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xPatterns Clinical Auto-Coding

xPatterns Clinical Auto-Coding (C.A.C.) improves the efficiency, accuracy and revenue capture of the medical coding activity within healthcare organizations. Using optimized natural language processing (NLP) and proprietary inferencing and machine learning technologies, xPatterns C.A.C. automatically generates clinical codes, including ICD-10 directly from clinical encounter notes such as physician notes, lab results, and discharge records.
xPatterns C.A.C. provides cloud-based interfaces that allow coders to review, if needed, modify the generated codes. xPatterns C.A.C. has been designed with full security and HIPAA-compliance considerations, and can be seamlessly integrated with existing HIT and EMR systems via HL7.

  • With xPatterns C.A.C., hospitals and healthcare provider organizations benefit from higher coding accuracy, improved billing, faster coding turnaround time, reduced A/R (Accounts Receivable) outstanding days, lower denials and reduced claims reworking.
  • Hospitals and physicians offices using xPatterns C.A.C. enjoy higher revenues, more cash-on-hand, and lower coding costs per patient.

xPatterns C.A.C. is feature-rich. It includes workflows accommodating the roles played by administrators, coders and doctors in coding. xPatterns C.A.C. detects under-coding, over-coding, and miscoding, highlighting potential opportunities where higher billing is justified.

  • Financial managers can view real-time dashboards showing coding productivity, organizational trends and other analytics.
  • Coders are able to quickly examine the system’s recommendations, and then confirm or adjust the codes as needed, thus becoming much more efficient; the coder’s primary tasks become review and validation.

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xPatterns C.A.C. uses a combination of innovative inferencing and machine learning. It incorporates user feedback to learn coding best practices as it processes your records. With its sophisticated adaptive technology, xPatterns C.A.C. improves over time, optimizing coding for each organization.

The xPatterns C.A.C. Product Suite

The cloud-based, interactive C.A.C. web application is optimized for four distinct encounter scenarios:

  • xPatterns C.A.C. for Hospital Inpatient
  • xPatterns C.A.C. for Hospital Outpatient
  • xPatterns C.A.C. for Physician’s Office
  • xPatterns C.A.C. for Audit

Two-Stage Intelligent Analysis

Enables a highly accurate two-stage coding process. The first is Medical Concept Extraction, which uses proprietary natural language processing to ingest the unstructured data in Clinical Encounter Notes and identify relevant medical terms. The second stage, Medical Coding Inference, analyzes these terms to determine the most appropriate billing codes.

Ensuring Coding Quality and Accuracy

The recommended codes xPatterns C.A.C. generates are based on ICD-9, ICD-10, CPT and HCPCS guidelines, plus other important sources including NCCI edits, as well as OCE, MCE and MUE. The system can learn from experienced coders by extracting codes from prior encounter note records and making recommendations when similar diagnoses and CPT patterns are detected. The system also provides justification terms for the recommended codes in a single screen.

Learning and Feedback

The system learns from other coders and recently-acquired encounter notes and codes. As a result, it grows more accurate over time. It can detect under-coding, over-coding and miscoding and suggest corrections to coders in sub-second response time. When a coder makes a correction, the system learns that pattern and applies it to future encounter note coding. Organizations can add and configure their own unique set of coding and grouping rules.

Integration with your EMR and Billing Systems

Integration with HIT systems is primarily through HL7. xPatterns C.A.C. supports HL7 versions 2.6 and 3.0. Deployments typically require interaction with the customer’s IT team. Offered as a cloud solution, xPatterns C.A.C. can typically be installed out-of-the-box and configured within a few weeks, reducing upfront capital expense, cost of ownership, and impact on IT resources. Each deployment of xPatterns C.A.C. is carried out by exercising our demonstrated delivery methodology. Atigeo is invested in the success of each engagement, and we strive to ensure enhanced service to our customers.

Best Practices for HIPAA Compliance

Atigeo has implemented several features into xPatterns C.A.C. that are regarded as best practices for HIPPA compliance. Aside from tracking user access and logging detailed transactions for each record, the application consistently encrypts Personal Health Information (PHI) while the data is at rest or while the data is in transit. Detailed access logging provides other benefits for analytics by providing metrics for productivity, time-to-code, and time spent on rework.

The automated coding solution was designed from the ground up with security and privacy policies in mind. User access is controlled through multi-stage security checks including authentication and domain access controls. Strong user account names and passwords are enforced, and usage is tracked so that suspicious activity can be detected and flagged.

Realizing the Cloud Advantage

xPatterns C.A.C. is offered as a cloud solution, and can be installed and configured in less than two weeks. The cloud implementation advantages include lower upfront capital expense, and lower cost of ownership. IT support requirements are minimal, both at launch and while in operation. This is a significant improvement over legacy, on-premise installations which typically require significant IT involvement and expenditure.

Another advantage of xPatterns C.A.C. is that all software updates are made in the cloud, with no impact to end users. Updates happen regularly (including code set updates) and do not disrupt operation nor require any IT support.

Rich Document Type Support

Medical documents of various types are supported including any text, Word or PDF documents.  While coders are not given the option to annotate the original documents, they can refer to the documents easily, and add their comments as needed. A wide variety of clinical notes and note types are supported including admit notes, surgical notes, diagnostic notes, and discharge notes.

Auditing Historical Records

The incorporation of xPatterns C.A.C. within a hospital’s EMR and billing systems often begins with an automated audit of a healthcare provider’s historical medical records. xPatterns C.A.C. enables healthcare providers to perform automated audits of their historical medical records. By processing large blocks of EHR and claims records—in the millions—providers can analyze their organization’s performance in terms of unrealized revenue opportunities, coding accuracy, and documentation sufficiency. Furthermore, xPatterns C.A.C. can provide analytical insight into organizational trends on core measures such as clinical outcomes, physician performance, and coding errors and anomalies based on a variety of categories (by type of procedure; type of patient status; by insurance provider; by specialty, and by other custom categories).

 

Outpatient Portal Inpatient Portal Physician Portal
Clinical Codes
  • ICD 9 CM (vol. 1, 2)
  • ICD 10 CM
  • CPT + modifiers
  • HCPCS + modifiers
  • ICD 9 CM (vol. 1, 2, 3)
  • ICD 10 CM
  • ICD 10 PCS
  • ICD 9 CM (vol. 1, 2)
  • ICD 10 CM
  • CPT + modifiers
  • HCPCS + modifiers
Grouping Codes
  • APC Grouper
  • Hospital Chargemaster
  • DRG (both working and finalized DRGs)
  • RVU
  • E/M calculation
Compliance & Rules
  • NCCI & Bundling Edits
  • Custom Rules
  • NCCI & Bundling Edits
  • Custom Rules
  • NCCI & Bundling Edits
  • Custom Rules