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Coding Automation Tool (CAT)

The manual task load required to analyze complex medical records can contribute to both systemic under-billing and potential disputes. To expedite payer review, approval, and reimbursement, the Coding Automation Toolkit (CAT) automatically delivers annotated, pre-audited, billing-ready documents. CAT provides consistent, immediate, fully documented "second opinions," extracting all pertinent medical codes and highlighting patient encounter records for observation and cross-reference. It then alerts for diagnoses associated with high reimbursement risk and provides billable CMS-compliant E&M, MACRA, DRG, and Emergency Medical Service audit trails that match up 1:1 with patient documentation.
CAT analyzes medical documents against a regularly updated array of coding conventions and formulas. The following databases are currently supported:
  • CPT Current Procedural Terminology
  • HCPCS Health Care Procedure Coding System ("Hick-Picks")
  • ICD9-V1 International Classification of Diseases, volume 1
  • ICD9-V3 International Classification of Diseases, volume 3
  • ICD10-CM International Classification of Diseases, Clinical Modification
  • ICD10-PCS International Classification of Diseases, Procedure Coding System
  • MODS Procedure Code Modifiers
  • NDC National Drug Codes
  • CDT Current Dental Terminology

Core Benefits and Specifications

The Coding Automation Toolkit (CAT) is a new software suite for medical industry providers, coders, and revenue cycle managers. Developed by the National Billing Center (NBC), CAT analyzes patient records and extracts a full spectrum of relevant codes and procedures to shorten billing uncertainties and timelines. CAT also functions as a built-in pre-auditing tool. CAT provides a simple, flexible solution for revenue cycle management and reimbursement analysis that fits into any healthcare information technology (HIT) environment and delivers scalability, transparency, and control.
CAT requires less than 0.5 GB of free hard drive space, is compatible with any version of MSWindows and installs, and runs independently of CPU, RAM, or system requirements. CAT has a tiny footprint that encourages high-efficiency, secure, real-time patient encounter processing. With CAT, there are no seat, desktop, or server licenses, no limits or extra charges - just patient records processed into color-highlighted code extractions and billing documents.
Installing CAT takes less than a minute. Users need no specialized training, seminars, or conferences. It can be easily integrated into every workflow, whether on-premise, remote, hybrid cloud, or in HIT environments ranging from rudimentary to elaborate. All CAT requires is a secure Internet connection for version-stamped updates, database synchronizations, and client usage reports. Communications are performed via secure connections -“ data elements are encrypted and then sent/received using POST (HTTPS).
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Processing Patient Encounter Records

Each client is assigned a unique password, User, and Administrator ID. These tokens authorize administrators and users to define proprietary automation features, process patient encounter records and configure selected terminology to conform with internal templates. Once CAT is activated, administrators can define and surrogate any desired number of additional sub-users such as an inhousephysician, assistant, department, coder, or third party.
NBC’s technical approach differs markedly from products based on natural language processing (NLP) or heuristic Hidden Markov Models. CAT does not rely on guesswork; it is database-driven and constitutes a finite-state machine. Patient encounter records are not recorded on NBC servers; this makes CAT the most secure data solution currently available.
CAT has no particular format or content requirements and supports DOC, DOCX, PDF, RTF, TXT, importing EMRs, and EHRs as stand-alone files. Faxes and imagesare converted into text using a built-in optical character recognition (OCR) engine. Patient encounter records are not recorded on NBC servers, making CAT the most secure data processing solution available amongst current competitor options. Unless otherwise required, NBC does not record or view patient data.
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Accuracy and Discipline

To deliver leading out-of-the-box accuracy, CAT checks each word in the medical document across several layers of keywords in the context of all available codingconventions and formulas. The same checks are conducted against a proprietary database of possible alternatives, synonyms, and anatomical analogs. Either an exact match or weighted determination is made based on multiple factors (such as patient gender or age) or combined with the calculation of relevant qualityscores and bonuses.
  • Daily database upgrades and synchronization
  • Incorporates edits developed by the National Correct Coding Initiative (NCCI)
  • Provides crosswalks between coding types (ICD to CPT, NDC to HCPCS)
  • Triggers alerts for codes associated with high reimbursement risk
  • Searchable databases of all coding types
  • Ability to dig into ICD10-CM (tree-view)
  • Document annotation (for communications between coders and providers)
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Deployment, Pricing and Databases

The ongoing, self-learning process of CAT optimization is defined by your internal workflow and conventions. CAT learns when an operator manually changes,adds, or deletes any code to an organization-specific standard. CAT records this interaction uploads it to the NBC servers and applies it the next time it seesmatching or similar text. CAT operators can share manual changes between themselves, HIT departments or coding providers, and analyze on- or off-line torefine at will.
NBC charges per single patient record processed. This constitutes one billable “click” and signifies a literal mouse click of a single on-screen button. All codeextractions are considered a single click, and per-click pricing depends on document processing volume. If an operator chooses to process the same document through DRG multiple times, that is still one click. If an operator wishes to process a document through the E&M, DRG, and PQRS modules simultaneously, all these actions are considered a single click. NBC does notcharge installation, setup, or termination fees.
The databases used by CAT are constantly evolving. Various government, public, and private organizations (CMS, the American Medical Association, the Food &Drug Administration) release data on different schedules and CAT keeps up with all of them. Additionally, NBC constantly updates CAT based on customer feedback. NBC maintains and manages all releases and changes; our databases are updated on the server-side once a day. For a CAT operator, the process of updating databases to the latest release is a simple matter of clicking the “sync” button.
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Reimbursement Models

Once CAT has extracted all relevant codes, users can process their results against several additional reimbursement modules—Evaluation and Management (E&M), the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), Medical Severity Diagnosis-Related Groups (DRG), and Emergency Medical Services (EMS).

Evaluation and Management (E&M)

CAT determines E&M service levels at 99%+ accuracy. It constructs and verifies a meticulous, highly defensible log of all E&M processes per current CMS formulasand advisories. It also calculates elements within history, examination, and Medical Decision Making (MDM) to identify service levels and reimbursements based on CMS-defined norms, including location-sensitive compensation. When the appropriate E&M service level is determined, CAT generates an MS Word document comprising source text and all E&M elements (e.g., HISTORY-HPILOCATION), which are inserted into the document as color highlighted tags. For example, an individual user can easily see that ROS (Review of Systems) was calculated as “extended” because 2 to 9 systems were documented; each documented system is highlighted in the text.

Medicare Access and Children’s Health Insurance Program Reauthorization Act

To calculate MACRA reimbursement modifiers, CAT scans every document through an internal sequence of variables and formulas. For example, patient last name, patient date of birth, or patient hemoglobin level can serve separately or together as base formulas for each MACRA-driven metric. CAT provides both PQRS or MIPS options, transparently recording each code, modifier, and indicator to report whether a “Performance Met,” “Performance Exclusion,” or “Performance Not Met” grade is warranted.

Medicare Severity Diagnosis-Related Groups (DRG)

The DRG module is a high-fidelity metric for reimbursement analysis. It is an exact digital translation of U.S. Centers for Medicare and Medicaid Services(CMS) algorithms and specifications. DRGs are automatically generated based on all determined diagnostic and procedural codes. CAT allows users to quickly change or swap primary diagnosis or procedure codes, re-generate DRG outcomes, and backtrack to inspect or correct provider omissions or mistakes.The DRG processing module matches up 1:1 with the Patient Encounter Record as recorded, and maintains a log of DRG processes wherein users and serviceproviders.

Emergency Medical Services (EMS)

CAT evaluates ambulance healthcare records for patient medical conditions, transport assessment, and service level for each leg. Then it extracts date of service, patient information, POP address, a destination address, mileage, and generates all information needed to file a claim including HCPCS codes, modifiers, units, charges for trip, mileage and transport indicators.
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