OVERLAND PARK, Kansas—Netsmart, a provider of health care IT for post-acute and human services providers, announced the launch of AlphaCoding, an augmented intelligence (AI) solution designed to help transform clinical coding by driving accuracy, efficiency and compliance.
Built on AI models and guided by Centers for Medicare & Medicaid Services (CMS) standards, Netsmart said AlphaCoding delivers near real-time, evidence-based coding recommendations to support health care professionals across care settings.
The AlphaCoding solution aims to assist health care organizations by surfacing relevant information to support confident and informed coding decisions. Within the AI-driven solution is Benny, an AI coding assistant. Benny functions as a supportive tool for an organization’s coding staff by offering suggestions for coders to react to, ultimately working to reduce the manual effort often associated with medical coding. Benny’s coding assistant skill set includes record extraction, clinical concept recognition, code determination, coder verification and final validation/electronic health record (EHR) updates.
Key features of AlphaCoding and Benny include:
- ICD-10 Suggest: Rapidly analyzes clinical documentation to recommend precise diagnosis and procedure codes.
- Computer-Assisted Coding: Supports coders by automating code suggestions based on in-depth clinical review.
- Quality Reporting: Assists with aligning coding with CMS quality metrics, supporting compliance efforts.
- Productivity Enhancement: Streamlines coding workflows to help reduce time spent on documentation and review.
The computer-assisted coding tool reviews clinical records, which are often up to more than 50 pages per day, identifying key patient details and helping to guide coders in achieving accurate coding outcomes. Each recommendation includes source citations and clear explanations, empowering clinical coders to make confident, compliant decisions.
“AlphaCoding has already made a measurable impact on our coding accuracy and efficiency,” said Melissa Ward, post-acute care executive, Adventist Health. “It’s intuitive and enhances our clinicians’ expertise by surfacing the appropriate details and helping align with CMS guidelines, allowing us to code faster and more confidently than ever before.”
Initially applied to ICD-10 coding, AlphaCoding will extend into palliative and behavioral health inpatient coding, with future plans to support CPT and HCPCS coding across additional service lines.
“AlphaCoding is the next step in expanding our Alpha platform for revenue cycle management innovations,” said Erica Gregory, senior vice president and general manager of revenue cycle management, Netsmart. “Our goal with AlphaCoding and Benny the coding assistant is to empower health care professionals with a clinical augmentation tool that enhances accuracy and efficiencies in medical coding. By providing logical explanations aligned with CMS guidelines, citation links and the ability to review underlying documentation, AlphaCoding supports coders in making informed decisions quickly, ultimately improving compliance and revenue cycle management.”
Within the Alpha platform, AlphaCollector utilizes AI and robotic process automation (RPA), which aims to help collection staff work the right claims at the right time, ultimately looking to accelerate cash. A key component of AlphaCollector is Benny, the digital collections sidekick. Similar to Benny the coding assistant, Benny the digital collections sidekick functions as part of the team, providing recommendations to help guide next steps in the collections process.