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Computer Assisted Coding Of Medical Information - Market Opportunities, Strategies, and Forecasts, 2007 to 2013
WinterGreen Research, Inc., Aug 2007, Pages: 246
The number of procedures that use computer assisted coding is set to increase rapidly as the technology becomes more accurate. The trials have been completed successfully. The systems automate a tedious process and create efficient operation in the hospital and physician office environment. In this manner the automation that has been used by banks and manufacturing operations for years is moving to healthcare.
Whereas the healthcare systems have struggled with a payment and collections system that takes 30% of revenue, the banking and financial services industry has been able to run with automated billing systems that take 3% of revenue. As these economies of scale and technology are adapted to the healthcare delivery organizations through computer assisted coding, the most efficient organizations will acquire the less efficient ones.
Computer assisted coding fits seamlessly into a healthcare work flow. An unstructured digitized text from any source. Input can come from transcription services, voice recognition output, and typed note. No templates are needed. Computer assisted coding structures the note and applies appropriate codes. Computer assisted coding checks 100% of the notes and sends information to the billing system or sends notes to auditors for further review. Studies have documented the issues with E&M coding. Over-coding can lead to increased institutional risk. The result is frequent under-coding and lost revenue.
Manual coding processes are tedious and time consuming. After a patient is discharged, a clerk would physically retrieve the medical documents and pass it to a health records analyst who would extract the appropriate information for the billing system. Then the medical record would be passed onto a coder who would write the codes onto a paper face sheet. Next the face sheet would get passed to a data entry operator who would again access the billing system and enter the coding information into the account for final billing.
Computer assisted coding is set to evolve a hybrid technology where the physician develops natural language descriptions of patient conditions that are combined with a set of scales to evaluate patient condition in a more methodical and measurable manner. Just as patients are asked to measure pain on a scale of one to ten, so also physicians will measure patient condition as it relates to a relative scale.
The scale will not be universal, but rather, specific to the physician. The scale will be relative to a physician own experience. In this manner, the expertise of the physician will carry over from one patient to another.
The physician will develop techniques for describing patient condition that are in natural language, then these will be adapted to a coding scale that the physician has control of as well as the natural language coding software.
Computer assisted coding applications depend on the development of production quality natural language processing (NLP)-based computer assisted coding applications. This requires a process-driven approach to software development and quality assurance. A well-defined software engineering process consists of requirements analysis, preliminary design, detailed design, implementation, unit testing, system testing and deployment.
NLP complex technology defines the key features of a computer assisted coding (CAC) application.
The centres for Medicare and Medicaid services (CMS) is focused on reducing overpayments attributable to claims that do not meet medical necessity requirements. Compounding the situation, CMS rules and policies are updated and are interpreted differently from a fiscal intermediary (FI). A fiscal intermediary may cover multiple states with the same edits. Coding professionals are being asked post-service to help correct claims that were rejected because of medical necessity errors.
If medical necessity validation problems are not identified until a significant number of claims has been rejected, an organization may face not only substantial financial and compliance risks. The costly losses of efficiency are incurred by reworking and resubmitting rejected claims.
The number of hospitals has been steadily declining for 20 years in the U.S. Going forward, the IT department will rule the hospital and the physician office. Just as Kaiser has moved to become a major player in the US health care delivery system, so also any organization will have to master IT, just as Kaiser has with the help of IBM.
The number of patients and procedures is growing as health care delivery is evolved in a more sophisticated manner. In the US, the number of procedures is anticipated to increase rapidly as the population bulge from the baby boomers who are relatively well off creates demand for better healthcare delivery.
Worldwide, the markets are anticipated to grow from $44.8 million in 2006 to $2.3 billion in 2013. The markets are primarily U.S. markets because of the primary role that insurance plays in the health care delivery system. Worldwide markets start to grow as more hospitals and physician offices seek to get control of systems costs and introduce automated process systems.
Check Out These Key Topics:
Natural Language Computer Assisted Coding Market Shares
Worldwide, Computer Assisted Coding Market Forecasts
Hybrid Technology
Healthcare Industry Largest Industry In The United States
Medical Necessity and Medical Necessity Errors
Electronic Coding Technologies
Natural Language Solutions
Computerized Workflow System
Claims Scrubbers
LingoLogix GoCode Technology
TeSSI® (Terminology Supported Semantic Indexing)
Technology Requirements
Electronic Coding for Physician Practices
Medical Necessity/Correct Coding Tools
Physician Electronic Medical Record (EMR) Systems
Language and Computing: Ontology Assisted Solutions
Report Methodology
This is the 310th report in a series of market research reports that provide forecasts in communications, telecommunications, the internet, computer, software, and telephone equipment. The project leaders take direct responsibility for writing and preparing each report. They have significant experience preparing industry studies. Forecasts are based on primary research and proprietary data bases. Forecasts reflect analysis of the market trends in the segment and related segments. Unit and dollar shipments are analyzed through consideration of dollar volume of each market participation in the segment. Market share analysis includes conversations with key customers of products, industry segment leaders, marketing directors, distributors, leading market participants, and companies seeking to develop measurable market share. Over 200 in-depth interviews are conducted for each report with a broad range of key participants and opinion leaders in the market segment.
About the Principal Authors
Ellen T. Curtiss conducts strategic and market assessments in technology-based industries. Previously she was a member of the staff of Arthur D. Little, Inc., for 23 years, most recently as Vice President of Arthur D. Little Decision Resources, specializing in strategic planning and market development services. She is a graduate of Boston University and the Program for Management Development at Harvard Graduate School of Business Administration. She is the author of recent studies on worldwide telecommunications markets and the Top Ten Telecommunications market analysis and forecasts.
Susan Eustis has done research in communications and computer markets and applications. She holds several patents in microcomputing and parallel processing. She is the author of recent studies of the Regional Bell Operating Companies' marketing strategies, Internet equipment, a study of Internet Equipment, Worldwide Telecommunications Equipment, Top Ten Telecommunications, Digital Loop Carrier, Web Hosting, and Application Integration markets. Ms. Eustis is a graduate of Barnard College.
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