How Medical Coding Automation Enhances Primary Care Practices

Medical Coding Automation

Physicians are currently facing challenging times. The existing shortage of doctors, compounded by the pandemic, has exacerbated the patient-to-physician ratio. With an increase in patients, there’s a corresponding surge in administrative tasks for doctors. Consequently, this diminishes the time available for patient care and heightens stress levels among physicians. Furthermore, this situation often leads to a rise in coding or documentation errors, impacting the financial health of medical practices.

So, how can medical practices address this issue? The answer could lie in embracing Medical Coding automation.

While you might perceive Medical coding automation as mainly impacting coders, the technology’s implications extend far beyond that realm. In fact, it has a substantial impact on medical practices and directly influences the well-being of physicians. This stems from the core of a physician’s administrative responsibilities.

Statistics reveal that 58% of physicians identify administrative duties as the leading cause of burnout. The gravity of this situation becomes evident when considering that recent research in 2022 determined that primary care physicians would need to dedicate 2.6 to 3.2 hours each day to documentation and inbox management in order to offer guideline-recommended care to a panel of 2,500 patients. Such administrative burdens detrimentally affect physicians’ overall well-being and efficacy, contributing to feelings of frustration, imbalanced work-life scenarios, and reduced productivity.

Medical Coding automation emerges as a potential solution to alleviate this burden. Beyond liberating physicians from coding tasks, the AI technology significantly enhances the quality and speed of the revenue cycle within practices. It identifies incomplete or absent documentation at an earlier stage, enabling staff to rectify issues promptly. This streamlined approach results in more precise coding, heightened revenue capture, and grants physicians more valuable time to dedicate to patient interactions

Three Instances Highlighting Coding Automation’s Role in Ensuring Accurate Revenue Capture in Primary Care

Given that AI coding is notably more exhaustive and precise than its human counterpart, it aids medical practices in securing accurate compensation for their comprehensive efforts. Here are several practical, real-world instances that exemplify this advantage within primary care practices.

Example 1: Capturing Annual Checkup and Problem Visit in a Single Appointment

During an annual wellness checkup, it’s not uncommon for patients to present new health issues or receive treatment for existing chronic conditions. Despite both the annual wellness visit and the problem-focused appointment being separately reportable, there might be instances where physicians overlook the need to document them as such.

AI, however, is adept at identifying this oversight and accurately coding for both visits when warranted. For instance, in a scenario where an established patient necessitates code G0439 for the annual wellness visit and code 99213 (or an alternative evaluation and management code) for the problem-focused visit, AI would ensure proper coding. With relative value units (RVUs) of 3.84 and 2.68 respectively, encompassing both services translates to compensation around $216, considering the 2023 CMS conversion factor of $33.06 per RVU.

Example 2: Streamlining Medical Coding for Vaccinations

Vaccine coding is recognized as intricate by both medical professionals and coders. It involves two distinct code categories: one for the vaccine type and another for its administration.

These codes vary based on the vaccine type. Similarly, administration codes can diverge due to factors such as the mode of administration (oral, intramuscular, etc.), patient age, whether consultation was provided, and the number of components.

Adding to the complexity, codes can differ based on the manufacturer, vaccine formulation, and updates to coding guidelines. Despite a physician’s attention to detail, coding errors can occur. However, AI coding automation is equipped to encompass all these intricacies and execute accurate coding to ensure rightful reimbursement.

Example 3: Precision in Assigning E/M Code Levels

Amidst their busy schedules, physicians face time constraints for post-visit documentation, often under pressure to attend to the next patient. This can lead to errors in assigning Evaluation and Management (E/M) codes, particularly when addressing complex conditions requiring extensive treatment.

Here, medical coding automation serves as a crucial reimbursement aid. It can identify specific elements – like point-of-care tests, management of multiple conditions, or newly prescribed medications – that physicians might inadvertently omit. This ensures the accurate coding of the encounter, reducing the documentation effort for doctors. The difference is significant. While a 99213 code corresponds to 2.68 RVUs, a more comprehensive case supporting 99215 involves 5.31 RVUs, amounting to approximately $87 more.

In a landscape where physicians are increasingly occupied, coding automation presents a smarter avenue to alleviate their administrative load while simultaneously enhancing revenue capture. For practices grappling with patient influx and billing complexities, AI coding might be just the remedy they need.