Hybrid human and computer-assisted coding workflow
A computer system increases the efficiency with which billing codes may be generated based on a chart, such as a medical chart. The computer system provides the chart to a computer-assisted coding (CAC) module, which produces an initial set of billing codes and an initial assessment of the accuracy and/or completeness of the codes. The computer system decides whether to send the initial set of billing codes to an initial human reviewer. If the computer system sends the initial set of billing codes to the initial human reviewer, then the initial human reviewer reviews the chart and the output of the CAC module, and attempts to fix errors in the CAC output. The system provides the chart and the current (initial or modified) codes to a final human reviewer, who may be more highly skilled than the initial human reviewer, for final verification and modification.
1. A method performed by at least one computer processor executing computer program instructions stored on at least one non-transitory computer-readable medium, the method comprising:
(A) receiving, by a chart routing module executed by the at least one computer processor, data representing a medical chart;
(B) determining, by the chart routing module, whether the medical chart qualifies for automated processing by a computer-assisted coding (CAC) module, wherein determining whether the medical chart qualifies for the automated processing comprises:
determining whether the medical chart has a high confidence of being coded accurately by the CAC module, comprising determining whether the medical chart describes a complex medical procedure;
(C) in response to determining that the medical chart does not describe a complex medical procedure:
providing, by the chart routing module, the medical chart to the CAC module;
performing CAC, by the CAC module, on the medical chart to produce an initial set of billing codes automatically;
receiving, by the chart routing module, the initial set of billing codes from the CAC module;
determining, by the chart routing module, whether a skill value associated with an initial reviewer exceeds a particular value;
providing, by the chart routing module, the initial set of billing codes to the initial reviewer in response that the skill value associated with the initial reviewer exceeds the particular value;
receiving, by the chart routing module, from the initial reviewer, a modified set of billing codes and modified code assessment data that represents an assessment of accuracy and completeness of the modified set of billing codes; and
providing, by a coding output routing module executed by the at least one computer processor, a final coding output for a final review, wherein the final coding output comprises the medical chart, the modified code assessment data, and the modified set of billing codes, and wherein providing the final coding output for the final review results in correctness of errors in the modified set of billing codes received from the initial reviewer and increase in efficiency of a coding process, which lead to increase in accuracy of the final coding output and reduction in costs associated with the coding process; and
(D) in response to determining that the medical chart describes a complex medical procedure:
providing the medical chart to the initial reviewer;
receiving the initial set of billing codes from the initial reviewer; and
providing the initial set of billing codes for the final review, wherein providing the initial set of billing codes for the final review results in correctness of errors in the initial set of billing codes.
2. The method of claim 1 , wherein the data representing the medical chart includes data representing a freeform text document.
3. The method of claim 1 , wherein the data representing the medical chart includes data representing a structured document.
4. The method of claim 3 , wherein the data representing the structured document comprises data representing an XML document.
5. The method of claim 1 , wherein the data representing the medical chart comprises data representing a data record in a database.
6. The method of claim 1 , wherein the data representing the medical chart includes data representing at least two of: a freeform text document, an XML document, and a data record in a database.
7. A system comprising at least one non-transitory computer-readable medium storing computer program instructions executable by at least one computer processor to perform a method, the method comprising:
(A) receiving, by a chart routing module executed by the at least one computer processor, data representing a medical chart, wherein the chart routing module is configured to perform one or more routing determinations on the data;
(B) determining, by the chart routing module, whether the medical chart qualifies for automated processing by a computer-assisted coding (CAC) module, wherein determining whether the medical chart qualifies for the automated processing comprises one of:
determining whether the medical chart comprises scanned handwritten notes; and
determining whether the medical chart has a high confidence of being coded accurately by the CAC module;
(C) in response to determining that the medical chart qualifies for the automated processing by the CAC module:
providing, by the chart routing module, the medical chart to the CAC module;
performing CAC, by the CAC module, on the medical chart to produce an initial set of billing codes automatically;
receiving, by the chart routing module, the initial set of billing codes from the CAC module;
determining, by the chart routing module, whether a skill value associated with an initial reviewer exceeds a particular value;
providing, by the chart routing module, the initial set of billing codes to the initial reviewer in response to determining that the skill value associated with the initial reviewer exceeds the particular value;
receiving, by the chart routing module, from the initial reviewer, a modified set of billing codes and modified code assessment data that represents an assessment of accuracy and completeness of the modified set of billing codes; and
providing, by a coding output routing module executed by the at least one computer processor, a final coding output for a final review, wherein the final coding output comprises the medical chart, the modified code assessment data, and the modified set of billing codes, and wherein providing the final coding output for the final review results in correctness of errors in the modified set of billing codes received from the initial reviewer and increase in efficiency of a coding process, which lead to increase in accuracy of the final coding output and reduction in costs associated with the coding process; and
(D) in response to determining that the medical chart describes a complex medical procedure:
providing the medical chart to the initial reviewer;
receiving the initial set of billing codes from the initial reviewer; and
providing the initial set of billing codes for the final review, wherein providing the initial set of billing codes for the final review results in correctness of errors in the initial set of billing codes.
8. The system of claim 7 , wherein the data representing the medical chart includes data representing a freeform text document.
9. The system of claim 7 , wherein the data representing the medical chart includes data representing a structured document.
10. The system of claim 9 , wherein the data representing the structured document comprises data representing an XML document.
11. The system of claim 7 , wherein the data representing the medical chart comprises data representing a data record in a database.
12. The system of claim 7 , wherein the data representing the medical chart includes data representing at least two of: a freeform text document, an XML document, and a data record in a database.