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Simplify CPT and E/M Coding Processes with Computer-Assisted Coding Software

By AGS Health

July 26, 2022

Digital transformation is ubiquitous across businesses and industries. However, different technologies have been frontrunners in the digital race for each field. For retail, it’s chatbots. For manufacturing, digital twins. For health information management (HIM), that role undeniably belongs to computer-assisted coding (CAC) systems. Medical coding software has provided significant benefits for the value-based healthcare ecosystem. AI and automation technologies have emerged as pivotal forces of transformation.

The global market for AI and automation in healthcare is projected to grow at a 46.2 percent compound annual growth rate (CAGR) from USD 6.9 billion in 2021 to USD 67.4 billion in 2027. This demonstrates the significant benefits of utilizing AI for coding, with AI and CAC solutions paving the way for a more automated future.

Healthcare providers are beginning to understand the promise and urgency to integrate these services into their operations. Medical coding software integration has yielded significant benefits.

In fact, coders using CAC significantly outperform the decision health benchmark. AGS’s CAC solution, for instance, has helped providers:

  • Improve productivity by as much as 50%
  • Reduce denials by 20-30%
  • Improve risk score capture by 20%

Executives should consider these outcomes when discussing how to enhance revenue cycle operations.

Ongoing changes to CPT codes reinforce the importance and usefulness of CAC in simplifying coding and documentation for outpatient evaluation and management (E/M) services. Using technology to augment staff offers numerous benefits which should not be ignored.

How New CPT Guidelines Influence CAC Implementation

As the impact of medical coding becomes more closely tied to revenue outcomes, it also becomes more integrated into the overall business infrastructure for providers. Understanding Current Procedural Terminology (CPT) is crucial.

The CPT refers to codes, descriptors, and guidelines used to describe procedures and services performed by physicians and other healthcare providers during the caregiving process. These codes serve as the foundation for E/M coding, governed by a long-standing set of constantly evolving guidelines.

The 2021 CPT E/M coding guidelines were intended to reduce administrative pressure on physicians. Touted as one of the “first major overhauls in more than 25 years,” the hope was to streamline documentation requirements for healthcare professionals.

The major question at the time was: How do these guideline changes influence CAC implementation?

Powered by an amalgamation of AI and NLP technologies, CAC software can analyze and use unstructured data, thus making it easier to assign accurate E/M codes based on the data gathered. This significantly reduces the time spent manually filtering through data and inputting it into the system.

As new codes and revisions are introduced in the CPT code set, CAC systems can better classify outpatient services and structure the management process. In the past, CAC played a crucial role in strengthening legacy infrastructure’s shortcomings, such as its lack of effective coding capabilities.

CAC implementation capabilities continue to improve, ensuring its continued growth in the years ahead.

However, there are pain points to consider with CAC implementation, as with any technology, including:

  • Increased hardware and software costs
  • Improperly built templates resulting in inaccurate code selection
  • Poor adherence to industry standards
  • Potential cloning of codes

Simplifying Your Medical Coding Needs – The AGS Way

With the benefits and drawbacks of CAC systems understood, it’s time to identify the right solution.

The right partner will help you achieve your healthcare objectives by presenting a CAC solution that addresses your specific coding needs. And this is where AGS can help.

AGS’s comprehensive CAC solution streamlines and optimizes the entire coding process by assuming end-to-end ownership of the implementation and framework. Powered by a combination of NLP and ML capabilities with CPT E/M logic algorithms, our CAC solution automates E/M coding assignments by:

  • Identifying every potential ICD code –implied or explicitly mentioned – based on available data
  • Capturing code across all components of documentation
  • Automatically selecting the proper E/M codes based on the latest CPT criteria using either total time or relevant factors to maximize overall documentation

These capabilities can take the coding process even further - suggesting case history codes, assigning examination types, and even assessing the complexity levels of various outpatient cases.

AGS’ CAC solution addresses many of the typical pain points associated with CAC implementation by:

  • Giving you control of your software and hardware costs based on your budget.
  • Collating and organizing data comprehensively from various sources, ensuring that templates are correctly built, preventing inaccurate code selection.
  • Offering end-to-end support and implementation courtesy of our industry experts and proprietary technology, ensuring industry standards are followed every step of the way.
  • Providing accurate E/M code selection and management powered by AI automation to prevent any potential cloning in code and subsequent errors.

Medical coding has never been more effortless. When CAC is combined with ever-changing CPT E/M coding guidelines, it elevates the ability to maximize reimbursements. When technology supplements staff, who can then validate code recommendations, client reimbursements increase, but it takes the right partner to make it happen.

If you are ready to begin discussions about how AGS’ CAC solution can benefit your organization, we invite you to contact us today.

AGS Health

Author

AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.

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