Autonomous coding enjoys a high level of trust among healthcare finance professionals who use or plan to use the technology, with 45 percent indicating it often works well and 16 percent placing complete trust in it. Yet despite its emergence as a powerful tool for streamlining and improving error-prone manual coding processes, autonomous coding suffers from an awareness problem, with 52 percent saying they do not know what it is.
Those are the findings of a new survey from the Healthcare Financial Management Association (HFMA) on behalf of AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S. More than 450 healthcare finance professionals were surveyed during the 2023 HFMA Annual Conference on their knowledge of and value expectations for autonomous coding, including 60 percent that use or plan to use autonomous coding.
More than half (52%) of respondents said they don’t know what autonomous coding is and 30 percent either did not or were unsure if it could be trusted.
“Despite high expectations around its potential to increase coder productivity and coding accuracy, reduction in denials, missed charges and low-risk scores, and accelerated provider decision-making, autonomous coding suffers from a knowledge gap that must be closed if we are to see broader adoption,” said Thomas Thatapudi, CIO of AGS Health. “Until we can fully educate finance leadership on the potential autonomous coding holds for improving the healthcare revenue cycle, we are unlikely to see an acceleration in use cases for AI-powered technology which includes autonomous coding.”
Among the key benefits of autonomous coding is its ability to eliminate the potential for human errors that result in missed reimbursement opportunities, backlogs, delays, and claims errors, and its ability to push accuracy levels to near perfect percentages. All of which can be achieved in near real time with the right integration pipelines. Autonomous coding is also faster than its human counterparts – it can complete charts in seconds – yet it also understands what it does not know, flagging it for human review.
AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announced today the release of Intelligent Authorization, a single-source solution that automates and optimizes the financial clearance process and avoids prior authorization-related denials.
Part of AGS Health’s AI Platform, Intelligent Authorization streamlines and expedites processes by up to 90% through a variety of configurable automation solutions that improve operational efficiency, reduce costs, and enhance the patient experience.
“Half of all denials can be traced back to prior authorization and other front-end revenue cycle issues, jeopardizing provider organizations’ financial health and negatively impacting the patient experience by limiting transparency and delaying access to care,” said Matt Bridge, senior vice president of RCM Services, AGS Health. “Intelligent Authorization addresses the underlying issues causing prior authorization-related denials while streamlining and accelerating financial clearance processes. Customers report doubling production volumes and tripling the number of days in advance their patient access teams can secure authorizations, which in turn expedites appointments to better support patient needs and fill open time slots – resulting in improved revenue growth and an enhanced patient financial experience.”
A platform-agnostic solution, Intelligent Authorization prevents denials, reduces aged A/R, improves net revenue reimbursements, and increases clean claim rates across a variety of specialties, including radiology, oncology, occupational and physical therapy, surgery, and infusion/diagnostics. Compared to manual processes, it enhances productivity and reduces the time required for financial clearance activities, delivering:
75%-85% faster eligibility and benefit determinations
85%-90% improvement in authorization determination time
65%-80% less time spent on authorization initiations
75%-85% shorter authorization follow-up times
Up to 80% faster price estimations
Intelligent Authorization achieves these outcomes by automating eligibility and benefits determination processes, including order entries, scheduling, rescheduling, and monthly and annual re-verification processes. It automates authorization status via robotic process automation (RPA) and generates good faith estimates based on the fee schedule and embedded payer- and client-specific rules, which are then transferred back to the EMR.
Finally, Intelligent Authorization offers insightful and actionable analytics including self-service reports, customized dashboards, and flexible data management that enables users to view insights across different dimensions, create action plans, and make decisions faster.
“Smart workflow tools feature fast, flexible data transfers to the EMR through HL7, simplified task management and automated case assignment, and enhanced document management and accessibility, all of which come together in Intelligent Authorization to eliminate financial clearance issues created by error-prone, time-consuming manual processes,” said Suhas Nair, director of product management, AGS Health. “By leveraging the latest advances in RPA and AI technologies, Intelligent Automation helps healthcare organizations implement the tools needed to strengthen their financial footing and better service their patients.”
Revenue cycle management solutions provider AGS Health announced the launch of operations in Manila, Philippines. Serving as a strategic growth partner to more than 100 major healthcare providers across the U.S., the expansion will offer AGS Health and its customers increased access to global talent.
Identified as one of the most popular outsourcing destinations in the world, the Philippines is known for the quality of skills offered in the business process outsourcing (BPO) sector. With strong medical backgrounds and voice-based skills, AGS Health aims to focus on supporting end-to-end accounts receivable services. “By augmenting our service line with patient calls, responding to patient queries, and timely patient follow-ups, the addition of our Philippines operations represents an exciting added value to our customers,” said Patrice Wolfe, CEO of AGS Health.
As the company continues to grow, AGS Health is diversifying its global operating locations. The Manila office is the second recent global addition for the company, following the opening of its Jaipur, India office in June 2022. With more than 11,000 employees worldwide, AGS Health combines a global pool of expertly trained, college-educated resources with AI-enabled technology to leverage the latest advancements in modern revenue cycle practices.
The COVID-19 global pandemic and widespread natural disasters have highlighted the importance of business continuity planning. With an already-extensive presence established in India, AGS Health strengthens its infrastructure with this cross-country addition.
“Our expanded footprint reduces the risk of business disruptions to our clients should operations be interrupted in India,” Wolfe said, adding “The Philippines emerged as our top choice for its solid, low-risk infrastructure and its role as a top business center.”
Health equity is a focus of providers, regulatory agencies, and payers as they seek ways to eliminate care disparities across race and ethnicity, gender, sexual orientation, and socioeconomic status lines. Its significance is further impacted by new quality-based care models beyond those established by the Patient Protection and Affordable Care Act of 2010.
The challenge for many healthcare organizations participating in these new reimbursement models is how to view health equity and social determinants of health (SDoH) to understand the actual value of this information. Often overlooked is that healthcare organizations’ coding and revenue cycle management (RCM) departments already aggregate information that can help better understand inequities in care delivery and health equity across their patient populations.
A Primer on SDOH Impacts
SDoH impact many health risks and outcomes, which is why this data is vital for clinical care and reimbursements. Defining factors can include anything from geography, race, gender, and age to disability, health plan, or any other shared characteristic. Of increased importance, SDoH issues are most often experienced by the most vulnerable members of society: the poor, less educated, and other disadvantaged groups.
SDoH is linked negatively with outcomes, including higher hospital readmissions, length of stay (LOS), and increased need for post-acute care. Value-based payment programs, therefore, may penalize organizations that disproportionately serve disadvantaged populations if they do not collect and respond to SDoH data.
For example, addressing food insecurity — a key SDoH data point — by connecting patients to programs like Meals on Wheels, Supplemental Nutrition Assistance Programs (SNAP), or food pantries is proven to reduce malnutrition rates and improve short and long-term health outcomes.
In the case of SNAP, which is the primary source of nutrition assistance for more than 42 million low-income Americans, participants are more likely to report excellent or very good health than low-income non-participants. Low-income adults participating in SNAP incur about 25% less medical care costs (~$1,400) per year than low-income non-participants.
AGS Health, a revenue cycle management (RCM) solutions provider and partner to some of the largest healthcare systems in the U.S., launched its AGS AI Platform, a connected solution that blends artificial intelligence (AI) and automation with award-winning human-in-the-loop services and expert support to maximize revenue cycle performance.
Industry-wide, health systems are being stretched as they face chronic and worsening labor shortages while attempting to address higher denial rates and an onslaught of audits. Shrinking margins limit organizations’ ability to reinvest in care delivery. In this time of high turnover, the AGS AI Platform helps to reduce stress, prevent burnout, and improve job satisfaction by offering the ability to automate high-volume repetitive tasks, allowing skilled staff to focus on more complex tasks.
“AGS Health is excited to deliver this platform as a lifeline to provider organizations in challenging times,” says Patrice Wolfe, CEO of AGS Health. “With our industry expertise, AI-enhanced technology, and specialized services, AGS Health is helping healthcare organizations achieve the financial freedom necessary to invest in the latest healthcare innovations and deliver high-quality care to their communities.”
The platform allows healthcare organizations to gain enhanced visibility into day-to-day operations and the overall performance of the revenue cycle, including intelligent worklists, productivity reports, customizable dashboards, root cause analyses, and executive reporting. Performance trends and predictive analytics help to prevent bottlenecks, reduce denials, and mitigate revenue leakage.
AGS Health, the tech-enabled revenue cycle management solution provider for major healthcare organizations across the U.S., has again been named a Leader and Star Performer in Revenue Cycle Management (RCM) Operations by Everest Group. The company was recognized in the top quartile for performance in market success and capability advancement as part of Everest Group’s Revenue Cycle Management Operations PEAK Matrix Assessment 2022.
The report assesses 31 RCM service providers based on market impact and the ability to deliver services successfully-as defined by subdimensions including market adoption, portfolio mix, value delivered, and strategic vision-to identify each organization’s overall market leadership position, labeled as Aspirant, Major Contender, or Leader.
AGS Health is honored to be recognized as a Leader for the second consecutive year, and a Star Performer for the third consecutive year. Star Performers are selected based on year-over-year advances in areas including growth, innovation, and technology investments.
“As delighted as we are to receive this industry recognition, we are most proud that it represents the value we continue to deliver to our clients through ongoing investment in innovation and service,” says Patrice Wolfe, CEO of AGS Health. “It demonstrates our commitment to helping ease our customers’ administrative and financial burdens through a strategic mix of technology, analytics, and process improvement, so they can focus on their core mission of providing high-quality patient care.”
AGS Health serves as a trusted partner in A/R management, coding, and business analytics to more than 100 major healthcare providers across the U.S. The company’s 100% graduate workforce of 10,000+ results-focused revenue cycle experts processes more than $50 billion in A/R annually and codes an excess of 41 million charts.