CAC & ICD-10: How to evaluate what CAC can do for healthcare providers
There is a real concern that ICD-10 will create strong productivity losses and increases in claim denial. I say claim denial is a real concern not because of a conscious effort by payers to reduce reimbursements.
But it is very likely that some diagnoses and procedures won't be coded accurately after Oct. 1, 2013. That's going to affect productivity and revenue.
"Computer assisted coding (CAC) can help really mitigate those effects," said Mark Morsch, vice president of technology at A-Life Medical, an OptumInsight company. "When you have CAC, results have shown that you really make a group of coders both really productive and more accurate."
Morsch said CAC is the "technology that directly assigns codes from clinical documentation." He directs A-Life’s linguists and software engineers in the development of natural language processing (NLP) applications.
NLP is the "software technology that can process narrative text or unstructured or semi-structured text from clinical documentation." That text is in some sort of electronic format and the NLP and CAC technologies figure out what medical codes can be assigned. The text can come from electronic health records (EHR) or speech transcriptions.
"Really the higher quality of the NLP produces better, more accurate results," said Morsch. Which should bolster productivity and accuracy. "CAC was a nice to have, and with ICD-10 it's a must have in some sense."
For more on CAC & ICD-10, see also:
Don't order yet
If you have been paying attention to this blog, you should know that contracting with healthcare vendors and payers is a process. And when it comes to CAC, Morsch recommends you consider these factors:
- "You need to really be able to educate yourself about the different technologies and products in the market," said Morsch. You need to understand what the different tools can do.
- "Organizations need to know where they are now in terms of their own metrics - their own performance in terms of productivity, quality, their financial metrics." You need to understand how performance has changed to justify the return on investment in CAC and collecting more data.
- "You need to understand how this will affect your coding, your organization overall and how potentially that need to be modified," said Morsch. You're going to have to plan how this effects people and how they do their jobs.
But don't get a CAC system and think it's going to fix all your ICD-10 challenges. "It doesn't solve all of them, but it solves a big part of them," said Morsch. The ICD-10 transition will generate a lot of worries such as:
- Selecting the right codes,
- Making sure that those codes are justified
- Interfacing coded data correctly to billing systems
- Educating billing teams about those codes
- Providing data back to physicians about documentation
"You know there are other aspects of the whole revenue cycle that are also important for the administrator to have a handle on," said Morsch. There s a bigger picture that administrators need be aware of. Relations with payers and educating the physicians for example. Those are things that aren't going to be solved by CAC.
Order now before it's too late
Like any aspect of your ICD-10 implementation, it's time to make the decision. "We think it is very important to make these decisions ... in a very efficient manner. Because we do see a very strong demand for CAC," said Morsch. Vendors will have less time to dedicate to their clients the closer it gets to the ICD-10 implementation deadline. "We would recommend now closing in on some decisions."
Since productivity and revenue challenges can be part of the ICD-10 transition, Morsch wants to get started on preventing them. He believes the right CAC system will drive accuracy in a practice. "Accurate coding is essential to make sure folks don't have any revenue loss as part of this transition."