By: Sabrina Yousfi, MBA, RHIA, CCS, CDIP, Senior Vice President, Mid-Revenue Cycle Solutions, Amanda Corley, Vice President Coding Solutions, Nick Raup, Senior Vice President of AI and Automation Solutions
The integration of artificial intelligence (AI) and blended shore initiatives is reshaping the way healthcare organizations manage their mid-revenue cycle (MRC). This innovative approach is not only driving cost-efficiency but also significantly enhancing accuracy in medical coding and billing processes. In this post, we explore how these cutting-edge solutions are redefining MRC management and the profound impact they’re having on the healthcare industry.
The Power of AI in Revenue Cycle Operations
Artificial intelligence is redefining revenue cycle operations by automating routine, mundane tasks, reducing errors, and increasing efficiency all the while with significant savings and reduction in AR days. Healthcare providers are increasingly incorporating AI into their workflows to streamline processes and improve financial outcomes. Some key benefits include:
- Automated coding: AI algorithms can accurately code medical encounters, reducing the workload on human coders and minimizing errors
- Predictive analytics: AI-powered systems can predict claim denials and identify potential revenue leakage, allowing for proactive interventions.
- Enhanced productivity: By handling routine tasks, AI frees up staff to focus on more complex, value-added activities.
Blended Shore Initiatives: A Global Approach to Talent
Blended shore initiatives combine the strengths of onshore auditors and offshore coding resources to create a highly efficient and cost-effective workforce. This approach enables healthcare organizations to tap into global talent while ensuring quality control, compliance, and a two-step quality assurance process.
At the recent AHIMA24 conference, e4health contributed to an insightful presentation titled “Engaging a Global Workforce.” Melissa Koehler, DHA, MBA, RHIA, CHDA, CDIP, CCS, CCDS, Director of HB Coding Operations and Quality at Inova Healthy System, Julianne Seaman, Vice President Solution Design at e4health, and Amanda Corley, Vice President Coding Solutions at e4health provided valuable insights into designing effective blended shore solutions. Their combined expertise highlighted how the blended shore coding and auditing model has transformed Inova’s revenue cycle, addressing key questions surrounding this innovative approach. Many offshore myths were debunked such as:
Myth
The quality of offshore coding can’t match the standards required for specialized facilities.
Offshore coding poses more security risks.
Offshore coders lack the productivity of their onshore counterparts.
Integrating offshore resources is a complex and time-consuming process.
All offshore coding services are essentially the same.
Reality
- Offshore coders often possess superior clinical background knowledge compared to typical workspaces. Their expertise extends to coding for Level I trauma and academic facilities, ensuring high-quality outcomes.
- Through robust security measures and SOC2 compliance, e4health ensures exceptional data protection, mitigating potential risks associated with offshore operations.
- e4health’s offshore coders are held to the highest productivity standards, often matching or exceeding onshore performance metrics.
- With e4health’s strategic planning and efficient execution, the onboarding process for offshore resources is streamlined and effective.
- e4health implements a rigorous dual audit model, combining onshore and offshore resources. This approach maintains exceptional quality standards, with coders and auditors held to identical performance criteria. The process includes auditing the auditors themselves, ensuring comprehensive quality control.
To learn more about successful blended shore medical record coding programs, download our comprehensive eBook here. This valuable resource defines five reasons offshore coding goes wrong and offers new best practices for blended shore coding, providing essential insights for healthcare organizations looking to optimize their coding processes.
The Synergy of Tech and Service
One of the most significant advantages of e4health’s approach is the combination of cutting-edge technology and expert services. This unique offering addresses a critical gap in the market, providing healthcare organizations with a single, integrated solution for their MRC management needs.
By leveraging AI-powered coding technologies and a global workforce, e4health delivers:
- Reduced total cost of ownership for healthcare providers
- Improved coding accuracy and consistency
- Streamlined vendor management
- Enhanced scalability to meet fluctuating demand
- Reduced cost per transaction due to higher volumes
Flexible Models for Diverse Needs
e4health’s AI-powered technology is at the forefront of driving significant improvements in productivity and accuracy across all service models. What sets this technology apart is its ability to continuously learn and optimize its performance as it processes more medical charts. This ongoing refinement leads to incremental cost savings over time, with the potential to achieve savings of 40% or more compared to traditional coding methods. The innovative approach not only enhances immediate efficiency but also ensures long-term value through continuous improvement.
e4health offers a range of coding service models to meet the unique needs of each healthcare organization:
- Onshore: Utilizing domestic coding talent
- Offshore: Leveraging global expertise
- Blended: Combining onshore and offshore resources for optimal efficiency
- Staff augmentation and full outsource models
The Evolving Role of Medical Coders
As AI takes on more routine coding tasks, the role of medical coders is evolving. Rather than being replaced, coders are transitioning into higher-value positions such as auditors and denial specialists. This shift presents exciting career growth opportunities, allowing professionals to develop new skills and take on more complex responsibilities.
A recent article in the Journal of AHIMA titled “Artificial Intelligence More Likely to Transform HI Jobs Than Replace Workers” by John McCormack supports this perspective. The article emphasizes that AI technologies are reshaping health information (HI) jobs rather than outright replacing workers. It suggests that AI will augment human capabilities, leading to a transformation in roles rather than obsolescence.
For medical coders, this transformation means focusing on tasks that require human expertise, such as interpreting complex cases, ensuring compliance, and providing insights that improve overall coding quality. As AI systems handle routine coding tasks, human coders will increasingly serve as strategic partners in health data management, leveraging their expertise to optimize AI-generated results and drive continuous improvement in coding accuracy and efficiency.
Financial Impact and ROI
The financial benefits of implementing AI-enabled coding solutions can be substantial. While specific savings vary based on factors such as hospital size and current coding processes, e4health’s clients have reported significant cost reductions. The medical coding and billing market is expanding rapidly, projected to grow at a CAGR of 9.35%, indicating rising demand for integrated solutions that utilize AI to meet evolving healthcare billing requirements.
Long-Term Benefits for Healthcare and Public Health
Beyond immediate cost savings and efficiency gains, the integration of AI and blended shore initiatives in MRC management has far-reaching implications for healthcare quality and public health:
- Improved data accuracy for better clinical decision-making
- Enhanced research capabilities through more reliable coding
- Increased cash flow, leading to improved financial stability for healthcare providers
- More time for healthcare professionals to focus on patient care
Embracing the Future of MRC Management
As the healthcare industry continues to evolve, embracing AI and blended shore initiatives is becoming increasingly crucial for organizations seeking to optimize their mid-revenue cycle management. By partnering with innovative solutions providers like e4health, healthcare organizations can drive cost-efficiency, enhance accuracy, and ultimately deliver better patient outcomes.
To learn more about how e4health’s AI-powered, blended shore solutions can transform your organization’s MRC management, contact our team of experts today.