decisionhealth Newsletters, Part B News - 2019 Issue 3 (March)
Don't over-rely on computer-assisted coding tools or risk non-compliance
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Article Overview
This article addresses the use of computer-assisted coding tools in electronic health record workflows and why automated recommendations still require human oversight. It discusses general compliance concerns, including inaccurate prompts, documentation limitations, update issues, and the need to verify claims before submission. The piece is aimed at physicians, coders, compliance staff, and practice managers who use or evaluate coding technology. It also references federal oversight and guidance from CMS and the HHS Office of Inspector General.
Why This Topic Matters
Organizations that use coding automation need to understand the compliance and audit risks that can arise when software suggestions are treated as final. The article helps readers recognize that coding technology can support workflow, but cannot replace review processes needed to avoid denials, overpayments, and enforcement exposure.
Article Sections
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Computer-assisted coding and EHR prompts
Introduces automated coding support within electronic health record systems and third-party tools. Describes the general promise and limitations of these systems in coding workflows.
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Risks and compliance concerns
Summarizes the main reasons automated suggestions can be unreliable, including documentation issues, missing billing components, and federal compliance concerns. References CMS and HHS Office of Inspector General attention to the topic.
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Evaluating and overseeing CAC tools
Outlines practical considerations for assessing vendors, monitoring accuracy, confirming updates, and keeping human review in place. Also emphasizes ongoing auditing of software and records.
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CAC compliance summarized
Provides a brief recap of the article’s main themes and oversight priorities for organizations using computer-assisted coding tools.
What You Will Learn
- How computer-assisted coding tools fit into EHR-based coding workflows
- Why automated coding suggestions can create compliance risk
- What factors to consider when evaluating a coding automation product
- Why regular review, auditing, and staff oversight remain important
- How federal guidance and oversight relate to coding technology use
Who Should Read This
- Physicians
- Medical coders
- Compliance officers
- Practice managers
- Revenue cycle staff
- Health IT leaders
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