Why AI Medical Coding Isn’t a Replacement for Professional Coders

While AI medical coding has demonstrated that it can assist professional coders in their jobs, it shouldn’t be used to substitute their work. Here are the reasons why, and our recommendations if your team needs help.

1. Data Quality and Standardization

AI systems thrive on high-quality, standardized data. In the context of medical coding, this means having patient records that are accurate, complete, and consistently formatted. Yet anyone in healthcare could tell you that this is often not the case.

For example, if a patient’s medical history is not fully recorded, or if the correct terminology is not used across an entire practice, AI medical coding may misinterpret which CPT codes are appropriate for billing. As AAPC notes, certified human coders are trained to navigate these complexities because they understand that a good portion of medical documentation can have different meanings based on context.

2. Integration With Existing Systems

The healthcare industry relies on a variety of systems that handle electronic medical records (EMRs), each with its own unique architecture and data management protocols. Integrating AI with them can be both daunting and require significant customization so that normal workflows for patient documentation and billing are not interrupted. 

This complexity can actually make AI medical coding less efficient than the manual processes performed by human coders who are already familiar with these systems.

3. Regulatory Compliance

Healthcare providers and networks are already aware of the legal consequences they face when patient data does not meet industry compliance for ICD-10 and HIPAA. Adding an AI system to that mix creates an even greater potential for errors in billing and patient care when systems are not kept up to date with the latest coding versions. 

Certified medical coders are more reliable and aware of these regulations, and make sure to look for coding changes when they’re announced.

4. Training and Adaptation

AI systems require extensive training on large datasets to achieve accuracy in medical coding. As we already mentioned, these systems need to be updated regularly to keep pace with changes in coding standards and medical practices. Because this can be resource-intensive, it can also be difficult for smaller healthcare providers to implement and maintain. 

Conversely, human coders can quickly adapt with ongoing education and experience, offering a more flexible and responsive solution.

5. User Acceptance and Trust

For AI medical coding to be truly effective, healthcare professionals must be able to trust the system. As of this blog post, there is still sufficient skepticism about the accuracy and reliability of AI-driven coding. 

Medical professionals may be hesitant to rely entirely on it, for fear of errors with billing and compliance. Building this trust will take time and refinement; and, in many cases, human coders will still be needed to review and validate AI’s work to ensure its accuracy.

6. Cost and Resource Allocation

Implementing AI solutions can be expensive, requiring significant investments in technology, training, and maintenance. Smaller healthcare providers may find it challenging to justify these costs, particularly without a clear return on their investments.

Professional medical coders provide a more straightforward and proven solution — especially when you outsource them.

7. Security and Privacy Concerns

AI systems must be designed with robust security measures to protect sensitive patient data. Any breach or failure to keep this information secure could lead to legal action and the loss of patient trust. 

While not immune to errors, human coders can be held accountable more easily, and are often better equipped to manage data in a secure manner.

AI Medical Coding vs. Outsourced Coding

While it’s true that AI medical coding can be a powerful tool, the nuances and complexities of a practice’s data still require the judgment and experience of human professionals. 

However, we understand if it may be too difficult to hire, train, and compensate enough coders within your organization to meet your current needs and budget. That’s why we highly encourage you to outsource these services to our team. HCRS has a pool of certified, professional coders who are available to help with any project, and can scale as the needs of your organization change.

Contact us today to learn more about a customized program!