Where should human coders remain in the loop and why?
Human coders should remain in the loop for complex, ambiguous, or high-risk coding scenarios, such as interpreting nuanced clinical documentation, handling rare procedures, and applying payer-specific rules. This is necessary because AI cannot fully replace human judgment, contextual understanding, or ethical oversight. Their involvement safeguards accuracy, prevents costly denials, and ensures coding decisions align with […]
Which coding tasks can AI safely automate end-to-end today?
AI can safely automate end-to-end coding tasks such as charge capture from clinical documentation, ICD-10 and CPT code assignment, eligibility and payer rule validation, claim creation, and compliance checks. These tasks are well-suited for automation because they rely on structured data, standardized code sets, and repeatable workflows, allowing AI to reduce errors, accelerate claim submission, […]
What is a medical coding AI agent, and how is it different from rules-based auto-coding?
A medical coding AI agent is a digital assistant that uses machine learning and natural language processing to interpret clinical documentation and assign accurate codes. Unlike rules-based auto-coding tools that rely on static logic and predefined keyword matches, it learns from coding outcomes over time. The key difference is that AI agents adapt dynamically to […]