Dolbey announces the release of Fusion CAC™, Computer-Assisted Coding solution Orlando, Florida – At the 2008 HIMSS convention in Orlando, Dolbey announced the release of Fusion CAC™ powered by EMscribeTM for the hospital coding market. By utilizing advanced coding technology, Fusion CAC™ increases the efficiency and consistency of a human coder while resulting in a reduction in the amount of time between when a patient is discharged and when billing is complete. Medical coding is the means of translating a patient’s medical chart into numeric codes that will be used for billing by the care providers. Presently, this manual process requires skilled practitioners, already in high demand, to scan and read documents to create the medical billing codes. This manual process creates a lag time between when the coding can begin and when a bill is complete. Fusion CAC™ is a new, computer-assisted coding solution that utilizes natural language processing (NLP) and exclusive patent-pending algorithmic software to electronically analyze entire medical charts to pre-code with both CPT procedure and ICD9 diagnostic nomenclatures. Manual coders, enhanced with the results of Fusion CAC™, easily approve or amend the automatic results to reduce effort by as much as 80%. This reduced effort translates directly to a reduction in the time between discharge and revenue capture. This reduced effort also translates into cost savings from the reduction in manual coding costs including outsourcing. The Fusion CAC™ solution utilizes the powerful and fast coding engine, EMscribe™, which has been designed to integrate with a hospital’s existing coding system. Dolbey is providing demonstrations and ROI Case Studies in booth #6145 from the HIMSS tradeshow floor.
Dolbey Annouces the first Inpatient and Outpatient Computer-Assisted Coding Product
June 10, 2008 — heather155New coding software by Voice Products could trim hospital reimbursement time
June 10, 2008 — traci119Voice Products Inc., a Wichita company with 40 employees throughout five states in the Midwest, received some national attention with a new product it unveiled at the Health Information Management Systems Society technology show last week in Orlando.
The software is called Fusion CAC, a computer-assisted coding solution that Voice Products president and CEO Dean Tullis says will make health care providers more efficient in inpatient and outpatient coding.
“There’s a shortage of coders, and it’s taking a long time to code things that should be very simple,” Tullis says. “The (aging) baby boomers are making that a bigger problem than it already is. Hospitals need to speed up how they code records so they can get reimbursed more quickly (by insurance companies).”
The Fusion CAC is supposed to do that. The product’s first case study, conducted by Robert Wood Johnson University Hospital in New Jersey, says the Fusion CAC resulted in an 89 percent time reduction by saving an average of 80 seconds for every outpatient chart.
The software reads the medical record, and highlights words throughout it. It then puts up codes automatically based on those words.
Tullis describes medical charting as a long, tedious process that can put hospitals behind their paperwork by days or even months.
“That’s millions of dollars being held up,” says Mickey Lynch, district manager for Voice Products. “It’s cash flow. We’re introducing the first product of its kind, really, and part of the reason it was so popular (in Orlando) is because it eliminates human error.”
Money Back Guarantee
Judy Edwards, director of health information management at Via Christi Health Management, says she’s keeping a close eye on the marketplace for a computer-assisted coding system.
“The most sophisticated systems are for outpatient services — which consequently is the area where we would be most likely introduce computer-assisted coding,” Edwards says. “That’s not likely to happen, however, until we are further along with our conversion to digital medical records.”
The price of the software, Tullis says, is based on a hospital’s bed count. He is offering a money-back guarantee. It uses IDC 10 coding, which Tullis says is more detailed and complex than the IDC 9 that is being used in the United States now but will soon be outdated.
Linda Simon, coding and reimbursement manager for health information at Wesley Medical Center, says that based on her research, the Fusion CAC is attractive.
“The coding process is directly related to the cash flow and reimbursement of an organization,” Simon says. “If new technology can expedite the process while maintaining accuracy, it is something to consider.”
Voice Products Inc.
Computer-assisted bar-coding system significantly reduces clinical laboratory specimen identification errors in a pediatric oncology hospital.
June 10, 2008 — heather155To assess the ability of a bar code-based electronic positive patient and specimen identification (EPPID) system to reduce identification errors in a pediatric hospital’s clinical laboratory. STUDY DESIGN: An EPPID system was implemented at a pediatric oncology hospital to reduce errors in patient and laboratory specimen identification. The EPPID system included bar-code identifiers and handheld personal digital assistants supporting real-time order verification. System efficacy was measured in 3 consecutive 12-month time frames, corresponding to periods before, during, and immediately after full EPPID implementation. RESULTS: A significant reduction in the median percentage of mislabeled specimens was observed in the 3-year study period. A decline from 0.03% to 0.005% (P < .001) was observed in the 12 months after full system implementation. On the basis of the pre-intervention detected error rate, it was estimated that EPPID prevented at least 62 mislabeling events during its first year of operation. CONCLUSIONS: EPPID decreased the rate of misidentification of clinical laboratory samples. The diminution of errors observed in this study provides support for the development of national guidelines for the use of bar coding for laboratory specimens, paralleling recent recommendations for medication administration.
Outsourcing Vs. CAC: Is there a Choice?
June 9, 2008 — chris107The HIM profession is continuously adapting to change, as driven by the practice of medicine, coding guidelines, government regulations and information technology. For medical coders and their managers, this means not just learning the new ICD-9 and CPT codes each year, but understanding new and updated rules related to abstracting and billing and keeping up with changes in the workplace and work processes. The Internet and secure remote coding applications have extended the HIM department into coders’ home offices. Document workflow and imaging systems are helping to reduce the paper chase that bogs down operational efficiency by providing online access to patient records. However, this technology requires coders to learn new systems and methods for finding information and entering data.
Add to this the shortage of qualified coding professionals described in a recent American Health Information Management Association (AHIMA) survey. Published in the September 2006 Journal of AHIMA and titled “Coders Wanted, Experience Required,” the study found that 76 percent of respondents who had open coding positions within the preceding 12 months reported having difficulty or extreme difficulty filling the positions. Lack of qualified resources puts an HIM organization under stress and causes coding managers to consider other options to supplement their staff or increase productivity. Outsourcing of coding work can fill those gaps, either on a temporary or long-term basis. Also, computer assisted coding (CAC) technology is emerging as an option that can enhance productivity and provide other benefits. While not strictly an either-or choice, outsourcing and CAC have both competitive and complementary aspects that are worth a closer look.
The Outsourcing Relationship
How does a manager choose the approach that is best for her organization? There isn’t a one-size-fits-all method for outsourcing or a single CAC application that works for every organization. Apart from the financial terms, four common factors describe an outsourcing relationship:
1. Scope
2. Control
3. Location
4. Duration
Scope is the extent of the coding process covered by an outsourcing arrangement. For example, a very small scope is a single coder working in single medical specialty such as radiology, while a large scope is the complete coding operation for a billing service or provider organization representing hundreds of thousands or more patient visits per year.
Control is the division of management and operational work responsibilities between the HIM organization and its outsourcing partner. This includes managing the day-to-day workflow, coder training, exception handling, auditing, technical support and performance assessment. An important consideration in the workflow and training is the responsibility for payer specific and site specific coding requirements. Those requirements should be explicit and clearly documented for the outsource resources to assume responsibility.
Location is not just where the outsourced resource is geographically located, but also how the location affects the manner in which the work is done. Outsource coders can work either on-site or remote, and the remote location may be anywhere from across town to across the globe. An important aspect of location is whether the outsource personnel will be directly interacting with the HIM organization’s computer applications or using their own computer applications. Using different applications requires interfacing between the two systems.
Finally, duration is the length of time of the outsource contract. This can vary from a few days to work off a small backlog or cover vacations to multi-year commitments.
To be successful in an outsourcing relationship, a manager should understand his/her organization’s goals and expectations with regard to these four factors. Also, just as employee performance should be regularly evaluated, outsourcing relationships should have performance measures with established benchmarks for coding quality, turnaround time, compliance with privacy and security policies and customer support.
The Benefits of CAC
CAC applications can be described by four potential benefits. Not all CAC applications will offer all four benefits in every situation, so decision makers should evaluate closely what an application can offer their organization:
Trimming the Coding Process: Can Computers Help?
June 9, 2008 — heather155What effect does computer-assisted software have on productivity? Does natural language processing improve accuracy?
It is a well-known fact that there is a tremendous shortage of coders in the United States. While there have been many solutions offered to increase the number of coders, we must also look at ways to increase coder productivity and effectiveness. Computers can do just that—allow coders to review records and assign codes faster.
Technology helps coders by providing faster, easier access to the documents and information necessary for code determination and by preselecting codes for review.
Technology to Support Access to Documentation
One of the barriers to efficient coding occurs as a result of the paper flow associated with outpatient services. Inpatient records are gathered from nursing units at the time of the patient’s discharge and taken to the HIM department for processing, including coding. Even in the largest facilities, there are less than an average of 250 inpatient discharges per day—most facilities have less than 100 records per day to process.
Outpatient records are generated in many locations, including emergency departments (EDs), ambulatory surgery centers, diagnostic areas, specialty treatment areas, clinics, and off-campus facilities. There are often thousands of records generated daily. In the past, these records or documents may not have been sent to HIM but instead kept in satellite record repositories or computer systems. Since each encounter must be coded with a diagnosis and Current Procedural Terminology (CPT) procedure code and because coding should not be done without the medical record, the resulting paper flow issues have been problematic for most hospitals.
Computer-Assisted Coding Helps Healthcare Fruad: Study by AHIMA
June 8, 2008 — chris107The U.S. healthcare industry can save nearly $16 billion annually by integrating antifraud protections into a national, interoperable health data exchange, according to research unveiled at the AHIMA’s 77th annual conference.
Twin studies commissioned by Health and Human Services (HHS) and conducted by AHIMA contractors suggest that while computer-assisted coding can help thwart fraud, it can also increase the potential for wrongdoing.
“One of the things that was the most surprising to me is that EHRs [electronic health records] can increase exposure to fraud,” said national health information technology coordinator David J. Brailer, MD, PhD, whose office authorized the work.
“One of the lesser-known frauds in healthcare is identity theft in the name of healthcare,” Brailer explained at the San Diego conference.
The AHIMA research cites an estimate by the National Health Care Anti-fraud Association that fraud accounted for at least 3% of healthcare spending, or $51 billion, in 2003, but also mentions that fraud-related losses could run as high as 10%, or $170 billion.
But automated coding software and other fraud-fighting applications could produce a net savings of $15.5 billion per year if properly integrated into a system of interoperable EHRs, the studies show.
Additionally, the research serves to define best practices for fraud prevention and detection for policymakers and healthcare organizations to consider while building a national health information network (NHIN). At the top of the list of 10 principles for preventing healthcare fraud is the declaration, “The Nationwide Healthcare Information Network (NHIN) policies, procedures, and standards must proactively prevent, detest, and reduce healthcare fraud rather than be neutral to it.”
Computer-Assisted Coding made auditing a breeze!!
June 7, 2008 — traci119Your department doesn’t have to code anything wrong to feel the beginnings of a peptic ulcer as soon as someone announces that there’s going to be a coding audit. The department members are doing their job, of course, no matter who decides there should be an audit. They make sure there’s no low-hanging fruit or money being left on the table—or whatever the newest buzz phrase is that week.
Let’s look at what that really means, however, to the department’s daily process. The impact on staff (and their reputations) depends on several conditions.
How Many Charts Will Be Audited?
The very first task is to identify and pull all the charts. In the event that the auditor already knows which charts it wants pulled, you can skip this part. Payors usually have a specific group of charts they have identified as being in their target population for review. Medicaid may lean toward specific patients such as moms and babies with higher-paying diagnosis-related groups (DRGs) but a short length of stay. Medicare is more likely to focus on DRGs with a high percentage of complications/comorbidities (CCs), one-day stays no matter what the DRG, or certain ambulatory payment categories (APCs) such as those for chest pain and asthma.
How many charts will be included in the audit will determine how many additional hours you will need to budget for the effort. Remember that you will need to figure time for looking up location, retrieving the charts, then identifying and holding them until the audit is complete. Don’t forget to calculate time to reretrieve any that are pulled in the middle for patient care or physician review and to return them all to file after the auditors have finished. Don’t return them too fast or you’ll be digging them back out for your own reviewers to validate or refute any concerns identified by the initial group of chart detectives.
Whose responsibility is it to pay for the additional hours? Do they intend to send internal reviewers or do you have to copy charts and mail them to the auditor? Negotiate that on the front end if you get the opportunity.
How Computer-Assisted Coding can help in an Audit?
How do you deal with audits at your facility. I know we had hybrid charts that mainly reside with paper. Our Codes are printed on a face sheet that is attached to the chart which was a nightmare. Now when we have audits there is no panic there are no peptic ulcers. We now use a computer-assisted coding program to help track our audits. Since most of the chart even if you do have an entire paper record it can be processed by the CAC program and this creates hyperlinks to the codes making auditing a breeze. If you need more info about it let me know. I can share our story…
Opportunity Knocks
June 6, 2008 — heather155As the healthcare industry inches toward an electronic-based system, HIM professionals have a chance to become major players in the transition.
“Quality Healthcare Through Quality Information.” The AHIMA’s tagline is simple yet powerful. It captures the essence of what the association is all about. If our efforts result in better information for both patients and care providers, we’ve made healthcare better. But the opposite—poor information can cause poor healthcare—is also true. While the industry is making great strides to improve the quality of information available for healthcare decision making, we can always do more.
Over the next decade, the U.S. healthcare system will continue to transition from paper-based records to electronic health records (EHR) to share healthcare data, reduce medical and pharmacy errors, avoid redundant tests, and improve patient safety—all of which require quality information. Functions will, of course, vary by organization, as many do now. Some of these functions will continue, some will vanish, and many new roles will emerge. Regardless, HIM will continue to be a necessary component of healthcare organizations.
In fact, core HIM functions do not disappear when healthcare moves further into the information age, they become more critical. Many qualities needed to manage the paper medical record are the same qualities necessary to manage the EHR. Attention to detail; ability to compare competing data sources and reach a conclusion about data accuracy; project management; creative problem solving; categorization of data; data reporting; evaluating, understanding, and interpreting regulatory standards; and the many other skills that HIM professionals possess will be critical to maintaining an accurate and functional EHR.
Waves of Change: Computer-Assisted Coding the Latest Tech Tool for Coders
June 4, 2008 — heather155Do coding backlogs leave you feeling wiped out? Perhaps a little help will get matters under control.
No other area within HIM has undergone significant changes as often as clinical coding. Working as a clinical coder when diagnosis-related groups (DRGs) were introduced in the 1980s, I witnessed a profession being propelled to the top of the surf. And there has been no going back.
Waves of many sizes continue to pound the shores of clinical coding. There are always new diseases and procedures to learn, stricter regulatory requirements to comply with, and advanced technology tools to implement. Today, another new wave is approaching and it’s called computer-assisted coding (CAC).
As with encoder technology 20 years ago, CAC is another technology tool for the coder. First envisioned as an evil plot to destroy the coding profession, CAC systems actually help coders become more productive, accurate, and consistent. Comments from coders who use CAC back up that assertion1:
— “It’s an amazing tool for coders. You can be better and faster at what you already do. And it will definitely make your job more interesting.” Joan Davignon, CCS, QA coding specialist
— “I would tell coders to give it a try. It’s easy to use and learn.” Denise McCreesh, RHIT, LGPN
CAC systems are coming and it’s time to grab a surfboard, take some lessons, and get ready to ride the wave. This article defines CAC, discusses how it works, identifies some best practices, and provides real-life feedback from early adopter hospitals and coders.
Waves Will Always Come
As I write this article, I’m overlooking the ocean in Nags Head, N.C. It is Christmas weekend and the beach is quiet, almost desolate. Yet the waves keep coming ashore. Waves are consistent, dependable, and guaranteed. Regardless of size, they are always there. Changes to clinical coding are just as inevitable.
Recovery Audit Contractors
June 4, 2008 — chris107
The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program as a demonstration program to identify improper Medicare payments – both overpayments and underpayments. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers.
Under the demonstration program operating in California, Florida and New York, RACs can review the last four years of provider claims for the following types of services: hospital inpatient and outpatient, skilled nursing facility, physician, ambulance and laboratory, as well as durable medical equipment. The RACs use automated software programs to identify potential payment errors in such areas as duplicate payments, fiscal intermediaries’ mistakes, medical necessity and coding. During fiscal year 2006, the RACs collected $69 million in overpayments and found $3 million in underpayments. An additional $232 million was identified for collections, but the final outcome has yet to be determined. The Tax Relief and Health Care Act of 2006 made the RAC program permanent and authorized the Centers for Medicare & Medicaid Services (CMS) to expand the program to all 50 states by 2010. The agency has already expanded RAC review to Massachusetts and South Carolina, with plans to expand RAC review to several more states in 2008 and 2009, and all states by 2010.
