Computer-assisted coding depends on the accuracy of the input.
There is considerable interest in computer-assisted coding or “CAC.” The proponents say it will reduce costs, coding backlogs and discharged not final billed claims. There are several companies in this space, the largest being 3M with more than $30 billion in revenue every year.
CAC is part of a larger move into artificial intelligence or AI. Many companies, including those in the healthcare sector, would like to replace costly humans with computers. In the 1960s, the television program, “The Twilight Zone,” had an episode in which a man running a manufacturing plant turns to robots to reduce costs and increase efficiency. In the episode, Wallace V. Whipple replaces people with robots, despite the stern warning of the employees. The show ends with Mr. Whipple, drinking in a bar, angrily complaining as his robot doppelganger sits in his chair at the office smoking a cigar. All the humans are gone, replaced by robots that look like people.
With CAC we do not have human-looking robots sitting at desks coding accounts. We have computer software matching data from electronic medical records into diagnosis and procedure codes.
The benefits of CAC include the fact that it is fast, scalable, consistent and accurate based on the data in the medical record. There are no coding backlogs as CAC software can run through unlimited claims in a fraction of a second. It never codes for things not in the medical record.
The first problem facing CAC is “garbage in garbage out,” GIGO. CAC depends on the assumption that the medical record is complete and accurate. Let’s take evaluation and management (E&M) services as an example. The computer can look at the electronic medical record to find documentation of the patient’s history and physical. It can look for the documentation of the review of systems and it can look at the amount of time from the time the patient is admitted until the patient is discharged. The software can then give a code for the service. What is needed is to know if all the data is being correctly being loaded into the system and if the data is accurate? Did the physician really have the “face time” the medical record states?
The second issue is oversight of the coding process. When healthcare providers are doing manual coding, there is at least some communication between health information management (HIM) and billing. All the stakeholders in the revenue cycle usually meet regularly to discuss challenges. Overdependence on CAC can break down this communication. Compounding this is the fact that computers can make mistakes faster than humans.
In conclusion, CAC can increase consistency and accuracy to the coding process, but like any other revenue cycle process, will require daily oversight and making sure the documentation supports the coding.
Imagine receiving notice that your healthcare organization faces a potential multimillion-dollar repayment demand based on the review of just 100 claims. This scenario, playing out
Some of you may have read my article from last week kindly published as a special bulletin. For those who did not, let me recap.
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
