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Using MAIstro for Medical Coding
Daryl Loomis
Business Development
Access Integrity
Data Harmony Users Group Meeting
Febru...
An Extremely Brief History
• Access Integrity (AI2) founded in 2011 by Margie
Hlava, Jay Ven Eman, and John Kuranz.
• Of t...
How It Works
• Leverages Data Harmony in the medical space to
deliver relevant ICD-10, CPT, and HCPCS code
recommendations...
So What’s the Problem?
• Providers are required by clinic management to
provide ICD-10 codes for an encounter. Doesn’t
the...
AI2 Integration Basic: Medical Claims Compliance (MCC)
Upload a file or paste text for
analysis
Codes are suggested based ...
AI2 Integration Intermediate: Find-A-Code (FAC)
Everything in MCC also exists in Find-A-
Code, with some additions.
Zip co...
AI2 Integration Advanced: IntegraCoder (IC)
IntegraCoder validates the codes
selected within the EHR.
View and select modi...
ICD-History
• ICD-9 was adopted as a standard in 1979.
• ICD-10 completed in 1992 and adopted by most
of the world by 2010...
9/30/2015
Dr. Manley looks peaceful, but
what’s in his dreams?
The labyrinthine hellscape of
ICD-10.
F51.5 – Nightmare Disorder
10/1/2015
The next morning, people still got
sick and doctors still had to doctor.
That’s when the real monster under
the ...
Evaluation
and
Management
(E&M)
F40.248 – Other situational type phobia
OH THE HORROR!
What Is E&M?
• A tiny division of the CPT code set that
determines the level of service during an
encounter.
• E&M determi...
Why is E&M Important?
• It determines how much a provider gets paid for
a particular encounter.
• Overcoding E&M can trigg...
The Data Harmony Solution: eMDoc
• Uses five thesauri to differentiate between the
various places where E&M is calculated....
eMDoc: A Closer Look
The final E&M calculation (CPT code) is
presented at the top, along with the
time spent with the pati...
Where Is AI2 Headed?
• E&M revealed other places for Data Harmony:
• HCC (Hierarchical Condition Coding): 79
specific IDC-...
– Other situational type phobia
• I hope I didn’t trigger
this for you.
G47.419 – Narcolepsy without cataplexy
Questions?....
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DHUG 2017 - Access Integrity

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Daryl Loomis describes how Access Innovations improves medical coding using their patented Data Harmony software.

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DHUG 2017 - Access Integrity

  1. 1. Using MAIstro for Medical Coding Daryl Loomis Business Development Access Integrity Data Harmony Users Group Meeting February 7, 2017
  2. 2. An Extremely Brief History • Access Integrity (AI2) founded in 2011 by Margie Hlava, Jay Ven Eman, and John Kuranz. • Of the six markets in the medical space that were considered, the provider market was deemed the most lucrative for this technology. • Multiple Electronic Health Record (EHR) integrations including athenahealth and Allscripts.
  3. 3. How It Works • Leverages Data Harmony in the medical space to deliver relevant ICD-10, CPT, and HCPCS code recommendations. • The massive rule bases (4.6 million lines for ICD-10) analyze the content and context of the providers’ notes in an EHR. • Delivers highly relevant diagnosis and procedure coding suggestions, while supplying revenue cycle and denial management resources.
  4. 4. So What’s the Problem? • Providers are required by clinic management to provide ICD-10 codes for an encounter. Doesn’t the clinic hire coders to do this? • Providers are out of their element and miss codes that can pay them more. MAIstro captures and recommends these. • Doctors want to be doctors, but they have to take time with unfamiliar code sets and concepts, keeping them from providing you the care they know they should deliver.
  5. 5. AI2 Integration Basic: Medical Claims Compliance (MCC) Upload a file or paste text for analysis Codes are suggested based on context Selected codes are separated from suggestions for copying and pasting into an EHR. Search functionality for code and description.
  6. 6. AI2 Integration Intermediate: Find-A-Code (FAC) Everything in MCC also exists in Find-A- Code, with some additions. Zip code is required to calculate Relative Value Units (RVUs), which determine how much a practice gets paid. Health care is cheaper in Cheyenne than Boston. Book View surfaces the hierarchy, allowing users to see the codes surrounding the suggested codes. Scrub functionality checks selections against medical databases and returns errors if they exist. This is not a well- coded note.
  7. 7. AI2 Integration Advanced: IntegraCoder (IC) IntegraCoder validates the codes selected within the EHR. View and select modifiers for more accurate reimbursement. Search individual code sets or search globally. Feedback button allows for easy communication. Charge pushes selections back into the EHR billing screen.
  8. 8. ICD-History • ICD-9 was adopted as a standard in 1979. • ICD-10 completed in 1992 and adopted by most of the world by 2010, rendering ICD-9 obsolete. • Implementation stalled over and over in the United States until 2015, when a reprieve was filed with Congress on hiatus, preventing a vote. • Much to clinics’ dismay, ICD-10 would be implemented on October 1, 2015.
  9. 9. 9/30/2015 Dr. Manley looks peaceful, but what’s in his dreams? The labyrinthine hellscape of ICD-10.
  10. 10. F51.5 – Nightmare Disorder
  11. 11. 10/1/2015 The next morning, people still got sick and doctors still had to doctor. That’s when the real monster under the bed emerged. Mama! A turtle bit me right on the hand! W59.21XA – Bitten by turtle, initial encounter Y92.830 – Public park as the place of occurrence of the external cause
  12. 12. Evaluation and Management (E&M) F40.248 – Other situational type phobia OH THE HORROR!
  13. 13. What Is E&M? • A tiny division of the CPT code set that determines the level of service during an encounter. • E&M determines how much time a provider spent with a patient, the thoroughness of the examination, and the level of associated risk.
  14. 14. Why is E&M Important? • It determines how much a provider gets paid for a particular encounter. • Overcoding E&M can trigger audits, which can potentially bankrupt a practice. • As a result, practices undercode E&M, causing lower reimbursement while still putting practices at increased risk. • Practices report an accuracy rate of only 30% for E&M coding.
  15. 15. The Data Harmony Solution: eMDoc • Uses five thesauri to differentiate between the various places where E&M is calculated. • Pulls information from patient history, examination, and risk/decision-making areas of the EHR. • If it’s not in the documentation, it didn’t happen, no matter what actually occurred during an encounter. DOCUMENT WHAT YOU DID! • Should we actually look at it?...yes we should.
  16. 16. eMDoc: A Closer Look The final E&M calculation (CPT code) is presented at the top, along with the time spent with the patient and the calculations of each individual section. Green text indicates what was checked in the examination. Clicking the “?” will highlight where in the note that piece occurs, giving providers at-the-ready documentation for why an encounter was coded to a certain level. This fact is CRUCIAL for combatting audits.
  17. 17. Where Is AI2 Headed? • E&M revealed other places for Data Harmony: • HCC (Hierarchical Condition Coding): 79 specific IDC-10 codes that determine level of payment. • NCCI (National Correct Coding Initiative): A grouping of CPT and HCPCS codes that reflect connections between procedures and their ICR-10 diagnosis counterparts. • RAF (Risk Adjustment Factor): A sliding scale to determine an individual’s level of “risk” compared to their age and status.
  18. 18. – Other situational type phobia • I hope I didn’t trigger this for you. G47.419 – Narcolepsy without cataplexy Questions?... Or maybe dinner? For further questions, contact me at dloomis@accessintegrity.com or visit us at www.accessintegrity.com. Thank you!

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