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The Journal of AHIMA published an article in the June 2019 issue called “Computer-Assisted Coding Reality Check” by Mary Butler. The article takes a closer look at the impact of Computer Assisted- Coding (CAC) by examining studies, interviewing HIM professionals and Dolbey’s Product Manager, Heather Eminger-Gladden, CCS.
What is CAC?
How does Computer- Assisted Coding software work? Butler explains that “CAC uses natural language processing (NLP) to extract and translate transcribed free-text data into information for billing and coding purposes.” As the software learns from the coder, it picks up on frequently used codes and becomes more accurate. CAC even learns from instances when the coding professional overrides suggested codes. “CAC’s success is contingent on the reasoning, knowledge, and editing skills of the human beings who use it,” says Butler.
The AHIMA Foundation conducted a study with the Cleveland Clinic to see if coding professionals experienced a reduction in time per record while using CAC software. The results showed a 22% time reduction in comparison to coders who did not use the technology. In addition to the shortened record time, Cleveland Clinic maintained quality for procedures and diagnoses.
CAC in the Industry
Other HIM professionals like Monica Pinette, MBA, RHIA, CDIP, CCS, CPC, the vice president of HIM at UConn Health, has seen similar results with Computer-Assisted Coding. Pinette expected the new code set to slow her coding team down during the ICD-10 transition in 2015. However, CAC software allowed her team to easily code three to four charts per hour beating the industry average of 2.5 records. Pinette also credits CAC for familiarizing her coding staff with ICD-10 more quickly. In Butler’s article, Pinette explains “With CAC it would actually highlight procedure codes and diagnosis codes and slate them for you. Then, coders could use the CAC’s evidenced-based feature where you could go back and validate the procedures and diagnosis codes [suggested by the CAC engine]. And in a way, kind of helped to teach the coders by seeing those codes over and over again.”
Pinette goes on to debunk the myth that “CAC does the coding for you.” She emphasizes that humans are still needed with this technology because not every given code is correct or necessary. Deanna Klure, RHIT, CCS, CDIP, director, coding education, nosology, CAC/clinical documentation improvement (CDI) business applications at Kaiser Permanente, also emphasizes that CAC is just a tool that works as well as the human using it.
The Future of CAC
Vendors and market research alike expect a growth in the market for CAC technology. This growth is largely due to a successful transition to ICD-10 which is leading providers to invest in software that can maximize data.
Dolbey’s own, Heather Gladden, CCS, remembers the huge upswing of organizations looking at CAC systems prior to ICD-10. When the new code set was implemented, the desire seemed to slow down. Now, the tide has turned yet again. Gladden says
“We’ve seen a huge uptick in people looking at CAC, over the last year and a half and also because of adoption of EMRs [EHRs]. They had EMRs early on and now some organizations are switching out their EMRs. We saw a lot of organizations say ‘We’re in the middle of upgrading our EMRs and working on value-based purchasing (VBP),’ so they were working on quality measures. In the last year we’ve seen a lot of people looking.”
According to Gladden, providers are becoming more comfortable with CAC systems. They are seeing the software help other organizations improve the quality of their coded data, which improves their case mix index, decreases payment denials, shorten accounts receivable days, participate in VBP and bundle payment initiatives, and identify patients at risk for readmissions. She also sees organizations turn to CAC for not only coding, but or a collaborative workspace for clinical documentation improvement, quality, ancillary departments, and internal auditors. CAC also empowers coding teams by providing them with a comprehensive workspace and enabling them to complete more accurate work in less time.
Finally, CAC improves the quality of coded data. Kristi Fahy, RHIA, who is an account executive at DVS, a premier partner of Dolbey, believes that providers who aren’t using CAC are leaving money on the table. “Pay-for-performance and quality based on VBP… all those initiatives have to have good coding otherwise they’re not going to get reimbursed appropriately,” Fahy says. She also mentions one of Dolbey’s clients with nine hospitals. The health system went from coding 20 inpatient charts per day to 30 charts with Dolbey’s Fusion CAC. With an emergency department, Fusion CAC improved their charts from 100 to 175 per day. These rates of productivity are all from eight-hour workdays. Fahy adds “The data is really there to show that productivity. The same site had an external auditor come in and the auditors confirmed that the quality had really improved with the codes.”
For the full article by Mary Butler, click the link.