Mercyhealth Achieves Notable Revenue Growth Through Automation
Mercyhealth recently reported a commendable 5.1% increase in revenue, alongside a remarkable 50% decrease in accounts receivable days, credited to the automation of high-volume claims processing across ten distinct specialties.
Kelly Pierson, the director of coding and clinical documentation integrity, attributes the leap in performance to the application of autonomous AI coding, which has significantly alleviated the burdens associated with a surge in claims volume.
“As patient volumes escalated, we recognized the necessity for an AI partner,” she remarked, noting the upswing in both physician and emergency room visits.
This regional health system, which encompasses seven hospitals across Illinois and Wisconsin, serves over 2.4 million patients each year. However, Pierson expressed that finding experienced coders proved to be a formidable challenge.
“We were competing even against our own organizations for talent. The workload was considerable,” she added.
Coding plays a crucial role within the revenue cycle, acting as a complex nexus for medical claims and documentation, which is essential for minimizing denials and ensuring that hospitals receive their rightful financial compensation.
Over two years ago, the health system determined that it was time to leverage technology to alleviate this strain.
Initially, they contemplated adopting computer-assisted coding but subsequently evaluated autonomous coding vendors, ultimately selecting Arintra due to their highly customizable logic and flexibility accommodating varying payer rules.
Since implementing this high-volume claims automation, Mercyhealth has achieved a notable 5.1% revenue boost and halved its accounts receivable days.
The impact has allowed coders to focus on higher complexity claims. While Pierson initially had reservations about entrusting AI with such responsibilities, she recognized the potential to capture lost revenue.
“We were among their first health systems and Epic clients,” she shared. “We’ve been operating with them for two and a half years now.”
To bolster confidence in the AI, Pierson and her team ensured that coders audited a percentage of the automated coding, subsequently redirecting staff into proactive audit roles.
“The initial trepidation surrounding AI has transformed into significant coding confidence,” she asserted. “Now, we embark on payer audits with a renewed sense of assurance.”
She highlighted an early indication of advancement, noting a 5% month-over-month revenue uplift, paired with a decrease in coding work queue durations from an average of 16 days to just 7. “Our pre-accounts receivable days have substantially declined,” she added.
Moreover, the performance of coding staffing has seen pronounced improvement. “They are now actively engaged, exploring avenues for additional revenue,” said Pierson, observing a shift in focus towards enhancing documentation and growth opportunities rather than being mired in daily tasks.
Notably, the variability previously experienced among coders has dissipated. Presently, the health system is exploring vendors for further AI initiatives.
Source link: Healthcarefinancenews.com.
