Accounts Receivable: The Power of CDI and CAC in Healthcare Medical Billing

The demand for clinical documentation multiplied exponentially when healthcare organizations began using electronic health records (EHRs). Thankfully, EHRs made it easier than ever to document copious amounts of data with just a few clicks. Yet, even with the simplicity of this new technology, documentation remains a common issue in claims processing. Missing or incomplete documentation results in claim denials, adding to time in A/R.

The volume of accounts receivable that providers experience can be better controlled when tools are in place to help ensure proper medical documentation and coding. When Clinical Documentation Improvement (CDI) and Computer-Assisted Coding (CAC) tools are used, medical coding accuracy improves — reducing denials and ensuring timely payment to providers.

Quality documentation improves CAC’s accuracy because the medical records are more comprehensive and the system has the data needed to make recommendations. When combined, these two powerful tools achieve more positive results than using CAC alone. Both generate better medical documentation and coding, which can have a direct and positive impact on claim submission times, compliance, and reimbursement.

Medical coding mistakes and missing clinical documentation are costly. Claim denials add up and can result in write-offs. Not only do denials prevent much-needed cash flow, but they also result in medical coders having to rework and resubmit claims — wasting valuable resources. By ensuring claim accuracy prior to submittal, coders can help ensure timely payment and ease financial burdens in A/R.

CDI and CAC help produce high-quality documentation, meaning medical records are complete, precise, legible, consistent, clear, timely, and the required documentation is provided. High-quality documentation translates to medical records that contain the specificity needed to accurately reflect the care delivered.

CDI and CAC leverage a variety of technologies ranging from AI with algorithms that allow computers to ‘think’ and ‘learn’ like humans to simple logic-based process automations. These built-in technologies allow decisions to be made faster and more accurately.

Clinical Documentation Improvement (CDI): How does it work?

CDI facilitates the accurate representation of a patient’s clinical status, which translates to improvements in coded data. Having the necessary documentation for patient services is essential for reimbursement and gaining a comprehensive look at patient medical history. Missing documentation results in lower quality of care.

Learn more about Computer-Assisted CDI Software.

Computer-Assisted Coding (CAC): How does it work?

CAC (and CDI) uses natural language processing (NLP) to review document text within electronic health records (EHRs). When presented with diagnostic words, the software applies an “if this, then that” algorithm and the coding rules to propose codes.

When medical records contain all the necessary documentation and information, CAC improves because the system has a complete patient profile and uses that information to present medical codes. Providers can better determine the appropriate care for patients when they have access to complete patient documentation.

If confidence is low, the system flags the claim for coder review. The system learns and adapts to the direct coder feedback.

AGS’s Machine Learning in Clinical Development and NLP algorithms are trained on real clinical documents to provide cutting-edge accuracy. We have successfully built one of the world’s most advanced Natural Language Processing technology and tested it on diverse clinical data sets for precision.

Learn more about Computer-Assisted Coding Software.

Driving Outcomes: Quality, Financial, and the Patient Experience.

Documentation deficiencies extend beyond the patient experience, impacting reimbursement and regulatory requirements. Advancements in technology are changing the healthcare landscape and care delivery. For quality and patient care to improve, healthcare teams and clinicians need access to high-quality patient data. CDI and CAC are helping hospitals nationwide better prepare for ongoing challenges.

At AGS Health, we assess each customer’s unique environment, goals, and needs and present our recommendations based on their situations. Explore AGS Health’s CDI and CAC offerings, or message me to learn more.