Why Technological Advancements will Act as Facilitators and Not Replacements for Medical Coders

By Ben Walker
September 21, 2020

The role of medical coders has advanced dramatically in the last few decades with the arrival of encoders, specialized software programs that assist in choosing codes. With this technology, the coding process has been streamlined and accuracy in patient records has been enhanced significantly.

The US Bureau of Labor Statistics predicts that the employment of medical records and health information technicians is projected to grow 11 percent from 2018 to 2028, much faster than the average for all occupations.

However, concerns have been significantly heaping around the growing implementation of technology within the profession, stating it could potentially limit the role of medical coders. Will technology go down to become a replacement for medical coders? Or will it rather prove to be a boon and take all that excess workload off their shoulders? Let’s find out!

But before that, let us try to comprehend the different aspects of modern technology that have streamlined a number of medical-coding related tasks to augment results and facilitate better outcomes.

Few Ways Technology is Streamlining Medical Coding Operations:

1) Speeding Up the Coding Process

There are a number of ways in which modern technology is speeding up the coding process in healthcare organizations today. For one, a number of hospitals rely on what is known as ‘cliff notes’ today - a document that is automatically generated by a computer after processing the medical records of a patient. This in turn, ends up saving a lot of money and ameliorates outcomes.

Earlier, coding professionals had to interpret and translate information regarding patient visits using a codebook manual. Today, encoders have completely refined the coding process and brought it down to a few simple “clicks.”

Many large hospitals have now begun experimenting with machine learning(ML) and artificial intelligence (AI) backed computer assisted coding (CAC) systems. These solutions help in fixing codes, identifying mistakes, and assisting the coders with real-time feedback to augment their results. Not surprisingly then, a report by Frost & Sullivan estimates that the market for healthcare AI tools is set to be worth a whopping $6 billion by 2021.

Another important technology that accelerates the pace at which coders can complete their work is medical transcription. Medical transcriptionists listen to recorded dictation from medical professionals and create written documents on the basis of these recordings. The transcript then becomes part of the medical record, which is used by medical coders to assign electronic codes to patients’ symptoms, diagnoses, procedures and medication.

2) Bringing Down Overall Costs

Today, machine learning (ML) and artificial intelligence (AI) technologies are playing an increasingly important role in bringing down the costs of medical coding for healthcare organizations. In 2018, the U.S. spent 16.9 percent of gross domestic product (GDP) on health care, nearly twice as much as the average OECD country. Nearly a third of this amount is simply directed towards medical billing and administrative costs.

Machine learning tools can proficiently interpret every single word in a patient’s medical record — this helps a hospital steer clear of upcoding, duplicate charges and unbundling related errors.

As a matter of fact, the push towards this may be coming from insurance agencies instead of the hospitals themselves. Issues like upcoding — where a patient is incorrectly mapped to a condition that is more serious than what they really are ailing from — can tend to shoot bills upwards, a major portion of which is borne by insurance companies.

3) Aiding in Research and Improving the Accuracy of the Coding Process

Encoders are designed in a way that not only makes the job of coding professionals trouble-free, but also enhances the accuracy of the coding process by reducing the risk of human error - medical codes are updated on a yearly basis, and codebooks are kept current at all times to ensure proper documentation of a patient’s visit. In the past, facilities had to purchase new codebooks each year, but encoders are continually updated with the most current codes.

Apart from increasing accuracy of the coding process, encoders can also help make it easier to research and identify the appropriate code for a specific procedure.

Today, there is a wide variety of encoders in the market to choose from. They can also be specifically designed to meet the specific needs of hospitals or medical facilities.

Moving on to the most important section of this piece:

Can Technology Ever Truly Replace Medical Coders?

As easy as it may sound, medical coding just isn’t a field that can get entirely automated any time in the near future.

A recent survey commissioned by the Royal Society found that when compared to functions like personalized learning, policing, and transportation, consumers were least troubled about the association of AI in healthcare. This is majorly because a seemingly sizable chunk of healthcare-related tasks and patient interactions is still handled by medical professionals. Patients don’t expect to be consulting a robot anytime soon.

Even as the implications of technology on backend healthcare cannot be overstated, it cannot be expected to completely take over billing and coding in healthcare. The possible risks with potential documentation errors and wrongful diagnosis are too high for these technologies to be running without any form of human supervision.

For instance, as in the case of cliff notes, although their objective is to speed up the coding process, there are tens and hundreds of unavoidable mistakes that a coder needs to fix.

A recent article from Huffington Post references a University of Minnesota professor’s research that projects 30-40 percent of medical bills contain errors. A report from the Medical Billing Advocates of America estimates that as many as 80 percent of all medical bills include incorrect information. Relying on encoders alone can be a risky proposition. The role of a coder, therefore, remains as important as ever.

Heather Golfos, CPC, a coding department assistant manager at Physicians Professional Management, believes that while software applications may allow coders to find codes easily, programs can be flawed. “I would recommend that coders search for codes through the code book, even though it can be a time-consuming process,” she says.

Lately, some coders have begun to use search engines to find codes in order to hasten the coding process. “[The Internet] is a good way to begin a search, but I tell my coders to always check whatever they find against the code book,” Golfos says. “That said, if you’re not having any luck in that way, especially if you don’t know where to start, sometimes you have to go online and Google it to see what you get. That can lead you in the right direction, but it can’t be where your research ends. The code book is always the best source. The Internet can have a lot of information, but much of it can be completely inaccurate.

Like Elbert Hubbard once said,“One machine can do the work of fifty ordinary men. No machine can do the work of one extraordinary man.”

So, as one may wonder, what lies ahead?

The ideal future simply is one where human coders co-exist in perfect harmony with these state-of-the-art technologies that oversee the process to make the system as error-free as possible. While technological advancements will radically alter how work gets done, its larger impact will be felt in complementing and augmenting human capabilities, not replacing them.

Ben Walker is the CEO of Transcription Outsourcing that provides transcription services for the academic, medical, legal, law enforcement, and financial industries globally. 

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