Accounts Receivable: The Power of CDI and CAC in Healthcare Medical Billing
ByAGSHealth December
28,2022
Thedemandforclinicaldocumentationmultipliedexponentiallywhen healthcareorganizationsbeganusingelectronichealthrecords(EHRs). Thankfully,EHRsmadeiteasierthanevertodocumentcopiousamountsof datawithjustafewclicks.Yet,evenwiththesimplicityofthisnew technology,documentationremainsacommonissueinclaimsprocessing. Missingorincompletedocumentationresultsinclaimdenials,addingtotime inA/R.
Thevolumeofaccountsreceivablethatprovidersexperiencecanbebetter controlledwhentoolsareinplacetohelpensurepropermedical documentationandcoding.Whenclinicaldocumentationimprovement(CDI) andcomputer-assistedcoding(CAC)toolsareused,medicalcodingaccuracy improves–reducingdenialsandensuringtimelypaymenttoproviders.
QualitydocumentationimprovesCAC’saccuracybecausethemedicalrecords aremorecomprehensiveandthesystemhasthedataneededtomake recommendations.Whencombined,thesetwopowerfultoolsachievemore positiveresultsthanusingCACalone.Bothgeneratebettermedical
documentationandcoding,whichcanhaveadirectandpositiveimpacton claimsubmissiontimes,compliance,andreimbursement.
Medicalcodingmistakesandmissingclinicaldocumentationarecostly.Claim denialsaddupandcanresultinwrite-offs.Notonlydodenialspreventmuchneededcashflow,buttheyalsoresultinmedicalcodershavingtoreworkand resubmitclaims–wastingvaluableresources.Byensuringclaimaccuracy priortosubmittal,coderscanhelpensuretimelypaymentandeasefinancial burdensinA/R.
CDIandCAChelpproducehigh-qualitydocumentation,meaningmedical recordsarecomplete,precise,legible,consistent,clear,timely,andthe requireddocumentationisprovided.High-qualitydocumentationtranslates tomedicalrecordsthatcontainthespecificityneededtoaccuratelyreflectthe caredelivered.
CDIandCACleverageavarietyoftechnologiesrangingfromAIwith algorithmsthatallowcomputersto‘think’and‘learn’likehumanstosimple logic-basedprocessautomations.Thesebuilt-intechnologiesallowdecisions tobemadefasterandmoreaccurately.
Clinical Documentation Improvement (CDI): How does it work
CDIfacilitatestheaccuraterepresentationofapatient’sclinicalstatus,which translatestoimprovementsincodeddata.Havingthenecessary documentationforpatientservicesisessentialforreimbursementandgaining acomprehensivelookatpatientmedicalhistory.Missingdocumentation resultsinlowerqualityofcare.
LearnaboutAGSHealth’sCDIsolution.
Computer-Assisted Coding (CAC): How does it work
CAC(andCDI)usesnaturallanguageprocessing(NLP)toreviewdocument textwithinelectronichealthrecords(EHRs).Whenpresentedwithdiagnostic words,thesoftwareappliesan“ifthis,thenthat”algorithmandthecoding rulestoproposecodes.
Whenmedicalrecordscontainallthenecessarydocumentationand information,CACimprovesbecausethesystemhasacompletepatientprofile andusesthatinformationtopresentmedicalcodes.Providerscanbetter determinetheappropriatecareforpatientswhentheyhaveaccessto completepatientdocumentation.
Ifconfidenceislow,thesystemflagstheclaimforcoderreview.Thesystem learnsandadaptstothedirectcoderfeedback.
AGS’sMachineLearninginClinicalDevelopmentandNLPalgorithmsare trainedonrealclinicaldocumentstoprovidecutting-edgeaccuracy.Wehave successfullybuiltoneoftheworld’smostadvancedNaturalLanguage Processingtechnologyandtesteditondiverseclinicaldatasetsforprecision.
LearnaboutAGSHealth’sCACsolution.
Driving Outcomes: Quality, Financial, and the Patient Experience
Documentationdeficienciesextendbeyondthepatientexperience,impacting reimbursementandregulatoryrequirements.Advancementsintechnology
arechangingthehealthcarelandscapeandcaredelivery.Forqualityand patientcaretoimprove,healthcareteamsandcliniciansneedaccesstohighqualitypatientdata.CDIandCACarehelpinghospitalsnationwidebetter prepareforongoingchallenges.
AtAGSHealth,weassesseachcustomer’suniqueenvironment,goals,and needsandpresentourrecommendationsbasedontheirsituations.Explore AGSHealth’sCDIandCACofferings,orspeakwitharepresentativetolearn more.
Source of content:
https://www.agshealth.com/blog/accounts-receivable-the-power-of-cdi-and-cac-in-healthcare-medical-billing/