Adventist Health Enhances ICD-10 Coding Efficiency, Accuracy and Compliance with AI

Overview

Adventist Health is a nonprofit, integrated health system serving more than 80 communities on the West Coast and Hawaii with more than 400 care locations. Founded on Adventist heritage and values, the organization delivers care across hospitals, clinics, home care and hospice in both rural and urban communities.

Within that continuum, post-acute and home-based care introduces a familiar operational reality: high clinical documentation volume, constant regulatory pressure and the need to keep revenue cycle performance strong without slowing the work of clinicians and coders.

Overcoming the challenges of compliance and regulatory oversight

When Adventist Health enlisted McBee (part of Netsmart) for outsourced ICD-10 coding services, the expectations were the ones any large care-at-home organization recognizes immediately: quality that holds up under audit, speed that supports billing velocity and accuracy that protects compliance and reimbursement integrity. Thanks to a healthy four-year history of working with McBee, Adventist Health leadership was able to embark on the automation journey with confidence.

As the organization explored how AI (augmented intelligence) could be applied responsibly in ICD-10 coding, Adventist Health turned to AlphaCoding¹, the Netsmart augmented intelligence solution that helps drive coding accuracy, efficiency and compliance. Built on advanced AI models and guided by the Centers for Medicare & Medicaid Services (CMS) standards, AlphaCoding aims to deliver near real-time, evidence-based coding recommendations to help coders work smarter, mitigate risk and achieve high-quality coding at scale. With compliance and reimbursement on the line, CMS guidelines remain the source of truth for the AI model, rather than learning from previously coded charts, keeping accuracy at the forefront.

Quality was first and foremost. Gaining efficiencies and still maintaining compliance was paramount. Knowing [AlphaCoding] is built on the CMS coding guidelines was imperative.”

- Melissa Ward, Post Acute Care Executive, Adventist Health

Proven coding experience and established trust

The Adventist Health leadership team’s trust in the McBee OASIS and coding team was paramount to the success of the project. The transparent oversight and human-focused nature of the augmentation applied by AlphaCoding means that AI isn’t intended to replace coders but rather is intended to expand the capabilities and potential of human coders. The AI-generated suggestions provided by AlphaCoding are reviewed by coders with years of ICD-10 experience. This means an expert remains in the loop, resulting in a human-centered process.

That context matters because AI in revenue cycle and coding documentation can only earn trust through reproducibility, transparency and governance. In other words, the standard of excellence is not just faster coding. Far from it, it is consistent and supported coding that stands up to scrutiny while making day-to-day work easier for the people responsible for getting it right.

Our relationship with the McBee OASIS and Coding team alongside our quality team was paramount as we navigated AI-assisted coding together, and the outcome was exceptional. Measurable improvement in coder accuracy early on is amazing, considering how quickly we need to move.”

- Melissa Ward, Post Acute Care Executive, Adventist Health

Proving the potential of AI-assisted medical coding

Ward emphasized Adventist Health’s interest in cost savings without sacrificing quality as a major consideration in their pursuit of an AI-assisted medical coding solution. As operational costs increase alongside the widespread adoption of other unproven AI tools, maintaining efficiency, effectiveness and accuracy is an industry-wide concern.

For organizations considering AI-supported coding assistance, Adventist Health’s experience highlights the potential for improved confidence, stronger alignment to CMS guidelines and a clearer path to quality performance at scale.

Maintaining compliance while remaining cost-efficient is important. Addressing both of those things is difficult for any vendor. But that’s exactly the results we saw with AlphaCoding. We saw efficiency and consistency in the ICD-10 coding and great feedback from our team related to the integration.”

- Melissa Ward, Post Acute Care Executive, Adventist Health

Setting the standard for AI in medical coding

As AI becomes more common in revenue cycle and coding operations, post-acute leaders will keep demanding the same fundamentals they have always demanded, just with higher expectations: transparency into how work is performed, confidence in compliance safeguards and evidence that quality is improving, not becoming harder to validate.

The AlphaCoding experience with Adventist Health underscores what the “standard of excellence” can look like in practice: using AI as workflow augmentation, keeping accountability with trained coders and driving efficiency without sacrificing compliance.

Our team felt more assured of accuracy and compliance, and we happened to be in survey window for 13 locations. We didn’t receive [a single] finding on coding inaccuracy.”

- Melissa Ward, Post Acute Care Executive, Adventist Health

¹ Solution currently under development and testing with early adopters. Netsmart makes no guarantees when, or if, solution will be generally available.