Modern healthcare is in a state of unprecedented innovation. Healthcare professionals (HCPs) have an opportunity to harness the power of data, robotics, and artificial intelligence (AI) to discover new treatments and find new ways to reach patients.
However, with these new exciting advancements in medicine comes increasing challenges and pressure that healthcare establishments and providers face with the modern healthcare system. With dwindling healthcare staff, overwhelming patient volume, burnout, and rising costs, many healthcare establishments struggle to find ways to keep costs down and improve productivity.
Enter iCode Workflow 2.0 (iCW 2.0). GeBBS Healthcare Solutions’ latest workflow software platform provides HCPs with a one-stop coding solution that makes coding and billing seamless. Having built the platform based on customer feedback, providers can streamline their coding process to be more effective and efficient.
With an AI-enabled coding and auditing platform, HCPs can meet the challenges of running a business in the modern healthcare system. iCode Workflow 2.0 can help providers combat costs, increase efficiency, and improve accuracy with more features, easy onboarding, and full support.
This white paper discusses how iCW 2.0 has been updated to meet the healthcare needs of today and how HCPs can harness the power of AI to improve their coding and auditing platform to meet the needs of a changing healthcare environment.
Challenges Facing HCPs in the Modern Healthcare System
As healthcare systems and providers are moving out of the pure emergency mode that has transformed the industry over the past couple of years, they face new challenges that will impact their effectiveness in the next era of medical care. Healthcare professionals that face these challenges and find innovative solutions will be better prepared to meet patient needs, provide a better patient experience, and remain profitable.
Increasing Patient Volume
As lockdown measures subside and patients feel more comfortable meeting with their providers for more routine appointments and procedures, they are getting treatment in mass for the first time in years. While providers are meeting with an increased number of patients, more of the cases are more advanced and complex than they might have otherwise been before the pandemic. Because many patients have avoided seeing the doctor over the past few years, more cases are advanced because of a lack of early intervention. As a result, many providers are feeling overloaded.
This rapidly growing patient volume is only expected to increase as more of the population ages. Experts estimate that physician offices and clinics will experience 18% growth by 2029. HCPs need to view these changes as a permanent reflection of patient needs to come, rather than a temporary inconvenience that will subside in the near future, and plan for ways to adapt to this new volume.
Talent Shortage
Finding and retaining talent is an increasing problem for organizations across industries. Healthcare has been hit particularly hard by the talent crunch, and it has made an impact on HCPs’ ability to meet the rising patient needs. One study found that 62% of physicians surveyed stated that they were concerned about staffing shortages at their hospital or clinic.
This talent shortage is a problem that experts predict will only grow in the years to come as fewer people choose to enter a demanding albeit rewarding healthcare career. By 2034, The United States could experience a shortage of anywhere from 37,800 to 124,000 physicians. Plus, Cleveland Clinic Lerner College of Medicine projected a shortage of 510,394 registered nurses by 2030. With these critical shortages for the foreseeable future, HCPs need to develop innovative solutions to increase efficiency and productivity.
Staff Burnout
With the flux of new patients and an ever-worsening talent shortage, burnout amount medical care staff is growing and shockingly common. Even before the pandemic, healthcare staff burnout was a significant problem. However, the stresses and demands of the pandemic pushed many workers over the edge.
This burnout affects employee well-being and patient care. It will also continue to compound the challenges healthcare providers face. One-third of nurses plan to quit their job by the end of 2022, and many will leave healthcare altogether. These nurses cited stress associated with their job as the primary factor in quitting.
Healthcare organizations can combat this burnout by finding ways to increase productivity and ease the overloaded burden that staff already feel. Reducing the amount of ineffective work that keeps workers away from the higher value and more fulfilling parts of their roles will help ease some of the physical and mental exhaustion leading to widespread burnout.
Rising Inflation
Increased consumer spending combined with critical supply shortages has led inflation to reach its highest level in over 40 years. For many businesses, this rise in prices is not a significant problem, and they pass on the increasing costs of doing business to their customers. However, healthcare establishments are unable to follow this same process of passing on costs to insurers.
In addition to HCPs dealing with the rising cost of providing care, they face potential Medicare cuts that could significantly impact how they can function and remain profitable. As a result, many healthcare establishments need a way to combat rising costs and reduce overhead.
Growth of Value-Based Care
Many hospital systems and insurers are transitioning from a fee-for-service to a fee-for-value model. In fact, experts estimate that the market will reach $7.3 billion by 2027 as more choose to participate in this type of care. It provides both patients and hospitals with a number of benefits, including higher quality care and leaving behind a race-to-the-bottom approach that makes it an attractive model to adopt. However, many HCPs find it challenging to be profitable in this new care model.
The fee-for-value model forces HCPs to change how they operate and view care to be successful. They will need to rely on technology and human resources that promote interoperability to ensure compliance and lighten the load of personnel.
Increasing Coding Complexity
For many years, health organizations relied on manual coding to get payments for their services. Coders would read through thousands of pages of charts to document chronic conditions. It was a time-consuming process that slowed down coders and disrupted chart retrieval processes for physicians and nurses. It ultimately slowed down the payment process, resulted in costly errors, and held up providers.
To further complicate the process, the coding process is getting more complex, and remaining compliant is a challenge for even the most experienced coder. There are more than 9,500 ICD-10CM diagnosis codes in 86 categories for the latest Centers for Medicare and Medicaid Services’ Hierarchal Condition Categories (CMS-HCC) Version 24 model alone. This is just for risk adjustment: the commercial Health and Human Services HCC (HHS-HCC) model has over 11,000 diagnosis codes.
The coding process has become too burdensome for coders to handle on their own. It has resulted in slower payments and increased the acceleration in healthcare burnout as the staff is forced to spend more time charting and documenting than in the more rewarding aspects of their career. Plus, coders are not used most effectively and struggle to get the information they need to document properly.
Coding issues have compounded many of the challenges HCPs face. It means their workers are even more burned out, and they get less or slower payments, more overhead costs, and struggle to make value-based care a success.
iCode Workflow 2.0: Meeting the Needs of Modern Healthcare
With the challenges facing healthcare, many HCPs are turning to technology to help them fill critical gaps. iCode Workflow 2.0 does just that. Using AI-enabled features, providers can now get the support to make coding more efficient than ever.
Some of the benefits that iCW 2.0 offers include:
More Features and Checks
Claim denials and rejections result in significant revenue leakage for many HCPs. Research into denial rates shows that out of $3 trillion in claims submitted by HCPs, $262 billion were denied. This ended up translating into almost $5 million per provider in denials, on average. In addition, about 65% of those denied claims were never resubmitted.
Providers are leaving significant cash on the table by failing to prevent and minimize these denied claims. Technology can help. iCode Workflow offers the correct code capture to help reduce these denials and help providers get payments. Using AI, providers can improve the accuracy of their filings. Inbuilt CMS-defined edits and rules help minimize claim rejection by automatically catching errors, including CCI, MUE, LCD, and MIPS.
In addition to automatically catching errors that might lead to denial, real-time dashboards enable leadership to get more from iCW. Leaders get higher transparency and enhanced workflow planning to increase productivity and accuracy.
Easy to Use
A solution is only effective if staff will use it. iCode Workflow makes navigating coding technology as easy as possible. With an emphasis on the user experience, providers and staff can take advantage of the user-friendly design to navigate the platform and accomplish their tasks with ease.
Taking advantage of all that iCW offers does not require users to be coding experts. The user interface is easy to navigate and quickly sets up and configures client accounts. There is no need for any code changes to customize it to meet your needs.
With rapidly growing patient volumes, providers need solutions that will grow alongside them without the headache of reconfiguring or switching platforms. iCW is scalable to keep up with changing and increasing needs.
Multispecialty Coding
Not all healthcare coding is the same. Providers in various medical specialties need a platform that meets their specific needs. iCode is a multispecialty coding platform that works as a universal tool across fields, including anesthesia, emergency, radiology, and more. The solution is flexible to handle various input formats for every specialty to help coders reduce errors and improve their accuracy and efficiency.
From built-in assisted coding for various specialties to physician-based multispecialty coding, iCode provides users with the tools to accomplish their goals regardless of their field.
Artificial Intelligence
Artificial intelligence (AI) is foundational to the modern medical approach. From assisting with surgery to booking appointments, many HCPs rely on AI for many tasks within their establishments. Now they can harness technology to improve their coding practices and workflow. Coders will be able to meet the increasing demands and complexity of coding with a platform that enhances their skills with AI.
iCode Workflow uses iCAE, a cognitive analytics engine, to extract data and code assignments from structured and unstructured medical charts to reduce the time coders need to spend combing through medical notes. Research shows that iCAE increases coder productivity by at least 40% and accuracy by over 90%. Not only does it cut down on wasted time, but iCAE improves RAF scores and HEDIS captures.
Easy Onboarding
Onboarding new technology is often a headache for HCPs. New solutions can often tie up critical systems, slow down processes, and frustrate staff. iCode Workflow avoids these onboarding pains with its easy integration. The platform integrates seamlessly with the electronic health record (EHR) system and any practice management system you are using. Plus, the solution has enhanced integration capabilities with existing clients and third-party systems.
The integration capabilities of iCW enable providers to quickly and effortlessly onboard the solution into their current workflow system.
Full Support
It is comforting to know you can get help when you need it. Customer support ensures that HCPs have all the tools and training they need to use the iCode Workflow platform easily and get the most from their investment.
The Support Team works closely with the staff for the first month to provide long-term implementation support and training. In-depth onboarding with as much training as your team needs ensures that your implementation is successful and that you can continue using the platform to your advantage.
Insightful Reports
In addition to critical coding support, the platform provides leaders with the insights they need to run an effective practice. With a deeper understanding and accurate overview of their workflow, leaders can make more productive and effective changes to run a successful business.
iCode Workflow provides these critical insights by generating a number of reports that help leaders get a deeper understanding of their organization.
Just a few of the reports that iCW generates include:
Batch Status Report. This report enables users to quickly understand batch information from upload to output generation. Users can see whether the batch has been completed and, if not, what percentage of charts are present in different buckets in the system.
Coder Productivity Report. Coder productivity provides information about the number chart coded by coders. It also reports on chart quality control performed in the system on different dates. The report gives detailed information on how long coders take to code a chart and the quality of the chart.
Coder Accuracy Report. Users can get detailed information about the coding accuracy of each coder. They can see specifics such as sampling percentage, DPO and DPU achieved as well as variation.
Hold Report. Management can get details on all holds in the system, including the number of charts put on hold by sub-clients, which coder put it on hold, and how many days it has been holding.
Aging Report. Users can get information on the charts currently aging in their system. They can know which status these charts are currently. This way, they can see where the system chart got stuck, whether it is in any coder’s hold bucket or in exception pending status. This allows the responsible user can take appropriate action on time to keep up with the turnaround time of the charts.
TAT Report. Turnaround time is critical to ensure providers are paid in a reasonable timeframe. The TAT report provides users with details about the turnaround time of the charts. Users see how many days it took to get charts out of the system and if any chart missed the goal TAT. Users can also see the different statuses the chart has been through to get better insights.
Audit Trail Report. Users get information about any changes made to a chart through the audit trail report. For example, they can see the date and time a chart was coded and then when it underwent quality checks by the users.
In the fast-paced and sometimes complicated job of coding, details can get lost, and productivity suffers. iCode Workflow generates reports that help provide critical clarity to help improve processes, accuracy, and efficiency.
iCode Workflow 2.0: Leading Innovation to Meet HCP Needs
As a platform based on customer feedback, upgrades to the latest version of iCode Workflow meet the changing needs and innovations of healthcare establishments. Just a few of the improvements include:
Expanded and improved AI-powered technology helps users get deeper insights and enhance efficiency.
New UX design changes have created a more user-friendly experience so that HCPs and staff can get more use from the platform.
Additional workflows and third-party integrations like Encoder and Rules enable HCPs to get more insights, improve their processes, and have an easier onboarding process.
With added templates for each specialty, users will get even more use from the platform. Additional audits for different workflows and coding charts mean users will gain deeper insights and improved processes in our newest version.
In short, the enhancements found in iCW 2.0 means that users get more customized and automated uses from the platform. They also benefit from more insights, enhanced processes, improved productivity, and an exceptional user experience.
Case Study: Increased Coding Abilities
One of our current clients was utilizing iCode Workflow 1.0 for coding as a part of the coding services offered by GeBBs Healthcare Solutions. Although they loved its coding abilities and used both radiology and pathology charts, they needed to code beyond these two specialties. In addition, they required to poll input data in one-hour intervals and needed a provision to generate output files at request.
Because GeBBS uses customer feedback to drive improvements, we were already working to enhance these features before this client even had to ask. iCode Workflow 2.0 met the client’s need to code in different specialties with CAC support. Plus, additional workflows and templates helped the client get the needed custom reports and output file integration with their HIS.
Case Study: Inpatient Code
Another client required inpatient coding capabilities and needed to meet specific data requirements for their patient demographics. Because of their particular needs, they set 30 custom rules that had to be followed for coding validations.
The client’s specific needs weren’t a problem through iCode Workflow’s customizable coding templates and the robust in-built Rule Engine. The Rule Engine gives administrators set business-specific conditions for their coding process. As a result, users can personalize it to meet their needs and improve accuracy.
Meeting the Needs of Modern Healthcare through a Customizable Platform
The modern healthcare system is complex and full of challenges and opportunities. Providers who can meet these challenges with innovation and automation will help improve the healthcare experience for both patients and staff. One of the best ways to reduce staff burden and improve efficiency is through coding and workflow processes.
With iCode Workflow 2.0, providers receive a multispecialty platform that offers deeper insights and automation to improve accuracy, enhance productivity, and lower overhead costs. From the AI-enabled assisted coding engine and in-built CMS-defined edits and rules to scalable cloud architecture and robust systems, HCPs have the tools they need to code more effectively. In addition, the full support that GeBBs Healthcare Solutions offers ensures that users will get the most from the platform’s capabilities.
The improvements made to iCode Workflow ensure that HCPs continue to be at the cutting-edge of coding technology and get the most from automation. It means that they have the tools they need to meet the challenges of modern medical care — and start thriving in the new age of healthcare.
To learn more about iCW 2.0 and how it can improve your coding workflow and overall processes, contact us today are gebbs.com.
