Computer-assisted coding depends on the accuracy of the input.
There is considerable interest in computer-assisted coding or “CAC.” The proponents say it will reduce costs, coding backlogs and discharged not final billed claims. There are several companies in this space, the largest being 3M with more than $30 billion in revenue every year.
CAC is part of a larger move into artificial intelligence or AI. Many companies, including those in the healthcare sector, would like to replace costly humans with computers. In the 1960s, the television program, “The Twilight Zone,” had an episode in which a man running a manufacturing plant turns to robots to reduce costs and increase efficiency. In the episode, Wallace V. Whipple replaces people with robots, despite the stern warning of the employees. The show ends with Mr. Whipple, drinking in a bar, angrily complaining as his robot doppelganger sits in his chair at the office smoking a cigar. All the humans are gone, replaced by robots that look like people.
With CAC we do not have human-looking robots sitting at desks coding accounts. We have computer software matching data from electronic medical records into diagnosis and procedure codes.
The benefits of CAC include the fact that it is fast, scalable, consistent and accurate based on the data in the medical record. There are no coding backlogs as CAC software can run through unlimited claims in a fraction of a second. It never codes for things not in the medical record.
The first problem facing CAC is “garbage in garbage out,” GIGO. CAC depends on the assumption that the medical record is complete and accurate. Let’s take evaluation and management (E&M) services as an example. The computer can look at the electronic medical record to find documentation of the patient’s history and physical. It can look for the documentation of the review of systems and it can look at the amount of time from the time the patient is admitted until the patient is discharged. The software can then give a code for the service. What is needed is to know if all the data is being correctly being loaded into the system and if the data is accurate? Did the physician really have the “face time” the medical record states?
The second issue is oversight of the coding process. When healthcare providers are doing manual coding, there is at least some communication between health information management (HIM) and billing. All the stakeholders in the revenue cycle usually meet regularly to discuss challenges. Overdependence on CAC can break down this communication. Compounding this is the fact that computers can make mistakes faster than humans.
In conclusion, CAC can increase consistency and accuracy to the coding process, but like any other revenue cycle process, will require daily oversight and making sure the documentation supports the coding.
Coding in the post-acute care world has taken on a new significance in the past five years. For those of us who are coders, this
External audit volume more than doubled in 2024 over 2023 while total at-risk dollars increased fivefold to $11.2 million, impacting healthcare provider organizations’ cash flow
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
