Optimizing CPT/ICD Coding and Revenue Cycle for Innovative Mental Health Treatments
Tidemark Therapy, one of the fastest-growing mental health providers in the USA, was facing significant challenges with their revenue cycle management, particularly around complex CPT and ICD-10 coding for innovative treatments like Spravato (esketamine) and Transcranial Magnetic Stimulation (TMS). These cutting-edge treatments required specialized coding knowledge that was difficult to maintain across their expanding network of clinics.
Key challenges included:
Initial claim denial rate
Annual revenue leakage
Hours per week on coding
Klyrone implemented a comprehensive AI solution combining our Clinical Diagnosis Assistant and RCM Optimization Suite, specifically tailored for mental health services and specialized treatments.
We developed a specialized AI model trained on mental health documentation, treatment protocols, and coding guidelines specific to Spravato and TMS treatments. This engine could identify the subtle clinical indicators that justify specific procedure and diagnosis codes.
Our system analyzed clinical notes in real-time to identify missing elements required for proper coding and reimbursement of specialized treatments, prompting providers to include necessary documentation before claim submission.
We incorporated payer-specific requirements for mental health treatments, especially for newer therapies like Spravato and TMS, ensuring claims met the exact documentation and coding standards of each insurance provider.
Our agentic AI system performed autonomous pre-submission claim reviews, identifying potential issues and suggesting corrections based on historical denial patterns and current payer guidelines.
We conducted a comprehensive analysis of Tidemark's existing coding practices, denial patterns, and documentation workflows for Spravato and TMS treatments.
We trained our AI models using anonymized clinical documentation and claims data specific to mental health treatments, with special focus on Spravato and TMS procedures.
Our solution was integrated with Tidemark's existing EHR and practice management systems, ensuring seamless workflow incorporation without disrupting clinical operations.
We launched a 60-day pilot program at three Tidemark locations, allowing for real-time adjustments and optimization before full-scale deployment.
Following successful pilot results, we rolled out the solution to all Tidemark locations with ongoing monitoring and optimization.
Reduction in coding-related denials for Spravato and TMS treatments
Additional annual revenue captured through improved coding accuracy
Reduction in time spent on administrative coding tasks
Increase in approved Spravato treatment authorizations
Growth in TMS treatment volume due to streamlined processes
Return on investment within the first year
Denial rates for Spravato and TMS claims before and after Klyrone implementation
"Klyrone's AI solution has transformed our revenue cycle for specialized mental health treatments. The system's ability to identify the nuanced documentation requirements for Spravato and TMS has dramatically reduced our denial rates and allowed our clinicians to focus on patient care rather than coding complexities. The ROI has been remarkable, but even more valuable is the reduced administrative burden on our clinical team."
AI systems require deep domain expertise in specialized treatments like Spravato and TMS to effectively optimize coding and documentation.
The rapidly evolving landscape of mental health treatment requires AI systems that continuously update based on new coding guidelines and payer policies.
Successful implementation depends on seamless integration with clinical workflows to ensure adoption without adding administrative burden.
Learn how Klyrone can help you improve coding accuracy, reduce denials, and maximize revenue for specialized treatments.
Klyrone