Computer Assisted Coding

The number of procedures that use computer assisted coding is set to increase rapidly as the technology becomes more accurate. The trials have been completed successfully. The systems automate a tedious process and create efficient operation in the hospital and physician office environment. In this manner the automation that has been used by banks and manufacturing operations for years is moving to healthcare.

Whereas the healthcare systems have struggled with a payment and collections system that takes 30% of revenue, the banking and financial services industry has been able to run with automated billing systems that take 3% of revenue. As these economies of scale and technology are adapted to the healthcare delivery organizations through computer assisted coding, the most efficient organizations will acquire the less efficient ones.

Computer assisted coding fits seamlessly into a healthcare work flow. An unstructured digitized text from any source. Input can come from transcription services, voice recognition output, and typed note. No templates are needed. Computer assisted coding structures the note and applies appropriate codes. Computer assisted coding checks 100% of the notes and sends information to the billing system or sends notes to auditors for further review. Studies have documented the issues with E&M coding. Over-coding can lead to increased institutional risk. The result is frequent under-coding and lost revenue.

Manual coding processes are tedious and time consuming. After a patient is discharged, a clerk would physically retrieve the medical documents and pass it to a health records analyst who would extract the appropriate information for the billing system. Then the medical record would be passed onto a coder who would write the codes onto a paper face sheet. Next the face sheet would get passed to a data entry operator who would again access the billing system and enter the coding information into the account for final billing.

Hybrid Technology
Computer assisted coding is set to evolve a hybrid technology where the physician develops natural language descriptions of patient conditions that are combined with a set of scales to evaluate patient condition in a more methodical and measurable manner. Just as patients are asked to measure pain on a scale of one to ten, so also physicians will measure patient condition as it relates to a relative scale.

The scale will not be universal, but rather, specific to the physician. The scale will be relative to a physician own experience. In this manner, the expertise of the physician will carry over from one patient to another.

The physician will develop techniques for describing patient condition that are in natural language, then these will be adapted to a coding scale that the physician has control of as well as the natural language coding software.

Computer Assisted Coding Engine
Computer assisted coding applications depend on the development of production quality natural language processing (NLP)-based computer assisted coding applications. This requires a process-driven approach to software development and quality assurance. A well-defined software engineering process consists of requirements analysis, preliminary design, detailed design, implementation, unit testing, system testing and deployment.

NLP complex technology defines the key features of a computer assisted coding (CAC) application.

Focus On Reducing Overpayments
The centers for Medicare and Medicaid services (CMS) is focused on reducing overpayments attributable to claims that do not meet medical necessity requirements. Compounding the situation, CMS rules and policies are updated and are interpreted differently from a fiscal intermediary (FI). A fiscal intermediary may cover multiple states with the same edits. Coding professionals are being asked post-service to help correct claims that were rejected because of medical necessity errors.

If medical necessity validation problems are not identified until a significant number of claims has been rejected, an organization may face not only substantial financial and compliance risks. The costly losses of efficiency are incurred by reworking and resubmitting rejected claims.

The number of hospitals has been steadily declining for 20 years in the U.S. Going forward, the IT department will rule the hospital and the physician office. Just as Kaiser has moved to become a major player in the US health care delivery system, so also any organization will have to master IT, just as Kaiser has with the help of IBM.

The number of patients and procedures is growing as health care delivery is evolved in a more sophisticated manner. In the US, the number of procedures is anticipated to increase rapidly as the population bulge from the baby boomers who are relatively well off creates demand for better healthcare delivery.

Worldwide, the markets are anticipated to grow from $44.8 million in 2006 to $2.3 billion in 2013. The markets are primarily U.S. markets because of the primary role that insurance plays in the health care delivery system. Worldwide markets start to grow as more hospitals and physician offices seek to get control of systems costs and introduce automated process systems.

What Are You Afraid Of?

When new technology hits the market, HIM departments can turn into scary places. Here’s how those in the trenches overcame their fears and embraced the technology.

By Lynn Jusinski

Stressfuland evendownright scary,implementing a new technology that affects HIM personnel is a huge step. Will it work right? Will the staff embrace the new workflow practices? Will the employees know that this won’t put them out of a job?

With Halloween a little over a month away, ADVANCE took a look at some of the ways that HIM professionals overcame their fears and found out that technology may not be that scary after all. Their tales won’t have you cowering under the covers, but they’ll show you how even when faced with a few fears about a new technology on the market, you can get through it—and even see vast improvements in your department along the way.

 

Demons, Dracula and Document Management

At Tift Regional Medical Center in Tifton, GA, the business office and HIM department sought out a document imaging and electronic medical record (EMR) piece to add to their existing systems. First, the business office would implement the new technology, McKesson’s Horizon Business Folder™, and then a few months later, HIM would come on board with the Horizon Patient Folder™ from McKesson. At least, those were the plans.

When the business office began having to make some big decisions concerning the electronic document management system (EDMS), it became apparent that the HIM department would be losing a say in the process, unless the implementation was escalated for the HIM department. The HIM director, Kathy Alberson, jumped aboard, months in advance of when the department was slated for implementation of Horizon Patient Folder. “It brought high anxiety to our HIM department and others because they had to escalate the decisions and the workflow that they needed to move to an electronic environment,” said Guy McAllister, chief information officer (CIO).

The HIM director looked to where she knew she could get support through the rough patches�she spoke to colleagues at the American Health Information Management Association, and she looked at other HIM departments that had already gone through the EDMS implementation process. Teams were formed to address policy and other issues that came up before and during implementation, and soon, worries about how the workflow in HIM would go were put to rest. “Today, we’re live and we wouldn’t go back,” McAllister said.

Horizon Patient Folder included an electronic signature piece, and with the new systems in place, printing is out of the question at Tift. The HIM director is adamant about not printing, and makes sure no one does because the results can be scary. For example, a physician printed out a copy of a record and wrote notes on it�a no-no at Tift, because every notation becomes part of the record, and a handwritten addition would get lost in the system and could compromise patient care.

Recovery audit contractors collect $371.5 million in improper payments

On February 28, the Centers for Medicare & Medicaid Services (CMS) announced that the recovery audit contractor (RAC) demonstration program had collected or repaid $371.5 million to healthcare providers during fiscal year 2007. The demonstration program began in California, Florida, and New York–the three states that process the largest number of Medicare claims. The goal of the demonstration project was to lower the Medicate payment error rate.

The RAC program returned $247 million to the Medicare Trust Fund after accounting for the money repaid to healthcare providers, dollar amounts overturned on appeal, and the operational costs of conducting the program itself. Overpayments collected from healthcare providers accounted for 96% of the improper payments that RACs uncovered. Underpayments, which were repaid to healthcare providers, accounted for the remaining 4%.

A vast majority of overpayments that RACs identified occurred because healthcare providers submitted Medicare claims that did not comply with coding or coverage rules. Other payment problems that RAC audits uncovered included billing a procedure multiple times when the provider only performed it once, submitting multiple claims, and using an outdated fee schedule. Inpatient hospitals submitted a majority of the claims that resulted in underpayments. The RAC audit program in California, New York and Florida will help to Medicare implement a similar, nationwide program no later than in 2010.

Coding’s Little Helper

By Robbi Hess

For The Record

Vol. 19 No. 18 P. 20

 

Taking advantage of computer-assisted coding can make life easier for overworked

HIM departments.

 

These days, it seems we automate anything and everything, from paper towel

dispensers and assembly lines to parking garages and lawn sprinkler systems. The technology can be a

tremendous time saver and provide unheard-of convenience.

Not to be left behind in the wake of all this technological progress is the coding industry, where computer-assisted coding (CAC) is gaining steam as a powerful tool.

 

Sheri Poe Bernard, CPC, CPC-H, CPC-P, vice president of member relations at the American Academy of Professional Coders, says the term computer-assisted coding is relevant because CAC is the difference between computerized coding and auto coding. “When you add the term assisted—computer-assisted coding—the industry is building in the idea that it needs to have a manual review of what the computer has come up with,” she explains. “A coder needs to make certain that what the computer has come up with is correct. Were the correct codes selected? Were compliance rules followed? The idea of computer-assisted coding is more viable and more practical when put into use with the idea of it being looked at by a human.” Because computers have yet to master the ability to extract inferences from information, there is a continued need for a certified coder to be in the mix.

 

“Having CAC in place will certainly streamline things because the coder can go through significantly more

claims if using the computer as an assistant rather than coding from scratch,” Bernard says. “The

interesting part of CAC is that it more easily employs rules based on methods and is much less subjective in coding it than what you get from human coders.”

 

As an example, Bernard says if Medicare issues a new rule effective April 1 and a claim was filed March

15, the new rules shouldn’t apply to that bill. In the auto system, it would be triggered by the date and

would only apply rules that are date-specific to that procedure. “People sometimes tend to muddy up the dates and will code using today’s rules rather than the rules in place on the date of the encounter,” she says. “CAC will clean up these problems, and we will see more consistency within organizations and industrywide.” Beth Friedman, RHIT, president of The Friedman Marketing Group, says CAC is starting to be used extensively in niche, outpatient areas, with the most common being radiology. But she sees the technology expanding into the emergency department and other specialty areas.

 

Computer-assisted Coding Software Improves Documentation, Coding, Compliance, and Revenue

Abstract

The use of computer-assisted coding (CAC) software is becoming more common at the point of care. Two main approaches to CAC software have been used—structured input (SI) and natural language processing (NLP). This study focuses on the use of SI software at the point of care and its impact on quality of procedure documentation, codes, and effects on reimbursement for both the professional and facility offices.

Key words: computer-assisted coding, procedure documentation, coding, reimbursement

Introduction

CAC software has become more prevalent at the point of care. A number of studies have been undertaken to measure the impact of structured input CAC software on physician documentation, coding, and reimbursement. This paper will summarize the studies to date.

Background

Correct documentation at the point of care has been a major challenge for healthcare organizations. Clinicians are expected to deliver patient care in a safe and effective manner while also ensuring that all relevant details are captured in the documentation process.

In a typical institution, physician documentation is generated primarily via a dictation and transcription system. The physician dictates the procedure note, a transcriptionist types the dictation, and the physician reviews and signs the transcribed note.

Coding for these procedures can be handled in a variety of ways. In general, the hospital HIM department reviews the transcribed procedure note and, using encoding tools, generates current procedural technology (CPT) and international classification of diseases (ICD) codes. These codes are then entered, either manually or electronically, into a billing system and the bill is sent to the payer.

Physician billing for these same procedures is less predictable. Oftentimes, the physician’s office does not employ a coder. Instead, the physician chooses codes on a paper billing sheet, which is then typed into the physician’s billing system by clerical staff.

Make way for the new nonhuman coder: Computer-assisted coding may be the wave of the future

Long gone are the days of tedious manual-based coding where coders didn’t have the luxury of access to encoders or the Internet. Today’s coder is savvy in the ways of the electronic world-a world in which computers play a large role in the day-to-day coding routine.

 

And up until now, however, coders have used computers only to assist in assigning codes. But imagine a world in which the computer itself reads the medical record, scans for vocabulary and syntax, and then assigns the code-all on its own. Sound like something out of the future?

 

Think again. Computer-assisted coding (CAC)-the use of computer software to generate a set of medical codes for review and validation-is actually a practice in place at some facilities. And although the idea of letting a computer assign a code might make some leery, there’s nothing to be afraid of, says Susan Fenton, RHIA, MBA, manager in practice leadership for the American Health Information Management Association in San Antonio. “I think it’s a continued evolution, and instead of being scary, I think it’s incredibly exciting,” she says.