Applied AI: The Practical Use of Autonomous Coding
With over 30 years of experience in Revenue Cycle Management Koha Health’s CEO, Brian Hall, discusses how inefficient and manual RCM processes can be eliminated by incorporating new innovative technologies. Koha offers customizable strategies that ensures that clients are able to achieve total finical health.
Q: For almost 40 years Koha Health has been focused on building a successful revenue cycle management company with an impressive roster of partnerships across the country. Can you share more about Koha Health, the customers you serve and solution offering?
A: With 40 years of experience optimizing the revenue cycle from beginning to end, Koha Health draws upon deep industry-specific knowledge to deliver value through service line expansion, fine-tuning provider management, incorporating innovative technology, and developing a customized financial strategy to ensure practices arrive at the future they envisioned. Our core solutions are grounded in strategic advisory services, revenue cycle optimization and patient experience optimization.
Koha Health focuses on working with Orthopedic, ASC, and musculoskeletal related practices who wish to remain independent or are building for the future and need comprehensive support to optimize and secure their financial position. Koha has an innovative approach and expansive service offering ensuring each practice makes steady progress toward total financial health and achievement of personal goals.
Q: The U.S. medical coding market is estimated to be a 17-billion-dollar business and with a 30% shortage of medical coders nationwide, how is Koha leveraging AI/ML and other contemporary technologies to drive efficiency, performance and scale?
A: Our secret sauce is the combination of aiHealth's autonomous coding and RCxRules rules engine. Together they allow Koha to reimagine manual and inefficient coding processes. With aiHealth, self-learning AI tools consolidate the notes from various clients/systems and funnel the resulting codes through RCxRules. This creates efficiencies in the overall workflow. For many groups, their coders need to know insurance/payor rules on top of coding. With the aiHealth platform feeding RCx, it’s feasible for a note to be consumed by aiH, autonomously coded, pushed to RCxRules, pushed to the practice management system and to the payer without ANY user intervention - yet with a high confidence the claim is clean and will be paid accurately.
As with any AI/ML, it is self-learning, so the more that is coded through the platform, the smarter and more efficient it will get.
aiHealth provides productivity reporting per user, per organization, and per provider. It has Lag time reporting for any SLAs which need to be met in getting notes in and out of the system.
Q: In recent months, the healthcare market has seen an increase in provider organizations and private equity backed groups partnering with Revenue Cycle Management companies to outsource components or all of their revenue cycle functions. What is driving this trend and what differentiates Koha Health’s revenue cycle capabilities?
A: We actually prefer to call it co-sourcing. Outsourcing implies giving it away and forgetting about it. Co-sourcing on the other hand emphasizes the importance of working together with a partner. To answer the question, staffing shortages, increasing costs combined with decreasing reimbursement, complex and changing requirements, and a changing payor mix due to a sharp increase in patient financial responsibility have all combined to make revenue cycle co-sourcing an increasingly appealing solution to practices of all types.
Payer reimbursements have declined by 20% while the cost of operating a medical practice has increased by 39%. Practice overhead now accounts for about 60% of a provider’s gross income. These sobering stats demonstrate how running a practice and achieving financial sustainability has become more challenging than ever.
About Brian Hall:
As CEO of Koha Health, Brian Hall leverages 30 years of experience to lead and nurture a company culture that is unlike any other in the industry. Brian has a growth mindset, and as an impassioned entrepreneur and visionary is always thinking about what is next. He challenges the status quo and norms in healthcare and develops Innovative solutions and services that can disrupt the system and help our clients reach their goals. Brian has cemented community at the core of Koha’s identity, and as such, he has set a personal goal of altruism that is backed up by his active participation with numerous non-profits as well as a corporate goal for Koha to give a percentage of revenue back to our communities and our clients’ communities.