Computer Assisted Coding Margaret L. Hulvey, MSHA, RHIA, CHC, CHP, ECMp Healthcare Business Consultant Hyland Software, Inc.
Computer Assisted Coding A software application that analyzes medical record information and suggests diagnosis and procedure codes by searching phrases and words within the documentation.
Quick ICD Primer World Health Organization (WHO) International Classification of Diseases (ICD) Research Policy Making Providers Insurers Reporting of mortality and morbidity United States currently using ICD-9 (1979) ICD-10 began world-wide 1994
Adoption in the United States Very slow to adopt First go live was scheduled for 2013 Pushed to 2014. Pushed to 2015... Not expected to be delayed, again..
What s the difference? ICD-9 includes Over 17,000 codes (Dx and Procedure) XXX.XX ICD-10 includes Over 141,000 codes (Dx and Procedure XXX.XXXX
How does the hospital/provider use them? At patient discharge, two major departments take over : HIM (Health Information Management) Patient Financial Services (PFS)
How does the hospital/provider use them? HIM (Health Information Management) Coders notified of account ready for coding Coders analyze the clinical information Assign appropriate diagnosis/procedure codes Send to Patient Financial Services
How does the hospital/provider use them? Patient Financial Services Receives coding and charges from ChargeMaster and HIM Prepares claim Scrubs claim Sends to payor Manages RAs, denials, more information Posts payments/bill patients/collections
Computer Assisted Coding
Computer Assisted Coding A software application that analyzes medical record information and suggests diagnosis and procedure codes by searching phrases and words within the documentation.
Pre-requisites for Success Encoder ECM (Enterprise Content Management) solution in place All required documents are accessible electronically
So how does it work? Unifies hybrid medical records presents the coder with one consolidated view of the case (all electronic medical records and scanned image documentation) Leverages optical character recognition and natural language processing (NLP) Extracts clinical information from text and recommends relevant ICD and CPT codes Grammar and syntax aware CAC Overview
Why use CAC? Improve Accuracy Shorten reimbursement time ICD code assignment audit trail ICD-10 Increased specificity 141,000 codes in ICD-10 70,000 codes in ICD-9 Higher level of supporting documentation required Coding validation vs. coding look-up CAC Overview
Four KEY Reasons to Integrate with CAC Ensure rapid deployment for rapid ROI. The CAC Integration is a predefined solution that can be quickly deployed in hosted or premises-based environments with minimal bandwidth from busy IT staff. Reduce upfront costs. EMRs typically charge for each application interface, so passing the entire patient record through the established interface to the CAC application makes financial sense. CAC Integrations
Expand coding support beyond the EMR. Equip coders with easy access to all information they need for fast, accurate coding and validation. Reduce denials, speed reimbursements and minimize rework. Minimize dreaded productivity drops come October 2014. By integrating with a CAC solution now, organizations ensure coders have time to get to know the system before the switch to the more complex ICD-10. Act early to mitigate productivity dips and process delays. CAC Integrations
What is the software s role? Stores a portion of the patient s medical record History & Physical Operative Reports Discharge Summary ECM and EMR documents are viewable from the CAC software and displayed upon request Customers have a greater need for CAC software with ICD- 10 CAC Overview
Process Flow Transcription Interface Scanned Document EMR/ECM Database Encoder Document Request Documents (Text or Image) CAC Software
User Experience
User Experience
What does this mean for HIM staff? Increased accuracy Improved productivity Coding staff concerns Better support for remote coding Automation of basic repetitive disciplines Radiology Laboratory
Patient Financial Services? Improved productivity Improved claims accuracy Quicker bill submission DNFB reduction Fewer denials or requests for more documentation?
Coders versus CAC
Return on Investment Software cost More detailed bills = higher reimbursement? Increased cash flow Also depends on: How much of the record is electronic How good is the CDI program?
Return on Investment Software cost More detailed bills = higher reimbursement? Increased cash flow Also depends on: How much of the record is electronic How good is the CDI program?
Questions?