When it comes to coding, lack of preparation opens the door to multiple risks for the healthcare organization – especially the rapidly evolving nature of today’s medical coding that can significantly impact a healthcare organization’s revenue stream and financial bottom line. It’s an issue we explored in depth in our recent webinar, Embrace Code Changes and Improve Coder Productivity with Computer-Assisted Coding (CAC) Software.
The annual release of new ICD-10, CPT, and HCPCS code sets can disrupt both coding operations and the revenue cycle, as can the quarterly updates to both CPT and HCPCS codes. Updates also come from Medicare Administrative Contractors (MACs) year-round. When these updates are not implemented in a timely manner, it can delay claims processing and cause denials.
Additionally, outdated code sets can impact the level of specificity which may create lags in reimbursements as payers request more specific codes on diagnoses that were updated in the latest code set. It can also impact the capture of chronic conditions, create a deficit in quality measures that cause a loss of eligibility for certain programs such as grants and Medicare/Medicaid, and may cause commercial payer benchmarks to be missed resulting in a loss of incentives.
The good news is that today’s artificial intelligence (AI) powered Computer-Assisted Coding (CAC) programs make implementing updated codes – including preventing use of removed codes – a quick and painless process while also improving coder productivity and accuracy.
In the case of one 470-bed teaching hospital, implementing the right CAC solution resulted in a 38% reduction in DNFC days, reduced complex denials by 13%, and increased coder productivity by 33%.
A CAC Primer
CAC technology accurately generates medical codes directly from clinical documentation, allowing healthcare organization to improve compliance with payer and quality reporting requirements while also improving their bottom line. CAC doesn’t eliminate medical coding experts from the process; coders must still review and revise codes identified by the CAC software and cross-check them against standards before they are assigned. It does, however, make coders more effective and their coding more accurate.
An effective CAC program can positively impact the coding process in five key areas:
- Performance – Coders don’t have to chase down information or lose valuable time identifying charts that need coding. When coupled with the reduction in manual entry points, the result is accelerated performance of the coding team.
- Correctness – Because it is AI, natural language processing (NLP), and clinical language understanding (CLU) CAC software can “understand” the context of the clinical documentation, allowing it to more accurately select codes which in turn improves correctness and reduces denials.
- Consistency – Unlike humans, knowledge is built into CAC and it never tires, which means codes are generated consistently regardless of the volume of charts it must analyze.
- Transparency – CAC’s audit trails provide transparency and rationale behind coding decisions, which helps increase the trust factor.
- Compliance – Regulatory and payer compliance are built into CAC systems.
CAC’s workflow architecture also aligns objectives with the coding workflow to prioritize and generate key metrics.
CAC and Training
Ongoing coder training is an important aspect of any coding program – with or without CAC – as well-trained coders ensure charts are coded to the highest level of specificity and accuracy. This, in turn, ensures the healthcare organization receives highest appropriate reimbursement while reducing the risk of denials, which can be costly to rework.
The ideal training cadence is monthly and quarterly, which not only ensures coders are up to date with the latest code sets but also offers them the opportunity to be cross trained on other types of coding. Offering continuing education and training also positively impacts coder recruitment, retention, and job satisfaction. And, when coupled with ongoing coding audits, it ensures the healthcare organization remains compliant with requirements and regulations.
CAC software has an important role to play in coder training by offering oversight to ensure codes are meeting the new requirements – even if they have not had time to train on everything. CAC can also help offset production decreases that happen when coders need to look up the new codes or miss something due to documentation changes. It helps prevent denials from the use of old, incorrect codes and provides relevant and the most updated coding references at their fingertips.
All are Not Equal
There are many CAC systems on the market, but not all are equal in terms of functionality and effectiveness. The most efficient solutions should be able to adapt to existing clinical workflows rather than forcing process changes. They should also act as a catalyst to ensure that coders are able to code clinically valid codes and get them out the door faster.
Look for CAC systems that have the ability to bring the knowledge of past denials due to coding errors into the system to prevent them from re-occurring, which ensures claims are cleaner from the get-go. CAC should also offer complimentary solution such as CDI and Audit to help multiply the gains.
Finally, when part of an AI-powered end-to-end revenue cycle management platform that includes automation, CDI, enterprise audits and analytics, CAC can drive improvements across the board. This includes an average Case Mix Index improvement of up to 5% and coder productivity increase of up to 40%, as well as a reduction of coding denials of up to 50% and a decrease in DNFB of one-to-three days – making it worth the investment.
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