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Case Study

A US REVENUE CYCLE MANAGEMENT OUTSOURCER LEVERAGES AUTONOMOUS CODING TO DRAMATICALLY REDUCE CODING SPEND, ACCELERATE TIME-TO-BILLING AND MAXIMIZE AUDIT-READINESS

About the client

A leading Revenue Cycle Management (RCM) Business Process Outsourcer (BPO), at the forefront of healthcare innovation with integrated multi-technology solutions. One of their clients chosen for piloting is hospital network of over 15 hospitals, and dozens of affiliate hospitals, health neighborhoods, health at home, urgent care centers and emergency rooms, with > 200 physician practices and clinics. They have over 400,000 ED visits/year and annual coding spend of roughly $2M (for ED only).

A leading technology-driven healthcare BPO, at the forefront of healthcare innovation looked to optimize Revenue Cycle anagement for one of its customers – a large healthcare network with over 15 hospitals and dozens of clinics and healthcare centers. 

30%

reduction in coding workload

8.3%

reduction in coding turnaround time

3%

less denials

The Challenge

As BPO healthcare providers are constantly looking for new ways to cut down operational costs, accelerate denial handling, reduce A/R time and maximize coding accuracy, the client was looking into several promising technologies in the field of medical coding and chose to run its pilot with nym.

“We were already using CAC (Computer Assisted Coding) solutions, but those did not made the impact we hoped for. We were looking to optimize our customers’ revenue cycle in a big way.”

says the BPO customer success manager, “We looked for a solution that meets several challenges: Human coders shortage, high cost, insufficient output, constantly changing coding guidelines and limited transparency for our customers.”

The last point was a key driver in their decision as nym has the ability to explain its rationale behind every coding choice. 

How nym helped

As part of an evaluation pilot nym was fed 100,000 charts and results were compared against human coder results. 

“Having a coding solution that can justify its rationale is imperative.” Says VP of the Business Process Outsource center, “We’ve never seen anything like it – the system even knows when it can’t be 100% sure and flags a chart for human coding. Nym’s solution successfully coded 1789 charts/hour vs. Average human coder who completes 12 charts/hr). 

We haven’t seen levels of speed and accuracy this high – up until now. For us, it is a  total game changer – we are now able to provide our clients with maximum visibility, transparency and audit-readiness.”

Results

In total time of just 57 hours nym successfully coded more than 100,000 charts, relieving the coding workforce of 30% of the workload – this represents a savings of 14571 person hours and 14.3% reduction in coding turnaround time with additional benefits such as XX% increase in coding quality and 3% reduction in denials.

“Nym provided us instant value in terms of cost reduction, workload reduction, improving revenue cycle management” Says the Head of Revenue Cycle Management,”and the best part is that it provides audit trail for every chart, so you’re covered in case of an audit or dispute.”

Future plans

Productivity improvement across the board is significant – “An average coder spends seven minutes on a chart while nym figures it out in less than two seconds and with better accuracy. We’ve saved that provider over $0.5M just in the pilot” Says the network’s CEO, “and with the projected development of the technology, in less than ___ years we’ll be able to cut their coding spend in 80%!”

Amihai Neiderman, Nym’s CEO, confirms: “We set out to transform revenue cycle management with direct-to-billing autonomous coding” Says Amihai, “Currently we can reduce denials and operational expenses up to 40%, but Nym is constantly evolving and we can safely assume this percentage will grow up to 80% in the foreseeable future.”

Results

“The immediate improvement in the bottom line is dramatic, the cut in costs is nothing short of incredible. We’ve managed to cut 30% of our coding overhead with direct-to-billing, lightning-fast auto coding AND scale up our coding efforts. While our human coders can’t code as quickly as Nym, they are now free to focus on more complex charts. This alone has significantly improved our coding accuracy and quality, resulting in substantial increase in revenue.”

Head of revenue cycle management
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