Hamid Tabatabaie, President & CEO, CodaMetrix
What does CodaMetrix do?
CodaMetrix is a SaaS technology company providing an AI-powered platform to facilitate healthcare revenue cycle management and medical coding. The company’s cutting-edge platform combines machine learning (ML), deep learning and natural language processing (NLP) to translate clinical notes automatically, accurately, and autonomously into billing and diagnostic codes that meet coding requirements while reducing human coding workload.
CodaMetrix’s CMX platform is multi-specialty, translating codes across radiology, pathology, surgery, gastroenterology, and bedside professional coding. It works with leading health systems Mass General Brigham, UMass Memorial Health, University of Miami Health System, Yale Medicine, Henry Ford Health and University of Colorado Medicine.
What trends are you seeing in the AI-based Revenue Cycle Management space?
Health systems face a global shortage of medical coders, with approximately 18-30% of positions unfilled. Not well known outside of healthcare circles, medical coders do the tough work of reading doctors’ notes and applying appropriate codes for imaging, exams, diagnosis, and treatment. Although unglamorous, this work is absolutely crucial for hospital revenue capture. Health systems spend millions on coding and still end up with misclassified codes and claim denials due to coding errors.
To submit a claim, medical coders manually sift through physician reports to understand a patient’s condition, the doctor’s diagnosis, and prescribed treatment plans – including prescriptions and procedures. They then convert these non-standardized notes into a set of standardized codes to submit for reimbursement. But there are tens of thousands of classification options coders navigate to submit a claim, leading to a 40% or more error rate. Medical coders must also “speak the language” of physicians to verify information even though they’re not medically trained.
Some hospitals are offshoring coding work to fill staffing gaps, but that comes with its own set of concerns and quality issues. For CFOs looking to solve these challenges, a better path forward is to automate parts of the coding function. Artificial intelligence (AI) makes coding more efficient and accurate, and streamlines the revenue cycle. This eases the workload for medical coders and relieves doctors of unnecessary administrative burden. It also helps CFOs to cut costs, avoid lost revenue, and significantly reduce denials.
The value is there, but so is the skepticism. CFOs have been burned in the past by AI technology “improvements” that promise the world but fail to scale and adapt, or that require ongoing resources to keep pace with ICD and CPT updates.
CFOs and rev cycle teams considering adopting AI for coding should be aware that many rules-based NLP and NLU systems require lots of manual human intervention. They should instead look for AI that adapts autonomously. Fully autonomous coding means that an AI platform can read the doctor’s notes, decide the appropriate codes, assign those codes to the case, and send it directly to billing.
What is your biggest concern?
AI is under intense scrutiny. And there’s a lot of fear that AI will replace humans.
Our deep conviction at CodaMetrix is that AI is augmentative. Our platform in particular automates medical coding so that the existing medical coding workforce can focus the majority of their time on complex cases that require more attention, detail, and skill. We also want to liberate (burnt-out) physicians to focus on patient care, rather than getting entangled in labor-intensive medical coding work.
What’s next for CodaMetrix?
We intend to:
- Become the autonomous AI medical coding platform of choice for every major health system in the United States
- Expand our product to serve more medical specialties
- Use our technology for Auto-Adjudication of claims at the point of care and automating the painful and costly Prior Authorization processes.
- Refine and advance our overall product capabilities
- Continue growing our world-class talent base
How is CodaMetrix improving healthcare?
We improve healthcare by helping health systems function as healthy businesses. Without efficient and accurate medical coding, health systems cannot capture revenue. We also give health systems a scalable path forward amidst a labor shortage and increasingly complex medical coding work.
From a physician standpoint, we help doctors manage burnout and avoid back-office work they were not trained to do. And from a patient standpoint, we help patients get their care on time, when they need it, without delays or denials.