custom]
     
     Analytics and Reporting
     
     Obtain answers to critical questions related to performance benchmarking,
     root cause analysis, predictive analytics, and operational improvements.
 * Services
   * Patient Access Services
     * Patient Scheduling Services
     * Integrated Financial Clearance Services
       * Insurance Eligibility and Benefits Verification Services
       * Prior Authorization Services
       * Patient Payment Estimation Services
   * Medical Coding Services
   * Patient Financial Services
   * [Custom]
 * AGS AI Platform
   * * Intelligent Authorization
     * Autonomous Coding
     * Computer-Assisted Coding
     * Computer-Assisted CDI
     * Code Auditing
     * Revenue Cycle Automation Analytics
     * Clinical NLP APIs
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 * Introduction
 * Technology
 * Conclusion
 * Contact Us


Introduction Technology Conclusion Contact Us


EMBARK ON A JOURNEY TOWARD OPTIMIZED FINANCIAL HEALTH AND OPERATIONAL EXCELLENCE
WITH MEDICAL CODING AUTOMATION

Scroll Down



THE EVER-EVOLVING HEALTHCARE REVENUE CYCLE


RISING PATIENT VOLUMES AND AN AGING POPULATION.

Despite its cyclical portrayal, the healthcare revenue cycle is constantly
evolving based on economic conditions, government regulations, payer policies,
and patient expectations. This continuous evolution is especially evident in
medical coding.

From a tedious manual process

to a system of automated technologies,

advancements in medical coding are enabling healthcare leaders to overcome a
myriad of challenges . . .

According to the American Medical Association, recent studies show a

30%

shortage of medical coders.

And a 2023 AHIMA report found that

48%

of respondents experienced decreased reimbursement and slower claims processing
due to understaffing.

Meanwhile, a survey by Harmony Healthcare found that

32%

of hospital executives cited coding as their top concern regarding denials.

Despite these challenges, just

45%

of respondents to a 2023 AHIMA survey reported the adoption of artificial
intelligent (AI) and machine learning (ML) in their departments.

and only

11%

of respondents to a KLAS Research survey said their organizations had embraced
coding automation.

However, among those KLAS Research survey respondents,

40%

said they plan to invest in autonomous coding over the next 12 to 24 months.

|

The journey to coding automation is unique for each healthcare organization, and
every organization is at a different stage

The size of your organization, the complexity of your current systems, your
financial resources, and many other factors can play a role in your progress.
Furthermore, your specific needs and strategic priorities can influence the pace
and approach you take to automate.

While many hospitals and health systems are just beginning to explore coding
automation opportunities, others are already integrating advanced AI-powered
solutions into their coding processes.

?

Where are you in your coding automation journey?


CHOOSING WISELY: NAVIGATING THE LANDSCAPE OF CAC SOLUTIONS

Rule-Based CAC Systems NLP-Based CAC Systems Utilizes predefined rules,
templates, and logic to interpret and code medical documentation. Uses advanced
algorithms to understand and interpret language, identifying relevant medical
terms and context within documentation. Reliable only in stable, well-defined
scenarios where the rules are clear and comprehensive. Can handle a wider
variety of languages and contexts through ML to achieve high accuracy. Requires
significant manual effort to update rules and templates for new codes,
guidelines, or practices. Easier to adapt to new information and changes in
medical terminology or coding guidelines. Limited in handling complex language
and context, often struggling with ambiguous or nuanced medical terminology.
More adept at managing complex, unstructured data and ambiguous terms, offering
better understanding of context and intent.

Many organizations start their coding automation journey with a
computer-assisted coding (CAC) platform. However, not all CAC systems are
created equal.

There are two primary types of CACs: those that utilize rule-based logic and
those that employ natural language processing (NLP), an artificial intelligence
technology that interprets, analyzes, and responds to text.

While each type can offer improvements in productivity and efficiency,
rule-based systems have inherent limitations that hinder their effectiveness.

Another factor to consider when exploring coding automation systems is the
platform’s ability to suggest codes for professional coding services.

While most coding automation software supports facility coding, only a few are
properly equipped to handle professional-fee coding. At AGS Health, we refer to
these as computer-assisted professional coding (CAPC) platforms.

CAPC systems ensure precise coding across all professional specialties,
encompassing ICD-10 CM, CPT, HCPCS, modifiers, and professional E&M levels. In
some cases, these systems can also support the coding of Merit-based Incentive
Payment System (MIPS) Quality Incentives, consolidating your traditional coding
and MIPS coding processes into one streamlined and efficient workflow.

Another factor to consider when exploring coding automation systems is the
platform’s ability to suggest codes for professional coding services.

While most coding automation software supports facility coding, only a few are
properly equipped to handle professional-fee coding. At AGS Health, we refer to
these as computer-assisted professional coding (CAPC) platforms.

CAPC systems ensure precise coding across all professional specialties,
encompassing ICD-10 CM, CPT, HCPCS, modifiers, and professional E&M levels. In
some cases, these systems can also support the coding of Merit-based Incentive
Payment System (MIPS) Quality Incentives, consolidating your traditional coding
and MIPS coding processes into one streamlined and efficient workflow.


0% - 0%

Increase in productivity


0 - 0 DAY

Decrease in discharged not finally coded (DNFC)


UP TO 0X

Return on investment (ROI)

Coding automation provides greater flexibility and scalability to coding
operations by enhancing the accuracy, efficiency, and productivity of health
information (HI) professionals. This technology provides a cost-effective
approach to addressing labor shortages while mitigating coding-related denials,
enhancing regulatory compliance, and streamlining billing processes.

TODAY’S LEADING CODING AUTOMATION SOLUTIONS OFFER A ROBUST SET OF FEATURES AND
CAPABILITIES, INCLUDING:


INTELLIGENT WORKLIST PRIORITIZATION



Streamline processes and optimize coding practices with automated queueing,
routing, and smart allocation of charts.


REAL-TIME ANALYTICS



Insightful reporting, charts, dashboards, and code analysis enable real-time
coding, financial, and organizational metrics visibility.


NLP-BASED ICD-10-CM, PCS, CPT, AND E&M CODE AUTOMATION



Leverage NLP to automatically suggest billable codes from different types of
clinical documents.


GEOGRAPHIC REDUNDANCY



Achieve 99+% uptime and feel confident in the security and accessibility of your
data with multi-location storage.


AUTOMATED AND ACCURATE CODING SUGGESTIONS



Improve coding quality and productivity by leveraging clinical NLP with deep
knowledge graphs to assign accurate codes with a complete audit trail.


FASTER DEPLOYMENT AND ZERO DOWNTIME



A fully cloud-based infrastructure allows for more efficient deployment with
none of the maintenance hassles of onsite servers.


ONE-CLICK CODE VALIDATION AND ACCEPTANCE



Automatically identify charts with potential queries for seamless validation and
acceptance.


COLLABORATION ACROSS TEAMS



A unified data platform facilitates collaboration between coding, health
information management (HIM), physicians, and CDI teams within the system.

Click for sound





16:58










I really like the fact that AGS Health’s approach leverages a combination of
technology and human input. What really attracted me was the partnership that
AGS said they would give us – and they’ve proven repeatedly that this is a
partnership. It’s the ability to enhance the CAPC program while knowing that, in
the end, there is still a human to verify, to do the eyeball check. That is an
undervalued thing in healthcare, and it’s so incredibly important for what we
do.

— Beth Kushner, DO, CCDS, CPCO, Chief Medical Informatics Officer, St. Joseph’s
Health

Read More

One of the absolute best features in CAC, and I can’t stress this enough, are
the real-time reports and dashboards that are at my disposal every day, at any
given time. I know our CMI and many other productivity and financial metrics.

— Liza Simanovskaya, Director for HIM, Richmond University Medical Center

Read More

You really don’t know what you are missing until you start implementing a
program like CAC and working with a vendor like AGS... The results have been
tremendous in terms of return on investment. We have realized a $1.03 million
impact on our bottom line, which is more than a 10x return.

— Jason Lesch, Former Chief Financial Officer, Auburn Community Hospital

Read More
< >

Even with coding automation, your coding accuracy will depend on the clarity and
completeness of your clinical documentation. As part of your coding automation
strategy, it's essential that you evaluate medical coding and clinical
documentation improvement (CDI) together.

To translate a patient's condition into precise codes, CDI requires a
comprehensive, multidisciplinary, enterprise-wide effort. Intelligent automation
is key.

On the road to coding automation, CDI software is a logical next step for many
organizations. Using NLP and ML technologies, it analyzes digital patient charts
automatically, identifies missing and incorrect diagnoses in clinical
documentation, and suggests potential queries based on clinical data.

Even with coding automation, your coding accuracy will depend on the clarity and
completeness of your clinical documentation. As part of your coding automation
strategy, it's essential that you evaluate medical coding and clinical
documentation improvement (CDI) together.

To translate a patient's condition into precise codes, CDI requires a
comprehensive, multidisciplinary, enterprise-wide effort. Intelligent automation
is key.

On the road to coding automation, CDI software is a logical next step for many
organizations. Using NLP and ML technologies, it analyzes digital patient charts
automatically, identifies missing and incorrect diagnoses in clinical
documentation, and suggests potential queries based on clinical data.


0% - 0%

Decrease in length of stay (LOS)


0% - 0%

Increase in case-mix index (CMI)


UP TO 0%

Reduction in denials

Incorporating CDI software with coding automation systems enables you to gain a
comprehensive view of unstructured data, addressing issues such as length of
stay (LOS), mortality risk (ROM), severity of illness (SOI), compliance, and
other strategic priorities. By structuring this data, you can improve clinical
analysis, code accuracy, compliance, and revenue.

KEY FEATURES AND CAPABILITIES TO EVALUATE IN A CDI PLATFORM INCLUDE:


INTELLIGENT WORKFLOWS



Streamline CDI processes and improve efficiency with smart worklists to easily
identify cases for review and prioritization.


ADVANCED ANALYTICS



Instantly understand the impact of your CDI program with measurements of CMI,
risk scoring, quality measures, and staff productivity.


POWERFUL CONCURRENT REVIEW WORKFLOW



Review cases concurrently to identify documentation opportunities and reduce A/R
and DNFB days.


COLLABORATION ACROSS TEAMS



A unified data platform facilitates collaboration between coding, health
information management (HIM), physicians, and CDI teams within the system.


ALERTS AND NOTIFICATIONS



Automatically notify users in real-time of quality measure alerts for HACs,
readmissions, and PSIs.


GEOGRAPHIC REDUNDANCY



Multi-location data storage ensures 99+% uptime and provides a greater degree of
confidence in the security and accessibility of data.


AUTOMATED QUERY SUGGESTIONS



Automatically presents suggested queries based on predicted coding and current
documentation leveraging NLP with deep knowledge graphs.


FASTER DEPLOYMENT AND NO DOWNTIME



A cloud-based infrastructure allows for more efficient deployment without the
maintenance hassles of onsite servers.

El Paso Children’s Hospital

AGS Health’s paradigm-shifting, computer-assisted CDI solution provides the
functionality, customer service, technical support, and ease of use that will
move any facility to the forefront of CDI.

— Clinical Documentation Improvement Specialist, El Paso Children’s Hospital

Read More
< >

With increased regulatory scrutiny and the continuously shifting landscape of
rules and regulations, code auditing has become another key factor for coding
automation.

Despite the abundance of code auditing technologies available today,
interoperability across CAC, CAPC, and CDI remains a shortcoming for most
auditing platforms. A fully integrated auditing solution led by advanced AI can
help you enhance compliance and protect your hard-earned revenue.

Advanced capabilities, such as audit case selections, integrated encoders,
automated audit reports, and a centralized feedback center, can help transform
the code auditing process from a retrospective, stand-alone process into an
automated, real-time, and collaborative revenue cycle compliance solution.

With increased regulatory scrutiny and the continuously shifting landscape of
rules and regulations, code auditing has become another key factor for coding
automation.

Despite the abundance of code auditing technologies available today,
interoperability across CAC, CAPC, and CDI remains a shortcoming for most
auditing platforms. A fully integrated auditing solution led by advanced AI can
help you enhance compliance and protect your hard-earned revenue.

Advanced capabilities, such as audit case selections, integrated encoders,
automated audit reports, and a centralized feedback center, can help transform
the code auditing process from a retrospective, stand-alone process into an
automated, real-time, and collaborative revenue cycle compliance solution.


AUDIT CASE SELECTION

A combination of advanced search and rules engines allows users to create
meaningful audit populations based on various parameters, such as diagnosis
codes, CPT E&M/HCPCS codes, principal/secondary diagnoses, procedures,
modifiers, and more. Users can easily create pre-bill and retrospective audits
using an interactive audit worklist interface.


INTEGRATED ENCODER

This feature incorporates a fully integrated, proprietary encoder that includes
codebook, groupers and pricers, and compliance edits, such as Medicare Code
Editor (MCE), Medicare National Correct Coding Initiative (NCCI), and Local
Coverage Determinations (LCDs)/National Coverage Determinations (NCDs). The
module also integrates and interfaces with other leading encoders.


DETAILED AUDIT REPORTS

Automated audit reports are generated for audited cases with a code-by-code
comparison of the coder and auditor versions. The comparison includes detailed
changes for POA, code ranks, CCs/MCCs, discharge dispositions, DRG, weight, SOI,
and ROM. Missed query opportunities and physician documentation issues are also
quantified for all audited cases.


FEEDBACK CENTER

The feedback center displays each audited case to HI professionals. They get a
detailed comparison of the original and auditor versions. A commenting feature
allows HI professionals to respond in real time to auditor feedback and ensures
a complete end-to-end communication trail.

Among the most recent developments in coding automation is the emergence of
autonomous coding tools. This emerging technology uses advanced AI tools,
including ML, NLP, clinical language understanding (CLU), computational
linguistics, knowledge graphs, and large language models (LLMs), to make coding
processes more efficient and accurate by analyzing large amounts of medical data
and assigning codes without human input.




BUT JUST HOW HANDS-FREE IS AUTONOMOUS CODING?

While current autonomous coding platforms are effective based on simpler,
high-volume medical visits, they are not yet capable of fully automating 100% of
an organization’s coding workflows based on medical complexity.

Depending on the complexity and specialty of the coding tasks, you can expect
approximately 40-50% of codes to be generated autonomously at the outset.
Environments with repetitive data and lower variability, such as emergency
departments and radiology, are particularly well-suited for autonomous coding.

Despite performance variations, this level of automation can offer significant
benefits to understaffed organizations. However, it's crucial for HIM and RCM
leaders to prepare for any potential issues that may arise with incomplete or
incorrect charts.

With human input and feedback, autonomous technologies can grow and evolve. As
autonomous coding technologies analyze how human coders resolve fallout charts,
they'll start identifying trends and coming up with new logic to reach
autonomous ranges of 70-80% in the future. With enough time and data, autonomous
coding can significantly improve your speed and accuracy.

Unlike most other autonomous coding solutions, AGS Autonomous Coding offers true
coding autonomy by combining advanced artificial intelligence with award-winning
coding services into one solution. In this way, hospitals and health systems can
fix staff shortages, coding-denial issues, compliance problems, and more right
away while AI models get trained to be more efficient. Additionally, this human
oversight offers an extra degree of confidence as you move to more advanced
coding automation.





With human input and feedback, autonomous technologies can grow and evolve. As
autonomous coding technologies analyze how human coders resolve fallout charts,
they'll start identifying trends and coming up with new logic to reach
autonomous ranges of 70-80% in the future. With enough time and data, autonomous
coding can significantly improve your speed and accuracy.

Unlike most other autonomous coding solutions, AGS Autonomous Coding offers true
coding autonomy by combining advanced artificial intelligence with award-winning
coding services into one solution. In this way, hospitals and health systems can
fix staff shortages, coding-denial issues, compliance problems, and more right
away while AI models get trained to be more efficient. Additionally, this human
oversight offers an extra degree of confidence as you move to more advanced
coding automation.



|

It's natural for HI professionals to feel concerned about the impact of coding
automation. After all, these features were designed to transform the way coding
processes are managed. But embracing these tools can help elevate HI
professionals' roles.

Coding automation not only eliminates tedious and repetitive tasks but also
allows HI professionals to transition into higher-level responsibilities, such
as auditing, compliance, or specialized coding. It's a great opportunity to
learn new skills and stay on top of changes. Additional benefits include:

It's natural for HI professionals to feel concerned about the impact of coding
automation. After all, these features were designed to transform the way coding
processes are managed. But embracing these tools can help elevate HI
professionals' roles.

Coding automation not only eliminates tedious and repetitive tasks but also
allows HI professionals to transition into higher-level responsibilities, such
as auditing, compliance, or specialized coding. It's a great opportunity to
learn new skills and stay on top of changes. Additional benefits include:


REDUCED BURNOUT

HI professionals can avoid tedious tasks and complete their work more quickly,
preventing stress and anxiety caused by large backlogs and extended work hours.


IMPROVED JOB SATISFACTION

Automating routine tasks allows HI professionals to focus on more complex cases,
which challenges them to think more critically when solving problems.


CAREER DEVELOPMENT

By taking on more responsibilities, they can better demonstrate their skills,
which opens the door to new opportunities for career growth and higher salaries.


GREATER COLLABORATION AND LEARNING

Coding automation tools enable team members to collaborate more effectively and
act as learning resources to stay current with coding changes and best
practices.

Coding automation is a complex journey that requires substantial planning,
dedication, and perseverance. As such, healthcare leaders must understand that
this journey isn’t just about adopting new technology—it’s about making
thoughtful, strategic decisions that impact every facet of their operations. It
demands careful consideration of where, when, and how to apply these tools.

To navigate this process effectively, healthcare organizations need expert
partners who not only understand the technology but also have deep experience in
the healthcare operations these technologies support. Revenue cycle management
is a delicate web of interconnected processes, and even slight changes can have
significant consequences. Therefore, choosing a partner who can identify the
most impactful automation opportunities and provide comprehensive technology and
service solutions is essential for success.

At AGS Health, we believe in the promise of AI with a human touch. We work
closely with customers to engineer solutions that meet their unique needs and
goals. Our highly acclaimed technologies and deep expertise in coding services
enable us to support healthcare organizations at every stage of automation
maturity.




LET’S TRANSFORM YOUR CODING OPERATIONS TODAY

Whether you are starting your coding automation journey or seeking advanced
capabilities like autonomous coding, AGS Health is here to help!

Contact us today to schedule a free consultation with one of our coding
automation experts. Discover how our unique blend of intelligent automation and
award-winning services can help streamline your organization’s mid-cycle
operations and improve your long-term financial health.


AGS CONTACT FORM



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