AI Medical Coding Market Map
This is part of Elion’s weekly market map series where we break down critical vendor categories and the key players in them. For more, become a member and sign up for our email here.
While the end-to-end revenue cycle is riddled with inefficiencies, perhaps no aspect is more maligned than medical coding.
It’s expensive, inefficient, and error-prone, not to mention challenging to staff with high team member turnover.
Automation for the win
Over the last five years, fully autonomous medical coding solutions have emerged, promising to address many of these pain points.
The idea is simple: take the medical chart, fully code it leveraging several types of AI (NLP, machine learning, and deep learning), and send it directly to billing without human involvement.
For provider organizations and health systems with high coding volumes, the potential impact is massive.
Good and getting better
Initially, autonomous coding was applied to relatively straightforward encounters in high-volume specialties, such as radiology and pathology.
Recently, coverage has expanded to more complex areas, including emergency medicine and a wide range of outpatient encounters. However, given their intricacy, some types of medical coding, like inpatient facility coding, remain out of scope for all vendors today.
Phone a friend
Evaluating solutions in this space can be tricky. Given the significant implementation effort involved, up-front product performance comparisons are difficult, making vendor references particularly important.
Based on conversations with customers and vendors in the space, key criteria to evaluate in a potential AI medical coding solution include:
Breadth of coverage across specialties and code types
Coding accuracy and automation rates (but be sure to define automation clearly!)
Support quality and responsiveness
Coding auditability and transparency
Pricing (obviously)
Surveying the landscape
Three established vendors (CodaMetrix, Fathom, and Nym) have garnered the majority of funding and large contracts thus far. However, a growing number of upstarts are hot on their heels, including Arintra, Maverick Medical, Phare Health, RapidClaims, and Synaptec Health.
We’re also watching whether vendors in adjacent categories, such as AI Ambient Scribes and AI Clinical Documentation Improvement, begin to develop more robust medical coding solutions and compete in this space.