Empowered Patient Podcast How AI is Transforming Medical Coding and Impacting Hospital Revenue Cycle Management with Linda Schatz AKASA
Linda Schatz, Director of AKASA, explains the role of Clinical Documentation Integrity (CDI) specialists in ensuring accurate coding and bridging the gap between clinical documentation and specific, accurate codes to ensure proper reimbursement. The complexity of medical coding often leads to errors, which can be nearly eliminated by using AI to review 100% of patient encounters to identify inconsistencies and help CDI and coding professionals process more accurate claims quickly. Accurate documentation is important for hospital revenue, patient care quality, and perception of the hospital's performance.
Linda explains, "Well, the old adage, if it isn't documented, it wasn't done. If the doctor uses incorrect or perfectly acceptable medical terminology, it doesn't translate into an appropriate code. You've heard the term UIs, this is years ago, right? Grandma had UTIs and died. In the coding world, that used to code for a simple UTI. So the hospitals are getting paid for a patient that took care of a UTI, when in reality that patient was septic. To the outside world, it looks like Grandma came to the hospital, something that could have been treated outpatient, and she died. So the public perception of quality is less. So not only is it revenue, it's quality, but ultimately it's delivering patient care."
"I'm an old nurse. I've been in this field for over 40 years. I've worked across the NICU, PICU, and adult ICU. I've worked in access hospitals to large academics and all the way through hospice. That's pretty unique as a nurse to have that big of a background. Then I became a CDS, or clinical documentation specialist, or integrity specialist, and learned the documentation and coding aspect."
"Then I moved into the consulting role and worked with organizations and physicians all across this nation, helping them learn how to do this. And so you've got the clinical background, the coding background, and now I understand how generative AI works. And so while you're a new nurse, you're a horse, right? When we hear a heartbeat, we think of a horse, and after years, you earn your stripes and you become a zebra, and then you add all of these multiple areas of expertise, you become uniquely valuable as a pink zebra."
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