AI Solutions Save Time And Reduce Denials With Significant Impact
Presented by Mark Anderson & John Gwin
Thursday February 27th, 2025
10am PT / 11am MT / 12pm CT / 1pm ET
This program is scheduled for 60 minutes and is valid for 1 CHBME credit.
Member Price: $49.00
Non Member Price: $99.00
Description:
The presentation will discuss results of a case study that involved using new AI technology designed to decrease time to identify correct ICD-10 coding that decreased encounter denials and reduced pending claims on a myriad of specialties, including, but not limited to Family practice, primary care, surgery, plastic, Emergency Room, Internal Medicine, pediatric patients. From contract signed to testing of the first 100 encounter progress notes (SOAP Notes) generated by two different EHR software products, within 90 days the results, were impressive. The RCM service vendor AI coding software read the patient’s clinical progress note and within an average of 30 seconds, the software provided the coder with the recommended appropriate ICD-10 codes with 98% coding accuracy. The coder selects the recommended ICD-10 codes and attached that code each the appropriate line-item CPT codes based on Correct Coding initiatives (CCI edits).
Based on initial testing, it was determined that the average coder could increase hourly coding from 22 encounters to 48 encounters, an impressive 118% improvement. Over the course of the first month, coder productivity decreased slightly but overall, the number of coded encounters per coder hour increased from 22 to 41, still an average improvement of 86%.
We also found improvement in overall RAF score. RAF scores, or Risk Adjustment Factor scores, are used by CMS to estimate the cost of healthcare for Medicare Advantage beneficiaries. Higher risk scores represent patients with a greater than average disease burden. A higher RAF score means higher payments to the provider, thus more reimbursement to the HBMA member.
Learning Objectives:
Course participants will be able to:
- Learn about advancements in AI generated Computer Assisted Coding (CAC).
- Learn about the financial and operational benefits of CAC.
- Learn about what is required to successfully create a CAC program.
Speaker Bios:
Mr. Mark Anderson, CEO of AC Group, Inc. has been a healthcare executive for over 50 years. He has worked for and consulted in over 350 hospitals, and with over 500 physician practices related to daily operations and governance, long-range planning, facility planning, workflow redesign, technology design and implementation, as well as executive leadership over numerous financial and operations departments including Technology, purchasing of supplies and medical equipment, Human Resources, staffing and performance, quality management. He has also work with HBMA for over 20 years. Mr. Anderson has been a corporate executive with 5 separate IDN's and serves at the COO of 100 Hands CIN.
He have served as a CEO, COO, and CFO in smaller rural hospitals and since 2010, and helped 28 ACOs regarding moving from FFS to VBR. Mr. Anderson has created over 20 Care Coordination and Patient Engagement programs, has worked on numerous HIPAA cases and requirements, developed the 7-Stages of VBR functionality matrix and created over 500 RFPs for supplies, equipment and technology solutions and services.
John Gwin, HBMA Innovatiion committee member. Colleagues and clients would describe me as decisive with analytical decision-making skills, strong observational abilities, the leadership qualities needed to affect change, an insatiable thirst for growing my knowledge base, and a sense of humor only I could love...AKA I'm blunt arse who thinks he is usually right with a bit of Chili's flair. I'm a big culture junkie (just shy of a Tony Hsieuh tattoo) in that I genuinely believe that if my team doesn't love showing up to work, I'm not doing my job. I
love tech to the point that my Instagram ads are all applications (so sad).
Originally a pre-med student, I have a BS from DePaul University in Chicago, Illinois. I love footy (coaching only now and a rabid Liverpool supporter), my horse dog (doggo argentino) and I live with my lovely landlord in MPLS.
Actively accepting speaking/publication engagement opportunities on relevant topics. Open to new partnership synergies. Always happy to have a conversation ...never know where they may take you.
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