How AI and Analytics Can Automate CMS Coding for Physicians

One year into COVID-19, physicians are still stretched thin, especially with stringent Centers for Medicare and Medicaid Services coding requirements that burden already overworked healthcare providers.

But analytics programs, especially combined with artificial intelligence, can help by automating coding and quality reporting while alleviating clinician burnout and reducing errors.

First, real-time help and information functions are available through the system to guide healthcare professionals at the point of data entry. Second, in the area of pre-claim submission, the system validates the recommended and required clinical documentation (against the existing documents). Any gaps or errors are highlighted and accordingly resolved. This results in the avoidance of potential denials and unnecessary administration while positively impacting quality ratings.

AI provides a real-time help function, offering assistance pertinent to a clinical scenario at the point of data entry. This help function is an algorithm based on national, state, and provider organization guidelines.