Actionable Intelligence: The Future of Coding

May 8, 2018

In today’s healthcare environment, some things have stayed the same—doctors in white lab coats see patients, the documentation compiled drives codes that are applied to the encounter, and those codes help create a final bill that is sent to the appropriate party to be paid. But with an inflow of disruptive technologies into the healthcare environment, a lot has changed, however many of the recipients of this innovation have been patients receiving care. New diagnostic equipment, more advanced clinical protocols and enhanced technologies have helped to deliver more precise and accurate care capabilities to the patient. Unfortunately for providers and health systems, much of this innovation has not touched the back-office capabilities where the arduous and important work of medical coding, compliance and billing occurs.

This is a critical area for any provider or health entity because it’s truly how clinical activities are turned into dollars that help to keep the physician and related staff paid. If it takes too long to get a bill out the door, the physician may not be able to pay his or her employees or bills. If a bill goes out the door incorrectly the physician may not be collecting as much as they are entitled to, or worse yet may not be compliant and risk having their practice audited by CMS or another commercial entity. From the moment a patient walks into a care location data is collected and shared at dizzying speeds across a variety of systems and provider organizations must stay vigilant and innovate to ensure they are being paid accurately and timely for the care they deliver.

In many healthcare environments, it is a tale of two cities, where clinical activities occur in a figurative silo and then, many days later, are sent to a separate “city” which is the coding and billing team. This siloed approach costs organizations millions of dollars in the form of inaccurate billings, delayed billings and wasted time in re-processing by clinicians and other operational personnel due to mistakes in work flow, data, or basic communication. In order to drive value and lower costs, primary care, emergency departments, and other healthcare systems must break down these silos.  

QueueLogix is focused on removing these silos through more integrated, intelligent and efficient workflows that are made possible through QueueLogix licensed software and QueueLogix coding and compliance experts. One way QueueLogix is helping healthcare organizations stay ahead is through the delivery of what we call “Actionable Intelligence”. We already known physicians are burning out. These pressures that clinicians face are being brought on by the wide array of tasks that they must accomplish.  Some tasks are focused on specific clinical protocols while others are focused on documentation specifics or specific items related to value-based care and quality measure capture. The challenge with these array of tasks that physicians must accomplish is that they are largely situationally dependent and oftentimes clinicians are not “guided” based on information and data that is already known and stored in the EMR about the patient presentation, past history or other important variables.

With Meaningful Use mandates and the expansion of EMR technologies into every care setting, organizations now have been given a veritable treasure chest of data and information to pull upon about each patient that comes into their care environment. However, the sad reality is that most physicians and clinical organizations have not been able to properly harness this information and data to make it “Actionable”. This is where QueueLogix comes in. By integrating QueueLogix software into the EMR, and by utilizing our ScribeAmerica presence, we can now unlock this treasure chest of data to accomplish great things on behalf of patients, clinicians and the broader healthcare enterprise. Below is a quick example of “Actionable Intelligence” at work in a QueueLogix guided enterprise:  

Example 1 – Before QueueLogix: A healthcare organization struggles with denials from a particular insurance company when it tries to bill for fracture care in the emergency department setting. The insurance company, Aetna, requires the use of a specific modifier, modifier “54”. The healthcare company, Acme, has sent out emails to their clinical staff, nursing team, coders and scribes indicating the high number of denials they are receiving and it’s impact on cash flow for the organization as well as the many hours of extra work required for each patient encounter upon a denial occurrence. Despite their efforts to educate via email and through in-service seminars they are not able to alleviate the confusion and denials that occur.

After QueueLogix Actionable Intelligence Approach: QueueLogix utilizes it’s LiveSuite platform to integrate with the EMR. As a patient registers into the Emergency Department, the QueueLogix systems receives all information about that patient including the insurance and patient reported chief complaint. As the physician and scribe enter the room, the scribe is able to click on the patient in the LiveSuite chat box to assign themselves to that encounter. Upon assignment, the scribe is able to see a pop-up box that indicates a warning that this patient has Aetna & has reported a chief complaint that is commensurate with a fracture care scenario. The alert indicates that because the insurance is Aetna additional precautions need to be taken in documentation to ensure that a denial does not occur. This is “Actionable Intelligence.” In this instance data from the EMR was utilized in combination with other variables and identified rules to guide team members through a series of steps that assures the most beneficial outcome for patient, insurer, physician and health system.

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

Betting on even the best intentioned healthcare teams to modify and optimize charts can have significant downside and result in lost dollars. It’s easy for busy clinical or clerical personnel to overlook opportunities to make sure the right codes are billed for the care that was delivered. However, combining the care team with the back office staff through intelligent software, like QueueLogix’s LiveSuite, ensures processes can be automated for for real-time notification  of appropriate staff. This targeted notification ensures the right outcome without burdening team members with thousands of rules to remember. In effect, QueueLogix is leveraging the data we’re collecting within the EMR and other systems to intelligently alert personnel only when the time and situation is right.

“With Actionable Intelligence, the LiveSuite system is helping provide guidance that can make a significant difference for the healthcare entity in how quickly they are paid, how accurately they are paid and drastically reducing the labor hours it takes to get a bill out the door,” says Ingram.

With a suite of cloud based modules including LiveCode QueueLogix  is leading the charge to unlock the value of the data healthcare organizations are collecting today, and ensure that data can be used intelligently to drive the right actions. By applying these principles we know we can help organizations further reduce physician burnout, improve speed and accuracy of billing and even driven higher patient satisfaction.

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