Terms doctors use when treating patients often don’t match the coding terms needed for billing and insurance records, says Dr. Jon Elion, president and CEO of ChartWise: Clinical Document Intelligence.
“Doctor’s notes that are fine to communicate medically may not have the exact content needed by the hospital’s coding department for billing purposes,” said Elion, a cardiologist at The Miriam Hospital in Providence. “So, we built software that has the extensive expertise built in to help identify those gaps.”
The SAAS, or software as a service, is a system that assists the reviewer of the chart while the patient is present.
The company’s software, used primarily by hospitals, can have the added benefit of boosting reimbursement rates, but that is not its primary objective, Elion said. The main purpose, he says, is to improve the delivery of health care.
“Our software is working to help the hospital get the most complete, high-quality documentation possible,” he added. “We want the medical record to reflect everything accurate happening with the patient, not just get higher reimbursement.”
By way of example, Elion explained that simply recording symptoms that include “a high white-blood-cell count, fever, cough, and green sputum” as pneumonia is not enough for a hospital to get reimbursed appropriately once the illness is treated with antibiotics. The coding term that has to be used explicitly in that case is “probable pneumonia,” he said.
The goal is to ensure that hospitals are not deprived of the reimbursements they are entitled to get, he explained.
With the introduction of the Affordable Care Act and upgrading of medical codes used to determine reimbursement rates, hospitals weren’t sure how to adapt, so initially there was some reluctance to sign on with ChartWise, Elion said. However, clients who got a return on their investment within eight weeks were eager to commit, he said, and there is now a backlog of 60 prospective clients.
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