CodaMetrix, a leading AI technology company in healthcare revenue cycle management, is on a mission to address the underutilized and clinically insufficient medical codes that drive $4.5 trillion in annual spending on healthcare in the U.S.
CodaMetrix proudly announces that the CodaMetrix AI Platform achieved Epic Toolbox designation for the fully autonomous coding category. Toolbox features products that meet Epic’s recommended integration practices (“Blueprint”) for the product type.
Today, the primary aim of medical coding is to inform claims for timely and accurate reimbursement by complying with payers’ coding guidelines. This focus often leads providers to select codes that are sufficient for claims submission but lack critical clinical value. Physicians often rely on a few familiar codes in their documentation, which can unintentionally overlook valuable specificity. Fully autonomous coding can reduce human hours by replacing portions of manual or partially automated coding processes. Accurate coding will reduce costs for both providers and payers, avoiding some of the 20-25% of U.S. healthcare spending wasted on administrative tasks.
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“Medical codes are intended to be a codified representation of patients’ clinical history, but current coding practices often stop at meeting reimbursement rules because today coding at the optimal level of detail is expensive to do manually. CodaMetrix uses AI to reduce cost and improve quality in the predominantly fee-for-service settings. We’re honored to be selected by #1 ranked health systems in 14 states, 4 health systems ranked in the top 5 in other states, and the largest radiology group in the U.S.,” said Hamid Tabatabaie, CEO of CodaMetrix. “These organizations, representing over $110 billion in annual net patient revenues, validate our mission and acknowledge that current coding methods lead to medical charts being routinely re-coded for various purposes, including quality measures, compliance, clinical registries, population health, value-based care, research, and clinical trials.”
This year, U.S. News added data from Medicare Advantage plans in its analysis of the “Best Hospitals” rankings. “As a result, we analyzed far more patient records than we did just a year ago,” says Min Hee Seo, senior health data scientist at U.S. News & World Report. “The addition of Medicare Advantage data reflects the growing popularity of those plans,” Seo says. More than 30 million Americans are enrolled in Medicare Advantage plans.
“Risk-bearing care models, such as Medicare Advantage plans, often compel health systems to re-code cases, increasing both the administrative burden on physicians and the financial strain required to address gaps in medical coding. However, the use of large, curated datasets, clinically informed annotation, and AI-driven code generation is revolutionizing many aspects of healthcare, particularly administrative functions like coding, which are central to both revenue and clinical cycles,” said Dr. Tim Ferris, Senior Advisor at CodaMetrix. Dr. Ferris was most recently the National Director of Transformation at NHS in England, redesigning care services, harnessing the power of data and analytics, and building a learning health system that generates knowledge to improve population health. Dr. Ferris was previously the CEO of the Mass General Physicians Organization and formerly the Senior Vice President for Population Health at Mass General Hospital.
Several large health systems and academic medical centers, including Mayo Clinic, Mass General Brigham, Henry Ford Health System, University of Colorado Medicine, and Yale Medicine have collaborated with CodaMetrix to develop solutions that are in use across the CodaMetrix network of customers.
Source: Businesswire