Navigating the value transformation journey: improving financial performance through coding and documentation improvement

In a previous post, I discussed the need to have clinical technology in place that allows for interoperability, that improves physician adoption, and that helps you streamline clinical and administrative processes. In this post, I’ll discuss technology that can further help your organization get its financial house in order as it journeys from volume to value.Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth

The implementation deadline for ICD-10 is less than a year away. Much has been written on this blog and in other forums about the potential of ICD-10 to hinder revenue cycle productivity and interrupt cash flow. Appropriate training and a good corps of consultants can go a long way to making you ICD-10 prepared. But technology also plays a vital role in your preparedness, especially for mitigating productivity lags and speeding up cash flow.

Improve revenue cycle productivity with CAC

Computer-assisted coding is “the use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation,” according to the American Health Information Management Association (AHIMA). Most CAC applications generate this list of codes by automatically analyzing electronic documentation using a natural language processing (NLP) engine. This documentation analysis is the key to CAC’s effectiveness. After analyzing documentation, the NLP engine serves up a list of potential codes to the coder, who then validates the appropriate code.

An NLP engine’s proficiency at documentation analysis is key to helping hospitals through the ICD-10 conversion. The speed with which an NLP engine can accurately review patient charts will help mitigate the productivity drop that hospital leaders are expecting when ICD-10 becomes the standard code set. Additionally, since ICD-10 is expected to make the current coder shortage worse, improved productivity from quicker documentation review and subsequent suggestion of codes can help coding departments do more with less.

A study conducted at Cleveland Clinic concluded that when coders utilize CAC to suggest codes, then independently verify those codes, productivity increases and accuracy remains constant.

Improve coding and billing accuracy with automated CDI

But even if coders are well-trained for ICD-10 and use CAC to improve their productivity, poorly documented records will slow the coding and billing process, or even make it impossible to submit a claim for the case. However, a technology similar to CAC also promises to improve revenue cycle productivity under ICD-10: automated clinical documentation improvement (CDI).

By automating patient medical record review using NLP, automated CDI can review hundreds of cases per day and identify those that have a high probability for documentation improvement. This allows CDI specialists to prioritize the cases on which they work, and minimizes the number of queries a physician needs to review to determine clinical relevance.

The technology also addresses low query response rates by integrating queries directly into the physician’s routine workflow and making physician queries more clinically relevant.

ICD-10 is a major challenge for health care providers of all kinds, including those transforming from volume to value. Computer-assisted coding and automated clinical documentation improvement can go a long way toward helping organizations improve the accuracy and efficiency of their revenue cycle during the ICD-10 implementation and beyond.

“Navigating the transformation journey” previous posts:

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