Why Human Validation Is Now Mission‑Critical (and How to Add It Overnight)
Artificial‑intelligence engines from Aidéo, Fathom, Nym, 3M, and others are transforming medical coding speed. Yet payers haven’t lowered the bar— they’ve raised it. Humana, Cigna, and multiple Medicare Advantage plans now insist on human coder attestation before an AI‑generated claim can drop. Meanwhile, the Department of Justice recently secured a $23 million False Claims Act settlement tied to unaudited AI up‑coding.
If AI delivers velocity, credentialed coders deliver the compliance safety net. Here’s how revenue‑cycle leaders are blending both without adding full‑time staff.
The Two‑Layer Safety Net
1. Real‑Time AI Coding Validation
After the AI assigns provisional codes, TCN’s board‑certified, specialty coders complete a rapid second‑pass review—chart‑by‑chart or by targeted sample.
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Scope – Emergency Medicine, Hospitalist, Anesthesia, Radiology, multi‑specialty clinics
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Checks – CPT, ICD‑10, modifiers, payer‑specific edits
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Outcome – Clean, attested claims that satisfy payer clauses and avoid downstream denials
2. Quarterly (or Ad Hoc) AI Coding Audits
Our compliance team analyzes historical AI‑coded encounters, benchmarks AI vs. human variance, and maps findings to DOJ/OIG and payer policies.
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Deliverable – Written report with variance analytics and up/under‑coding flags
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Bonus – Provider‑documentation insights that improve AI accuracy at the source
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Use Cases – Internal compliance committees, external auditors, board reporting
Compliance by the Numbers
$23 million – DOJ False Claims Act settlement (2025) tied to AI‑generated up‑coding that lacked human validation.
One certified coder review could have prevented it.
Why Leaders Add TCN Oversight
| Benefit | How It Helps |
|---|---|
| Peace of Mind | Meet payer mandates for human review—without hiring. |
| Audit‑Ready Evidence | Validation logs and variance analytics packaged for CMS or commercial payers. |
| Fast Activation | We log in via existing Epic, Cerner, or other EMR credentials—go‑live in hours. |
| Pay‑Per‑Chart Flexibility | No retainers, minimums, or long‑term contracts. |
Getting Started in Three Steps
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Book a 15‑Minute Compliance Call
Map your workflow and preload coder profiles (no cost, no obligation). -
Choose Your Coverage Model
Real‑time validation on every chart, a targeted sample, or quarterly audits—any specialty, any volume. -
Send the “GO” Signal
Email “GO”; TCN validates or audits within 48 hours.
AI will keep rewriting the speed limits of medical coding. With TCN’s human‑in‑the‑loop validation and audit services, you can accelerate confidently—no matter how strict the compliance terrain becomes.
The post AI Medical Coding Is Fast—Until Compliance Slows You Down appeared first on The Coding Network.
Source: The Coding Network
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