Anuraag Srivastava
Recently PCH Health organized a webinar on top medical coding trends for 2025. Our panelists included experts from the healthcare field, and insights were shared on the evolving nature of medical coding. Here are some highlights of the thoughts shared during the webinar:
Watch the full webinar below to gain expert insights and actionable solutions:
Thoughts on coding inaccuracies in denials
The panelists noted that there has been a notable increase in the number of denials due to coding errors. In their organizations, they have shifted to using revenue cycle management software, which essentially is rules-based and focuses on identifying the right code for the diagnoses prior to claim submission.
The companies are focussing on continuous education and training of their staff, and providing opportunities for feedback sessions and audits to reduce the number of coding errors. They are using pre-built technology that has built-in flags that identify potential errors in the audit process. Senior auditors and coders check for the accuracy of the codes using the latest coding standards.
Leveraging AI technology is another solution that panelists broached. Essentially, instead of teaching and educating the coders on the coding standards, an AI system learns the nitty-gritties. This way, the coders can focus on the errors AI makes. The technology also has the capability to group errors based on certain patterns and trends that the system detects. Identifying and handling errors in a group thus is easier than working through each individual case.
On Importance of Medical Documentation
Accurate medical documentation is essential for reducing claim denials. Companies deal with large data sets, and companies leveraging AI need to ensure that the codes are correctly coded in in the first place, since an error in filling the forms would lead to an error on AI’s end too. This means that clients should ensure that they are using the accurate coding information and are taking data only from the top coders.
The panelists also thought that creation and maintenance of medical documentation involves a multi-faceted approach. They collaborate with physicians in the form of Physicians Advisory Program to ensure that the right expertise is deployed on documentation. They have created easy to use guidelines for physicians and use technology to capture data. They are using technical tools that give alerts to the providers to reduce ambiguity and ensure accurate coding.
Teams that work with AI tools need special education and training for coding guidelines. They need to ensure they create better templates and use the right phrasing and keyword indicators so that AI systems can identify the terms and coding correctly.
Sometimes, practices get very busy and are not able to monitor the stacks of denials. Consistent auditing thus becomes crucial so that the issue is identified, before it impacts the practices’ accounts receivables. The Physician Advisory Board thus comes in handy since it includes both hospitalists and residents. There has been a notable improvement in coding ever since the board was established for close collaboration.
Thoughts on constant coding updates
Constant coding updates is another big challenge. Highly advanced coders help with creating CEU (Continuous Education Units) for the team. They are subscribed to the industry newsletters, webinars, seminars, and participate in several local and national coding organizations such as AHIMA and AAPC.
There is usually a dedicated team that checks for regular coding updates and coordinates with other teams, such as revenue integration, billing and coding teams. Regular internal training sessions are also organized with mini-webinars available to attend on a monthly basis, with an option to look at recordings. All of the resources are stored in a centralized location, such as sharepoint, so that even new employees have access to the knowledge.
Companies also pay for these CEUs that focus on specialty-specific training for coding and A/R management teams. Even insurance carriers roll out training modules that helps users navigate policy changes. There is also an increased focus on training the coders on local coverage determination (LCD) and national coverage determination (NCD) for Medicare. Center for Medicare and Medicaid Services (CMS) guidelines is a key. Coders need to be updated on changes in these guidelines.
Many organizations also rely on third party outsourcing support such as Lexicode for some of the training. There are 4 CEUs designed for year round training with subject matter expertise from Lexicode and Aideo, that could help with upskilling.
On different coding management strategies
The panelist highlighted three different coding management strategies.
One perspective was AI-led coding. This means that any NCD and LCD edits or any type of update is automatically loaded into the system. Any update that is not specific to state or insurance carriers can be managed by coders.
AI systems also follow rule-based systems. These rules could be specific to a carrier or a location. This involves no paperwork since based on a CPT code, the system brings out the necessary information for the user.
There are many advantages to integrating with AI. It helps reduce coder’s time in production. It helps tackle staffing challenges since it reduces time to submit claims. Coders essentially act as a quality control and manage the QA process by assisting the workflow where AI cannot. This could include looking into complex cases, and handling exceptions, when the AI system works on the norm.
The second type of management strategy was to partner with a third party service provider to enhance coding capabilities. For instance, WakeMed partners with Lexicode to do the same. Lexicode provides WakeMed with the coding expertise that complements their own efforts. They rely on a third party service instead of AI since AI technology is still at its infancy and cannot deal with all levels of complexity.
Lexicode, on the other hand, has a breadth of expertise and adjusts its staffing approach to meet the needs of its clients. With over 1000 coders, complex inpatient cases, backfill of emergency cases, and outpatient surgery cases can be managed efficiently.
Then comes the third approach to coding management, which is a hybrid approach, where both a third party service provider and an AI system is utilized to fulfill the coding requirements. In these cases, in-house coders act as a quality assurance check and deal with cases both the AI system and the third party service provider is not able to.
On evolving nature of coding
The panelist foresees the integration of AI and machine learning to deepen, helping with real-time coding and documentation. They expect that as coding capabilities evolve, coders will take up more of an analytical and supervisory role, overseeing the AI system, and ensuring that the systems are regularly updated.
This doesn’t mean that it will eliminate all human coders. The technology would only reduce the claim denials, while allowing human coders to have an oversight on the functionings. There is now an increase in the AI coding certifications. However, all panelists agreed that it is a thing of the future as the coding evolves, and is not something they are considering implementing at the moment.
The panelists also highlighted that communication will be the key. There needs to be a strong communication pathway for coders, AI, and providers to ensure higher coding accuracy in the future.
PCH Health: Your Coding Partner
Coding is just one piece. PCH Health has a lot more to offer. From revenue cycle management to denial management, PCH Health is your partner for not only your coding, but also other healthcare management needs. Contact us to request a demo.