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Computer-assisted Coding
Industry trends
The emergency department (ED) market is moving to initiatives that seamlessly integrate documentation and coding for services. The reason this trend has taken so long to take hold is the complexity of such an initiative and the fast paced environment where it resides. To understand the complexity, one must first understand the environment. The chaotic nature of the ED and its paper-driven process have led to silos of work representing documentation, charge capture, coding, record storage, etc. Enter the EDIS. The EDIS unites most of these functions into one platform. The platform's implementation is typically limited only by the imagination of the purchaser and offer great functionality regarding triage, tracking, documentation, charge capture, record storage and interoperability.
ED and CAC
The new charge capture and coding components of these EDIS platforms have been somewhat slow to come to market. Commonly referred to as Computer Assisted Coding (CAC), these processes are often a by-product of the larger EDIS and sold as such. For instance, automated ED facility charging might come as a feature in the facility nursing documentation portion of the EDIS. Because charge capture in an ED is mission-critical due to the revenue that is generated, automated processes make prospects somewhat leery. Often these charge capture processes are cumbersome to implement, hard to support from an audit perspective, and put the revenue capture potentially at risk.
This is an area that deserves diligence during the sale and implementation of an EDIS because coding and charging are overseen by many regulatory agencies like the Joint Commission, OIG, and CMS, among others. Other national entities like AHIMA's eHIM have designated decision trees to help clients wade through the myriad competitors' platforms and decide which system may be best for them. Given the environment of the ED, this component is often overlooked during EDIS implementations, because these factors are seen as just too risky.
Differentiation and unique capabilities
When considering an EDIS/CAC vendor, some components of the decision-making process should be mandatory. For instance, is the charging created from the nursing documentation going to be supported from a compliance and revenue perspective? Many vendors don't automate any more than the existing hospital process, which constitutes small return on investment, and no ability to audit and support compliance initiatives adds unreasonable risk. The ability to audit what happened in the clinical record and how the codes and charges were derived is essential. A payer or compliance audit would demand it, so an EDIS should be able to produce it.
The future
The partnerships and technology exist to embed a coding platform in a clinical facility nursing record application such as Picis' ED Pulsecheck. During the course of each ED clinical encounter, information would seamlessly populate the coding application, which in turn would create a powerful CAC tool and subsequent return on investment. Imagine an environment where the algorithm, ancillary facility charges, and professional charging are automated all the way to the coders' hands in HIM. CAC enables them to do their coding work smarter and faster. It marries the charging process to the coding process and allows clinicians to practice and coders to code. During audits, it allows a compliance division to stand with the vendor's compliance department. It lends oversight via a service organization standing by to help with the coding or auditing of records when needed. Interoperability allows all of these advantages to roll up to the enterprise for audit reporting, payer compliance, and monitoring productivity.
The glimmerings of this future are already evident in E/Code's support for assisted professional coding in Cerner's PowerNote ED, with more to come.
For more information about AHIMA eHIM, visit
http://library.ahima.org/xpedio/groups/public/documents/ahima /bok1_025099.hcsp?dDocName=bok1_025099.
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