Medical Savant delivers multiple coding engines, each with its own unique characteristics.
Evaluation and Management is charged based level of service (Level 1 to Level 5) provided by the provider. The level of service is a reflection and time, skills and effort expended by provider staff such as nurse, radiologist and attending MD. Medical Savant delivers out of the box E&M Level coding engine for Emergency Room services and Professional Services (Clinic, Urgent Care, Specialist, etc.) and enables adaptation of customer specific coding rules by leveraging the flexible Rules Engine.
Medication administration via routes other than oral are often chargeable items. Examples of chargeable medication administration are:
- IV Hydration
- IV Push
- Intramuscular or Subcutaneous Injections
Medication Administration charges are governed by a complex set of rules that includes administration durations, overlap between multiple medications, same-time, sequential and concurrent administration rules and medical necessity. Medical Savant implements a flexible Medication Administration coding engine that can be configured for a vast number of scenarios. The coding engine extracts the relevant elements such as drug name, route, start time, stop times and location from the encounter document, applies the rules established by the healthcare payer industry in conjunction with the internal policies established by the provider and derives the administration charges.
Procedures performed in different healthcare environments are sometimes contained in verbose document. Often, elements pertinent to the procedures such as type of procedure (surgery, radiology), anatomical site and specificity, type of operation (incision, reduction, excision, etc.,), device used, approach (external, endoscopic, etc.), complexity (layered, simple) and dimensions (length of incision) are spread across the document. Medical Savant implements a rules-extraction of procedure elements and codes the CPT and Charges contained in the providers’ charge data master (CDM).
Modifiers are appended to procedure charges to signal special circumstances related to the procedure to the payer. Some examples are:
- Anatomical Site specificity (Left, Right) of procedure
- Multiple similar procedures are performed on the same day
- By the same doctor
- By different doctors
- One charge (for example E&M Level) includes another separately chargeable service (Radiology) charge
There are complex reimbursement rules governing when a procedure is allowed and when (and what) modifiers are to be added and when a procedure is disallowed. Medical Savant implements the rules established by the payer industry and derives Modifiers where necessary.
Diagnosis – ICD
Medical Savant identifies disorder phrases from relevant parts of the documentation such as Chief Complaint, Primary Impression, Radiology Reports, Patient History and History of Illness and automatically derives ICD 10 code. In addition, it semantically categorizes the disorder (Neoplasm, Injury, Disease, Deformity, Symptoms, etc.), determines whether it is acute or chronic condition and sequences the diagnoses as per the rules established by the payer industry.
The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI), is a health care quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States. Likewise, the Merit-Based Incentive Payment System (MIPS) is an emerging payment mechanism that will provide annual updates to physicians starting in 2019, based on performance in four categories: quality, resource use, clinical practice improvement activities and meaningful use of an electronic health record system. Each system has numerous measures which are to be reported based on documentation for services performed and the patient. Medical Savant implements these performance reporting capabilities using the flexible Rules Engine.