By Julius Blum
Vice President – Solutions, Streamline Health, Inc.
The giant online retailer Amazon.com recently announced it may soon introduce machines to box up 600-700 customer orders per hour in an effort to speed up delivery times. That’s a whopping four to five times the rate of a human. These machines could be a step in the right direction considering Amazon Prime boasts more than 100 million subscribers globally. The number of daily transactions must be staggering, and retaining its customers requires the company to think outside the box.
The same could be said in healthcare, an industry plagued by chronic inefficiencies. What if providers could similarly embrace automation to increase coding efficiency and revenue integrity in an effort to refocus on high-quality patient care? Given the complexity of today’s regulations as well as the high volume of claims submitted on a daily basis, automation can relieve some of the burden on HIM staff tasked with coding and abstracting a plethora of data (e.g., clinical data, performance metrics, HCCs, quality indicators, present-on-admission indicators, and more). All of these elements influence how payers determine the acuity of care delivered, the value/quality provided and subsequent reimbursement for the encounter. Successfully managing all of these variables is crucial for revenue integrity.
Automated coding analysis vs. claim scrubbing and computer assisted coding (CAC)
When thinking about revenue cycle automation, three solutions come to mind:
- Claim scrubbing
- Automated coding analysis
Claim scrubbing has been around for a while; however, there are limitations with this technology, most notably the fact that’s it’s centered on a quantitative process.