HIM 510 Module 8 Trends Short Paper Example

Four Trends Reshaping Revenue Work: Transparency, Prior Authorization, AI Coding and Remote Teams at Laurel Point

[Student Name]

Southern New Hampshire University

HIM 510: HIM Applications and Systems

Module Eight Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Four Trends Reshaping Revenue Work: Transparency, Prior Authorization, AI Coding and Remote Teams at Laurel Point

Administrative complexity is expensive. Comparing two neighboring systems, Himmelstein et al. (2020) put American administrative spending at roughly double Canada's share of total health costs, with billing and insurance work a leading reason. Several current trends aim to reduce that complexity or change who bears it, and each lands partly on health information management. This paper examines four of them from Laurel Point Regional Medical Center's point of view and recommends a response to each.

Trend 1: Price Transparency and Good Faith Estimates

Since 2021, federal rules have required hospitals to post machine-readable files of their standard charges and negotiated rates and a consumer-friendly list of shoppable services. Gondi et al. (2021) examined early compliance and found that many hospitals had not fully met the requirements in the rule's first months, and enforcement has since tightened with penalties that scale with hospital size. Under the No Surprises Act, patients without insurance, or choosing not to use it, are also owed a written estimate before scheduled care. For Laurel Point, these rules make charge data and coding a public matter: estimates depend on the codes likely to be billed, so health information and revenue integrity staff must help keep the charge master and estimate logic accurate. Recommendation: assign revenue integrity to reconcile the posted files with the charge master quarterly and audit a sample of good faith estimates against final bills.

Trend 2: Prior Authorization Reform

Authorization errors caused 31% of Laurel Point's denials. A federal rule finalized in 2024 gives Medicare Advantage, Medicaid and certain other plans, starting in 2026, 72 hours to answer urgent prior authorization requests and seven calendar days for routine ones, to give a specific reason for denials and, beginning in 2027, to support prior authorization through standardized electronic interfaces. The rule does not cover all commercial plans, and it will not remove authorization requirements, but it should shorten waits and allow authorization to be requested from within the record. Recommendation: plan now with the record vendor for the electronic authorization interface, and in the meantime measure payer response times so the hospital can document compliance problems once the deadlines apply.

Trend 3: AI Coding Tools

Vendors now offer tools that suggest or assign codes using natural language processing and large language models. The evidence urges caution. Soroush et al. (2024) tested several large language models on generating medical codes from code descriptions and found that even the best model produced exact matches for fewer than half of diagnosis and procedure codes, often returning codes that were close but wrong. Specialized tools built for coding and tied to documentation perform better than general models, but no tool removes the need for coder review. For Laurel Point, an AI assistant could raise productivity on simple outpatient cases while posing compliance risk if suggestions are accepted without review. Recommendation: pilot an assistant only for outpatient radiology and laboratory cases, require coder review of every suggestion, log acceptances and compare accuracy with human-only coding in quarterly audits before any expansion.

Trend 4: Remote Coding as a Permanent Model

Most of Laurel Point's coders now work from home, as in many hospitals since 2020. Remote work widens the hiring pool and can improve productivity. In the well-known travel agency trial by Bloom et al. (2015), staff randomly assigned to home work outperformed their office colleagues and left the company far less often, although a number later asked to come back for company and conversation. Coding differs from call center work, but the lesson that remote arrangements can work well when managed deliberately applies. Remote coding also raises security questions, such as home network protection, screen privacy and printing. Recommendation: keep remote coding, require hospital-managed devices with encrypted connections and no local printing, hold monthly virtual team sessions and include remote coders in career ladders and education.

How the Trends Connect

The four trends share a direction: more data exchanged electronically, more of the hospital's financial logic exposed to patients and regulators and more automation in routine work. Each increases the importance of accurate codes and complete documentation, because errors are now visible to patients through estimates, to payers through electronic authorization and to auditors through AI acceptance logs. Health information management's traditional strengths, accuracy, compliance and governance, become more valuable, not less.

What the Trends Mean for Staffing and Skills

The trends also change what health information staff need to know. Estimate audits require staff who can read a charge master and follow a service from order to bill. Electronic prior authorization requires analysts who understand interface standards well enough to test what the payer receives. AI coding requires auditors who can spot plausible but wrong codes and understand how a tool reaches its suggestions. Remote teams require supervisors who manage by measures and connection rather than by presence. Laurel Point's education budget should shift accordingly, with coders offered training in auditing and data analysis so that automation adds to their roles instead of replacing them.

Summary of Recommendations

Table 1 summarizes the responses.

Table 1. Trends and Recommended Responses

Note. Prepared by the author for the revenue cycle committee.

Conclusion

Transparency rules, prior authorization reform, AI coding and remote work are changing revenue operations quickly. None of them can be ignored, and none should be adopted uncritically or all at once. Laurel Point should meet each with a measured response: accurate public data, preparation for electronic authorization, cautious and audited AI use and a managed remote workforce. In each case, the health information team's commitment to accurate and compliant data is the hospital's best protection.

References

Bloom, N., Liang, J., Roberts, J., & Ying, Z. J. (2015). Does working from home work? Evidence from a Chinese experiment. Quarterly Journal of Economics, 130(1), 165-218. https://doi.org/10.1093/qje/qju032

Gondi, S., Beckman, A. L., Ofoje, A. A., Hinkes, P., & McWilliams, J. M. (2021). Early hospital compliance with federal requirements for price transparency. JAMA Internal Medicine, 181(10), 1396-1397. https://doi.org/10.1001/jamainternmed.2021.2531

Himmelstein, D. U., Campbell, T., & Woolhandler, S. (2020). Health care administrative costs in the United States and Canada, 2017. Annals of Internal Medicine, 172(2), 134-142. https://doi.org/10.7326/M19-2818

Soroush, A., Glicksberg, B. S., Zimlichman, E., Barash, Y., Freeman, R., Charney, A. W., Nadkarni, G. N., & Klang, E. (2024). Large language models are poor medical coders: Benchmarking of medical code querying. NEJM AI, 1(5). https://doi.org/10.1056/AIdbp2300040