Intelligent Coding Technology from Optum Helps Hospitals Accelerate Transition to New ICD-10 System and Improve Clinical Documentation

Intelligent Coding Technology from Optum Helps Hospitals Accelerate Transition to New ICD-10 System and Improve Clinical Documentation

OptumInsight

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launched its newest generation of coding technology. Optum Enterprise CAC, a computer-assisted coding (CAC) platform, helps hospitals accelerate their transition to ICD-10, increase productivity and simplify coding and documentation processes.

Enterprise CAC includes a Coding and Reimbursement Module that combines with comprehensive Optum reference, encoding and reimbursement tools. This single application eliminates data hand-offs between the applications that scan and render diagnosis and procedure codes from clinical records and those that apply the codes to billing statements and other documentation.

Enterprise CAC also features an available Optum CDI (clinical documentation improvement) Module, which pre-screens clinical records for inconsistencies or insufficient detail to support ICD-10 coding requirements, and then sends queries to clinicians to amend the documentation. The module, developed in collaboration with the University of Pittsburgh Medical Center (UPMC), will support efforts to drive documentation improvement over the course of a patient’s care (Watch the .)

“Traditional clinical documentation improvement efforts require ongoing manual records reviews that are time- and staff-intensive. Optum CDI automates these processes, improving productivity, while ensuring documentation is complete and accurate for coding and reimbursement,” said Adele Towers, M.D., M.P.H., medical director, UPMC Health Information Management. “Using technology to complete administrative tasks more efficiently will be imperative to hospitals’ financial health as we transition to ICD-10.”

“Our work with Optum is leading to the development of coding technologies that support ongoing process improvement and the ability to resolve documentation issues before patients leave our care,” said Nancy M. Soso, M.S., R.H.I.A., executive director of Health Information Management at UPMC. “ICD-10 magnifies our need to stem potential administrative errors before they find their way into clinical documentation. We believe Optum’s Enterprise CAC and CDI technologies will be critical to ensuring complete, accurate coding and supporting institution-wide process improvement efforts.”

Two years after implementing Optum’s CAC technology, UPMC increased inpatient coding productivity 21 percent, saving approximately $200,000 annually through reduction in overtime. In that same period, UPMC improved its case mix index (CMI), a critical measure for ensuring accurate Medicare and Medicaid reimbursements, by 8 percent, resulting in a $22 million improvement in revenues.

“Enterprise CAC features innovative coding technology that automates administrative tasks and supports documentation process improvement throughout the health system,” said Kyle Pak, senior vice president and general manager at Optum. “We believe intelligent CAC technology will play a central role in helping our clients overcome the complex patient care and business challenges facing the health system, including transitioning to ICD-10, which can present significant technology and workflow challenges.”

Enterprise CAC provides a unified solution to help hospitals manage workflow and complete coding for all hospital inpatient and outpatient encounters. Optum is leveraging its cloud infrastructure to deliver Enterprise CAC to hospitals, helping to ensure fast installation and upgrades, and lower total cost of ownership.

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Optum () is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. Optum comprises three companies – OptumHealth, OptumInsight and OptumRx – representing more than 35,000 employees worldwide who collaborate to deliver integrated, intelligent solutions that work to modernize the health system and improve overall population health.

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