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Physician Computer Assisted Coding for Professionals: Market Shares, Strategies, and Forecasts, Worldwide, 2017 to 2023

March 2017 | 299 pages | ID: PE19ABB6344EN
WinterGreen Research

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Next generation Computer Assisted Coding of medical information is able to leverage natural language software technology to support some automation of the billing process and use of analytics to achieve higher quality patient outcomes. The study has 301 pages and 110 tables and figures.

Computer assisted coding of medical information uses natural language solutions to link the physician notes in an electronic patient record to the codes used for billing Medicare, Medicaid, and private insurance companies.

Natural language processing is used determine the links to codes. 88% of the coding can occur automatically without human review. Computer assisted coding is used in all parts of the healthcare delivery system. The coding systems work well to implement automated coding process.

Physicians think about patient conditions in terms of words. Software is configured to achieve working with physicians who are more comfortable describing a patient treatment in words than codes. The electronic patient record, created using physician dictation, is used to form the base for the coding. Natural language solutions implement computer coding to identify key words and patterns of language. The physician dictation can be done using regular language that the software recognizes and translates into billing codes.

Properly designed natural language processing (NLP) solutions do not require physicians to change the way they work. They can dictate in a free-flowing fashion, consistent with the way they think, and are not limited to structured inputs that may or may not fully capture the unique circumstances of each patient encounter.

Matching codes generated from physician notes to standard treatment protocols promises to improve health care delivery. Accompanying that type of physician patient management against best practice promises to revolutionize health care delivery. The ability to further check as to whether the recommendations for follow up made by radiologists and matching the commendations with the actual follow up heralds’ significant promise of vastly improved health care delivery.

Computer assisted coding applications depend on the development of production quality natural language processing (NLP)-based computer assisted coding applications. This requires a process-driven approach to software development and quality assurance.

A well-defined software engineering process consists of requirements analysis, preliminary design, detailed design, implementation, unit testing, system testing and deployment. NLP complex technology defines the key features of a computer assisted coding (CAC) application.

Automation of process will revolutionize health care delivery. In addition to automating the insurance, billing, and transaction systems, streamlined care delivery is an added benefit. The ability to look at workflow and compare actual care to best practice is fundamental to automated business process.

The ability to link diagnostic patient information to treatment regimes and drug prescriptions is central to improving medical care delivery. Once a physician can see what conditions need to be followed, and see that appropriate care has been prescribed 100% of the time, care delivery improves dramatically. Diagnosis of conditions using radiology frequently results in detection of events that need follow-up.

“Growing acceptance of computer assisted coding for physician offices represents a shift to cloud computing and billing by the procedure coded. Because SaaS based CAC provides an improvement over current coding techniques the value is being recognized. Administrators are realizing the benefits to quality of care. Patients feel better after robotic surgery and the surgeries are more likely to be successful.”

The worldwide market for Computer Assisted Coding is $898 million in 2016, anticipated to reach $2.5 billion by 2023. The complete report provides a comprehensive analysis of Computer Assisted Coding in different categories, illustrating the diversity of software market segments. A complete procedure analysis is done, looking at numbers of procedures and doing penetration analysis.

Major health plans report a smooth transition to ICD-10. This is due to rigorous testing for six years. ICD-10 has had a positive impact on reimbursement. ICD-10 coding system requires use of 72,000 procedure codes and 68,000 CM codes, as opposed to the 4,000 and 14,000 in the ICD-9 system. Managing high volume of codes requires automation. Healthcare providers and payers use complex coding systems, which drives demand for technologically advanced CAC systems.

The market for computer-assisted coding grows because it provides management of workflow process value by encouraging increasing efficiency in care delivery for large Professional Physician Practice and Ambulatory Clinical Facility. By making more granular demarcation of diagnoses and care provided for each diagnosis, greater visibility into the care delivery system is provided. Greater visibility brings more ability to adapt the system to successful treatments.
COMPUTER ASSISTED CODING EXECUTIVE SUMMARY

Medical Best Practice Linking
CAC for Coders
Computer Assisted Coding Best Practice
Coding Solutions
Physician Computer Assisted Coding Services
Natural Language Computer Assisted Coding Market Shares
Natural Language Computer Assisted Coding of Medical Procedures Forecasts
Medical Best Practice Linking

1. COMPUTER ASSISTED CODING FOR LARGE PHYSICIAN PRACTICES AND AMBULATORY TREATMENT CENTERS MARKET DESCRIPTION AND MARKET DYNAMICS

1.1 Coding Challenge
  1.1.1 Computer Assisted Coding (CAC) Physician Practice Services Component
  1.1.2 Advances In Natural Language Processing And Informatics
  1.1.3 Using Electronic Health Record (EHR) Documentation To Generate Codes
1.2 Computer-Assisted Coding
  1.2.1 Physician Practice Industry Forces Affecting Development of CAC
  1.2.2 Application of CAC Technology
1.3 Development of a CAC Tool For Physician Use
  1.3.1 CAC Impact on the Coding Workflow
  1.3.2 Computers Replace Human Coders
  1.3.3 CAC Applied Without Human Intervention Depends On Critical Differences Between CAC Systems44
1.4 Healthcare Industry Largest In United States
  1.4.1 Building a Safer Health System
  1.4.2 Facilitating the Use of Technology in the Healthcare Industry
  1.4.3 Prescription Drug Modernization
1.5 Medical Necessity and Medical Necessity Errors
1.6 Physician Office Electronic Coding
  1.6.1 CAC Automates and Accelerates Auditing
1.7 Natural Language Solutions
  1.7.1 State Of Language Technology Evaluation
1.8 Computerized Workflow System
  1.8.1 Confidence Assessment Module
  1.8.2 Researching Electronic Coding Products:

2. PROFESSIONAL COMPUTER ASSISTED CODING MARKET SHARES AND FORECASTS

  2.1.1 Physician Practices With A Services Component Market Driving forces
  2.1.2 Medical Best Practice Linking
  2.1.3 CAC for Coders
  2.1.4 Computer Assisted Coding Best Practice
  2.1.5 Computer Assisted Coding Medical Information Solutions
  2.1.6 Coding Solutions
  2.1.7 Physician Computer Assisted Coding Services
2.2 Physician Office and Ambulatory Clinical Organizations Natural Language Computer Assisted Coding Market Shares
  2.2.1 3M
  2.2.2 3M
  2.2.3 3M Merging Quality With Reimbursement
  2.2.4 Optum
  2.2.5 Optum Automated Code Identification
  2.2.6 Optum
  2.2.7 nThrive / Precyse
  2.2.8 Dolbey
  2.2.9 McKesson
  2.2.10 Cerner
  2.2.11 TruCode
2.3 Natural Language Computer Assisted Coding of Medical Procedures Forecasts
  2.3.1 CAC Market Software and Services Segmentation
  2.3.2 CAC Hospitals and Facilities and Physicians Market Segment
  2.3.3 Computer Assisted Coding Physician Market
  2.3.4 Worldwide Computer Assisted Coding, Hospitals and Facilities and Physicians
  2.3.5 CAC Software Market Hospital and Physician Segments
  2.3.6 CAC Services Market Segment
  2.3.7 US Computer Assisted Coding Physician Software License / Maintenance and Cloud SaaS Services112
  2.3.8 Physicians Computer Assisted Coding
  2.3.9 US Computer Assisted Coding Software Units
  2.3.10 US Computer Assisted Coding Software / Cloud Services for Independent Radiology Clinics Market Forecasts120
  2.3.1 US Independent Radiology Imaging Centers
  2.3.2 Erroneous Selection of Principal Diagnoses Impacting Reimbursement
  2.3.3 Growth of the U.S. Healthcare Industry
2.4 Worldwide, Number of Patients and Procedures
2.5 Making The Shift To The Modern ICD-10 Requirements
2.6 Computer Assisted Coding Prices
2.7 Computer Assisted Coding Regional Analysis
  2.7.1 3M 360 Encompass System

3. COMPUTER ASSISTED CODING PRODUCT DESCRIPTION

3.1 3M
  3.1.1 3M 360 Encompass System
  3.1.2 3M 3M CodeAssist System
  3.1.3 3M APR DRG Solutions Aspects
  3.1.4 3M Merging Quality With Reimbursement
  3.1.5 3M APR DRG Software
  3.1.6 3 M Classification System For Patients
  3.1.7 3M APR DRG Software Features:
  3.1.8 3M Coding Technology
  3.1.9 3M Computer-Assisted Coding Solutions
  3.1.10 3M Medical Coding Tools Streamline Processes
  3.1.11 CodeAssist Automating the Medical Coding Process
  3.1.12 3M CodeComplete Outsource Solution for Medical Coding
  3.1.13 3M DataScout Clinical Data Extraction and Identification
  3.1.14 3M and American Academy of Professional Coders (AAPC)
  3.1.15 3M Data Mining Technology
  3.1.16 3M Systems for Overcoming Documentation Shortfalls
  3.1.17 3M Solutions for a Changing Healthcare Landscape
  3.1.18 3M Web-Based Coding Software Return on Investment
  3.1.19 3M Coding Software Functions
  3.1.20 3M Computer-Assisted Coding Solutions Targeted to Specialty Areas
  3.1.21 3M CodeAssist Functions
  3.1.22 3M CodeComplete Business Process Management
3.2 Dolbey
  3.2.1 Dolbey Coding Productivity Management
  3.2.2 Dolby Fusion Suite Modules
3.3 Optum Coding Service
  3.3.1 Optum Coding
  3.3.2 Optum CPT® Codes
  3.3.3 Optum Medicare Fee Schedule
3.4 McKesson
  3.4.1 Mckesson Watching the Cash
  3.4.2 McKesson Securing the Subsidy
  3.4.3 McKesson Quality Control And Process Improvement
3.5 Cerner Computer Assisted Coding
3.6 Platocode® Computer-Assisted Coding
  3.6.1 Platocode ICD 10
  3.6.2 Platocode® Solution For Ambulatory Surgery
  3.6.3 Platocode® API
  3.6.4 Communication Between 3rd-Party Applications And A Platocode Server
3.7 Nuance Computer Assisted Coding
  3.7.1 Nuance Clinical Documentation Review
  3.7.2 Nuance Clinical Documentation Compliance
  3.7.3 Nuance Clintegrity Computer Assited Coding (CAC)
  3.7.4 Nuance Clintegrity Computer Assisted Coding (CAC) Key Features
  3.7.5 Nuance Clintegrity Facility Coding Solutions for Healthcare
  3.7.6 Nuance Clintegrity Facility Coding
  3.7.7 Nuance Clintegrity Computer Assisted Coding (CAC) Features
  3.7.8 Nuance Clintegrity Physician Coding
  3.7.9 Nuance Clinician Reimbursement Calculation
  3.7.10 Nuance Clintegrity Compliance & ICD-10 Transition
  3.7.11 Nuance Clintegrity Facility Coding
  3.7.12 Nuance Clintegrity Abstracting
  3.7.13 Nuance Clintegrity ICD-10 Education Services
  3.7.14 Nuance Automated Coding
  3.7.15 Nuance Natural Language Processing
  3.7.16 Nuance Natural Language Understanding
  3.7.17 Nuance Mapping and Modeling Disparate Controlled Medical Vocabularies (CMVs);
3.8 Artificial Medical Intelligence Emscribe CAC
  3.8.1 Artificial Medical Intelligence EMscribe Dynamic Search
  3.8.2 Artificial Medical Intelligence EMscribe Encoder
  3.8.3 AMI EMscribe® Dynamic Medical Term And Coding Search Tool
  3.8.4 Artificial Medical Intelligence Autonomous Coding
  3.8.5 Artificial Medical Intelligence (AMI) EMscribe Dx
3.9 CodeCorrect
  3.9.1 CodeCorrect Capture Revenue and Maintain Compliance
  3.9.2 CodeCorrect knowledge
  3.9.3 CodeCorrect Medical Necessity Verification and APC Performance Tools
  3.9.4 QuadraMed
3.10 M*Modal Coding
  3.10.1 M*Modal Workflow
  3.10.2 M*Modal Management Tools
  3.10.3 M*Modal Single Platform
3.11 nThrive / MedAssets-Precyse and Equation
  3.11.1 Precyse Medical Coding and Computer Assisted Coding

4. COMPUTER ASSISTED CODING RESEARCH AND TECHNOLOGY

4.1 Computer-Assisted Coding Technology
4.2 Hybrid Technology
  4.2.1 Computer Assisted Coding Engine
4.3 Optum Computer Assisted Coding Technology
4.4 Preventable Medical Conditions
4.5 Natural Language Processing (NLP) Medical Coding
  4.5.1 Rules Based Approaches
  4.5.2 Reports Based On Statistics
  4.5.3 Normalize the Data
4.6 Reports Must Be In Some Kind Of Electronic Format
  4.6.1 NLP Software Statistical Analysis
  4.6.2 Workflow
  4.6.3 Feedback for Machine Learning
  4.6.4 Coding
  4.6.5 Accuracy And Specificity Of Retrieval
  4.6.6 Natural Language Programming (NLP) Vocabulary Processor
  4.6.7 Robust Underlying Terminological Model And A Component Architecture
4.7 TeSSI® (Terminology Supported Semantic Indexing)
  4.7.1 L&C’s LinkBase® Medical Ontology
  4.7.2 Semantic Indexing With The TeSSI® Indexing Engine
  4.7.3 Semantic Indexing Solution Automates The Indexing Process
  4.7.4 Information Extraction with TeSSI® Extraction Engine
  4.7.5 Semantic Search with TeSSI® Search Engine

5. COMPUTER ASSISTED CODING COMPANY PROFILES

5.1 CAC Key Market Players
5.2 3M
  5.2.1 3M Business
  5.2.2 3M Health Care Segment
  5.2.3 3M Electronics and Energy Business
  5.2.4 3M Health Information Systems
5.3 Artificial Medical Intelligence
5.4 Cerner
  5.4.1 Cerner Business
  5.4.2 Cerner Acquired Siemens Health Services
  5.4.3 Cerner 2016 Fourth Quarter and Full-Year Highlights:
5.5 Craneware
5.6 Dolbey
5.7 EPIC
5.8 Group One / CodeCorrect
5.9 M*Modal
5.10 nThrive
  5.10.1 nThrive / Precyse
5.11 Nuance
  5.11.1 Nuance Healthcare
  5.11.2 Nuance Business Description
  5.11.3 Nuance Key Metrics
  5.11.4 Nuance Healthcare Trends
5.12 Quest Diagnostics
5.13 TruCode
5.14 UnitedHealth Group / Optum
  5.14.1 UnitedHealth Group / Optum
  5.14.2 UnitedHealth Group Optum Health Information Technology Acquires Clinical Data Analytics Vendor Humedica
  5.14.3 Optum Acquires Physician Practice Management And Revenue Management Software Firm, MedSynergies and Support Arm of ProHealth Physicians Group
  5.14.4 Optum MedSynergies Synergies
  5.14.5 Optum Life Sciences
  5.14.6 United Healthcare Revenue
5.15 Selected CAC Companies

LIST OF FIGURES

Figure 1. Computer Assisted Coding of Medical Information Market Driving Forces
Figure 2. Computer Assisted Coding of Medical Information Market Driving Factors
Figure 3. CAC Workstation Coder Benefits
Figure 4. CAC Management Tools
Figure 5. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES
Figure 6. ELECTRONIC CODING PRODUCT ISSUES
Figure 7. Computer Assisted Coding Software and Services Market Shares, Dollars, 2016
Figure 8. Computer Assisted Coding Market Forecast, Dollars, Worldwide, 2017-2024
Figure 9. Barriers to CAC
Figure 10. Electronic Coding Integrated Database Issues
Figure 11. Medical Necessity Online
Figure 12. Physician Office Computer Assisted Coding Key Benefits:
Figure 13. Natural Language Solutions System For Coding
Figure 14. Computerized Workflow System Systems Features
Figure 15. 3M Confidence Assessment Module System
Figure 16. Physician Practices and Ambulatory Care Centers CAC Market Driving Forces:
Figure 17. Computer Assisted Coding of Medical Information Market Driving Forces
Figure 18. Computer Assisted Coding of Medical Information Market Driving Factors
Figure 19. CAC Workstation Coder Benefits
Figure 20. CAC Management Tools
Figure 21. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES
Figure 22. ELECTRONIC CODING PRODUCT ISSUES
Figure 23. Large Physician Practice Computer Assisted Coding Software and Services Market Shares, Dollars, 2016
Figure 24. Radiology and Ambulatory Clinic Computer Assisted Coding Software and Services Market Shares, Dollars, 2016
Figure 25. Worldwide Computer Assisted Coding Facilities and Physicians Market Shares, Dollars, 2016
Figure 26. Computer Assisted Coding Software and Services Market Shares, Dollars, 2016
Figure 27. Worldwide Computer Assisted Coding License Shipments and Cloud Services Market Shares, Dollars, 2016
Figure 28. 3M CAC Research Areas
Figure 29. 3M Core of NLP Computer Assisted Coding
Figure 30. Optum CAC Key Benefits:
Figure 31. Optum LifeCode®, CAC Functions
Figure 32. Optum LifeCode®, CAC Reconciliation Functions
Figure 33. Optum CAC Reconciliation Module Functions:
Figure 34. Platocode® Computer Assisted Coding Solution Benefits
Figure 35. Computer Assisted Coding Market Forecast, Dollars, Worldwide, 2017-2024
Figure 36. Computer Assisted Coding CAC Market Forecasts, Dollars, 2017 to 2023
Figure 37. CAC Market Segments Software and Services Key Topics
Figure 38. Worldwide Computer Assisted Coding Hospitals and Facilities and Physicians Market Shares, Dollars, 2016
Figure 39. Worldwide Computer Assisted Coding: Large Teaching Hospitals, Mid-Size and Small Hospitals, and Clinical Facilities, Market Shares, Units, 2016
Figure 40. Worldwide Computer Assisted Coding, Hospitals and Facilities and Physicians, Market Shares, Units, 2016
Figure 41. Worldwide Computer Assisted Coding, License Shipments, Services, and Cloud Services
Figure 42. Worldwide and US Computer Assisted Coding Number of Large Physician Practices, CAC Installed Base, Market Forecasts, Number, 2017-2023
Figure 43. Worldwide and US Computer Assisted Coding Software and Cloud Services CAC Market Forecasts, Dollars, 2017-2023
Figure 44. Worldwide and US Computer Assisted Coding for Physicians CAC Market Forecasts, Dollars, 2017-2023
Figure 45. US Computer Assisted Coding Physician Software License / Maintenance and Cloud SaaS Services, CAC Market Forecasts, Dollars, 2017-2023
Figure 46. US Computer Assisted Coding Software License / Maintenance and Cloud SaaS Services CAC For Large Independent Physician Practices Market Forecasts, Dollars, 2017-2023
Figure 47. US Computer Assisted Coding Software Units Retired CAC For Large Independent Physician Practices Market Forecasts, 2017-2023
Figure 48. US Computer Assisted Coding Software Units Retired CAC For Large Independent Physician Practices Market Forecasts, 2017-2023
Figure 49. US Computer Assisted Coding Software and Cloud SaaS Services CAC For Independent Radiology Clinics Market Forecasts, Dollars, 2017-2023
Figure 50. US Computer Assisted Coding CAC Software License / Maintenance and Cloud SaaS Percent Penetration For Independent Radiology Clinics Market Forecasts, Dollars, 2017-2023
Figure 51. US Outpatient Procedures Forecasts, Number of Procedures, 2016-2023
Figure 52. US Computer Assisted Coding Outpatient Procedure Market Penetration Forecasts, % Penetration, 2017-2023
Figure 53. 3M APR DRG Software Functions: 2.5 Making The Shift To The Modern ICD-10 Requirements
Figure 54. Computer Assisted Coding Regional Market Segments Dollars, Worldwide, 2016
Figure 55. Computer Assisted Coding Regional Market Segments Dollars, Worldwide, 2016
Figure 56. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations
Figure 57. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations
Figure 58. 3M 3M CodeAssist System Features
Figure 59. 3M Codefinder Functions
Figure 60. 3M Codefinder Features
Figure 61. 3M Codefinder Intelligent Functions
Figure 62. 3M APR DRG Solutions Aspects
Figure 63. 3M Applications For Severity- And Risk-Adjusted Data
Figure 64. 3M Classification System
Figure 65. 3M APR DRG Software Features
Figure 66. 3M Medical Coding Tools
Figure 67. 3M DataScout Functions
Figure 68. 3M Clinical Information Extraction Functions
Figure 69. 3M Systems For Overcoming Documentation Shortfalls Focus
Figure 70. 3M Systems Topics
Figure 71. 3M Systems Metrics Included For Computerized Coding
Figure 72. 3M Web-Based Coding Software Return On Investment Metrics
Figure 73. 3M Web-Based Coding Software Key Benefits
Figure 74. 3M Coding Software Functions
Figure 75. 3M Coding Software Features
Figure 76. 3M Internet-Based Computer-Assisted Medical Coding Target Markets
Figure 77. 3M CodeAssist Functions
Figure 78. 3M CodeComplete Functions
Figure 79. Dolbey Fusion CAC Benefits
Figure 80. Dolbey Computer-Assisted Coding Solution Features
Figure 81. Dolby Computer Assisted Coding CAC Fusion Suite Modules
Figure 82. Optum Computer-Assisted Coding (CAC) Intelligent CAC Functions:
Figure 83. Optum Coding Service
Figure 84. Optum Medicare Fee Schedule
Figure 85. McKesson Practice Management Priorities
Figure 86. Cerner Discern nCode Functions
Figure 87. Cerner Discern nCode Key Features
Figure 88. Platocode Process
Figure 89. PlatoCode Code Set Filters
Figure 90. Nuance Personnel Impacted by Transition to ICD-10
Figure 91. ICD-10 Critical Business Concerns:
Figure 92. Nuance Clintegrity Facility Coding Healthcare Solutions Platform Functions
Figure 93. Nuance Clintegrity Facility Coding Healthcare Solution Functions
Figure 94. Nuance Clintegrity Computer Assisted Coding (CAC) Professional Fee Coding Functions
Figure 95. Nuance Clintegrity Clinician Coding Features
Figure 96. Nuance Clintegrity Facility Coding Features
Figure 97. Nuance Clintegrity Platform Modules
Figure 98. Nuance Clintegrity Platform, Modules Customizable Data Collection Fields Features
Figure 99. Nuance Advantages Of Automating Coding With Clintegrity
Figure 100. Nuance Coding Algorithms
Figure 101. Nuance Mapping And Modeling Disparate Controlled Medical Vocabulary Functions
Figure 102. Artificial Medical Intelligence EMscribe CAC
Figure 103. Artificial Medical Intelligence EMscribe Dynamic Search
Figure 104. Artificial Medical Intelligence (Ami) Emscribe Dx Benefits
Figure 105. Precyse Coding Services
Figure 106. PrecyseCode CAC Coding Functions
Figure 107. Computer Assisted Technology Functions
Figure 108. How ICD-9 and ICD-10 Are Different
Figure 109. ICD-9 and ICD-10 Different Formats
Figure 110. Semantic Indexing for Medical Ontology
Figure 111. Semantic Process Flow Index Component Medical Ontology
Figure 112. Information Extraction With Tessi® Extraction Engine Functions
Figure 113. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations
Figure 114. Current EPIC Computer Assisted Coding CAC Integrations


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