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Future of Healthcare – Medical Coding with AI

Future of Healthcare – Medical Coding with AI

Artificial Intelligence, Machine Learning, and Computer-assisted coding systems are the present and future of most industries that aim to take on challenges and achieve a more secure and efficient functioning. Coding for medical with Ai diagnosis and treatment is no exception.

In fact, the latest International Classification of Diseases ICD-10 international version has over 14,000 codes for diagnosis which gets further complex in the US with an addition of 70,000+ codes for diagnosis and another 70,000+ codes for treatment. It is beyond human abilities to memorize these codes and ensure accurate medical and dental billing services always.

The number of codes used in the enhanced version of ICD-10 in the US has already made medical coding and billing increasingly complex and vulnerable to errors. On top of this, healthcare

organizations are preparing for the implementation of the upcoming ICD-11 from January 2022. It is likely that the number of medical codes will go further up!

How Artificial Intelligence Can Help

Over the course of the last 2 decades, healthcare businesses have introduced and adapted to computer-assisted coding systems.

In fact, many such systems have already begun incorporating state-of-the-art Machine Learning methods and Artificial Intelligence aspects to enable the system to analyze the clinical documents and determine relevant codes. AI will take its leaps further in terms of increasing accuracy, efficiency, and revenue by overcoming human challenges with cognizance.

The CMS (Centers for Medicare & Medicaid Services) reported in FY 2017 that errors caused improper payments of $36.21 billion. Healthcare costing frauds due to false claims and charges were estimated up to $230 billion.

The primary cause remains improper documentation and/or lack of it. From detection and diagnosis to treatment, it is in dire need of simplification of the process of medical coding.

Sophisticated AI and cloud analytics like IBM Watson are transforming healthcare and clinical needs by revolutionizing medical coding and billing.

Here’s How…

  • Al not only simplifies and increases accuracy but also empowers the organization by identifying developments and patterns, identifying and evaluating errors, reducing the chances of duplication of codes and billing frauds.
  • It identifies the use of unique or rare codes.
  • AI analyzes the clinical notes, reports, and documents for the most relevant codes. For example, if a procedure is an appendectomy in a healthy patient, the coding is simple. But the same in a 70-year-old man with kidney disease and diabetes can take much longer manually. This is when AI becomes instrumental.
  • It recommends codes based on the diagnosis and treatments performed.
  • It also identifies the right codes for unstructured data in free form text also known as verbatims for example, ‘patient cannot taste anything. Finding the correct med DRA code in such situations is one of the most time-consuming tasks without AI.
  • Provides data on patient activity, code usage, medical services delivered, etc. for further optimization of the system.
  • Track codes from patient history to avoid manual entry on every visit.

4 Things to Consider While Choosing Medical Billing Software

The efficient billing process is the engine and timely payments are the fuel that keeps a medical practice running smoothly. Both are possible with the right medical billing software.

Automating the billing process while maintaining organized data files can help a practice increase revenue as well as patient satisfaction. It also keeps you well prepared in the event of any legal hassles.

But implementing an inefficient billing solution can cost you dearly. It can affect the patient flow, accounts receivables, payment postings, and ultimately, the sustenance of your practice.

So, while you are in the market for the best medical billing software and are hearing pitches from multiple companies, here are some aspects to consider in order to make the right call.

1. Cost

Expense is always an important factor to consider. In the case of medical billing software, these costs can vary.

Some may be free to install but charge huge subscription fees to use their premium tools, some may cost less initially but display many hidden fees later while others can cost more upfront but include unlimited use of different functions.

Choose according to the needs and size of your practice. It is advisable to consider long-term expenses and the scalability of the software as your practice expands. You don’t want to end up with a big surprise bill at the end of the year.

2. Features

Owing to leaps and bounds of technological advancements, medical billing software offers a host of features these days. Providers can choose the one that suits their current requirements as well as their vision for the future.

  • Certain features like HIPAA compliance are a must. You must go for software that provides encryption to maintain the privacy and confidentiality of patient and healthcare data.
  • A secure backup is another feature you will need to maintain documentation and data and get easy access when required.
  • Consider how many staff members and doctors will be accessing the software and whether it can handle the surge in billing periods efficiently.
  • Software that allows patient pre-registration is a boon, as new patients can complete the intake forms and you can verify the insurance before they arrive for their appointment.
  • Features that automate insurance payors listing, claims tracking, electronic remittance alerts, etc. are the core reasons for installing billing software in the first place.
  • Accounting is a crucial feature. The software automates many steps of the revenue cycle management from staff payroll, timesheets to allowing online patient payments and keeping a record of accounts receivables.
  • If you have outsourced certain tasks like insurance verification to a medical or dental billing company, the software should assist their secure access of patient data, thus saving you the hassle of being a middleman.
  • It will also be time-saving for you to choose a software that requires less intensive training to use various functions or tools.

3. Access

As mentioned earlier, you want the software to enhance your bottom line as you grow. Getting digitalized is a part of the process and you will be accessing patient records across various platforms and devices.

You need billing software that is supported by different operating systems on smartphones, tablets, and PCs. When associating with a company that provides medical or dental billing services, this access will prove instrumental.

If the software offers webinars and online training sessions for your staff, that would be a good influencer for your preference.

4. Provider’s Track Record

In October 2015, the Government mandated the transition to ICD-10 (International Classification of Disease Code). If the staff of the software provider is not proficient in the same, the maintenance can go for a toss. Ensure to prefer the one that is compliant and efficient in the guidelines.

Find out how long the provider has been in business and the reviews of their medical billing software from your peers. Look for testimonials that provide substantial information and not those intended for marketing purposes.

Finally, choose a company that is responsive and gives enough weightage to customer service. Don’t just go by fancy brochures or enthusiastic pitches, take an informed decision to discover the innumerable advantages of medical or dental billing software.


Here’s why you should optimize AR before the year ends!

Cash Reserves

As we discussed earlier, high AR is a nightmare for a medical or dental practice. With cash reserves decrease, specifically in an unstable economy and health crisis, adequate working capital cannot be guaranteed.
You want to finish the year with a positive workplace capital and profits so that you can begin anew in the next year Consult a medical billing company for taking up the task of optimizing your AR if you have too much on your plate.

Tax Return

Pending and delayed accounts receivables further complicate the process of filing tax returns. Do some preparatory work on your financial statements before the end assist with year to assist you file your rebate check and itemise your costs.


When AR delays go unnoticed, they can pose serious challenges to a practice’s financial health. There are now expert health and dental billing companies committed to ensuring that you receive the most amount of money feasible.
Optimizing the accounts receivables before the year end, helps to balance those complicated account books and prevents loss of revenue. For calculate revenue Optimizing Accounts Receivable Matter

Report & Analysis

If all pending accounts outstanding are collect before the year closes and the cycle is acceptable optimise, year-end reports provide a comprehensive picture of your revenue cycle.
Reports such as AR ageing reports, key performance indicators reports, and top insurance analysis reports can be conduct more precisely, allowing you to assess the practice’s performance based on negative and positive trends.
The insights provide an opportunity to improve your revenue cycle management.

Strategies to Optimize Accounts Receivables in Healthcare

  • Use Data Analytics to Analyze AR in detail:
    Upgrade your system with cutting edge technology with data analytics to track billing records, turnaround time, denial ratio, etc.
  • Prioritize Insurance Eligibility Verification:
    Make your medical billing system patient centric to allow for advance filling of forms. This assists insurance verification before the first appointment itself. Ensure accuracy in the information and re-verification before every visit to prevent claim denials.
  • Identify Reasons for Denial:
    Improve your invoice collection by identifying the typical errors which have resulted in denials and updating your processes. That will prevent repetitions of such errors as well as strengthen the need for attention to detail in claim filing.
  • Outsource to a Healthcare Revenue Cycle Management Company:
    At Astron EHS, we have expert billers and staff to deliver end-to-end medical and dental billing services. Make sure your hard-earned money reaches you.
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