The term “artificial intelligence” (AI) should not be misunderstood by Medical Coders, as there is a very clear and present reality evolving with the advancement of this technology.

Over 3,000 Medical Coders have been displaced in 2023 through layoffs and outsourcing (to overseas or technology solutions).

Reality Snapshot #1

While respecting the confidentiality of signed NDAs, we can share that AI technology that has recently been demonstrated to us had the following significant capabilities:

• Accelerated Workflows: Achieving in minutes what would take a human coder an entire work day. Dozens to hundreds of medical encounters processed in just minutes.
• Medical Record Analysis: Efficiently reviewing a significant volume of medical records.
• Code Assignment: Accurately assigning procedure, HCPCS, and diagnosis codes and modifiers.
• HCC Identification: Proficiently identifying Hierarchical Condition Categories (HCCs).
• Data Reporting: Generating reports on RVUs and other critical data points.
• Discrepancy Detection: Identifying potential documentation or guideline discrepancies.
• Provider Queries: Generating compliant queries for providers.
• Human Review Indicators: Highlighting data areas requiring human review. Through machine learning, these resolutions will diminish over time as AI "learns".

This is consistent with other vendors that we have not signed confidentiality agreements with and in fact these vendors have quite public solicitations that Medical Coders and related roles should take note of. (See below)

It would be prudent to review them. The message sent to organizations that employ Medical Coders is clear.

Reality Snapshot # 2

See the links for the italicized quotes from the vendors targeting healthcare organizations to provide AI solutions. Be reminded, this is in the marketplace now, not in the future. 

Citation 1

“How To Cut Billions in Needless Healthcare Costs”

“Learn more about how applying ML and AI to back-end administrative tasks that burden the healthcare system creates an opportunity for significant savings.”

“Machines: They Never Dread Mondays”

https://www.changehealthcare.com/insights/how-to-cut-billions-in-needless-healthcare-costs

Citation 2

“What if you had a coder who could code millions of charts per day at unparalleled accuracy and cost?”

https://www.fathomhealth.com/

Citation 3

"Slow, inefficient, error-prone manual coding keeps you from the financial peace you deserve. XpertDox’s autonomous coding solution accelerates the revenue cycle so you can get back to focusing on providing great healthcare."

https://www.xpertdox.com/

Awareness and Preparation Strongly Suggested

Medical Coders should remain aware of these and other solutions being marketed to the key decision makers of healthcare organizations.  Primarily C Suite Executives. (C Suite is top level organizational leaders, often with titles that start with "Chief" such as CEO, CFO, CIO, CMO, etc.)

The reality is that the industry is in the midst of a historical transformation. Not years from now. It is underway and accelerating.

Those who adapt are more likely to thrive, while those resistant to change face the potential for challenges and missed opportunities.

We urge our colleagues to prepare!

If not with us, be sure to prepare in a way that keeps your best interests at the forefront.

Preparation suggestions include:

• Gaining professional aptitude and understanding of Artificial Intelligence concepts. Encoders (which have existed for decades) are not AI. They are fundamentally based on "conditional logic". This is an example of understanding AI concepts.  
• Understand the range of AI implementation options for healthcare organizations.
• Remain vigilant of indicators that your environment may be transforming without transparency.
• Understand the impact of AI on roles.
• Broaden skills across a range of coding disciplines.

Some of the adaptive  strategies that we have become aware of by organizational leaders:

• Vendors plan to offer centralized coding support for records that AI cannot resolve. It is expected that many small to medium sized Medical Practices will exercise this option as it will result in significant labor and benefit savings. This consolidation will create roles with the AI vendors that will require coders with a broad range of coding skills and the ability to handle the higher level irregularities that AI cannot resolve. Larger organizations will also be offered this option and the best early indications are that about 50% would consider it thoroughly due to the significant labor and benefits savings. Labor and benefits are reported to be 50% to 70% of most businesses operating expenses.
• Larger organizations have indicated exploring the option of maintaining coding internally with reduced staffing.
• Small to medium sized practices have expressed that if they were to retain coding staff internally that it would be on a part-time or per diem basis if AI proves to be able to assume the majority of coding processes with efficiency and accuracy.