Computer Assisted Coding
What is CAC?
"The use of computer software that automatically generates a set of medical codes for review/validation and/or use based upon clinical documentation provided by healthcare practitioners."
Benefits of CAC
Enhanced Compliance Accurate coding the first time Complete traceability of codes to document for internal and external auditing Decrease vulnerability to Recovery Audit Contractor (RAC) program
Benefits of CAC
More Consistency Less room for coder interpretation Improve quality of less experienced coders bridging the coder experience gap
How Does CAC Work?
Analysis of context and interaction of words within a sentence /paragraph Rules out numerous possible meanings before forming a conclusion on the intended meaning of the word (this is the key and where many CAC systems differ) Applies ICD-9-CM guidelines to word meanings to determine codes
CAC and the Coder
CAC technology enhances the coding process CAC will not replace coders CAC transforms a coding professional into a medical documentation editor
Impact of CAC on Coding Professionals
Coder's role in CAC is critical to it's success Ultimate responsibility to validate and accept codes recommended by NLP Crucial to the auditing of each case before finalizing coding prior to billing
Impact of CAC on Coding Professionals
Computer-Assisted Coding Will change the role of coders. They will become more of an auditor of NLP output Will not replace coders but will be a tool to help improve their productivity, accuracy, and quality Will still require coders to review all handwritten documents in the patient record as CAC cannot read non-text document
Why the shift toward CAC?
Expansion of PPS to multiple healthcare settings Expanded coding rules (payer, CCI, gov't regulations) Increased need for data Increased scrutiny for coding errors and fraudulent claims
Benefits of CAC
Improved Coding Accuracy Identify and capture ICD-9-CM and CPT codes base on clinical documentation Decrease external audit dependency and costs
CAC-Natural Language Processing (NLP)
Natural Language Processing (NLP) is the technology behind computer-assisted coding Software that can 'read' electronic physician documentation, identify key clinical facts and map those facts to codes Physicians use standard dictation/transcription, speech recognition, or templates with free-text fields There are multiple technologies used for NLP within the industry
Benefits of CAC
Increased Coder Productivity Reduce coding backlogs, overtime and contract coding services dependencies
Benefits of CAC
Increased Revenue Improve Case Mix Index (CMI) Shorten revenue cycle Decrease number of denials and re-bills Reduce administrative costs
Why the shift to CAC
Increasing number of codes collected for accurate reimbursement Financial pressure to "drop" a bill efficiently to support the A/R process Increase efficiency Preparedness for ICD-10 transition
What the CAC Vendors Say
Maximize coder efficiency Streamline workflow Reduce time to complete case Improve coding quality Increase accuracy (lessen denials and rework) Consistency within the coding department Improve case mix index Shorten revenue cycle Timely billing Improve compliance Ease transition to ICD-10
