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Physician Computer Assisted Coding For Professionals Market: In-Depth Analysis and Forecast, Market Dynamics, Emerging Trends, Growth Factors
Next generation Computer Assisted Coding of medical information is able to leverage natural language software technology to support some automation of the billing process and use of analytics to achieve higher quality patient outcomes. The study has 301 pages and 110 tables and figures.Computer assisted coding of medical information uses natural language solutions to link the physician notes in an electronic patient record to the codes used for billing Medicare, Medicaid, and private insurance companies.
Natural language processing is used determine the links to codes. 88% of the coding can occur automatically without human review. Computer assisted coding is used in all parts of the healthcare delivery system. The coding systems work well to implement automated coding process.
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Physicians think about patient conditions in terms of words. Software is configured to achieve working with physicians who are more comfortable describing a patient treatment in words than codes. The electronic patient record, created using physician dictation, is used to form the base for the coding. Natural language solutions implement computer coding to identify key words and patterns of language. The physician dictation can be done using regular language that the software recognizes and translates into billing codes.
Properly designed natural language processing (NLP) solutions do not require physicians to change the way they work. They can dictate in a free-flowing fashion, consistent with the way they think, and are not limited to structured inputs that may or may not fully capture the unique circumstances of each patient encounter.
Matching codes generated from physician notes to standard treatment protocols promises to improve health care delivery. Accompanying that type of physician patient management against best practice promises to revolutionize health care delivery. The ability to further check as to whether the recommendations for follow up made by radiologists and matching the commendations with the actual follow up heralds’ significant promise of vastly improved health care delivery.
Computer assisted coding applications depend on the development of production quality natural language processing (NLP)-based computer assisted coding applications. This requires a process-driven approach to software development and quality assurance.
A well-defined software engineering process consists of requirements analysis, preliminary design, detailed design, implementation, unit testing, system testing and deployment. NLP complex technology defines the key features of a computer assisted coding (CAC) application.
Automation of process will revolutionize health care delivery. In addition to automating the insurance, billing, and transaction systems, streamlined care delivery is an added benefit. The ability to look at workflow and compare actual care to best practice is fundamental to automated business process.
The ability to link diagnostic patient information to treatment regimes and drug prescriptions is central to improving medical care delivery. Once a physician can see what conditions need to be followed, and see that appropriate care has been prescribed 100% of the time, care delivery improves dramatically. Diagnosis of conditions using radiology frequently results in detection of events that need follow-up.
“Growing acceptance of computer assisted coding for physician offices represents a shift to cloud computing and billing by the procedure coded. Because SaaS based CAC provides an improvement over current coding techniques the value is being recognized. Administrators are realizing the benefits to quality of care. Patients feel better after robotic surgery and the surgeries are more likely to be successful.”
The worldwide market for Computer Assisted Coding is $898 million in 2016, anticipated to reach $2.5 billion by 2023. The complete report provides a comprehensive analysis of Computer Assisted Coding in different categories, illustrating the diversity of software market segments. A complete procedure analysis is done, looking at numbers of procedures and doing penetration analysis.
Major health plans report a smooth transition to ICD-10. This is due to rigorous testing for six years. ICD-10 has had a positive impact on reimbursement. ICD-10 coding system requires use of 72,000 procedure codes and 68,000 CM codes, as opposed to the 4,000 and 14,000 in the ICD-9 system. Managing high volume of codes requires automation. Healthcare providers and payers use complex coding systems, which drives demand for technologically advanced CAC systems.
The market for computer-assisted coding grows because it provides management of workflow process value by encouraging increasing efficiency in care delivery for large Professional Physician Practice and Ambulatory Clinical Facility. By making more granular demarcation of diagnoses and care provided for each diagnosis, greater visibility into the care delivery system is provided. Greater visibility brings more ability to adapt the system to successful treatments.
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Companies Profiled
Market Leaders
3M
Optum
Dolbey
Selected Market Participants
Artificial Medical Intelligence
Cerner
Craneware
EPICGroup One / CodeCorrect
M*Modal
nThrive / Precyse
Nuance
Quest Diagnostics
TruCode
UnitedHealth Group / Optum
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Table of Contents
Computer Assisted Coding Executive Summary 18
Medical Best Practice Linking 21
CAC for Coders 21
Computer Assisted Coding Best Practice 24
Coding Solutions 26
Physician Computer Assisted Coding Services 28
Natural Language Computer Assisted Coding Market Shares 29
Natural Language Computer Assisted Coding of Medical Procedures Forecasts 31
Medical Best Practice Linking 33
1. Computer Assisted Coding for Large Physician Practices and Ambulatory Treatment Centers Market Description and Market Dynamics 34
1.1 Coding Challenge 34
1.1.1 Computer Assisted Coding (CAC) Physician Practice Services Component 35
1.1.2 Advances In Natural Language Processing And Informatics 36
1.1.3 Using Electronic Health Record (EHR) Documentation To Generate Codes 37
1.2 Computer-Assisted Coding 39
1.2.1 Physician Practice Industry Forces Affecting Development of CAC 40
1.2.2 Application of CAC Technology 42
1.3 Development of a CAC Tool For Physician Use 43
1.3.1 CAC Impact on the Coding Workflow 43
1.3.2 Computers Replace Human Coders 43
1.3.3 CAC Applied Without Human Intervention Depends On Critical Differences Between CAC Systems 44
1.4 Healthcare Industry Largest In United States 45
1.4.1 Building a Safer Health System 47
1.4.2 Facilitating the Use of Technology in the Healthcare Industry 48
1.4.3 Prescription Drug Modernization 49
1.5 Medical Necessity and Medical Necessity Errors 50
1.6 Physician Office Electronic Coding 51
1.6.1 CAC Automates and Accelerates Auditing 55
1.7 Natural Language Solutions 55
1.7.1 State Of Language Technology Evaluation 56
1.8 Computerized Workflow System 58
1.8.1 Confidence Assessment Module 59
1.8.2 Researching Electronic Coding Products: 61
2. Professional Computer Assisted Coding Market Shares and Forecasts 62
2.1.1 Physician Practices With A Services Component Market Driving forces 63
2.1.2 Medical Best Practice Linking 66
2.1.3 CAC for Coders 67
2.1.4 Computer Assisted Coding Best Practice 70
2.1.5 Computer Assisted Coding Medical Information Solutions 71
2.1.6 Coding Solutions 71
2.1.7 Physician Computer Assisted Coding Services 74
2.2 Physician Office and Ambulatory Clinical Organizations Natural Language Computer Assisted Coding Market Shares 75
2.2.1 3M 83
2.2.2 3M 85
2.2.3 3M Merging Quality With Reimbursement 88
2.2.4 Optum 89
2.2.5 Optum Automated Code Identification 90
2.2.6 Optum 93
2.2.7 nThrive / Precyse 94
2.2.8 Dolbey 94
2.2.9 McKesson 96
2.2.10 Cerner 98
2.2.11 TruCode 98
2.3 Natural Language Computer Assisted Coding of Medical Procedures Forecasts 98
2.3.1 CAC Market Software and Services Segmentation 102
2.3.2 CAC Hospitals and Facilities and Physicians Market Segment 104
2.3.3 Computer Assisted Coding Physician Market 106
2.3.4 Worldwide Computer Assisted Coding, Hospitals and Facilities and Physicians 108
2.3.5 CAC Software Market Hospital and Physician Segments 110
2.3.6 CAC Services Market Segment 111
2.3.7 US Computer Assisted Coding Physician Software License / Maintenance and Cloud SaaS Services 112
2.3.8 Physicians Computer Assisted Coding 115
2.3.9 US Computer Assisted Coding Software Units 118
2.3.10 US Computer Assisted Coding Software / Cloud Services for Independent Radiology Clinics Market Forecasts 120
2.3.1 US Independent Radiology Imaging Centers 121
2.3.2 Erroneous Selection of Principal Diagnoses Impacting Reimbursement 122
2.3.3 Growth of the U.S. Healthcare Industry 126
2.4 Worldwide, Number of Patients and Procedures 128
2.5 Making The Shift To The Modern ICD-10 Requirements 132
2.6 Computer Assisted Coding Prices 133
2.7 Computer Assisted Coding Regional Analysis 134
2.7.1 3M 360 Encompass System 137
3. Computer Assisted Coding Product Description 138
3.1 3M 138
3.1.1 3M 360 Encompass System 139
3.1.2 3M 3M CodeAssist System 141
3.1.3 3M APR DRG Solutions Aspects 147
3.1.4 3M Merging Quality With Reimbursement 148
3.1.5 3M™ APR DRG Software 150
3.1.6 3 M Classification System For Patients 150
3.1.7 3M APR DRG Software Features: 153
3.1.8 3M Coding Technology 155
3.1.9 3M Computer-Assisted Coding Solutions 156
3.1.10 3M Medical Coding Tools Streamline Processes 156
3.1.11 CodeAssist Automating the Medical Coding Process 157
3.1.12 3M CodeComplete Outsource Solution for Medical Coding 158
3.1.13 3M DataScout Clinical Data Extraction and Identification 158
3.1.14 3M and American Academy of Professional Coders (AAPC) 160
3.1.15 3M Data Mining Technology 161
3.1.16 3M Systems for Overcoming Documentation Shortfalls 162
3.1.17 3M Solutions for a Changing Healthcare Landscape 166
3.1.18 3M Web-Based Coding Software Return on Investment 179
3.1.19 3M Coding Software Functions 181
3.1.20 3M Computer-Assisted Coding Solutions Targeted to Specialty Areas 183
3.1.21 3M CodeAssist Functions 184
3.1.22 3M CodeComplete Business Process Management 185
3.2 Dolbey 187
3.2.1 Dolbey Coding Productivity Management 189
3.2.2 Dolby Fusion Suite Modules 191
3.3 Optum Coding Service 195
3.3.1 Optum Coding 196
3.3.2 Optum CPT® Codes 197
3.3.3 Optum Medicare Fee Schedule 197
3.4 McKesson 199
3.4.1 Mckesson Watching the Cash 200
3.4.2 McKesson Securing the Subsidy 201
3.4.3 McKesson Quality Control And Process Improvement 203
3.5 Cerner Computer Assisted Coding 204
3.6 Platocode® Computer-Assisted Coding 207
3.6.1 Platocode ICD 10 210
3.6.2 Platocode® Solution For Ambulatory Surgery 210
3.6.3 Platocode® API 211
3.6.4 Communication Between 3rd-Party Applications And A Platocode Server 211
3.7 Nuance Computer Assisted Coding 211
3.7.1 Nuance Clinical Documentation Review 212
3.7.2 Nuance Clinical Documentation Compliance 213
3.7.3 Nuance Clintegrity Computer Assited Coding (CAC) 213
3.7.4 Nuance Clintegrity Computer Assisted Coding (CAC) Key Features 216
3.7.5 Nuance Clintegrity Facility Coding Solutions for Healthcare 216
3.7.6 Nuance Clintegrity Facility Coding 218
3.7.7 Nuance Clintegrity Computer Assisted Coding (CAC) Features 219
3.7.8 Nuance Clintegrity Physician Coding 220
3.7.9 Nuance Clinician Reimbursement Calculation 222
3.7.10 Nuance Clintegrity Compliance & ICD-10 Transition 223
3.7.11 Nuance Clintegrity Facility Coding 224
3.7.12 Nuance Clintegrity Abstracting 224
3.7.13 Nuance Clintegrity ICD-10 Education Services 226
3.7.14 Nuance Automated Coding 229
3.7.15 Nuance Natural Language Processing 230
3.7.16 Nuance Natural Language Understanding 230
3.7.17 Nuance Mapping and Modeling Disparate Controlled Medical Vocabularies (CMVs); 231
3.8 Artificial Medical Intelligence Emscribe CAC 231
3.8.1 Artificial Medical Intelligence EMscribe Dynamic Search 233
3.8.2 Artificial Medical Intelligence EMscribe Encoder 234
3.8.3 AMI EMscribe® Dynamic Medical Term And Coding Search Tool 235
3.8.4 Artificial Medical Intelligence Autonomous Coding 236
3.8.5 Artificial Medical Intelligence (AMI) EMscribe Dx 237
3.9 CodeCorrect 240
3.9.1 CodeCorrect Capture Revenue and Maintain Compliance 240
3.9.2 CodeCorrect knowledge 240
3.9.3 CodeCorrect Medical Necessity Verification and APC Performance Tools 241
3.9.4 QuadraMed 242
3.10 M*Modal Coding 242
3.10.1 M*Modal Workflow 244
3.10.2 M*Modal Management Tools 244
3.10.3 M*Modal Single Platform 244
3.11 nThrive / MedAssets-Precyse and Equation 245
3.11.1 Precyse Medical Coding and Computer Assisted Coding 245
Continue…
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