Beyond Clean Claims: How Autonomous Coding Shrinks the Denial Gap

Denials consistently rank among the top 3 pain points for revenue cycle leaders. As payers use more AI tools, increase scrutiny on claims, and health systems remain staff capacity-constrained, even well-run health systems face a widening denial gap.

According to a 2024 survey of hospitals and health systems, nearly 15% of medical claims submitted to private payers are initially denied. Health systems then spend billions every year fighting these denials, which cost an average of $57 per claim to adjudicate with payers. 

While 57% of denials eventually get overturned and paid, providers lose time and money due to the costly review process.

Three forces are driving the denial gap: 

• Too many denials at the source
• Not enough bandwidth to appeal many of the denials 
• Rising costs to rework or challenge denials

Clean claims reduce denial rates, improve cash flow, and reduce the need for rework. But clean claims alone aren’t enough. Health systems also need the capacity, documentation consistency, and cross-functional workflow support to keep pace with payer demands. Without all three, even well-run organizations fall behind.

That’s where autonomous coding comes in. Yes, it produces cleaner first pass claims. But what truly shrinks the denial gap is everything that becomes possible beyond clean claims.

Accurate First-Pass Coding Reduces Denials at the Source

Autonomous coding improves first-pass accuracy immediately, providing health systems with a revenue lift almost right away due to fewer errors, fewer back-and-forth clarifications, and fewer preventable denials.

In practice, health systems using Arintra’s autonomous coding solution report over 5% revenue uplift, with much of that tied to accurate, compliant, and well-documented claims. But accurate first-pass coding represents just one part of the story. 

The gains also come from how autonomous coding reshapes the rest of the revenue cycle, particularly the workflow around denials.

The “More” That Actually Bridges the Denial Gap

1. Faster, Stronger Denial Appeals - Without Waiting on Coders

A surprising amount of preventable revenue loss happens simply because billing teams don’t have the time or documentation they need to appeal denials. They wait on coders. Coders struggle to keep up with chart volume and can’t always dig into payer questions quickly enough. 

By the time coders can work with the billing team, the denial window has passed, or the dollar value doesn’t justify the effort.

Autonomous coding breaks this bottleneck.

Because Arintra provides clear, shareable logic for every coding decision, billing teams can address most denials on their own without waiting for coder input. 

As one health system leader explained, "For charts coded by Arintra, our follow-up team no longer sends everything back to coding when there is a denial. They send it right back to the payer with the coding logic for the appeal."

This allows billing teams to challenge more denials faster, and even tackle smaller-dollar denials that would previously have gone unaddressed.

2. Coders Have the Bandwidth to Prevent Denials, Not Just React to Them

When autonomous coding handles high-volume encounters, coders regain the capacity to do work that reduces denials over time.

In outpatient care, coders typically only touch about 30% of charts because the sheer volume of patient charts exceeds coder’s bandwidth. They stay stuck doing rote work like adding modifiers, abstracting data, document verification, etc. The strategic work never happens because the high-volume operational work doesn’t stop.

Once Arintra takes over coding the bulk of charts, coders finally have the time to: 

• Work on denial analysis projects
• Proactively identify coding and documentation issues 
• Address gaps before they become systemic problems
• Reinforce correct coding practices with providers
• Drive improvements that lead to sustained denial reductions over time

This shift often gets overlooked in conversations about the denial gap. Yet it’s where the sustainable gains happen. Denials drop when coders move from routine coding to the strategic work that strengthens the entire revenue cycle.

3. Compliance Stays Current as Guidelines Change

Transitions in coding guidelines often trigger spikes in denials, especially when teams are still learning new rules or haven't fully updated templates and macros. New coding guidelines introduced each January commonly cause increased denials.

Even high-performing coding teams struggle during these transitions. Updating templates, retraining staff, and adjusting workflows all take time, and denials accumulate in the meantime.

Arintra addresses that risk by updating the coding engine proactively with each guideline change so that claims remain compliant even during periods of transition. Health systems have seen this firsthand. After Arintra standardizes documentation templates and coding rules, auditors validate accuracy across the board, not just chart by chart. 

As one health system leader put it: "With Arintra, every chart is coded accurately, with clear explanations." That consistency creates a stable foundation for compliance, even as chart volumes grow and requirements evolve.

Stronger Clinical Documentation Prevents Denials Before They Start

Accurate coding can only capture what’s documented in the first place. When there are gaps in documentation, they become gaps in revenue. 

The American Hospital Association identifies documentation as both a “clinical and strategic asset,” recommending that health systems prioritize it and use CDI tools to prevent denials before submission. Most autonomous coding solutions don’t address this. Arintra does. 

Arintra delivers precise, actionable feedback tailored to each provider's specific documentation patterns. Rather than generic guidance that providers struggle to implement, Arintra pinpoints specific gaps at the individual provider level, such as: 

• Missing medication details
• Incomplete visit complexity
• Undocumented procedures 

This specificity makes it easier for providers to adjust their documentation habits in ways that stick.

Better documentation captures the full clinical picture the first time so that claims reflect the services actually provided. Back-and-forth between providers and revenue cycle teams drops. While denials tied to documentation gaps, one of the most persistent sources of revenue leakage, start to disappear.

The Compounding Effect: Fewer Denials Now, Fewer Denials Later

Along with claim accuracy, Arintra’s autonomous coding solution improves the transparency, speed, documentation quality, and coordination around denials. A result of this is that health systems see multiplier effects: 

• Cleaner claims that reduce denials at the source
• Instant appeal readiness to recover revenue that would otherwise slip away, 
• Proactive coder oversight that prevents future issues
• Stronger documentation support for every claim
• Continual alignment with guidelines for compliance

The denial gap reflects the constraints on resources, documentation variability, and fragmented workflows that many health systems are struggling with. Arinta’s accurate, compliant, explainable coding immediately narrows that gap and shrinks it meaningfully over time. It's the difference between chasing denials and getting ahead of them.

Ready to stop chasing denials? Book a demo.

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