For over 15 years, 3M has been a top provider of computer-assisted coding through the 3M℠ CodeAssist℠ System, which can now include an optional work flow solution: 3M CodeMonitor System.
3M CodeMonitor automatically reviews clinical documentation and compares resulting E/M CPT® codes to physician-assigned E/M CPT codes. Depending on whether the codes agree or not, 3M CodeMonitor routes them on to billing or sends them back for review.
The result? Streamlined, comprehensive auditing and quick identification of areas to improve.
With thousands of codes, bundling rules, modifiers, global windows, patient types and payer rules, even well-intentioned coders and providers incorrectly identify service levels, and most physician practices do not systematically audit their clinical documentation against their selected codes.
Evaluation and management (E/M) coding is particularly challenging. The scope and complexity of these codes draw the attention of the Centers for Medicare & Medicaid Services (CMS) and other payers.
Providers may unintentionally over-code services with incomplete documentation that does not support their chosen E/M level. Similarly, under-coding results in lost revenue. Despite the revenue and increased compliance risks this behavior poses, most organizations do not have the time, coding staff or technology to conduct thorough, ongoing audits of their coding.
3M CodeMonitor is a workflow and auditing solution that works from within 3M CodeAssist to provide an automated review of provider coding. It can help you to safeguard appropriate and accurate reimbursement and lessen compliance risk from unintentional over-coding and under-coding when the documentation supports a higher level. The technology uses 3M’s proprietary natural language processing (NLP) platform to review and select codes based on the clinical documentation.
With 3M’s software-as-a-service approach, organizations receive a computer-assisted evaluation of their coding results. This provides a vastly improved ability to find and correct records, which can boost the efficiency of your coding and auditing staff.
The 3M CodeMonitor System offers a specialized workflow that compares the provider-assigned E/M code with the E/M code suggested by the 3M NLP engine.
If 3M CodeMonitor agrees with the provider codes, the note proceeds to billing.
If there is disagreement, the note is routed into a review queue. Each organization establishes the “disagreement threshold” and kick-out percentage that the 3M software applies.
In addition, management and audit reports allow organizations to assess documentation and coding patterns to address areas of disagreement.
3M CodeMonitor does not support any diagnosis comparison between user-provided diagnosis codes and the 3M NLP engine-suggested ICD codes. Notes routed directly to billing do not include any 3M NLP engine-suggested ICD codes.
However, notes routed for coder review are presented with the 3M NLP engine-suggested ICD codes. Codes approved in the 3M CodeMonitor web application are also included in the charge file.
All notes routed directly to billing have the original user-supplied codes returned in the charge file. For those notes routed back to coder work queues, the codes returned in the charge file are those approved by a coder in the 3M CodeMonitor web application.
A data interface (HL7 is preferred) is required to connect the following clinical data systems: Electronic medical record (EMR); admission/discharge/transfer (ADT); financial system; ancillary non-EMR; and the 3M NLP engine.
To do its job, 3M CodeMonitor needs the following data:
Both under-coding and over-coding create unnecessary compliance risk and potential for lost revenue. 3M CodeMonitor can help organizations combat and reduce coding compliance risks through its comprehensive review of your coding records.
When your organization uses 3M CodeMonitor to achieve consistent, compliant coding and documentation, you build a sturdy foundation for capturing appropriate levels of service—in other words, you are paid appropriately for the care you provide. And when the correct codes go to billing to generate a clean bill the first time, your A/R realizes benefits, too.
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