Use Case Healthcare
Billing
& Clinical Coding
DRG codes automatically suggested, revenue optimised through complete secondary diagnoses, audit-proof documentation. Fewer revenue losses, less re-coding.
Why Billing & Coding Is a Lever
Every missed secondary diagnosis costs real money
In the DRG system, coding determines revenue. Primary diagnosis, secondary diagnoses, procedures: every code influences the case group and therefore the reimbursement. Studies show that 15-25% of all cases are under-coded. Not deliberately, but because clinicians code under time pressure and miss secondary diagnoses.
In practice, the clinician codes on the day of discharge, often under time pressure, often incompletely. A clinical coder reviews and supplements, based on what is in the patient record. Where the documentation is incomplete, codes are missed. Every missed CC/MCC-relevant code can reduce revenue by £500-3,000 per case.
On top of this come payer audits: 12-15% of all cases are reviewed. If the documentation does not support the coding, revenue is clawed back. Hospitals lose on average 2-4% of their DRG revenue through under-coding and audit deductions. For a hospital with £80M in revenue, that is £1.6-3.2M per year.
How the Process Changes
Before / After
Proportion of under-coded cases (missing revenue-relevant secondary diagnoses)
The Solution in Detail
How We Automate Billing & Coding
01
Continuous Documentation Analysis
The AI agent reads the clinical documentation throughout the admission: discharge letters, surgical reports, findings, lab results, medications. Revenue-relevant information is identified and presented as a coding suggestion, with source reference.
NLP-based analysis of clinical text. ICD-10 and procedure code mapping. Identification of CC/MCC-relevant secondary diagnoses. Automatic linking of finding to diagnosis to code. Source reference for audit.
02
Automatic Coding Suggestions
For every patient: an automated coding suggestion with primary and secondary diagnoses, procedures and CC/MCC relevance. The clinical coder reviews the suggestion, rather than reading a blank record from scratch.
03
Audit-Proof Documentation
Every suggested code is linked to its source in the patient record. At payer audit: immediately demonstrable where the code comes from. No painstaking retrospective record searches.
Automatic mapping: code to finding/document. PDF export for audit response. Historical audit results as a learning basis. Early warning on audit-prone constellations.
04
Revenue Dashboard & Controlling
Dashboard: CMI (Case Mix Index), revenue development, coding quality, audit rate, length of stay vs. DRG benchmark. Drill-down to individual case. Comparison: departments, periods, coders.
Power BI dashboard. KPIs: CMI, revenue per case, under-coding rate, audit success rate, re-coding rate. Benchmarking against national reference data.
Results
What Coding Automation Typically Delivers
+12%
Revenue
optimisation
−60%
Less
re-coding
−45%
clawbacks
8 Min
(previously 30 min)
The greatest lever: complete secondary diagnoses. A single CC/MCC-relevant code missed on 500 cases per year can represent £250,000-1,500,000 in revenue difference.
Finance automation in hospital at Asklepios
One of Germany's largest private hospital groups faced growing workloads, increasing staff shortages, and a high volume of repetitive, error-prone processes across finance and administration. Manual data entry in SAP, duplicate documents, missed early-payment discounts, and labour-intensive accounts payable workflows were consuming capacity that was urgently needed for patient care.
Since 2018, Asklepios has been building an enterprise-wide automation programme under Sandra Schlösser (Head of RPA), with Lunatec as its strategic automation partner. Over 120 processes have been automated — from order confirmations and vendor checks to AI-assisted document processing with OCR. Lunatec supported development, scaling, and managed operations of the entire automation platform as a UiPath Diamond Partner.
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Related Use Cases
Clinical Documentation
Better documentation = better coding. The foundation for complete codes
Patient Admission
Admission data as the basis for coding. Diagnoses correctly captured from day one.
Clinical Data Extraction
Structured data from unstructured clinical documents is extracted automatically.
Ready?
What is your under-coding rate for DRG-relevant secondary diagnoses?
Let us look in 30 minutes at how AI-assisted coding can increase your revenue while making payer audits more defensible.
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