CodaMetrix CEO and President Hamid Tabatabaie returns to Outcomes Rocket, joining host and CEO Saul Marquez for the HFMA Annual 2024 National Insight Series. In this episode, they explore the transformative shifts in medical coding, highlighting how CodaMetrix’s advanced platform is enhancing the patient care experience.
Traditionally, medical coding focused only on meeting fee-for-service reimbursement requirements, often at the expense of fully enriched clinical data. Coders prioritized providing sufficient evidence for services rather than capturing every clinical detail of the patient encounter. This approach was practical when coding delays were a major bottleneck, slowing down the revenue cycle due to cost and time constraints. However, with AI advancements, there’s no longer a need for these trade-offs.
Today, AI is changing the game. It bridges the gap between clinical specificity and claims data, serving as a valuable partner for coders, even in tasks that aren’t fully automatable. This shift is driven by two main factors: a shortage of coding resources and the increasing demand for detailed coding due to the growing volume of patient health records and services. AI addresses these challenges by reducing manual coding volume and costs while improving the relevance and accuracy of clinical data.
In the world of value-based care and population health, coding can feel like a never-ending cycle. Large health systems, and even smaller ones, often recode data for various use cases. For example, fee-for-service coding handles reimbursement for encounters and hospitalizations. Meanwhile, population health teams pull charts and recode those same cases to capture clinical specifics. Clinical trials and recruitment departments do the same, looking at patient history and symptoms over time.
Each department—whether it’s for clinical trials, registries, or any other specialized area—codes data differently based on their needs. The challenge is that these processes often operate in silos, each with its own budget and focus, amplifying costs on the health system. But as healthcare becomes more integrated and value-based coding gains traction, it's clear that a unified approach is crucial.
CodaMetrix embraces this shift by focusing on what we call “value-based care coding.” This approach aligns with industry needs, leveraging AI to streamline and enhance the coding process, clinically enriching data that improves patient care and outcomes.
At CodaMetrix, we’re all about flexibility in coding quality—forget the rigid, one-size-fits-all standards. Our rating system, ranging from one to five stars, lets you choose the coding use case that best fits your health system’s needs, ensuring accuracy and relevance.
So, what’s the bottom line? It's time to step back and consider the broader impact of medical coding within your organization. Think enterprise. Your coding efforts go beyond immediate revenue collection—they also influence research, clinical care, and patient outcomes. By embracing the bigger picture, you’re not just driving revenue; you’re making a meaningful impact on the entire healthcare journey.
https://www.youtube.com/watch?v=jHU0nxuxAR4&list=PLVwgwecIFVlDqQuv5x_8rlDCoj1qNGv9e&index=2
