The Next Generation of Medical Coding
aiHealth has taken the time to interview one of our founders and board members, Jean Balgrosky PH.D., MPH, RHIA about aiHealth’s vision to reinvent medical coding processes. Jean talks about aiHealth’s Digitally Enabled Coding Platform and sheds light on the importance of AI in today’s healthcare industry. She also overviews the impact of aiHealth on coders, clinicians and outcomes, highlighting our focus on changing the lives of medical professionals with our platform.
Q: You have an extensive and successful background in healthcare technology, medical records management, innovation, and entrepreneurship. What excites you about your new company aiHealth and its Digitally Enabled Coding Platform?
A: At aiHealth, we have a common goal of improving the lives of patients, care providers, and administrative staff. We’ve assembled a diverse, expert team of seasoned healthcare technologists, operators, clinicians and revenue cycle professionals. Together, we are solving the frustrating inefficiencies impeding progress in healthcare’s revenue cycle operations.
aiHealth isn’t taking a “boil the ocean” approach to automating all revenue cycle processes (i.e., prior authorization, appointments, claims, customer service). We instead are focusing on reinventing a set of outdated medical coding workflows using contemporary technology such as Artificial Intelligence (AI) and Machine Learning (ML).
Squarely within our reach is digitally-enabled and autonomous coding for most cases, leaving the more complex work to the professionals. aiHealth’s Digitally- Enabled Coding (DEC) Platform leverages usable and trustworthy AI/ML to codify clinical documentation taken in from myriad data sources, including electronic health record systems (EHR(s)) and the many fax, paper, and other-format data sources that burden providers and coding professionals with administrivia, inconsistent data formats, and unsystematic pieces of paper.
Viewing this as a former CIO, Registered Health Information Administrator and lecturer at UCLA’s Fielding School of Public Health, integrity is the holy grail of health data and information systems. Accurate clinical documentation and coding are more than just dropping a claim to payers for reimbursement. They have implications that impact patient care, quality, and outcomes. We believe healthcare professionals deserve better.
Q: How has medical coding evolved and what’s accelerating the adoption of AI within revenue cycle management?
A: The current state of coding as part of overall data management and stewardship is ripe for improvement and modernization. Often error-prone, these menial coding tasks lead to boredom and no doubt, frustration, and as a result — burnout and increased turnover. If you couple this with labor shortages and difficulties of off-shore coding, providers are advancing the adoption of AI-ML to drive operational efficiency, quality, and professional satisfaction.
Like medicine, medical coding continues to advance and takes an occasional leap such as the implementation of ICD-CM10, eventually and surely to evolve to ICD-CM11. Today, Computer Assisted Coding (CAC) is commonly used in the coding workflow delivering “suggestions” and still requires 100% human review. Unfortunately, variability in clinical documentation coupled with natural language processing (NLP) presents inaccurate coding suggestions that result in re-work, denials, and ultimately the fidelity of patient acuity.
All this takes some of our most precious knowledge-workers, namely physicians, nurses, and coding professionals, and relegates them to data-entry and manual processes, without the support of modern computing. Proper automation makes the most of talent and time.
"aiHealth is assisting clients reimagine their coding processes."
Q: Are clients implementing aiHealth for efficiency, accuracy, or to address labor shortages?
A: Yes, all the above. I’d also include compliance and professional satisfaction!
A direct correlation lies between growing revenue cycle workforce challenges and acceleration of automation in revenue cycle operations. In a recent interview of health system leadership conducted by the Health Management Academy (HMA), 80% of participants stated their goals are to improve operational efficiency.
By implementing aiHealth’s Digitally Enabled Coding (DEC) Platform, our clients see an immediate increase in coding throughput, accuracy, and coder satisfaction. DEC codes 24 hours a day, 7 days a week, reducing total cost to collect, denials, and days in A/R.
We take compliance seriously. With off-shore coding issues related to compliance and quality, our US-based team ensures appropriate coding guidelines are followed. Far too often, clients are auditing their off-shore partner's work and as a result, adding avoidable cost to revenue cycle operations.
In a recent blog, Mayo Clinic’s John Halamka referenced AI/ML as being “Math, Not Magic”. aiHealth abides by the notion that AI/ML must be monitored and evaluated, including the key role that professionals play in its evaluation.
Q: What impact does aiHealth have on clinician satisfaction, coder retention, and quality outcomes?
A: This is perhaps aiHealth’s most exciting promise. Out of the principles of the Quadruple Aim, the opportunity to Improve Patient and Provider Experiences is at our fingertips. While speaking about aiHealth last week with an accomplished orthopedic surgeon about coding within his group’s practice, he mentioned they use a template, and their best coder reviews each one for completeness and accuracy before being submitted to the payer(s).
Plus, on top of maintaining his medical licensure and running a practice, he also said he takes a coding class every year. I asked him if, when he went to medical school, he imagined he would go to coding class every year. After a pause, he answered with a smile, “No”. It was a moment.
"Let us take coding as a primary responsibility off physicians’ and other clinicians’ backs. Let us help coding and medical records professionals work at the top of their potential and credentials."
Let’s enable contemporary technology, such as AI-ML, that can be readily trained to capture ICD-10 and CPT codes, as well as check for accuracy, and has the capacity to do it day and night. Let medical professionals add back a sense of joy to their work!
Q: For future entrepreneurs and healthcare leaders, what insights can you share to ensure we continuously drive innovation and push the status quo?
A: Always try to make things better. Use technology to pursue ways to not just automate current processes to go faster, but to innovate and create simpler, better ways to work. Pursue quality, satisfaction, and effectiveness in addition to efficiency. As Michael Hammer said in the 1990’s, take a baseball bat to the side of a process, and every time you automate, reengineer and reimine the processes you are automating! Reduce the number of steps in workflows. Involve key knowledge-workers. Begin where people are. Use technology to make change in ways that can be absorbed and adapted with agility – you don’t need to change everything all at once. Involve people to help guide your work to a brand-new place that they’ve dreamed of while laboring away in yesteryear’s assembly-line workflows. They know. Just ask them.
About Jean Balgrosky PH.D., MPH, RHIA,
Experienced in and committed to healthcare innovation, Jean Balgrosky PH.D., MPH, RHIA, is a force for change in technology, paving the way for excellence in solutions to redefine healthcare delivery. As the former CIO of large, complex healthcare systems such as Scripps Health and Holy Cross Health System (now Trinity Health System), Jean is an established industry leader and arbiter of change. Jean designed and executed the strategic health IT plan for Scripps Health, a multi-hospital system including the world-renowned Scripps Clinic. There she implemented an enterprise electronic health record (EHR), rebuilding Scripps’ IT architecture from the ground up. In addition, Jean has a Ph.D. in Health Services from the UCLA Fielding School of Public Health and has served on the faculty there for the past 10 years.