Kelly Pierson, director of coding and clinical documentation integrity at Mercyhealth
Photo: Kelly Pierson
Mercyhealth is a health system with 200 care locations in Wisconsin and Illinois. Not too long ago, one of its biggest challenges was keeping up with the volume of chart work while still ensuring staff were fully capturing the care delivered.
THE CHALLENGE
The organization was growing quickly, and chart volumes had increased to more than 130,000 per month. However, coding resources had not scaled at the same pace. As a result, a portion of encounters moved forward without full coding review, which created gaps in consistency and opportunities to more accurately reflect the care provided.
"At the same time, our coding team supported a range of priorities, denials, audits, provider questions and revenue opportunities for new services," recalled Kelly Pierson, director of coding and clinical documentation integrity at Mercyhealth.
"This often meant shifting focus between urgent needs, making it difficult to stay ahead of the work or operate as proactively as we would have liked. It became clear the demand for the team was continuing to grow and it wasn't something we could sustainably manage with traditional approaches alone.
"Ultimately, we knew we needed a more scalable way to support our growth – one that would allow the team to spend less time chasing volume and more time focusing on accuracy and insights and strengthening overall performance," she added.
PROPOSAL
The concept from vendor Arintra, Pierson explained, was to take on the high-volume, routine coding work that was putting the most strain on the Mercyhealth team so those staff members could focus on more complex and higher-value activities while still maintaining accuracy and compliance. The system was designed to fit directly into the provider organization's existing Epic EHR and coding workflows so it would not require staff to learn a new system or significantly change how they worked day to day.
"Before implementation, we also recognized that many of our processes had developed over time without a consistent standard," she said. "Part of the effort included aligning templates and creating clearer, more consistent coding policies across encounter types. Arintra worked closely with our team to understand our workflows and support this standardization, while also introducing a coding assist option to ensure that more complex or uncertain cases could still be reviewed by a coder when needed.
"We took a measured approach to adoption, starting with a small group of providers in family and internal medicine to validate the model," she continued. "This allowed us to assess performance and build confidence before expanding more broadly across specialties and larger provider base."
MEETING THE CHALLENGE
Mercyhealth embedded the autonomous coding system directly into its Epic EHR and existing revenue cycle workflows, allowing staff to address coding inefficiencies without disrupting day-to-day operations. Since it operates within the workflows, there was minimal change required in how work gets done. After an initial pilot, staff expanded use across multiple specialties and providers, building on the coding logic established early in the process.
"The platform now supports high-volume, routine coding with a strong level of consistency, helping improve the quality of claims on initial submission and reducing downstream rework," Pierson noted. "It also provides clear, traceable logic tied to the clinical documentation for each coding decision, which has made it easier to support audits and manage denials. Our team can leverage this information more efficiently, including submitting appeals with the appropriate rationale without adding unnecessary steps.
"As a result, our coding team is spending more time on complex cases and higher value work where their expertise is most needed," she added. "They are also able to focus more on areas like denial trends, revenue integrity and provider education."
RESULTS
Since implementing the system, Mercyhealth has seen measurable improvements in both financial performance and operational efficiency, largely driven by more consistent, complete coding, Pierson reported.
"We have seen a 5.1% increase in revenue, supported by more accurate capture of the care being delivered," she said. "By automating a large portion of routine coding with a high level of consistency, we were able to reduce variability and improve overall coding integrity.
"In addition, having better visibility into provider documentation patterns, and how those directly impact coding and reimbursement, has allowed us to focus education efforts where they matter most," she continued. "Together, these changes have helped strengthen overall reimbursement in a sustainable way."
The organization also has reduced pre-A/R days by approximately 50%, which has significantly improved the speed of the revenue cycle, she added.
"More complete and accurate claims on the front end have led to fewer downstream issues, including denials," she explained. "When denials do occur, our team now has clearer information to support follow-up and appeals, allowing them to work more efficiently without needing to route cases back through multiple touchpoints. This has not only improved turnaround times but also allowed us to address smaller-dollar denials that may not have been prioritized in the past.
"Today, the vendor's system supports more than 50,000 charts per month, with many routine cases moving through without manual intervention," she continued. "This has allowed our coding team to shift their focus to more complex and higher value work, including denial trends, revenue integrity initiatives, provider education and compliance efforts."
As a result, staff have been able to expand overall capacity without adding FTEs, which also is creating more meaningful opportunities for coders to grow and develop in their roles, she added.
"Overall, this has gone beyond improving coding accuracy – it has strengthened how we operate across the entire revenue cycle, from documentation through denial management," she concluded.
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