AI in Healthcare: Your Health Hits 95% Automation with Fathom's AI Coder

SAN FRANCISCO, CA – March 19, 2026 – In a move that signals a significant shift in healthcare administration, senior-focused care provider Your Health has achieved a staggering 95.5% automation rate in its medical coding process by deploying an artificial intelligence platform from Fathom. The implementation not only streamlined operations but also boosted coding accuracy to 98.3% and unlocked millions in previously uncaptured revenue, highlighting the transformative power of AI in one of healthcare's most complex financial environments.

Since implementing the touchless solution in October 2025, Your Health, which serves complex senior populations across South Carolina and Georgia, has seen dramatic results. The organization reported a 0.66 year-over-year increase in its average risk adjustment factor (RAF) scores—a critical metric in value-based care—and a revenue benchmarking increase of over $35 million, attributed to more complete and specific diagnosis coding.

"Your Health's results demonstrate the power of autonomous coding when applied to one of healthcare's most complex coding environments: senior-focused, multi-site, value-based care," said Andrew Lockhart, CEO of Fathom. He noted that achieving this level of automation at "better-than-human accuracy" validates both the technology's capabilities and Your Health's strategic vision for AI.

Unlocking Value in a Complex System

The financial implications of precise medical coding are profound, particularly for organizations like Your Health that operate heavily within value-based care models. In these systems, reimbursement is tied directly to patient outcomes and the documented complexity of their health conditions. Inaccurate or incomplete coding can lead to under-reimbursement, jeopardizing the financial stability needed to care for high-need populations.

Your Health's partnership with Fathom directly addressed this challenge. The reported 0.66 increase in average RAF scores (from 1.12 to 1.78) is a testament to the AI's ability to capture a more complete clinical picture from physician notes. This improved accuracy in Hierarchical Condition Category (HCC) capture led to a revenue benchmarking increase from $35 million to $70 million. Furthermore, the system drove a threefold increase in the capture of the G2211 add-on code, for complex patient visits, unlocking an estimated $511,000 in annual revenue that was previously missed. The operational efficiency also translated to a two-day reduction in the time from claim submission to cash receipt, improving liquidity.

This success story aligns with broader industry trends. A 2025 survey from Bain & Co. and KLAS Research identified revenue cycle management (RCM) as the top priority for health IT investment, with AI-powered medical coding being a leading use case. As providers face mounting financial pressures and a shortage of certified human coders, technologies that can deliver both accuracy and efficiency are becoming essential.

The Technology Behind the Transformation

At the heart of this shift is Fathom's AI, which leverages deep learning and natural language processing (NLP) trained on a massive dataset of over 750 million patient encounters. This allows the system to read and interpret unstructured clinical notes—the detailed, narrative descriptions written by doctors—and translate them into the standardized ICD-10 billing codes required by payers. The platform was deployed across all of Your Health's diverse care settings, including 14 physician offices, 278 assisted living facilities, and telehealth services, integrating seamlessly with its athenahealth electronic health record system.

The AI market for medical coding is becoming increasingly competitive, with firms like Nym Health, CodaMetrix, and offerings from giants like Optum and Microsoft's Nuance all vying to solve the same problem. The common thread is the use of sophisticated AI to parse complex medical language, identify diagnoses and procedures, and ensure compliance with ever-changing billing rules. Fathom's ability to achieve a 95.5% encounter-level automation rate from day one, as reported by Your Health, places it at the forefront of this technological race.

"With Fathom, the vision was simple: let clinicians be clinicians, and let the technology determine the codes based on what they've documented," said Chris Little, Chief Operating Officer of Your Health. "We needed a partner that could handle that complexity from day one — and deliver consistently across every setting."

Beyond the Balance Sheet: A New Role for Coders

While the financial and efficiency gains are striking, the implementation also points to a significant evolution in the healthcare workforce. Rather than rendering human coders obsolete, AI automation is freeing them from repetitive tasks to focus on more strategic, high-value work. The industry consensus is that AI will augment, not replace, human expertise.

The laborious process of manual coding contributes to administrative burden and burnout, not only for coders but also for clinicians who must ensure their documentation is perfect. By automating the vast majority of encounters, Your Health allows its clinical staff to concentrate more fully on patient care. As Will Stillinger, Chief Strategy Officer of Your Health, stated, "Our clinicians are free to focus on care, and that's exactly where we want them."

This shifts the role of the human coder to that of an auditor, a compliance expert, and a manager of exceptions. Coders are increasingly tasked with reviewing the AI's work on the most complex cases, handling appeals, and providing feedback to clinicians to improve documentation quality—a practice known as Clinical Documentation Improvement (CDI). This evolution requires upskilling but ultimately leads to a more engaging and impactful career path, moving coders from the back office to a more central role in the revenue cycle strategy.

Navigating Compliance in an AI-Driven World

The adoption of AI in such a sensitive area is not without its challenges, primarily centered on regulatory compliance and data security. Any system handling Protected Health Information (PHI) must be rigorously compliant with HIPAA, requiring robust security protocols, data encryption, and strict access controls. AI vendors like Fathom operate under Business Associate Agreements (BAAs) that hold them to the same data protection standards as the healthcare providers themselves.

Furthermore, with the Centers for Medicare & Medicaid Services (CMS) increasing its scrutiny through Risk Adjustment Data Validation (RADV) audits, the accuracy of AI-generated codes is paramount. An AI that inflates risk scores without proper documentation could expose a provider to significant financial penalties. This makes the "explainability" of the AI—its ability to show why it chose a specific code—a critical feature. It allows human auditors to validate the AI's logic and ensure every code is defensible.

Successful implementation, therefore, relies on a human-AI partnership. The AI handles the volume and velocity, while human experts provide the oversight, contextual judgment, and compliance assurance necessary to operate confidently in a highly regulated industry. Your Health and Fathom are scheduled to discuss their collaboration and results further at the upcoming RISE National 2026 conference in Orlando, offering other providers a deeper look into this model of success.