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Measuring the Success of Computer-Assisted Coding

By Jon Melling

As the switch to ICD-10 has officially passed, health care organizations are scrambling to improve productivity within their coding processes. Many organizations are exploring computer-assisted coding (CAC) as a means to improve efficiencies. By using natural language processing, CAC electronically identifies key terms within a medical document to determine the correct code needed for a billing statement. While the technology has been discussed for nearly two decades, it’s now a viable option for health care organizations, and a new sense of urgency has taken hold in the community to apply it in order to increase revenue while also cutting back the cost of coding.

Measuring Success
The benefits of CAC are widely known. It increases coder productivity and accuracy and reduces time to produce a bill, and therefore, a claim; this ultimately means more cash on hand for health care organizations.

Apart from increasing efficiencies, CAC also can increase revenue. A higher level of detail in documentation means more information on each bill; this could uncover previously unclaimed revenue. CAC can also decrease the number of denials, as incomplete documentation leads to incorrect or insufficient codes, and in turn, may lead payers to deny a claim.

To realize these benefits, a health care organization will be required to make investments in staffing to properly implement CAC. While the number of coders on staff likely won’t decrease, pressure to augment the number of coders with contract staff will be alleviated as they become more productive. This is especially critical, as skilled coders are difficult to come by in today’s market.

While the return on investment for CAC is currently difficult to measure given it impacts so many areas of the billing process, health care organizations using this technology should monitor the below metrics for any changes—good or bad. Tracking these numbers over time will help facilities weigh determine the success of their CAC implementations. Key performance indicators include the following:

• number of discharged patients not final billed;
• amount of cash on hand;
• number of charts completed each day;
• the number of days in accounts receivable; and
• number of queries sent back to physicians.

The Physician-Coder Link
Another crucial component to take into consideration when implementing CAC technology is the physician staff. Without excellent and complete physician documentation, the true value of CAC will not be realized. ICD-10 generally requires more information within the medical record; this could result in physicians inadvertently leaving gaps in documentation, such as observations.

On top of that, let’s say the chart isn’t fully electronic and needs to be accompanied by handwritten notes. This significantly reduces CAC’s effectiveness and thereby coder productivity. Luckily, there are technologies that can improve this process. Computer-assisted physician documentation, for example, will improve a physician’s documentation of a procedure by suggesting additional information that, based on the context, may be relevant that procedure. This prompt ensures physicians won’t submit incomplete documentation, thus improving the probability that CAC will be effective.

This technology is increasingly being linked with CAC to streamline the EMR process. However, this creates certain risks within a health care system. For example, there are workflow concerns, as some believe combining chart review and coding will cause confusion.

What Stands in the Way
While CAC appears to be a great resource for all health care organizations, there are still several adoption barriers, including cost, workflow challenges, and limited capacity. Many hospitals are already spread thin and are overwhelmed in the changing regulatory landscape, which makes it increasingly difficult to implement new systems.

There are also concerns as to whether CAC will replace the need for coders. However, this type of technology simply cannot be implemented without human support. The technology is inherently imperfect—no matter how fine-tuned it becomes, there will always be gaps, mistakes, and incorrect codes that will generate queries only a coder can resolve. The technology instead will elevate coders’ responsibilities, enabling them to view the process at a higher level and be more effective.

If your organization is considering CAC, it’s important to remember that this technology isn’t simply a plug-and-play solution and affects more than just the coding department. Physicians and physician staff, nurses, HIM, and other groups within the revenue cycle will be involved. Therefore, create an implementation plan that acknowledges the impact each group will experience as a result of these changes. The more you prepare, the more seamless your implementation will be.

— Jon Melling is a partner at Pivot Point Consulting.