Reducing Revenue Cycle Leakage with Cognitive Emulation

July 14, 2020 - By Ashley Binford

Today, most healthcare technology solutions that support revenue cycle billing, coding and documentation teams use systems and workflows that “think” like computers – not clinicians.

They leverage rules and check-lists, which only consider narrative documentation and can lead to unforeseen errors given the many nuances of the healthcare revenue cycle. 

Iodine Software takes a different approach. The company has pioneered a new application of artificial intelligence and machine learning called Cognitive Emulation. This approach uses proprietary AI technology and machine learning algorithms which allow a machine to interpret clinical data in the same way a clinician thinks, and emulate clinical judgement in a manner very similar to how providers of care assess and treat their patients. 

Augmenting the work of health system professionals with software that can actually think enables Iodine to solve numerous healthcare problems in new ways with proven results. Iodine analyzes the full clinical record for each patient much the way a clinician would, but at a massive scale: across over 20 million admissions worth of data and 1.5 billion medical concepts from over 480 hospitals across the country.

Iodine’s first application of Cognitive Emulation? Examining new ways to fix mid-revenue cycle leakage.

Applying Cognitive Emulation to the healthcare revenue cycle

Today, each stage of the CDI or documentation process represents an opportunity for leakage via incorrect or incomplete coding and documentation. Legacy software solutions focus on natural language processing – which means they are only looking at documentation in the patient record and not taking into account lab results, vital signs, cardiology and radiology results, and patient history (for example). Even health systems with mature CDI programs supported by legacy software solutions can see significant documentation improvement opportunities not making it into the final code – leaving millions of dollars on the table. 

For clinical documentation to be accurate and support reimbursement objectives, a CDI team would ideally review every record, every day throughout the stay and ensure all conditions are documented appropriately. In the current staffing environment, with typical case volumes, that is essentially impossible without the right type of technology.

Similar to how physicians base decisions on their knowledge of medical concepts, experience in the field, and clinical judgment, Iodine leverages its Cognitive Emulation approach (via its CognitiveML Engine) to consider and analyze the entire patient record. For example, rather than drawing conclusions simply from documentation, Iodine considers: 

  • Lab results
  • Vital signs
  • Orders
  • Medications
  • Demographic information
  • Patient history
  • Radiology results
  • Cardiology results
  • Working, target, and final codes
  • and Documentation

By matching this evidence against patterns observed across the billions of data points in Iodine’s database, the CognitiveML Engine determines the statistical likelihood a meaningful difference exists between a patient’s clinical state and what has been documented. Not only does Iodine identify instances of highly-likely but undocumented conditions, it also can identify where the clinical data contradicts what is documented to help avoid denials. As new data is reviewed, Iodine expands its knowledge base, becoming increasingly more intelligent and effective over time.

Proven results using Cognitive Emulation

Iodine applied its Cognitive Emulation approach to clinical judgement with the AwareCDI Suite to reliably identify areas of potential opportunity to accelerate productivity, data accuracy, and financial return. 

Cognitive Emulation drives smarter prioritization through the Iodine Concurrent module, which considers the entirety of the clinical record and patient experience to predict likely conditions, identify gaps between evidence and documentation, and help CDI teams query more effectively and efficiently. 

Cognitive Emulation is also the foundation of the Iodine Forecast module, which predicts final DRGs early in the patient’s stay–well ahead of the availability of final coded diagnoses which are typically only available days to weeks after discharge. Forecast™ increases the accuracy and efficiency of assigning working DRGs, supporting CDI workflow and enabling teams across the health system to make real-time, evidence-based predictions – without needing to wait for final coded data.  

Iodine clients consistently achieve substantial results utilizing Cognitive Emulation and the AwareCDI Suite to improve documentation integrity. Irrespective of any preexisting legacy tools, Iodine clients have seen:

  • A median 75% increase in query volume
  • A mean 4.3%, or 0.0633 point average, increase in CMI per facility
  • An increase in MCC capture at 94% of facilities after using Iodine 
  • $1.5 billion in additional appropriate reimbursement recognized annually

To learn more about Iodine’s Cognitive Emulation approach to solving mid-revenue cycle leakage, contact info@iodinesoftware.com.

Figures are based on a $6000 modeled base rate and actual measured MCC capture performance from the 2019 Iodine Performance Cohort Analysis of 339 facilities that compared measured MCC capture and CMI impact for the Iodine usage period 9/1/2018-8/31/2019 against pre-Iodine baseline performance.

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