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Leveraging AI based CAC: Key Strategies to Success in Professional Coding

Leveraging-AI-based-CAC

Professional Coding – Outlining the importance

In a value-based care ecosystem, professional medical coding practices are imperative in helping physicians & HIM staff sustain hospitals, clinics, and physician groups’ revenue streams. For a healthcare organization, patient insurance claim reimbursements depend on the accuracy of the medical coding process and subsequent documentation of treatment.

However, in 2015, the ICD-10 coding classification system introduced 19 times as many procedure codes and three times as many diagnosis codes than its predecessor (ICD-9). This made coding and documentation a complicated and onerous procedure and hospitals have struggled to optimize their coding framework ever since.

The recent influx of outpatient volumes has further exacerbated this challenge. With hospitals and clinics experiencing a growth in outpatient utilization and a dip inpatient volumes, there is a severe need for a shift in coding focus. But considering hospitals need to execute this change in a volume-based care model, it would involve changing how information is captured. Take for instance, chronically ill patients who need special care in order to be kept from being admitted. Documentation and coding will need to accurately capture the chronic condition and preventive treatment. A single overlooked criteria could potentially cause the hospital or clinic to not receive reimbursements for the treatment. Or at the very, least be reimbursed inadequately.

Moreover, with the prospect of healthcare audits emphasizing compliant medical coding & documentation and associated penalties or incentives, physicians face increasing pressure to deliver under the stringent requirements. Given these factors, the importance of an AI-powered solution in professional medical coding cannot be overstated. Efficient implementation of AI-enabled tools can not only significantly boost coding workflows but also open new avenues to scale operation.

Improving Coding practices to enhance efficiency and efficacy

The medical coding and documentation process is crucial in assuring claims reimbursements. And harnessing the capabilities of AI can substantially simplify this process. Various strategies can be implemented around AI-based Computer Assisted Coding (CAC) programs that optimize the chain of coding to compliance & revenue management.

Enabling better coding practices to improve accuracy

When it comes to professional coding services, accuracy is key challenge. In fact, the Centers for Medicare & Medicaid Services (CMS) estimated at total of USD 28.91 billion in improper payments during the fiscal year 2019.

AI-based CAC programs are capable of leveraging ICD-10-CM/PCS, CPT/HCPCS, and E/M compliant codes along with automated abstractions to ensure coding accuracy. Additionally, the holistic visualization of key stats and advanced analytics gives HIM professionals a deeper insight into incorrect codes and practices that can be effectively identified and rooted out.

Better management of coding resource and time

Often physicians are required to execute large volumes of coding and documentation simultaneously with regular healthcare work. This further exacerbates the pressure on the already overburdened healthcare professionals tasked to maintain the increasingly lofty standards that are expected in a value-based care ecosystem.

Computer-assisted Coding (CAC) software can assist medical coding professionals by identifying and mapping accurate medical codes. This effectively eliminates the need to dig through coding manuals to find the correct codes. By automatically suggesting accurate codes, an AI-enabled CAC software can improve efficiency of the coding process.

And when it comes to optimizing outpatient coding utilization, a AI-powered CAC software offers a turnkey solution. By automating the coding process, such a solution could streamline the workflow. Moreover, by reducing the need for manual intervention in the identification of coding categories, it also ensures greater accuracy in the outpatient coding process.

Revamping billing and coding practices to accelerate Code-to-Bill cycles

The synchronicity between medical coding and billing is key to accelerating code-to-bill cycles. A lack of interdepartmental communication results in gaps that can delay the entire process, thereby hindering the revenue cycle in general.

Since an AI-based CAC can serve as a unified data platform for different units of a healthcare organization, it ensures seamless inter-departmental communication. This allows for a comprehensive and coherent vision of key performance indicators. Combined with the ability to monitor each aspect of the coding practice, it enables an organization to accelerate code-to-bill cycles with minimal effort.

Practical improvements to reduce coding denials

According to the Medical Group Management Association (MGMA), optimized coding practices can assure a claims denial rate of less than 5%. Erroneous and incoherent coding practices is one of the most common reasons for claims denial.

We’ve explored how the ever-increasing workload coupled with the stringent coding guidelines often makes diligent coding a challenging proposition. This is where AI-based CAC programs can assist medical professionals by eliminating the bulk of manual coding requirements. With integrated analytical tools that assist in weeding out coding inaccuracies swiftly, they enhance, both, the efficiency as well as the accuracy of the coding process.

Track coding and organizational metrics in real-time

Increasing the accuracy of codes is one thing. But the most significant aspect of an AI-enabled computer-assisted coding software is its ability to provide real-time visibility into coding and organizational metrics. By enabling continuous supervision of the coding process a robust AI-enabled CAC solution can track coder productivity and accuracy. As a result, hospitals and healthcare institutions can promote a transparent approach to coding efficacy.

Moreover, AI-powered CAC software provides decision-makers with the ability to visualize key performance indicators (KPIs) in a comprehensive and coherent manner. This allows for a more effective decision-making process that focuses on higher care quality and the growth of revenue channels. In fact, hospitals have been experiencing a rise in revenues by leveraging AI-powered CAC.

AI-enabled CAC software can greatly simplify the medical coding process. However, without proper implementation, they can become an expensive affair that fails to deliver justifiable ROI. ezDI’s CAC solution, ezCAC, ensures that you reap the full benefits of the program. As the only born-in-the-cloud, fully automated, AI-enabled computer assisted coding software, ezCAC not only improves the efficiency of your coding workflow but also provides you real-time visibility of coding and organizational metrics. As a result, you can promote better decision-making and improve the productivity of your coding process.

To learn more about ezDI’s AI-based mid-revenue cycle management solutions visit www.ezDI.com and to see the live product demo of our Clinical Documentation, Coding, Compliance/Auditing, Quality Measures, Encoder, and Enterprise Analytics request a live demo.

Devanshu Yadav

Devanshu Yadav

Devanshu Yadav is a corporate strategist at ezDI Inc. He works for continuous advancement in bringing ezDI’s award-winning natural language processing (NLP) technology and comprehensive medical knowledge base to the market. He is considered as a subject matter expert in an emerging Healthcare AI driven technologies for mid revenue cycle management. He has contributed to the literature of healthcare professionals by engaging in numerous publications with HFMA. He is trusted & accomplished expert in intersection of technology, HIM, CDI and Coding, with a mission to set others up for success.

Devanshu has earned his post graduate degree in Business Administration and graduate degree in Electronics engineering. He is a firm believer in the abilities of technology to change the world, making the world a better place for all of us.

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