What you should know:
CodaMetrix, a leading AI technology company in healthcare revenue cycle management, is committed to addressing the underutilization and clinical inadequacy of medical codes that contribute to $4.5 trillion in annual healthcare spending in the United States.
The CodaMetrix AI platform has now received the Epic Toolbox designation for the fully autonomous coding category and meets Epic’s rigorous integration practices (“Blueprint”) for this product type.
CodaMetrix receives “Epic Toolbox” award
Challenges of medical coding:
– Current focus: The primary goal of medical coding is to verify claims for timely and accurate reimbursement in compliance with payer coding guidelines.
– Clinical value: This reimbursement-related focus often results in providers selecting codes that are sufficient for claims but lack critical clinical value.
– Doctor’s trust: Doctors tend to rely on a few well-known codes and may miss important details.
The CodaMetrix solution
CodaMetrix is an AI-powered SaaS platform focused on transforming medical coding. The platform supports over 220 hospitals using Epic and facilitates over 50 million outpatient visits per year with 60,000 physicians across 25 states. Key features include:
– Autonomous coding: Fully autonomous coding allows parts of manual or partially automated coding processes to be partially or fully automated, significantly reducing the number of working hours.
– Cost efficiency: Accurate coding through AI reduces costs for both providers and payers and can potentially avoid the 20-25% of U.S. healthcare spending currently wasted on administrative tasks.
Hamid Tabatabaie, CEO of CodaMetrix, said, “Medical codes should accurately reflect patients’ medical history. However, due to the high cost of manual coding, current practices often focus only on reimbursement rules. CodaMetrix’ AI technology reduces costs and improves quality, especially in fee-for-service environments.”
Impact of Medicare Advantage data:
– Advanced Analysis: U.S. News has included Medicare Advantage data in its “Best Hospitals” rankings, reflecting the growing popularity of these plans, which now cover more than 30 million Americans.
– Administrative burden: High-risk care models such as Medicare Advantage plans often require health systems to recode cases, increasing both administrative burden and financial burden.
Dr. Tim Ferris, Senior Advisor at CodaMetrix, highlighted the transformative potential of AI-driven coding: “Large, curated data sets, clinically sound annotations and AI-driven code generation are revolutionizing healthcare, especially administrative functions such as coding, which are central to both revenue and clinical cycles.”
Joint efforts:
Several well-known health systems and academic medical centers, including Mayo Clinic, Mass General Brigham, Henry Ford Health System, University of Colorado Medicine and Yale Medicine, have partnered with CodaMetrix to develop solutions that are now deployed across CodaMetrix’s client network.
