Actionable Intelligence: The Future of Coding

April 24, 2018

In today’s healthcare environment, some things have stayed the same—doctors in white lab coats see patients, the encounters are coded, and bills are sent to insurers. But with an inflow of disruptive technologies, a lot has changed. From moment to moment, data is shared at a higher frequency than ever before, and provider organizations are lucky if they capture and code a third of those encounters correctly.

In order to drive value and lower costs, primary care, emergency departments, and other healthcare systems are tasked with breaking down silos to address the increase in complex coding events that need to be documented within EHRs. The tale of two cities, where billing and coding departments are cities unto themselves, is no longer sustainable as technology outpaces standard processes. Through our analysis we’ve found that there is no-shortage of scenarios where competing demands, and lack of communication costs providers.

To stay ahead, merging clinical operations with back-office billing in novel ways is one solution to close reimbursement gaps. Empowering your organization to adapt to the digital environment with the use of medical scribes can also mitigate the burden of increased reporting guidelines. Assessing feedback loops between doctors and clerical staff is another way to direct resources to mission critical activities.

To truly optimize coding operations with precision and accuracy, at QueueLogix we rely on Actionable Intelligence, a methodology of identifying the data that matters to unite clerical and clinical activities.

Actionable Intelligence is a revenue-cycle management process that has proven to accelerate reimbursement by embedding automated processes that predict necessary actions, and most importantly, alert the appropriate parties required to address them in real-time. Having a high level of accuracy significantly reduces delays in reimbursement.

“We developed the process to catalyze a more efficient billing and coding process,” says QueueLogix President, Doug Ingram. “What is possible now with next generation technology is to merge the human aspects of billing and coding with insights gleaned from thousands of patient charts, in real time.”

Betting on even the best intentioned healthcare teams to modify and optimize charts has significant downsides. It’s easy for busy clerical support to overlook opportunities to refine reporting for higher-yielding codes. However, combining the care team with the right software to automate processes allows coders to notify the appropriate person that a chart must be updated with more information to properly bill for a procedure.

“With actionable intelligence, the coder is empowered by the data to say to the doctor, ‘We were able to bill this patient, however, we noticed in a particular area you could have documented the encounter a bit better,” says Ingram.

A little better could translate to thousands of dollars recovered from the clinic, so to speak. The good news is that every provider organization has access to data, though defining what is actionable requires intuitive, cloud-based software.

Leveraging Actionable Intelligence to avoid mismanaged touchpoints in the billing process may cause anxiety about price pressure. At QueueLogix efforts are underway within complex health systems to track coding events, and deliver insights with optimum value to financial stake-holders.

With a suite of cloud based modules including LiveCode and a forthcoming LiveApp, we are leading the trend to raise the visibility of actionable items. The usage of Actionable Intelligence has led to reduced suspended charts, downcodes, and coding errors.

“We’re letting doctors know how to optimize data and improve their process, so they can focus on what matters most,” says Ingram. With capabilities to assist both small and largescale organizations capitalize on Actionable Intelligence, Ingram sees healthcare transformed by data in the right way.

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