Claims and Coding
Secondly, we were pleased with the way their engine understood and interpreted medical terminology. Some of the other vendors’ engines required updating every time a new resident class or physicians’ group
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was added. That meant updating their en- gines indefi nitely.
“In addition, the A-Life engine demon- strated an increased capability to understand both English language and medical termi- nology. The Actus aesthetics were more user-friendly than the other products we evaluated. A-Life also had successful instal- lations of inpatient CAC at similarly sized hospitals, an advantage other vendors did not have at the time.” According to Setty, A-Life was the only vendor interviewed whose representatives could succinctly explain how their NLP engine operated and how it differed from other vendors’ products.
Diane Setty, RHIA, CPHQ, is OhioHealth’s corporate director of HIM.
OhioHealth proceeded with a phased approach. Phase I entailed the implementation of the diagnostics component of the software, with phase II focused on same-day surgery, observation and interventional radiol- ogy. Final outpatient phases are already scheduled and include emergency department and clinics. Inpatient coding is the next step.
The benefi ts A-Life’s Actus software is providing OhioHealth with a strong positive return on investment through the ability to do more with less and the promise of cleaner claim rates and a better case mix. The organization cur- rently uses Actus for outpatient diagnostics in fi ve of
Solution: A-Life Medical’s Actus CAC Software Benefi ts: Immediate benefi ts include a 17 percent average increase in diagnostic coder productivity within 30 days of implementation, increased coder efficiency and more compliant coding. In addition, Actus supports pre-bill, medical-necessity screening resulting in fewer rejected claims, enhanced traceability for coding audits and fewer missed charges for outpatient services. Long-term benefi ts include a projected overall 40 percent increase in coder productivity, resulting in enhanced capability to absorb additional increases in workload, revised coder performance standards, improved case mix for inpatient services and better preparation of coders for ICD-10.
14 February 2011
its eight facilities. Same-day surgeries, observations and interventional radiology are in the testing phase. According to Bobbie Vannatter, RHIA, CCS, CPC- H, the corporate coding manager and a member of the CAC selection team, “Phase I, outpatient diagnostics coding, resulted in approximately 75 percent of ac- counts being read by the NLP engine and results presented to the coders with no need for further action. Our 30 coders are all cross-trained in outpatient services so they cycle through the various services. A coder might only be scheduled to do diagnostics coding once a week – so they haven’t all had the opportunity to spend a lot of fo- cused time using the system and yet we’ve already seen a 17 percent average increase in coder productivity. In addition, we were able to achieve this dramatic improvement while also adding up-front medical-necessity screening and charge review to the coders’ workfl ow.” Feedback from coders has been largely
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positive. “The more they use Actus the more comfort- able they are with it – and the more they like it,” adds Vannatter. “The expectation is that productivity will substantially increase as coders become more familiar and profi cient with the system.”
Once profi ciency and a comfort level have been achieved, standards for production will be adjusted to refl ect the organization’s goals and effi ciencies gained from the engine.
The implementation of Actus has prompted OhioHealth’s coding management to re-evaluate their existing productivity measures. Once profi ciency and a comfort level have been achieved, standards for produc- tion will be adjusted to refl ect the organization’s goals and effi ciencies gained from the engine. The standards for diagnostic coding production, which are currently 22 to 24 per hour, are now averaging 28 to 30 per hour. An overall 40 percent increase in coder productivity is expected in this modality. To put this in perspective, this is the equivalent of coding approximately 20,000 more diagnostic cases per coder a year. Finally, A-Life customers of similar size and complex- ity as OhioHealth have experienced a 4 to 5 percent improvement in CMI resulting in a $10 million revenue boost, and all within six months of the system going live. OhioHealth expects to see similar benefi ts after inpatient CAC is installed.
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