An Encoder is not CAC, So what is CAC? Under the historical definition, CAC was the use of computer software that automatically generates a set of medical codes for review, validation, and use based upon provider clinical documentation.**
This post is for decision makers such as Director of HIM, Coding Director/Manager, IT Executives, Revenue Cycle Management Heads, and Chief Financial Officer, that are the direct or indirect beneficiaries after deploying the CAC software solutions.
With their historic announcement in January 2015, Medicare set clear goals for “transitioning from volume to value.” CMS is currently targeting 90 percent of all payments are tied to quality, or value, by 2018. Today’s efforts include programs such as hospital Value-Based Payment, Hospital- Acquired Conditions and Bundled Payments for Care Improvement initiatives. Tomorrow’s transformations in healthcare will bring about even more changes towards how hospitals will document, code, bill, and manage health information. With the transition from fee for service to value-based care, many hospitals are seeking to adopt technologies like CAC.
Computer assisted coding is used to improve coding efficiency, decrease documentation deficiencies, improve code selection accuracy and reduce accounts receivable. Although there are other solutions that can do this for your hospital, CAC software accomplishes these business needs by optimizing coding workflow. A well-engineered CAC application delivers complete integration of data from disparate sources into a single repository, eliminating the need for coders to traverse multiple information systems.
In a traditional environment, coding is performed by manually reading clinical notes from an EHR, or health information systems, and then using either a logic tree or a book-based encoder, to derive a code(s); essentially, manual abstraction of indicators that result in manual code generation. Do remember, An encoder is not CAC.
On the other hand, Artificial Intelligence-driven CAC leverages advanced technologies such as Natural Language Processing (NLP), Medical Ontologies, Computational Linguistics, and Machine Learning to read and interpret clinical notes. A CAC application identifies key coding indicators, also known as coding evidence, and the CAC application then suggests medical codes for that particular episode/diagnosis/procedure. The medical coder then simply reviews the suggested diagnosis and procedure codes and approves them for billing. CAC software should deliver all of the tools necessary to optimize coding, improve code selection and mitigate compliance risk. An effective CAC application will eliminate manual processes, rework, duplication of effort and provide the buyer with an opportunity to sunset expensive add-on software.
Assessing workflows and uncovering the advantages and benefits of implementing CAC for your hospital and helping select a CAC application/vendor that is able to “check off all of the boxes” during your evaluation is very challenging. If you a healthcare leader, manager, coder, or educator, register for an exclusive and educative webinar on How to Select Right Computer-Assisted Coding Technology & Vendor For Your Hospital?
Remember, An encoder is not CAC, and Computer-assisted coding (CAC) software is not just a tool for coders, it is also a collaborative workspace for CFO, HIM, Coding Supervisor, and CDI Staff.