Jordan Stone, Financial Leadership Council
Computer-assisted coding (CAC) has generated great interest from finance leaders aiming to offset anticipated productivity losses and minimize revenue uncertainty associated with the ICD-10 transition.
The software, which aids coders in translating physician documentation into a set of billable codes, has the potential to improve a handful of revenue cycle metrics in the process. But many health system leaders we have spoken with are wary of making significant investments in financial and IT resources without better understanding how CAC can help—and what difficulties it may bring.
To gauge early results, we engaged eight of the most advanced CAC adopters we could find and asked them about their experiences with the software. Based on what they told us, here are the three ways computer-assisted coding can improve financial performance.
Three ways that computer-assisted coding can improve financial performance
Robin Raiford and Jordan Stone
Merger and acquisition (M&A) strategies are no longer the exception among providers; whether motivated by financial insecurity or the need to integrate care across the continuum in response to risk-based payment, many health systems are actively seeking consolidation.
However, acquiring systems could be placing their meaningful use (MU) trajectories at risk in the acquisition process. More specifically, acquirers stand to lose millions of dollars in incentives and may face negative payment adjustments if the newly consolidated entity fails to meet MU thresholds.
What is meaningful use?
Meaningful use refers to requirements—specified in the 2009 HITECH Act—that hospitals, eligible professionals, and critical access hospitals must meet to qualify for Medicare and Medicaid incentives aimed at promoting electronic health record (EHR) use.
MU requirements are phased in across three stages of increasing responsibility and complexity. Systems eligible for “Stage 1” must complete the attestation process by Nov. 30, 2012 to receive EHR incentives for 2013.
Based on readiness in FY2013, all eligible, non-compliant providers will be at risk for “payment adjustments”—1% cuts to Medicare reimbursement—if they have not met MU targets. These penalties will be assessed starting in FY2015 and will increase by 1% annually through FY2018.
M&A strategy: Assess meaningful use early to prevent losses
Pressure on hospital margins, the need for increased revenue capture, and documentation complexities of ICD-10 (both in specificity and scope) all require a continued focus on clinical documentation improvement (CDI) programs.
Our research has found that the strongest CDI programs have, among other qualities, robust tracking and accountability mechanisms in place, as well as a focus on driving accurate DRG assignments to reduce denials and increase revenue.
Clinical documentation programs: Resolving discrepancies through automation and collaboration