Digital transformation is ubiquitous across businesses and industries. But for each sector, different technologies have been playing the role of frontrunners in the digital race. For retail, it’s chatbots. For manufacturing, digital twins. In the healthcare revenue cycle, that role undeniably belongs to computer-assisted coding (CAC) systems. Considering the value-based healthcare ecosystem, professional coding applications have provided marked benefits for the sector and AI and automation technologies have emerged as a pivotal force of transformation.
The global market for AI and automation in healthcare is set to continue growing from USD 4.9 billion in 2020 to a staggering USD 45.2 billion by 2026, exhibiting a CAGR of 44.9%. This is indicative of the great value in leveraging AI for coding, with AI and CAC solutions paving the way for a much more automated future.
Healthcare providers are beginning to understand the promise and are rushing to integrate these services into their operations. The benefits that have been reaped through the integration of professional coding software are numerous. In fact, coders using CAC significantly outperform the decision health benchmark. The EZDI CAC solution, for instance, has helped care providers improve productivity by as much as 50% alongside a 20-30% reduction in denials and a 20% improvement in risk score capture. Results such as these simply cannot be overlooked when it comes to discussions around enhancing the revenue cycle management process. With recent major changes having been implemented into the 2021 CPT code set, the importance and efficacy of CAC to further simplify coding and documentation for outpatient E/M services is one that cannot be ignored.
How New CPT Guidelines Influence CAC Implementation
As medical coding gains more traction, authorized healthcare bodies are also witnessing its deeper incorporation into the overall business infrastructure. Here, understanding Current Procedural Terminology (CPT), is of particular importance.
The Current Procedural Terminology refers to a set of codes, descriptors, and guidelines that are used to describe procedures and services performed by physicians and other healthcare providers during the caregiving process. These code sets form the bedrock for evaluation and management (E/M) coding, which is marked by a longstanding set of constantly evolving guidelines.
The newest set of CPT E/M coding guidelines, which came into effect from 1st January 2021 were implemented with an aim to reduce administrative pressure on physicians. Touted as one of the “first major overhauls in more than 25 years”, the further streamlining of documentation requirements promises to contribute to a better environment for healthcare professionals and their requirements.
That said, the question that seems to linger is how do these guideline changes influence CAC implementation?
Powered by an amalgamation of AI and NLP technologies, CAC software is capable of analyzing and utilizing data from unstructured notes, thus making it easier to assign accurate E/M codes based on the data gathered. This cuts down heavily on manual efforts of sifting through data and feeding it into the system.
With the inclusion of new codes and revisions in the 2021 CPT code set, CAC systems will be able to better organize outpatient services and bring structure to the management process. In the past, CAC played a significant role in shoring up the shortcomings of legacy infrastructure and its lack of effective coding capabilities. In the current scenario, amidst anticipation of further CPT E/M coding guideline revisions empathizing medical practitioners, the capabilities of CAC implementation have increased manifold ensuring its growth in the years to come.
However, as with all technology, there are pain points to consider with CAC implementation. Some of these concerns include:
- Increased hardware and software costs
- Improperly billed templates that result in inaccurate code selection
- Poor adherence to industry standards, if not managed properly
- Potential cloning of code
Simplifying your Coding Needs – The EZDI Way
With the good and the bad of what CAC systems firmly established, it all boils down to selecting the right solution. The right CAC software to address your exact coding needs must be supported by the right framework and partner to help you achieve your healthcare objectives. And this is where EZDI can help.
EZDI’s comprehensive CAC solution helps streamline and optimize every step of the coding process by assuming end-to-end ownership of the implementation and framework. Powered by a combination of NLP and ML capabilities with CPT E/M logic algorithms, EZDI’s CAC solution automates E/M coding assignments by:
- Identifying every potential ICD code – whether it is implied or explicitly mentioned – based on available data.
- Capturing code across all components of documentation.
- Automatically selecting the right E/M codes based on the latest CPT criteria using either total time or relevant factors to maximize overall documentation.
These capabilities can go a step further in simplifying the coding process by suggesting case history codes, assigning examination types and even evaluating the complexity levels of different outpatient cases.
To better help providers make an informed decision, EZDI’s pilot program offers an experience that is similar to the actual product environment. Through this program, EZDI implements the requisite software along with overall interface building as well. The program is designed to be flexible over the course of its lifecycle and, upon conclusion, users are free to choose whether they want to roll out the CAC solution across all remaining facilities and touchpoints.
With these benefits in place, the usual pain points that you might face with CAC implementation are overcome by EZDI’s solution:
- The customized model and pilot program allows you to manage your software and hardware costs in accordance with your budget.
- The ability to collate and organize data comprehensively from a variety of sources ensures that templates are billed properly, preventing inaccurate code selection.
- End-to-end support and implementation courtesy of our industry experts and proprietary technology ensures that industry standards are followed every step of the way.
- Accurate E/M code selection and management powered by AI automation prevents any potential cloning in code and subsequent errors.
Professional coding is now simpler than ever before, with the dual harmonies of CAC solutions and CPT E/M coding guidelines bringing a soothing relief to the healthcare industry. And with a partner like EZDI, things are only set to get better.