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Free Computer-Assisted Coding Webinar
October 28, 2009 — traci119Computer-Assisted Coding Technology Webinar, August 21st 2009 at 1pm
July 21, 2009 — dolbey
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Embrace or Fear CAC Future
June 23, 2009 — dolbey
By Michelle A. Dick, senior editor
Computer assisted coding enthusiasts believe it is the ticket to a streamlined coding process, with efficient
and accurate coding at a fraction of the price. Others fear it’s the end of professional coding as we know it;
and coders will have to adapt as computer software replaces job duties. Whether you see the glass half full
or half empty, your best bet is to understand the options that are in front of you.
How will CAC impact the ICD-10-CM transition, the coding process, the accuracy of coding, and the future
responsibilities of coders?
Will Software Complicate ICD-10-CM Transition?
The good news is that CAC and electronic health records may smooth the transition from ICD-9-CM to
ICD-10-CM. Computer application manufacturer e-MDs’ president, Michael Stearns, MD, CPC, is already
planning for ICD-10-CM implementation. Stearns said “We have an embedded terminology called the
Medicapaedia that is mapped to ICD-9-CM, ICD 10-CM, or any other terminology. This year, we will add
ICD-10-CM to prepare for use of our EHR in other countries. This allows for a seamless migration when
ICD-10-CM is required in the United States.”
Dean Tullis, president and CEO of Voice Products’ Fusion CAC, developed by Artificial Medical Intelligence,
said his company is working with hospitals already using ICD-10-CM in the countries of Canada and Brazil.
“We will provide an easy transition when and if the time arises for this coding system to become
standardized in the United States. The software model allows the ICD-9-CM and ICD-10-CM dictionaries to
be cross-walked and then tuned accordingly,” he told
Coding Edge.
Will Coding Robots Take Over?
Garbage in; garbage out. Because coding is a highly variable task, the error percentage rate with CAC is
also variable. There are factors affecting correct coding on the coding level and the reimbursement level.
Coding error percentage rates using CAC depends on the facility’s or practice’s needs, Tullis said.
“Every institution has its own coding subtleties … [Our product] Fusion CAC is no better or worse than a
coder. As part of our installation, we can tune our engine to the particular facility. However, some facilities
prefer not to tune the engine, but would rather have the coders select the codes, adding, or deleting codes
as necessary. Fusion CAC is NOT a coding robot and therefore does not ascribe to the misnomer term of
coding accuracy.”
Stearns agrees that the percentage of coding errors using E-MD EHR is dependent on who is using it. He
said, “It varies by clinic, but practices with efficient processes in place typically get well above 95 percent
acceptance (a denied claims rate of less than 5 percent). Some practices achieve consistently high
acceptance ratings as indicated by e-MDs customers and frequent membership monitoring of e-MDs
customers.”
Does a CAC Future Include CPCs®?
Will CAC replace certified coding professionals like robots replaced auto workers? Stearns said, “EHRs will
create new job opportunities for CPCs® in the area of pay-for-performance and related reporting activities,
which will soon be driving payment to a much higher degree. CPCs® will help practices by reviewing the
quality of automated coding support provided by the systems. It will also help auditors by increasing the
amount of information they can review, even from a remote location.”
Tullis said, “It is possible that coder responsibilities may change. Instead of being readers and procurers,
they will become reviewers and auditors. Coders will need to verify the codes within the documentation
and the system will require a level of human intervention, approval, and review. Many facilities work with a
hybrid medical record meaning they have paper records, progress notes, and legacy handwritten reports,
etc. We pre-code the chart components that reside in an electronic format but provide the means to enter
codes associated with the paper record, creating a single traceable chart record. Again, coders will need to
verify suggested codes and look at any handwritten data that doesn’t reside in electronic form.”
Will We be Invaded by Spies?
Anti-fraud software is a feature that many administrators are looking for; however, not all software has
this feature. When referring to Fusion CAC, Tullis confirmed the source documentation cannot be changed.
The codes suggested by Fusion CAC are the only component that can be altered at a coder’s discretion.
“Any time a code is changed, deleted, or added, a traceable log file is created noting the affected change
and the coder who made the change.
Every alteration, every action within Fusion CAC leaves a ‘paper trail.’ Everything can be tracked to a
specific user, including when and what time the change was made, down to a tenth of a second. The
software also uses reverse mapping where accepted codes are traced back and highlighted within the
original source documentation.”
e-MDs system, however, doesn’t “have anti-fraud software labeled as such. There are strong audit trails
that keep track of transactions,” said Stearns.
This is very helpful as it tightens the controls on how money must be handled. For example, one of the
most common ways that money might be stolen from a system is the cash copayments received. There is
a function in place that immediately starts the tracking system such that someone cannot take a
copayment, hand-write a receipt, and then take the money. Even if the transaction is deleted, the record is
retained in the audit trails. Many financial reports can be run based on a number of criteria to help narrow
down and find the source of problems. For example, one might run a report by specific user and compare
it with other users. If it appears that there is an anomaly, then the audit trails will reveal the detail such as
a reduced charge from the defaults automatically set by the system from fee schedules.”
What Impacts Coders Most?
In the future, Tullis said, we will see “positive impacts in the form of increased coder and HIM efficiency
offsetting many of the new and future regulatory pressures on HIM. It will help the coders deal with new
regulations being implemented such as POA indicators.”
Stearns said, “Technology will provide clinicians with the ability to provide higher quality care by
identifying compliance with guidelines. Coders are perfectly positioned to take advantage of their
understanding of medical terminology to set up systems to automate quality reporting. Coders will be
required to learn about more sophisticated terminologies such as systematized nomenclature of medicine
clinical terms (SNOMED CT®), but the basic knowledge they need to know will be similar to ICD-9-CM.
They will also need tools to embed coded concepts within applications that can later capture structured
data.”
Copyright © 2009 American Academy of Professional Coders | 2480 South 3850 West, Suite B, Salt Lake City, Utah 84120
Embrace or Fear CAC Future – December 2008 Coding Edge – AAPC Page 1 of 2
http://www.
Embrace or Fear CAC Future – December 2008 Coding Edge – AAPC Page 1 of 2
http://www.
Embrace or Fear CAC Future – December 2008 Coding Edge – AAPC Page 1 of 2
http://www.
Embrace or Fear CAC Future – December 2008 Coding Edge – AAPC Page 1 of 2
http://www.
Newark Beth Israel Medical Center Goes Live with Dolbey`s Fusion CAC Computer-Assisted Coding Solution
June 10, 2009 — traci119Automatically Scans and Codes Patient Records; Automatically Abstracts Patient
Data and Demographics
CONCORD, Ohio–(Business Wire)–
Dolbey announced that Newark Beth Israel Medical Center, part of the Saint
Barnabas Health Care System, has gone live with its Fusion CAC computer-assisted
coding (CAC) solution to increase the efficiency of its outpatient records and
automate data abstraction for streamlined billing and coding. Shortly, the
hospital will go live with Fusion CAC for its inpatient records.
Fusion CAC is a comprehensive CAC technology that scans the entire patient
record for appropriate ICD9-CM diagnostic and procedure codes and CPT codes
using innovative language processing technology. Its patent-pending algorithmic
software electronically analyzes entire medical charts to pre-code with both CPT
procedure and ICD9 diagnostic nomenclatures. Manual coders, enhanced with the
results of Fusion CAC can easily approve or amend the automatic results and
increase efficiencies by as much as 80%.
Newark Beth Israel Medical Center is using the Fusion CAC system to replace its
manual coding and abstraction process which requires staff to physically
retrieve medical documents and enter code information into the system
redundantly.
The hospital is already seeing the system significantly improving the efficiency
and consistency of human coders. Newark Beth Israel expects to see a reduction
in the amount of time between when a patient is discharged and when billing is
complete-also known as the discharged not final billed (DNFB). “The rollout of
Fusion CAC was an exceptionally seamless and smooth experience,” said Tom
Gregorio, vice president and CIO at Newark Beth Israel Medical Center. “The end
user coders embraced the technology and were up and running quickly. We went
live on schedule and the Fusion CAC technology easily integrated into the rest
of our hospital systems. In today`s economy, being able to expedite the coding
process and make the billing process as streamlined as possible contributes real
savings to our hospital`s bottom line. Fusion CAC is helping us do more with
less while allowing us to deliver a cleaner bill with consistent coding
standards across the organization.”
“Newark Beth Israel Medical Center is an excellent example of an innovative
hospital that is combating the growing cost of healthcare reimbursement by
decreasing its claims denials, improving data accuracy, and enhancing records
management to facilitate compliance,” said Stuart Covit, executive vice
president of Artificial Medical Intelligence.
About Newark Beth Israel Medical Center
Newark Beth Israel Medical Center, an affiliate of the Saint Barnabas Health
Care System, is New Jersey`s largest non-university-based teaching hospital. The
Medical Center provides comprehensive health care services to its local
communities and is a major referral and treatment center for patients throughout
the northern New Jersey metropolitan area. The Beth is also home to Children`s
Hospital of New Jersey, providing state-of-the-art care in nearly 30 pediatric
subspecialties.
About AMI
Founded in 2002, Artificial Medical Intelligence is a healthcare informatics
software developer, focusing on increasing efficiency within Health Information
Management. Its patented natural language processing engine, EMscribeTM, powers
Fusion CAC and provides suggested ICD9-CM and CPT codes for both the inpatient
and outpatient encounter. AMI`s solutions are targeted at hospital healthcare
facilities, communicating seamlessly with all hospital systems, as well as
larger clinics and physician practices that are looking to automate process
management and improve the processing medical documents. The company is
headquartered in Eatontown, New Jersey.
About Dolbey
Dolbey is a leader in providing dictation, transcription, speech recognition and
coding solutions for healthcare in the United States and Canada. Together,
Dolbey and Company, Inc. and Dolbey Systems, Inc. offer the award winning Fusion
Suite of integrated products which is backed by the industry`s largest
organization of certified professionals who assist in design, implementation and
support.
Dolbey
Traci Miller, Marketing Executive
800-878-7828 x 119 / tmiller@dolbey.com
www.dolbey.com
Copyright Business Wire 2009
Computers, Coding, and Change
March 30, 2009 — traci119by Chris Dimick
Computer-assisted coding won’t eliminate the profession, but it will change it dramatically.
Mythily Srinivasan thought she was out of a job. Out with human coders, in with computer-generated coding. At first that seemed to be her facility’s master plan.
When word first came to Srinivasan, CCS, and her fellow coders that the Robert Wood Johnson University Hospital in New Hampshire was implementing computer-assisted coding (CAC), they feared the worst.
“Like everybody else, I thought, ‘Oh my god, is it going to come and am I going to be replaced?” says Srinivasan, now the coding manager at the hospital and a 17-year coding veteran.
With its implementation in spring 2006, what Srinivasan soon found out was that CAC secured her job and made it better. Her fear soon melted into appreciation for a technology
that has eliminated some of the mundane coding tasks and in turn enabled her to better use her unique skills.
“Now [coders] are very comfortable with CAC, because you really need manpower to evaluate the codes [and] ensure they are coded correctly and according to the guidelines,” Srinivasan says. “There was a lot of input from the coders when we initially started this. And I think it allowed the coders to see that their coding knowledge base and judgment was critical to the coding process [and] that the system was truly an aid.”
With more and more healthcare facilities implementing CAC, many coders are wondering what the future holds for their profession. Some have a similar first impression as Srinivasan—computers will eliminate humans.
Some coding positions are at risk of deletion. Others will require an increased emphasis on advanced skills. But several HIM experts say coding professionals will always be in demand, no matter how advanced the technology becomes.
A Twilight for Routine Coding
Layoffs in the coding department are a possibility due to CAC. But the first jobs to be cut are typically bottom-tier positions that are difficult to fill, even when there isn’t a coding shortage, says Becky DeGrosky, RHIT, a former coding manager and current product owner, clinical products at Accuro Healthcare Solutions, based in Dallas.
That includes outpatient radiology coding and GI lab coding. Most organizations introduce CAC in radiology, due to the high volume and highly standardized documentation generated there.
But the technology is never going to replace jobs that require analytical skills, DeGrosky believes. “There are two levels of coders in my mind,” she says. “There are the real coders, they are like hen’s teeth, they are very hard to come by. These are the people that actually read the record and make the decision not just what codes to assign but ‘what am I supposed to be coding here.’”
This type of coder holds different skills than those who are coding primarily for billing purposes on routine procedures. The latter code “for radiology, the cath lab, the GI lab—those are the kind of folks that computer-assisted coding is going to definitely replace,” she says. However, that time is still several years off, and as good as the technology is right now, no system is being granted unmonitored coding rights.
Security in Learning
Radiology coders and others affected by CAC can move to new roles, if they are professionally versatile. In general, the more educated a person is on coding, DeGrosky says, the safer his or her job is.
That doesn’t necessarily mean people must rush back to school. Some coders express worry that CAC will require them to get formal degrees to keep their job. DeGrosky believes properly trained coding professionals who keep up on their credentials already have most of the formal education they will ever need to work beside CAC. However, as the industry changes, coders may need to brush up on their schooling.
Coders will most likely need to hone the coding skill that makes them unique as humans—critical thinking. Understanding disease processes and pharmacology, and having sound familiarity with anatomy and body systems will ensure coding professionals have their place alongside coding technology, according to Cecilia G. Hilerio, RHIT.
Hilerio, director of health information services at Robert Wood Johnson University Hospital, says that coders will require this knowledge as their role transitions to coding oversight specialists. This education will come from both in-house training and formal schooling.
“I think that the coder is going to have to be very keen on investigating further into the medical record, whether it is a hybrid record or a complete electronic record,” Hilerio says.
In the Near-term, Automating the Grunt Work
CAC codes procedures that many people currently don’t want to do. That was the experience at Massachusetts General Physicians Organization in Boston, a subsidiary of Massachusetts General Hospital.
In 2001 the facility instituted a CAC program in its radiology department because the facility couldn’t retain coders to do the work. “We had a backlog of exams, and we had a difficult time retaining qualified coders to do that type of coding,” relates Gloria Johnston, MBA, RN, CCS-P, CPC.
Johnston, a former associate director of coding for the organization, worked at the facility during the CAC implementation. The coding that CAC now performs “was just really boring work,” Johnston says. “We initially thought we could supplement our staffing by using the computer-assisted coding to code the boring stuff, then we could have our coders work on the more complex stuff.”
That happened, but there was an added benefit, Johnston said. Once coders were trained on the new CAC workflow, their productivity increased. CAC didn’t lead to any reductions in staff, instead it filled the perpetual staffing holes.
The technology makes life easier for a coder, Hilerio says. “I think this is really going to help coders, period,” she says.
CAC is good for the industry, agrees DeGrosky, because it saves the grunt work for the machine and enables coding professionals to turn their skills to more complex coding cases. “Assigning the same code to 100 charts over and over—who wants to do that?” she asks. “For a lot of people, this is going to provide them with an opportunity to shine.”
Shasha Graham, CPC, was skeptical at first when her facility implemented CAC. In fact, coders at Shands at the University of Florida feared the worst when it was announced that the radiology department was implementing CAC in July 2005.
“One of the first things that went through our heads when our manager told us we were going to implement [CAC] was, ‘Oh my god, we are going to lose our jobs,’” Graham says. “‘They are going to put in this machine that will do our coding—what are we going to do?’”
Graham says she soon realized that CAC would improve her job and enable her to better use her coding knowledge.
“A lot of coders are afraid that by getting CAC their job is in jeopardy,” she says. “But by having CAC, our jobs aren’t going anywhere. We still have as many coders now as we did when we started this two years ago.”
That’s not the larger plan, however. Managers at Shands told Graham and her fellow coders up front that part of the program’s goal is to eventually reduce the number of coders on staff.
That reduction “is not now, and it is not tomorrow,” Graham says. She believes the cuts will come eventually, but thinks it could be five or seven years before they do. “There is no timeframe,” she says.
After initial training to learn how to work with the CAC system, Graham required no additional training to do her new job. Everything she learned through her coding certification still applied, she says.
Transitioning to New Roles
A lot of Graham’s time is spent approving codes that the program assigns. Because approving codes for standard cases takes less time than manually assigning them, she has more time to devote to other aspects of her job as a quality assurance coder, including handling rejections and educating physicians on proper documentation.
When CAC was first implemented, Graham spent a lot of time helping train the program on proper procedures. Taking part in this process demonstrated the need for human expertise in coding, she says. She uses an example of coding a complete versus a limited ultrasound of the abdomen. The program may “code it out as complete, and you read in the notes that all eight of the components are not coded, then you change it.”
Once the program is adequately trained and reliable enough to code cases, Graham still needs to approve the assigned codes. Coding programs will never stop learning and will never stop needing humans to help train them, Johnston says. Reviewing the output is an essential part of the technology.
At Shands, Graham says CAC advanced the coder roles by allowing coders to work on different coding queues according to their expertise. When CAC was first implemented, the only thing that came through the program were plain films, which the entire coding team shared at the time. But as more and more was put through the program, like “fluros and ultrasound and mammos and CT and nuclear meds,” coding professionals started to handle reviews differently, she says.
“Some people stayed on the plain films, and then the more established coders were moved up to the harder areas,” Graham says. “You could learn the area and find your specialty.” This made for a more mentally challenging and, in turn, rewarding work atmosphere, she says.
CAC also helps eliminate the strain of perpetually backlogged cases and aids coders in catching inconsistencies and inaccuracies, she says. Being able to do better work each day led to more job satisfaction. “If anything, [CAC] helps. You have more time to do other things,” Graham says. “You are coding it out, seeing everything, and that is something to be proud of in a way.”
The implementation of CAC at Mass General, along with a workflow redesign, allowed coders to move from the hospital’s backroom to their homes and telework. “The coders had improved satisfaction and morale,” Johnston says. “They in turn became integrated with the department, became the experts in the department, and became involved in developing their protocols. So really a much more expanded role for the coder.”
Kristie Thibault, CPC, says CAC had a positive effect on her job. Now the leader of the ancillary coding team at Mass General, Thibault was present when CAC was implemented for plain x-rays and mammography in 2001. No one was sure what was going to happen, and some feared for their jobs. But fears were put to rest when they saw how it would improve their work.
“I was ecstatic, because we had an old system that was very un-user friendly,” Thibault says. It took time for the program to get up to speed. Once implemented, any reservations she held diminished when she saw the need for human interaction.
“It was not even two weeks into the program and [the coding staff] knew we had very good job security,” she says. They saw that the new technology was not going to “take over.” Radiology coders were able to move up to more advanced cases, like neurosurgery and vascular surgery, and had more time to query physicians.
Not everyone wants those “higher” coding roles, of course. For some, the opportunity to expand their role isn’t a big enough draw to embrace change. Still, even those stubborn in their ways are not at risk of CAC taking their job just yet.
But change is a part of life, DeGrosky says, evident by the file clerks who lost their jobs after hospitals adopted paperless medical records. In order to avoid becoming outdated, coders must pay attention to the times and stay at the forefront of the profession, she recommends.
Help Needed: Human
CAC at Shands leaves plenty of work for coders, Graham says. After all, the program can’t run and find additional information. “It can only go off the information that it found on that particular reading,” Graham says. “So you still have a lot of research to do as far as getting the procedures coded correctly and paid for.”
Healthcare organizations should not purchase a CAC product and expect it to replace coders. Vendors are usually careful not to promise such a thing, DeGrosky says.
No matter how advanced CAC becomes, healthcare facilities will still require skilled coders to implement, train, monitor, and audit computer-generated codes, according to Johnston. “Until the day comes that our nation’s healthcare system changes such that detailed health information becomes unnecessary, we are always going to need this process,” she says. “Without humans, there is really no way to ensure that accurate coding information is being assigned, whether it is assigned by a human or by the computer.”
“The computer can only do so much,” DeGrosky agrees. “These coders are still going to be needed, they are just going to be in a different role, an advisory role to the computer.”
Though the coding profession will remain essential, that doesn’t mean coders shouldn’t emphasize their worth when CAC is implemented at their facility. Coders need to work through the implementation process and “lay claim to their turf,” DeGrosky says. “Say, ‘Here is where I know I’m the expert.’”
The most important thing when it comes to any change is that HIM managers provide adequate information to their coding staff about the future. “How will this change my job?” is a big question that needs to be addressed from the beginning, Graham says. “New things are scary. It was intimidating at first, but once we started doing it we were like, ‘Wow, this is pretty cool.’”
Chris Dimick (chris.dimick@ahima.org) is staff writer at the Journal of AHIMA.
| Article citation: Dimick, Chris. “Computers, Coding, and Change.” Journal of AHIMA 79, no.1 (January 2008): 46-49. |
Embrace or Fear CAC Future
March 27, 2009 — heather155By Michelle A. Dick, senior editor
Computer assisted coding enthusiasts believe it is the ticket to a streamlined coding process, with efficient
and accurate coding at a fraction of the price. Others fear it’s the end of professional coding as we know it;
and coders will have to adapt as computer software replaces job duties. Whether you see the glass half full
or half empty, your best bet is to understand the options that are in front of you.
How will CAC impact the ICD-10-CM transition, the coding process, the accuracy of coding, and the future
responsibilities of coders?
Will Software Complicate ICD-10-CM Transition?
The good news is that CAC and electronic health records may smooth the transition from ICD-9-CM to
ICD-10-CM. Computer application manufacturer e-MDs’ president, Michael Stearns, MD, CPC, is already
planning for ICD-10-CM implementation. Stearns said “We have an embedded terminology called the
Medicapaedia that is mapped to ICD-9-CM, ICD 10-CM, or any other terminology. This year, we will add
ICD-10-CM to prepare for use of our EHR in other countries. This allows for a seamless migration when
ICD-10-CM is required in the United States.”
Dean Tullis, president and CEO of Voice Products’ Fusion CAC, developed by Artificial Medical Intelligence,
said his company is working with hospitals already using ICD-10-CM in the countries of Canada and Brazil.
“We will provide an easy transition when and if the time arises for this coding system to become
standardized in the United States. The software model allows the ICD-9-CM and ICD-10-CM dictionaries to
be cross-walked and then tuned accordingly,” he told
Will Coding Robots Take Over?
Garbage in; garbage out. Because coding is a highly variable task, the error percentage rate with CAC is
also variable. There are factors affecting correct coding on the coding level and the reimbursement level.
Coding error percentage rates using CAC depends on the facility’s or practice’s needs, Tullis said.
“Every institution has its own coding subtleties … [Our product] Fusion CAC is no better or worse than a
coder. As part of our installation, we can tune our engine to the particular facility. However, some facilities
prefer not to tune the engine, but would rather have the coders select the codes, adding, or deleting codes
as necessary. Fusion CAC is NOT a coding robot and therefore does not ascribe to the misnomer term of
coding accuracy.”
Stearns agrees that the percentage of coding errors using E-MD EHR is dependent on who is using it. He
said, “It varies by clinic, but practices with efficient processes in place typically get well above 95 percent
acceptance (a denied claims rate of less than 5 percent). Some practices achieve consistently high
acceptance ratings as indicated by e-MDs customers and frequent membership monitoring of e-MDs
customers.”
Does a CAC Future Include CPCs®?
Will CAC replace certified coding professionals like robots replaced auto workers? Stearns said, “EHRs will
create new job opportunities for CPCs® in the area of pay-for-performance and related reporting activities,
which will soon be driving payment to a much higher degree. CPCs® will help practices by reviewing the
quality of automated coding support provided by the systems. It will also help auditors by increasing the
amount of information they can review, even from a remote location.”
Tullis said, “It is possible that coder responsibilities may change. Instead of being readers and procurers,
they will become reviewers and auditors. Coders will need to verify the codes within the documentation
and the system will require a level of human intervention, approval, and review. Many facilities work with a
hybrid medical record meaning they have paper records, progress notes, and legacy handwritten reports,
etc. We pre-code the chart components that reside in an electronic format but provide the means to enter
codes associated with the paper record, creating a single traceable chart record. Again, coders will need to
verify suggested codes and look at any handwritten data that doesn’t reside in electronic form.”
Will We be Invaded by Spies?
Anti-fraud software is a feature that many administrators are looking for; however, not all software has
this feature. When referring to Fusion CAC, Tullis confirmed the source documentation cannot be changed.
The codes suggested by Fusion CAC are the only component that can be altered at a coder’s discretion.
“Any time a code is changed, deleted, or added, a traceable log file is created noting the affected change
and the coder who made the change.
specific user, including when and what time the change was made, down to a tenth of a second. The
software also uses reverse mapping where accepted codes are traced back and highlighted within the
original source documentation.”
e-MDs system, however, doesn’t “have anti-fraud software labeled as such. There are strong audit trails
that keep track of transactions,” said Stearns.
This is very helpful as it tightens the controls on how money must be handled. For example, one of the
most common ways that money might be stolen from a system is the cash copayments received. There is
a function in place that immediately starts the tracking system such that someone cannot take a
copayment, hand-write a receipt, and then take the money. Even if the transaction is deleted, the record is
retained in the audit trails. Many financial reports can be run based on a number of criteria to help narrow
down and find the source of problems. For example, one might run a report by specific user and compare
it with other users. If it appears that there is an anomaly, then the audit trails will reveal the detail such as
a reduced charge from the defaults automatically set by the system from fee schedules.”
What Impacts Coders Most?
In the future, Tullis said, we will see “positive impacts in the form of increased coder and HIM efficiency
offsetting many of the new and future regulatory pressures on HIM. It will help the coders deal with new
regulations being implemented such as POA indicators.”
Stearns said, “Technology will provide clinicians with the ability to provide higher quality care by
identifying compliance with guidelines. Coders are perfectly positioned to take advantage of their
understanding of medical terminology to set up systems to automate quality reporting. Coders will be
required to learn about more sophisticated terminologies such as systematized nomenclature of medicine
clinical terms (SNOMED CT®), but the basic knowledge they need to know will be similar to ICD-9-CM.
They will also need tools to embed coded concepts within applications that can later capture structured
data.”
Copyright © 2009 American Academy of Professional Coders | 2480 South 3850 West, Suite B, Salt Lake City, Utah 84120
Every alteration, every action within Fusion CAC leaves a ‘paper trail.’ Everything can be tracked to aCoding Edge
Computer-Assisted Coding Webinar
February 16, 2009 — heather155Webinar: Computer-Assisted Coding in the Industry Today In March 2009 Dolbey will be hosting a computer-assisted coding (CAC) educational webinar. During this free, one hour webinar, you will learn how current and future issues will impact the coding industry and how technology can be used to address them. Below is a short list of computer-assisted coding advantages and how they will impact the health care industry:
• Rules-based, configured by site
• Increased coding productivity
• Increased efficiency; frees professional from mundane tasks
• Comprehensive code assignment
• Consistent application of rules
• Electronic coding audit trail •
How CAC can help with coding issues
Due to limited space, early registration is strongly encouraged. Click Here to Register!
Newark Beth Israel Medical Center to Automate Scanning and Coding of Patient Records with Artificial Medical Intelligences’ EMscribe DX
November 13, 2008 — heather155System to Decrease DNFB by 3-5 Days, Increase Revenues and Efficiencies; Dolbey to Demo Fusion CAC Powered by EMscribe at AHIMA
SEATTLE– (BUSINESS WIRE) — Artificial Medical Intelligence (AMI) today announced that Newark Beth Israel Medical Center, part of the Saint Barnabas Health Care System, is implementing its EMscribeTM DX computer assisted coding (CAC) solution to automate the coding of its inpatient and outpatient records for streamlined billing and coding efficiencies.
Interested parties can see demonstrations of Fusion CAC Powered by EMscribeTM on the AHIMA trade show floor at Dolbey booth #413. Dolbey markets AMI’s EMscribe under the Fusion CAC name.
EMscribe DX is a comprehensive CAC technology that scans the entire patient record for appropriate ICD9-CM diagnostic and procedure codes and CPT codes using innovative language processing technology. Its patent-pending algorithmic software electronically analyzes entire medical charts to pre-code with both CPT procedure and ICD9 diagnostic nomenclatures. Manual coders, enhanced with the results of EMscribe can easily approve or amend the automatic results and increase efficiencies by as much as 80%.
Newark Beth Israel Medical Center is using the EMscribe system to replace its manual coding process which requires staff to physically retrieve medical documents and enter code information into the system redundantly. Medical coding is the means of translating a patient’s medical chart into numeric codes so that providers can receive reimbursement appropriately. Presently, this manual process requires skilled practitioners, already in high demand, to manually read documents and laboriously key in the medical billing codes.
After implementing EMscribe, the hospital’s medial coding process will significantly change because the AMI solution will automatically suggest appropriate ICD9 or procedure codes to staff coders. Coders will then approve the suitable codes and send the patient charts to the billing system. The hospital expects the system to significantly improve the efficiency and consistency of human coders while reducing the amount of time between when a patient is discharged and when billing is complete—also known as the discharged not final billed (DNFB) window by 3-5 days. It also expects to save considerable costs from reducing its dependency on outsourced coding.
“A proficient revenue cycle – scheduling, quality coding, billing and a good denial management program – is vital to the operational success of any hospital,” said Mitch Blume, administrative director patient financial services at Newark Beth Israel Medical Center. “The technology behind EMscribe is helping us to dramatically improve the efficiency and quality of our medical coding process. This in turn reduces billing cycle time and ultimately contributes real savings to our bottom line. We want to do everything right the first time around so that we can produce clean claims and secure positive cash flow for the hospital on an ongoing basis.”
“Hospitals like Newark Beth Israel Medical Center are beginning to recognize that an effective claims management program can counter the continuing effects of declining payments and increasing cost pressures,” said Stuart Covit, executive vice president of Artificial Medical Intelligence. “Inadequate information technology and changes in billing and coding guidelines can all contribute to a high rate of claim denials. The EMscribe technology is the answer for hospitals like Newark Beth Israel that require a more efficient medical record coding process so that they can provide better service to patients, doctors and providers and improve billing and claim management.”
Newark Beth Israel Medical Center will be implementing EMscribe throughout all departments that can utilize the improved coding system.
About Dolbey
Dolbey is a leader in providing dictation, transcription, speech recognition and coding solutions for healthcare in the United States and Canada. Together, Dolbey and Company, Inc. and Dolbey Systems, Inc. offer the award winning Fusion Suite™ of integrated products which is backed by the industry’s largest organization of certified professionals who assist in design, implementation and support.
About AMI
Founded in 2002, Artificial Medical Intelligence http://www.artificialmed.com) is a healthcare informatics software developer, focusing on increasing efficiency within Health Information Management. Its patented core solution, EMscribeTM Dx, provides suggested ICD9-CM and CPT codes for both the inpatient and outpatient encounter. The innovative solution also functions as an information abstraction engine, automating such values as “Present On Admission”, (POA), and drug abstractions, as well as a new Recovery Re-submission module plus other customized data abstractions, thus making it the most comprehensive hospital tested HIM-Coding solution available. AMI’s solutions are targeted at hospital healthcare facilities, communicating seamlessly with all hospital systems, as well as larger clinics and physician practices that are looking to automate process management and improve the processing of medical documents. AMI can also help customers achieve the goal of creating a complete electronic medical record. The company is headquartered in Eatontown, New Jersey.
Gaining a Coded Edge
November 13, 2008 — traci119Radiology Group, PC, SC, is a practice of 13 radiologists in Davenport, Iowa. The practice owns the Radiology Group Imaging Center, one of the most comprehensive imaging facilities in Iowa and Western Illinois.
To maximize growth, Radiology Group decided in 2000 to spin off its billing function into a separate company, P2P Medical Management, now Radiology Billing and Coding Specialists, LLC (RBCS).
RBCS independently provides services to radiology practices and physician groups, processing nearly 320,000 reports annually for clients across numerous hospitals and outpatient sites. As it grew, a paper-based coding process and chronic coder shortage created a bottleneck, limiting the operation’s ability to grow further.
“We received all reports on paper, with codes handwritten on them by our coders,” says Melissa Wagler, RBCS’ billing office manager. “We were always about four weeks behind in coding. If one of our coders took any time off, we fell even further behind.”
The reverberations of the coding backlog extended to other operational areas. Redirecting resources to handle the backlog meant other billing staff had less time to devote to denials, quality assurance, and other account activities.
A Coder’s Perspective on Computer-Assisted Coding Software
November 13, 2008 — heather155A Coder’s Perspective on Computer-Assisted Coding Software
By Greg Schnitzer, RN, CCS, CCS-P, CPC, CPC-H, RCC, CHC
Radiology Today
Vol. 9 No. 9 P. 34
For nearly a decade, computed-assisted coding (CAC) software has been available to help coders. So what is this software all about, and how does it help?
CAC software is used to “read” dictated and transcribed documents that are in an electronic format, much the same way a spell-checking program reads a document. The software recognizes words and phrases, as well as the regions of the document in which those words and phrases appear, and the contexts of those words and phrases. It then “predicts” through intricate statistical analysis, elaborate algorithms and rules, or a combination of the two what the proper CPT and ICD-9-CM codes should be for the procedures and conditions it finds.
Using CAC
A radiology group or a billing company, for example, contracts with a CAC software coding companies and arranges for its dictated and transcribed radiology reports to be sent electronically to the CAC company via the Internet. The CAC company then submits the reports to its coding software server. The coded reports will either be sent back to the provider where they can be reviewed by a coder with a Web browser or straight to the provider’s billing system, if the organization is comfortable with certain types of reports bypassing a coder for review.
Typically, the interface that a coder uses displays the note on one side of the screen and the automatically assigned codes on the other. The coder uses this interface to review the notes, look at the codes assigned by the software, make any necessary coding changes, and then approve the report to go into the billing system. Afterward, the coder is instantly provided with the next note for review.
Because this is generally done via the Internet, the coding process can be decentralized, and the coder could be working from anywhere. This opens up new possibilities for organizations looking for top talent, enabling them to hire from any location. At the same time, it frees coders to live and work wherever they prefer.
Additionally, sophisticated natural language processing systems modernize compliance efforts and internal audits, both concurrently and retroactively examining the flow of information for correct codes, poor dictation, and other issues that can muddle the process.
How Does It Work
Sophisticated CAC software is not based solely on key words appearing in a document. To be a valuable tool for the coder, it must be more advanced than that. It must be able to determine when a procedure or condition appears in a context that allows it to be coded vs. where it should not be coded.
For example, consider the following sentences that would appear in a typical radiology note:
1. I see a coin lesion on the patient’s left lung.
2. The patient’s father has a coin lesion on the left lung.
3. I have confirmed that the coin lesion is now absent in the patient’s left lung.
4. I have ruled out the presence of a coin lesion on the patient’s left lung.
5. There is a questionable coin lesion on the patient’s left lung.
Few coders would have trouble determining that while the coin lesion is codable in the first example, it would not be codable in the other examples. Clearly, recognizing the mere presence of the words “coin lesion” is insufficient to code the note correctly. While coding a condition is relatively easy, CAC software must be sophisticated enough to recognize myriad contexts where a phrase like coin lesion may not actually be a codable condition.
How can software recognize and know when the condition appears in a codable context or noncodable context? The short answer is that there are different computational approaches. Books could be (and have been) written about computational linguistics and natural language processing, as well as how software can be taught to “understand” language patterns and make predictions based on similar documents it has seen in the past. In essence, CAC software, supported by natural language processing, coaches computers to understand the English language and read physicians’ dictated reports to assign appropriate codes for patient encounters. Sophisticated software algorithms are written and millions of coded notes are analyzed by a computer to see how human coders coded the notes. Based on all the coding humans did, the software statistically predicts and learns to emulate a team of coders.
So what does this all mean for a coder? In its first decade of actual use for coding physicians’ notes, the magic that CAC software performs has become more elaborate. Early on, CAC software involved the simplest of notes such as routine mammograms, chest x-rays, and x-rays of a limb to evaluate a fracture. The technology could accurately assign those codes without a coder’s review. Using CAC can reduce the demands on human coders by removing their involvement in simple and repetitive coding tasks.
Candidly, most coders—including me—would be glad to be rid of these radiology reports. Not only are these notes the low hanging fruit of coding, they’re also the drudgery of coding. For a coder, working with a CAC software tool can mean the difference between coding their 200th screening mammography report of the day or spending their time with the more interesting and complex reports.
CAC software has become a valuable coding tool, just as encoders became valuable tools 20 years ago. But be forewarned, like virtually every other industry, technology is changing how people work. Keeping up with the changes such as CAC helps coders continue to succeed and do their jobs even better. CAC elevates coders professionally, focusing on advanced coding work and offering experience in auditing and quality control, ultimately making coders more competitive in the market.
