Coding
Real-time patient record review is becoming increasingly common because it aligns physician, coder, and CDI workflows and can help achieve revenue cycle efficiency. With retrospective reviews following patient discharge, most healthcare providers miss out on the opportunity for more accurate reimbursements, timelier reporting, and CDI program innovations.
Concurrent coding is a process whereby medical codes are assigned to patient medical charts throughout their stay at the hospital, rather than after they are discharged from the hospital. The process is an effective one that speeds up the billing cycle and prevents coding backlog. When physicians, CDIs, and coders work in unison, providers can achieve revenue cycle efficiency. However, the practice is not as common as you would assume. In fact, a recent survey by the Association of Clinical Documentation Improvement Specialists (ACDIS) showed that ~53% of hospitals still don’t have a concurrent coding program. Instead, the majority of hospitals rely on retrospective coding, which occurs after care has been delivered and claims have been submitted.
Coders and physicians have different experiences, and this can lead to a disconnect between their documentation standards. As documentation demands on physicians continue to increase, the gap of patient data captured and the information coders need to accurately code charts is further reinforced. When clinical documentation is reviewed and coded in real-time, gaps or errors in documentation can be identified while the information is still top of mind for physicians and before notes are locked in the EHR. As a result, coders can circumvent the limitations of retrospective analysis where clinical documentation issues can become longstanding ones.
By identifying these issues immediately after a physician visit, hospitals are more likely to capture the depth and complexity of a patient visit correctly the first time. If you want to improve your billing cycle, increasing first-time accuracy is the most important step. A strong concurrent coding program will decrease the time it takes to finalize accurate medical coding, which will result in fewer denials and less time spent determining the reason for denials, recoding, and resubmitting claims.
If you’ve ever been to the Health Information department at your hospital, you’ve likely seen the consequences of retrospective, manual coding processes. The evidence of coding backlogs can’t be missed. If medical notes are coded in real-time, with the help of next-generation computer-assisted coding, this backlog can be reduced or eliminated and health providers will have access to timely and accurate analytics about patient care and performance.
Real-time access to coded data can provide insight into current, predicted, and historical activities, helping providers to understand their risk and quality score data. This data will enable providers to improve efficiency and care coordination. With better insights, providers can make informed decisions to maximize their impact and minimize their costs.
Clinical documentation improvement has been inhibited by inefficient workflows and productivity-first priorities. By following a concurrent coding program, CDI can reprioritize clinical case reviews by monitoring metrics compared to long-term goals to identify areas of improvement. In other words, concurrent coding helps free up CDI time and resources so that they can be reconnected with providers and focus on improving clinical processes. In a survey conducted by ACDIS and others, respondents identified opportunities for program innovations that would benefit hospitals, including clinical validation case reviews, quality case reviews, HCC case reviews, outpatient case reviews, reviews of additional payers (like Medicare), and increased face-to-face communication and training with medical staff, like physicians. When physicians’, CDIs’, and coders’ workflows allow for collaboration, these innovations become possible.
By implementing a concurrent coding program at your hospital, you can be better equipped to improve care quality, make informed operational decisions, and access timelier reimbursements. The prospect of changing your coding process is daunting. However, while careful planning and a strong commitment are essential to facilitate a program transition, the benefits are worth the effort. Additionally, there are always ways to make this process much more manageable, namely an AI-powered solution that will suggest medical codes based on textual evidence for your coders in real-time.
By integrating an AI-powered concurrent coding platform into your coding workflow, you can maximize efficiency to improve documentation quality, optimize reimbursements, and enable real-time access to coded data. What’s more, you can create productive collaboration across your physician, CDI, and coding teams to work towards revenue cycle efficiency.
Semantic Health’s deep learning platform analyzes clinical notes as they are created to assign medical codes in real-time and present insights to coders and auditors in an intuitive user interface. This platform helps providers achieve the full benefits of concurrent coding, prioritize high-value opportunities, and work on improvement programs.
We welcome any questions and are happy to discuss a concurrent coding transition plan with you. Contact contact@semantichealth.ai to learn more.
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Semantic Health helps hospitals and health systems unlock the true value of their unstructured clinical data. Our intelligent medical coding and auditing platform uses artificial intelligence and deep learning to streamline medical coding & auditing concurrent with patient admission, improve documentation quality, optimize reimbursements, and enable real-time access to coded data for secondary analysis.
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