CON503: Applying AI for Coding Compliance and Operational Efficiency

Eligible for: ACMPE: 1 | ACHE: 1 | CEU: 1 | CME(AAPC*): 1 | CPE: 1.2 | PDC: 1
Traditional | Intermediate | Application
* This session is included in the 2025 MGMA Summit education program.

Traditional E/M coding and leveling of patient encounters is error-prone, time-consuming and stressful. In our experience, more than one-third of encounters for E/M services are inaccurately coded or insufficiently documented. According to CMS data, E/M codes were responsible for more than $1 billion in improper payments in FY 2021. Errors lead to claims denials and delayed payments; each denied claim costs nearly $120 on average to rework, and 65% of denied claims are never reworked at all. Fear of costly and time-consuming payer audits often leads providers to code defensively, and insufficient documentation often leaves providers unable to receive full reimbursement for services provided. In both cases, providers leave billable revenue on the table at a time when they are already being squeezed by rising costs and shrinking reimbursements. Meanwhile, providers frequently spend up to two hours each day on documentation — a burden cited by physicians as a leading contributor to burnout. AI shows great promise in helping providers improve coding accuracy and compliance; in reducing the amount of time spent on E/M leveling; and in capturing reimbursement for more of the services they provide. Even so, many physicians have not yet embraced AI-powered solutions, and many more lack awareness in how to assess their needs and evaluate potential solutions. This session will help bridge that knowledge gap.