By Nancy Hirschl, BS, CCS, AHIMA-Approved ICD-10 Trainer
Vice President of HIM Services, Streamline Health, Inc.
The way code auditing is performed at hospitals and other health care facilities is in need of a change. In many cases, major providers still use spreadsheets to manually track audit data. This antiquated method is time consuming, inefficient, susceptible to human error and often doesn’t provide adequate protection from financial risk.
When it comes to coding itself, the challenge is two-fold – memory and logic are both pieces of the puzzle. On the one hand, coders need to remember a large number of codes in order to do their job efficiently. On the other hand, coding can also be like a logic problem – multiple answers may technically be “correct,” but that doesn’t mean they’re the best answer. The final bill should accurately reflect both patient experience and provide organizations with the appropriate revenue.
A solution to these complicated problems arrives in the form of better software. Earlier this year, Streamline Health acquired Opportune IT, and together their auditing solutions will change code auditing forever. Here’s how:
Opportune IT’s CORE platform streamlines auditing workflows better than the competition. This coding opportunity reporting engine is not only designed to replace cumbersome spreadsheets, it also makes it easier than ever to share data between departments. Best of all, it’s a secure online program that can be accessed from anywhere. No matter where coders work from, they can take advantage of this optimized solution.
Coding and code auditing are very different tasks, yet both require using critical thinking to solve complex problems. The CORE platform empowers coders by making the auditing process easier than ever. By simplifying the workflow and removing much of the manual labor, CORE even allows organizations to perform more regular audits, rather than only annual ones. The ability to audit more frequently means further opportunities to find revenue mid-cycle. It also helps minimize risk by allowing more charts to be audited for over- or undercoding.
Hello, artificial intelligence
The next step in bringing code auditing into the 21st century is Looking Glass® eValuator, a new tool from Streamline Health. This is more than a piece of software – it’s a methodology for improving an organization using artificial intelligence. After a chart has been coded, eValuator immediately runs an audit and tells the coder how the DRG could be changed. In essence, eValuator vastly improves the moment-to-moment experience of coding.
It can help to think of eValuator as the automatic steering correction that comes with some newer car models. When the vehicle begins to drift too close to the edge of its lane, the steering wheel makes a nearly imperceptible adjustment to keep the driving experience smooth and accident free. Likewise, eValuator shows coders how a chart can be improved. It will even display potential lost or gained revenue in dollar amounts. Plus, its complex set of rules allows eValuator to display the chance of over- or undercoding in terms of percentage. The higher the percentage a chart receives, the higher it will be prioritized for a second look – eValuator will even suggest how a DRG might be adjusted to better reflect patient experience.
The best part about eValuator? It’s auditing prior to billing. Why wait until bills have already gone out — or already been collected upon — before running an internal audit? There’s no reason to risk earned revenue when there’s a solution that can be acted on before the bills even go out.
Together, CORE and eValuator are going to change the way organizations perform code audits forever. Automation, artificial intelligence and habit-building workflows are going to optimize audits and bring organizations into the 21st century.