Wiki Cac-info on CACs

nyyankees

True Blue
Messages
1,271
Location
Smithtown, NY
Best answers
0
anyone have any info on CACs? We have 2 facilities (in my area) that is incorporating this in place of coders. Epic, the EHR we have, is the system. Curious..
 
CACS Replace Coders

There have been a bunch out there starting with A-Life. And now many of the EM or ERHs will produce codes. but it has been pretty much accepted that the CAC codes must be reviewed, so typically the coders move into a coder/auditor position. Particularly with E&M, the output requires review.

Jim
 
we're looking at a 3M (web-hosted) application for outpatient labs, rehab services and rad. Hope to implement this summer. Southern NH hosptial has been using it for awhile with excellent results. You can (apparently) train the software to code based on your criteria. It's done through natural language processing, and for coding that is abstracted based on a written order, it's been quite successful, from what I understand from my colleagues at SNHH.
 
My experience of traveling around the country and auditing at facilities that replaced coders years ago with Epic and other 'need not a coder' programs is the following. After RAC audits and request for overpayments started coming into these facilities, they are hiring back coders and auditors to review the codes that are selected from these systems or in Epic's case, codes that are selected from the providers. What a coding program cannot do is decipher the correct modifiers 100 percent of the time which can lead to takebacks if not careful. It also cannot decipher a correct E & M level based on the documentation. Epic I know for sure, did a great marketing strategy of selling their program based on the fact that the provider can perform his own coding and coders can be replaced. This has lead to detrimental recovery affects for facilities, but great business for auditors. What these IT software companies forgot to include was the professional opinions of coders when implementing this software. Now they are getting on board with the program if I may, and are including more coding professionals in their implementation EHR/EMR.
 
Last edited:
My experience of traveling around the country and auditing at facilities that replaced coders years ago with Epic and other 'need not a coder' programs is the following. After RAC audits and request for overpayments started coming into these facilities, they are hiring back coders and auditors to review the codes that are selected from these systems or in Epic's case, codes that are selected from the providers. What a coding program cannot do is decipher the correct modifiers 100 percent of the time which can lead to takebacks if not careful. It also cannot decipher a correct E & M level based on the documentation. Epic I know for sure, did a great marketing strategy of selling their program based on the fact that the provider can perform his own coding and coders can be replaced. This has lead to detrimental recovery effects for facilities, but great business for auditors. What these IT software companies forgot to include was the professional opinions of coders when implementing this software. Now they are getting on board with the program if I may, and are including more coding professionals in their implementation EHR/EMR.

Interesting information. There can be some 'grey' areas in coding that a computer software cannot decipher. I can see how auditors have taken advantage of this scenario. How can a computer software appeal a RAC audit that wants money back? I always understood that a coder would need to oversee that CAC work but looks like coders will still be needed overall. Thanks.
 
Top