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

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

    • Report Code ID: RW00020828
    • Category Technology, Media, & Telecommunications
    • No. of Pages 301
    • Publication Month Mar-17
    • Publisher Name WinterGreen Research

    Publisher announces that it has published a new study Professional Physician Practice and Ambulatory Clinical Facility Computer Assisted Coding: Market Shares, Strategy, and Forecasts, Worldwide, 2017 to 2023. 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 299 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 regimens 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.

     

    According to Susan Eustis, lead author of the team that prepared the study, “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.

     

    Publisher is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, electronics.ca, and Thompson Financial. It conducts its business with integrity.

     

    The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust Publisher to work alongside them to ensure the success of the participation in a particular market segment.

     

    Publisher supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity.

     

    Table of Contents

     

    Computer Assisted Coding Executive Summary 18

    Medical Best Practice Linking 21

    CAC for Coders 21

    Computer Assisted Coding Best Practice 24

    Coding Solutions 26

    Physician Computer Assisted Coding Services 28

    Natural Language Computer Assisted Coding Market Shares 29

    Natural Language Computer Assisted Coding of Medical Procedures Forecasts 31

    Medical Best Practice Linking 33

    1. Computer Assisted Coding for Large Physician Practices

    and Ambulatory Treatment Centers Market Description and

    Market Dynamics 34

    1.1 Coding Challenge 34

    1.1.1 Computer Assisted Coding (CAC) Physician Practice Services

    Component 35

    1.1.2 Advances In Natural Language Processing And Informatics 36

    1.1.3 Using Electronic Health Record (EHR) Documentation To Generate

    Codes 37

    1.2 Computer-Assisted Coding 39

    1.2.1 Physician Practice Industry Forces Affecting Development of CAC 40

    1.2.2 Application of CAC Technology 42

    1.3 Development of a CAC Tool For Physician Use 43

    1.3.1 CAC Impact on the Coding Workflow 43

    1.3.2 Computers Replace Human Coders 43

    1.3.3 CAC Applied Without Human Intervention Depends On Critical

    Differences Between CAC Systems 44

    1.4 Healthcare Industry Largest In United States 45

    1.4.1 Building a Safer Health System 47

    1.4.2 Facilitating the Use of Technology in the Healthcare Industry 48

    1.4.3 Prescription Drug Modernization 49

    1.5 Medical Necessity and Medical Necessity Errors 50

    1.6 Physician Office Electronic Coding 51

    1.6.1 CAC Automates and Accelerates Auditing 55

     

    1.7 Natural Language Solutions 55

    1.7.1 State Of Language Technology Evaluation 56

    1.8 Computerized Workflow System 58

    1.8.1 Confidence Assessment Module 59

     

    1.8.2 Researching Electronic Coding Products: 61

    2. Professional Computer Assisted Coding Market Shares

    and Forecasts 62

    2.1.1 Physician Practices With A Services Component Market Driving forces

     63

    2.1.2 Medical Best Practice Linking 66

    2.1.3 CAC for Coders 67

    2.1.4 Computer Assisted Coding Best Practice 70

    2.1.5 Computer Assisted Coding Medical Information Solutions 71

    2.1.6 Coding Solutions 71

    2.1.7 Physician Computer Assisted Coding Services 74

    2.2 Physician Office and Ambulatory Clinical Organizations Natural Language

    Computer Assisted Coding Market Shares 75

    2.2.1 3M 83

    2.2.2 3M 85

    2.2.3 3M Merging Quality With Reimbursement 88

    2.2.4 Optum 89

    2.2.5 Optum Automated Code Identification 90

    2.2.6 Optum 93

    2.2.7 nThrive / Precyse 94

    2.2.8 Dolbey 94

    2.2.9 McKesson 96

    2.2.10 Cerner 98

     

    2.2.11 TruCode 98

    2.3 Natural Language Computer Assisted Coding of Medical Procedures

    Forecasts 98

    2.3.1 CAC Market Software and Services Segmentation 102

    2.3.2 CAC Hospitals and Facilities and Physicians Market Segment 104

    2.3.3 Computer Assisted Coding Physician Market 106

    2.3.4 Worldwide Computer Assisted Coding, Hospitals and Facilities and

    Physicians 108

    2.3.5 CAC Software Market Hospital and Physician Segments 110

    2.3.6 CAC Services Market Segment 111

    2.3.7 US Computer Assisted Coding Physician Software License /

    Maintenance and Cloud SaaS Services 112

    2.3.8 Physicians Computer Assisted Coding 115

    2.3.9 US Computer Assisted Coding Software Units 118

    2.3.10 US Computer Assisted Coding Software / Cloud Services for

    Independent Radiology Clinics Market Forecasts 120

    2.3.1 US Independent Radiology Imaging Centers 121

    2.3.2 Erroneous Selection of Principal Diagnoses Impacting Reimbursement

     122

    2.3.3 Growth of the U.S. Healthcare Industry 126

    2.4 Worldwide, Number of Patients and Procedures 128

    2.5 Making The Shift To The Modern ICD-10 Requirements 132

    2.6 Computer Assisted Coding Prices 133

    2.7 Computer Assisted Coding Regional Analysis 134

    2.7.1 3M 360 Encompass System 137

    3. Computer Assisted Coding Product Description 138

     

    3.1 3M 138

    3.1.1 3M 360 Encompass System 139

    3.1.2 3M  3M CodeAssist System 141

    3.1.3 3M APR DRG Solutions Aspects 147

    3.1.4 3M Merging Quality With Reimbursement 148

    3.1.5 3M™ APR DRG Software 150

    3.1.6 3 M Classification System For Patients 150

    3.1.7 3M APR DRG Software Features: 153

    3.1.8 3M Coding Technology 155

    3.1.9 3M Computer-Assisted Coding Solutions 156

    3.1.10 3M Medical Coding Tools Streamline Processes 156

    3.1.11 CodeAssist Automating the Medical Coding Process 157

    3.1.12 3M CodeComplete Outsource Solution for Medical Coding 158

    3.1.13 3M DataScout Clinical Data Extraction and Identification 158

    3.1.14 3M and American Academy of Professional Coders (AAPC) 160

    3.1.15 3M Data Mining Technology 161

    3.1.16 3M Systems for Overcoming Documentation Shortfalls 162

    3.1.17 3M Solutions for a Changing Healthcare Landscape 166

    3.1.18 3M Web-Based Coding Software Return on Investment 179

    3.1.19 3M Coding Software Functions 181

    3.1.20 3M Computer-Assisted Coding Solutions Targeted to Specialty Areas

     183

    3.1.21 3M CodeAssist Functions 184

    3.1.22 3M CodeComplete Business Process Management 185

    3.2 Dolbey 187

    3.2.1 Dolbey Coding Productivity Management 189

     

     

    3.2.2 Dolby Fusion Suite Modules 191

    3.3 Optum Coding Service 195

    3.3.1 Optum Coding 196

    3.3.2 Optum CPT® Codes 197

    3.3.3 Optum Medicare Fee Schedule 197

    3.4 McKesson 199

    3.4.1 Mckesson Watching the Cash 200

    3.4.2 McKesson Securing the Subsidy 201

    3.4.3 McKesson Quality Control And Process Improvement 203

    3.5 Cerner Computer Assisted Coding 204

    3.6 Platocode® Computer-Assisted Coding 207

    3.6.1 Platocode ICD 10 210

    3.6.2 Platocode® Solution For Ambulatory Surgery 210

    3.6.3 Platocode® API 211

    3.6.4 Communication Between 3rd-Party Applications And A Platocode

    Server 211

    3.7 Nuance Computer Assisted Coding 211

    3.7.1 Nuance Clinical Documentation Review 212

    3.7.2 Nuance Clinical Documentation Compliance 213

    3.7.3 Nuance Clintegrity Computer Assited Coding (CAC) 213

    3.7.4 Nuance Clintegrity Computer Assisted Coding (CAC) Key Features 216

    3.7.5 Nuance Clintegrity Facility Coding Solutions for Healthcare 216

    3.7.6 Nuance Clintegrity Facility Coding 218

    3.7.7 Nuance Clintegrity Computer Assisted Coding (CAC) Features 219

    3.7.8 Nuance Clintegrity Physician Coding 220

    3.7.9 Nuance Clinician Reimbursement Calculation 222

    3.7.10 Nuance Clintegrity Compliance & ICD-10 Transition 223

    3.7.11 Nuance Clintegrity Facility Coding 224

    3.7.12 Nuance Clintegrity Abstracting 224

    3.7.13 Nuance Clintegrity ICD-10 Education Services 226

    3.7.14 Nuance Automated Coding 229

    3.7.15 Nuance Natural Language Processing 230

    3.7.16 Nuance Natural Language Understanding 230

    3.7.17 Nuance Mapping and Modeling Disparate Controlled Medical

    Vocabularies (CMVs); 231

    3.8 Artificial Medical Intelligence Emscribe CAC 231

    3.8.1 Artificial Medical Intelligence EMscribe Dynamic Search 233

    3.8.2 Artificial Medical Intelligence EMscribe Encoder 234

    3.8.3 AMI EMscribe® Dynamic Medical Term And Coding Search Tool 235

    3.8.4 Artificial Medical Intelligence Autonomous Coding 236

    3.8.5 Artificial Medical Intelligence (AMI) EMscribe Dx 237

    3.9 CodeCorrect 240

    3.9.1 CodeCorrect Capture Revenue and Maintain Compliance 240

    3.9.2 CodeCorrect knowledge 240

    3.9.3 CodeCorrect Medical Necessity Verification and APC Performance

    Tools 241

    3.9.4 QuadraMed 242

    3.10 M*Modal Coding 242

    3.10.1 M*Modal Workflow 244

    3.10.2 M*Modal Management Tools 244

    3.10.3 M*Modal Single Platform 244

     

    3.11 nThrive / MedAssets-Precyse and Equation 245

    3.11.1 Precyse Medical Coding and Computer Assisted Coding 245

    4. Computer Assisted Coding Research and Technology 248

    4.1 Computer-Assisted Coding Technology 248

    4.2 Hybrid Technology 252

    4.2.1 Computer Assisted Coding Engine 252

    4.3 Optum Computer Assisted Coding Technology 254

    4.4 Preventable Medical Conditions 255

    4.5 Natural Language Processing (NLP) Medical Coding 256

    4.5.1 Rules Based Approaches 256

    4.5.2 Reports Based On Statistics 256

    4.5.3 Normalize the Data 257

    4.6 Reports Must Be In Some Kind Of Electronic Format 257

    4.6.1 NLP Software Statistical Analysis 258

    4.6.2 Workflow 258

    4.6.3 Feedback for Machine Learning 258

    4.6.4 Coding 259

    4.6.5 Accuracy And Specificity Of Retrieval 260

    4.6.6 Natural Language Programming (NLP) Vocabulary Processor 260

    4.6.7 Robust Underlying Terminological Model And A Component

    Architecture 261

    4.7 TeSSI® (Terminology Supported Semantic Indexing) 262

    4.7.1 L&C’s LinkBase® Medical Ontology 262

    4.7.2 Semantic Indexing With The TeSSI® Indexing Engine 263

    4.7.3 Semantic Indexing Solution Automates The Indexing Process 264

    4.7.4 Information Extraction with TeSSI® Extraction Engine 267

    4.7.5 Semantic Search with TeSSI® Search Engine 268

    5. Computer Assisted Coding Company Profiles 269

    5.1 CAC Key Market Players 269

    5.2 3M 270

    5.2.1 3M Business 271

    5.2.2 3M Health Care Segment 274

    5.2.3 3M Electronics and Energy Business 275

    5.2.4 3M Health Information Systems 275

    5.3 Artificial Medical Intelligence 279

    5.4 Cerner 279

    5.4.1 Cerner Business 280

    5.4.2 Cerner Acquired Siemens Health Services 281

    5.4.3 Cerner 2016 Fourth Quarter and Full-Year Highlights: 281

    5.5 Craneware 281

    5.6 Dolbey 282

    5.7 EPIC 282

    5.8 Group One / CodeCorrect 283

    5.9 M*Modal 284

    5.10 nThrive 285

    5.10.1 nThrive / Precyse 285

    5.11 Nuance 286

    5.11.1 Nuance Healthcare 287

    5.11.2 Nuance Business Description 287

    5.11.3 Nuance Key Metrics 288

    5.11.4 Nuance Healthcare Trends 289

    5.12 Quest Diagnostics 290

    5.13 TruCode 291

    5.14 UnitedHealth Group / Optum 292

    5.14.1 UnitedHealth Group / Optum 293

    5.14.2 UnitedHealth Group Optum Health Information Technology Acquires

    Clinical Data Analytics Vendor Humedica 293

    5.14.3 Optum Acquires Physician Practice Management And Revenue

    Management Software Firm, MedSynergies and Support Arm of ProHealth Physicians

    Group 294

    5.14.4 Optum MedSynergies Synergies 297

    5.14.5 Optum Life Sciences 299

    5.14.6 United Healthcare Revenue 300

    5.15 Selected CAC Companies 302

    Publisher, 303

    Publisher Methodology 304

     

    Figure 1. Computer Assisted Coding of Medical Information Market Driving Forces 19

    Figure 2. Computer Assisted Coding of Medical Information Market Driving Factors 20

    Figure 3. CAC Workstation Coder Benefits 22

    Figure 4. CAC Management Tools 23

    Figure 5. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES 27

    Figure 6. ELECTRONIC CODING PRODUCT ISSUES 28

    Figure 7. Computer Assisted Coding Software and Services Market Shares, Dollars,  2016 30

    Figure 8. Computer Assisted Coding Market Forecast,  Dollars, Worldwide, 2017-2024 32

    Figure 9. Barriers to CAC 42

    Figure 10. Electronic Coding Integrated Database Issues 52

    Figure 11. Medical Necessity Online 53

    Figure 12. Physician Office Computer Assisted Coding Key Benefits: 54

    Figure 13. Natural Language Solutions System For Coding 56

    Figure 14. Computerized Workflow System Systems Features 58

    Figure 15. 3M Confidence Assessment Module System 60

    Figure 16. Physician Practices and Ambulatory Care Centers CAC Market Driving Forces: 63

    Figure 17. Computer Assisted Coding of Medical Information Market Driving Forces 64

    Figure 18. Computer Assisted Coding of Medical Information Market Driving Factors 65

    Figure 19. CAC Workstation Coder Benefits 67

    Figure 20. CAC Management Tools 68

    Figure 21. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES 72

    Figure 22. ELECTRONIC CODING PRODUCT ISSUES 73

    Figure 23. Large Physician Practice Computer Assisted Coding Software and Services Market

    Shares, Dollars,  2016 76

    Figure 24. Radiology and Ambulatory Clinic Computer Assisted Coding Software and Services

    Market Shares, Dollars, 2016 78

    Figure 25. Worldwide Computer Assisted Coding Facilities and Physicians Market Shares,

    Dollars, 2016 79

     

    Figure 26. Computer Assisted Coding Software and Services Market Shares, Dollars, 2016 81

    Figure 27. Worldwide Computer Assisted Coding License Shipments and Cloud Services

    Market Shares, Dollars, 2016 82

    Figure 28. 3M CAC Research Areas 84

    Figure 29. 3M Core of NLP Computer Assisted Coding 86

    Figure 30. Optum CAC Key Benefits: 90

    Figure 31. Optum LifeCode®, CAC Functions 91

    Figure 32. Optum LifeCode®, CAC Reconciliation Functions 92

    Figure 33. Optum CAC Reconciliation Module Functions: 93

    Figure 34. Platocode® Computer Assisted Coding Solution Benefits 96

    Figure 35. Computer Assisted Coding Market Forecast,  Dollars, Worldwide, 2017-2024 100

    Figure 36. Computer Assisted Coding CAC Market Forecasts, Dollars, 2017 to 2023 101

    Figure 37. CAC Market Segments Software and Services Key Topics 103

    Figure 38. Worldwide Computer Assisted Coding Hospitals and Facilities and Physicians

    Market Shares, Dollars, 2016 104

    Figure 39. Worldwide Computer Assisted Coding: Large Teaching Hospitals, Mid-Size and

    Small Hospitals, and Clinical Facilities, Market Shares, Units, 2016 105

    Figure 40. Worldwide Computer Assisted Coding, Hospitals and Facilities and Physicians,

    Market Shares, Units, 2016 108

    Figure 41. Worldwide Computer Assisted Coding, License Shipments, Services, and Cloud

    Services 109

    Figure 42. Worldwide and US Computer Assisted Coding Number of Large Physician Practices,

    CAC Installed Base, Market Forecasts, Number, 2017-2023 112

    Figure 43. Worldwide and US Computer Assisted Coding Software and Cloud Services CAC

    Market Forecasts, Dollars, 2017-2023 113

    Figure 44. Worldwide and US Computer Assisted Coding for Physicians CAC Market Forecasts,

    Dollars, 2017-2023 115

    Figure 45. US Computer Assisted Coding Physician Software License / Maintenance and Cloud

    SaaS Services, CAC Market Forecasts, Dollars, 2017-2023 116

    Figure 46. US Computer Assisted Coding Software License / Maintenance and Cloud SaaS

    Services CAC For Large Independent Physician Practices Market Forecasts, Dollars, 2017-2023 117

    Figure 47. US Computer Assisted Coding Software Units Retired CAC For Large Independent

    Physician Practices Market Forecasts, 2017-2023 118

    Figure 48. US Computer Assisted Coding Software Units Retired CAC For Large Independent

    Physician Practices Market Forecasts, 2017-2023 119

    Figure 49. US Computer Assisted Coding Software and Cloud SaaS Services CAC For

    Independent Radiology Clinics Market Forecasts, Dollars, 2017-2023 120

    Figure 50. US Computer Assisted Coding CAC Software License / Maintenance and Cloud SaaS

    Percent Penetration For Independent Radiology Clinics Market Forecasts, Dollars, 2017-2023 121

    Figure 51. US Outpatient Procedures Forecasts, Number of Procedures, 2016-2023 128

    Figure 52. US Computer Assisted Coding Outpatient Procedure Market Penetration Forecasts,

    % Penetration, 2017-2023 129

    Figure 53. 3M™ APR DRG Software Functions: 131

    2.5 Making The Shift To The Modern ICD-10 Requirements 132

    Figure 54. Computer Assisted Coding Regional Market Segments Dollars, Worldwide, 2016

     135

    Figure 55. Computer Assisted Coding Regional Market Segments Dollars, Worldwide, 2016

     136

    Figure 56. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations 137

    Figure 57. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations 139

    Figure 58. 3M  3M CodeAssist System Features 141

    Figure 59. 3M Codefinder Functions 143

    Figure 60. 3M Codefinder Features 144

    Figure 61. 3M Codefinder Intelligent Functions 146

    Figure 62. 3M APR DRG Solutions Aspects 147

    Figure 63. 3M Applications For Severity- And Risk-Adjusted Data 149

    Figure 64. 3M Classification System 152

    Figure 65. 3M APR DRG Software Features 153

    Figure 66. 3M Medical Coding Tools 157

    Figure 67. 3M DataScout Functions 159

    Figure 68. 3M Clinical Information Extraction Functions 160

    Figure 69. 3M Systems For Overcoming Documentation Shortfalls Focus 163

    Figure 70. 3M Systems Topics 164

    Figure 71. 3M Systems Metrics Included For Computerized Coding 165

    Figure 72. 3M Web-Based Coding Software Return On Investment Metrics 179

    Figure 73. 3M Web-Based Coding Software Key Benefits 180

    Figure 74. 3M Coding Software Functions 181

    Figure 75. 3M Coding Software Features 181

    Figure 76. 3M Internet-Based Computer-Assisted Medical Coding Target Markets 183

    Figure 77. 3M CodeAssist Functions 185

    Figure 78. 3M CodeComplete Functions 186

    Figure 79. Dolbey Fusion CAC Benefits 188

    Figure 80. Dolbey Computer-Assisted Coding Solution Features 190

    Figure 81. Dolby Computer Assisted Coding CAC Fusion Suite Modules 193

    Figure 82. Optum Computer-Assisted Coding (CAC) Intelligent CAC Functions: 195

    Figure 83. Optum Coding Service 196

    Figure 84. Optum Medicare Fee Schedule 198

    Figure 85. McKesson Practice Management Priorities 200

    Figure 86. Cerner Discern nCode Functions 205

    Figure 87. Cerner Discern nCode Key Features 206

    Figure 88. Platocode Process 208

    Figure 89. PlatoCode Code Set Filters 209

     

    Figure 90. Nuance Personnel Impacted by Transition to ICD-10 214

    Figure 91. ICD-10 Critical Business Concerns: 215

    Figure 92. Nuance Clintegrity Facility Coding Healthcare Solutions Platform Functions 217

    Figure 93. Nuance Clintegrity Facility Coding Healthcare Solution Functions 218

    Figure 94. Nuance Clintegrity Computer Assisted Coding (CAC) Professional Fee Coding

    Functions 221

    Figure 95. Nuance Clintegrity Clinician Coding Features 222

    Figure 96. Nuance Clintegrity Facility Coding Features 224

    Figure 97. Nuance Clintegrity Platform Modules 225

    Figure 98. Nuance Clintegrity Platform, Modules Customizable Data Collection Fields

    Features 226

    Figure 99. Nuance Advantages Of Automating Coding With Clintegrity 228

    Figure 100. Nuance Coding Algorithms 229

    Figure 101. Nuance Mapping And Modeling Disparate Controlled Medical Vocabulary

    Functions 231

    Figure 102. Artificial Medical Intelligence EMscribe CAC 232

    Figure 103. Artificial Medical Intelligence EMscribe Dynamic Search 233

    Figure 104. Artificial Medical Intelligence (Ami) Emscribe™ Dx Benefits 239

    Figure 105. Precyse Coding Services 246

    Figure 106. PrecyseCode™ CAC Coding Functions 247

     

    Figure 107. Computer Assisted Technology Functions 249

    Figure 108. How ICD-9 and ICD-10 Are Different 253

    Figure 109. ICD-9 and ICD-10 Different Formats 254

    Figure 110. Semantic Indexing for Medical Ontology 265

    Figure 111. Semantic Process Flow Index Component Medical Ontology 266

    Figure 112. Information Extraction With Tessi® Extraction Engine Functions 267

    Figure 113. 3M 360 Encompass 1,500 Hospitals And Healthcare User Organizations 278

    Figure 114. Current EPIC Computer Assisted Coding CAC Integrations 282

    Computer Assisted Coding Executive Summary 18

    Medical Best Practice Linking 21

    CAC for Coders 21

    Computer Assisted Coding Best Practice 24

    Coding Solutions 26

    Physician Computer Assisted Coding Services 28

    Natural Language Computer Assisted Coding Market Shares 29

    Natural Language Computer Assisted Coding of Medical Procedures Forecasts 31

    Medical Best Practice Linking 33

    1. Computer Assisted Coding Market Description and

    Market Dynamics 34

    1.1 Coding Challenge 34

    1.1.1 Computer Assisted Coding (CAC) 34

    1.1.2 Advances In Natural Language Processing And Informatics 36

    1.1.3 Using Electronic Health Record (EHR) Documentation To Generate

    Codes 37

    1.2 Computer-Assisted Coding 38

    1.2.1 Physician Practice Industry Forces Affecting Development of CAC 39

    1.2.2 Application of CAC Technology 41

    1.3 Development of a CAC Tool For Hospital Inpatient Use 42

    1.3.1 CAC Impact on the Coding Workflow 42

    1.3.2 Computers Replace Human Coders 42

    1.3.3 CAC Applied Without Human Intervention Depends On Critical

    Differences Between CAC Systems 43

    1.4 Healthcare Industry Largest In United States 44

    1.4.1 Building a Safer Health System 46

    1.4.2 Facilitating the Use of Technology in the Healthcare Industry 47

    1.4.3 Prescription Drug Modernization 48

    1.5 Medical Necessity and Medical Necessity Errors 49

    1.6 Physician Office Electronic Coding 50

    1.6.1 CAC Automates and Accelerates Auditing 54

    1.7 Natural Language Solutions 54

    1.7.1 State Of Language Technology Evaluation 55

     

    1.8 Computerized Workflow System 57

    1.8.1 Confidence Assessment Module 58

    1.8.2 Researching Electronic Coding Products: 60

    2. Computer Assisted Coding Market Shares and Forecasts

     61

    2.1.1 Medical Best Practice Linking 64

    2.1.2 CAC for Coders 64

    2.1.3 Computer Assisted Coding Best Practice 67

    2.1.4 Coding Solutions 69

    2.1.5 Physician Computer Assisted Coding Services 71

    2.2 Natural Language Computer Assisted Coding Market Shares 72

    2.2.1 3M 75

    2.2.2 3M 77

    2.2.3 3M Merging Quality With Reimbursement 80

    2.2.4 Optum 81

    2.2.5 Optum Automated Code Identification 82

    2.2.6 Optum 85

    2.2.7 nThrive / Precyse 86

    2.2.8 Dolbey 86

    2.2.9 McKesson 88

    2.2.10 Cerner 90

    2.2.11 TruCode 90

    2.3 Natural Language Computer Assisted Coding of Medical Procedures

    Forecasts 90

    2.3.1 CAC Market Software and Services Segmentation 94

    2.3.2 CAC Hospitals and Facilities and Physicians Market Segment 96

    2.3.3 Computer Assisted Coding Physician Market 98

     

    2.3.4 Worldwide Computer Assisted Coding, Hospitals and Facilities and

    Physicians 100

    2.3.5 CAC Software Market Hospital and Physician Segments 102

    2.3.6 CAC Services Market Segment 103

    2.3.7 US Computer Assisted Coding Physician Software License /

    Maintenance and Cloud SaaS Services 104

    2.3.8 Physicians Computer Assisted Coding 107

    2.3.9 US Computer Assisted Coding Software Units 110

    2.3.10 US Computer Assisted Coding Software / Cloud Services for

    Independent Radiology Clinics Market Forecasts 112

    2.3.1 US Independent Radiology Imaging Centers 113

    2.3.2 Erroneous Selection of Principal Diagnoses Impacting Reimbursement

     114

    2.3.3 Growth of the U.S. Healthcare Industry 118

    2.4 Worldwide, Number of Patients and Procedures 120

    2.5 Making The Shift To The Modern ICD-10 Requirements 124

    2.6 Computer Assisted Coding Prices 125

    2.7 Computer Assisted Coding Regional Analysis 126

    2.7.1 3M 360 Encompass System 129

    3. Computer Assisted Coding Product Description 130

    3.1 3M 130

    3.1.1 3M 360 Encompass System 131

    3.1.2 3M  3M CodeAssist System 133

    3.1.3 3M APR DRG Solutions Aspects 139

    3.1.4 3M Merging Quality With Reimbursement 140

    3.1.5 3M™ APR DRG Software 142

    3.1.6 3 M Classification System For Patients 142

    3.1.7 3M APR DRG Software Features: 145

    3.1.8 3M Coding Technology 147

    3.1.9 3M Computer-Assisted Coding Solutions 148

    3.1.10 3M Medical Coding Tools Streamline Processes 148

    3.1.11 CodeAssist Automating the Medical Coding Process 149

    3.1.12 3M CodeComplete Outsource Solution for Medical Coding 150

    3.1.13 3M DataScout Clinical Data Extraction and Identification 150

    3.1.14 3M and American Academy of Professional Coders (AAPC) 152

    3.1.15 3M Data Mining Technology 153

    3.1.16 3M Systems for Overcoming Documentation Shortfalls 154

    3.1.17 3M Solutions for a Changing Healthcare Landscape 158

    3.1.18 3M Web-Based Coding Software Return on Investment 171

    3.1.19 3M Coding Software Functions 173

    3.1.20 3M Computer-Assisted Coding Solutions Targeted to Specialty Areas

     175

    3.1.21 3M CodeAssist Functions 176

    3.1.22 3M CodeComplete Business Process Management 177

    3.2 Dolbey 179

    3.2.1 Dolbey Coding Productivity Management 181

    3.2.2 Dolby Fusion Suite Modules 183

    3.3 Optum Coding Service 187

    3.3.1 Optum Coding 188

    3.3.2 Optum CPT® Codes 189

    3.3.3 Optum Medicare Fee Schedule 189

    3.4 McKesson 191

    3.4.1 Mckesson Watching the Cash 192

    3.4.2 McKesson Securing the Subsidy 193

    3.4.3 McKesson Quality Control And Process Improvement 195

    3.5 Cerner Computer Assisted Coding 196

    3.6 Platocode® Computer-Assisted Coding 199

    3.6.1 Platocode ICD 10 202

    3.6.2 Platocode® Solution For Ambulatory Surgery 202

    3.6.3 Platocode® API 203

    3.6.4 Communication Between 3rd-Party Applications And A Platocode

    Server 203

    3.7 Nuance Computer Assisted Coding 203

    3.7.1 Nuance Clinical Documentation Review 204

    3.7.2 Nuance Clinical Documentation Compliance 205

    3.7.3 Nuance Clintegrity Computer Assited Coding (CAC) 205

    3.7.4 Nuance Clintegrity Computer Assisted Coding (CAC) Key Features 208

    3.7.5 Nuance Clintegrity Facility Coding Solutions for Healthcare 208

    3.7.6 Nuance Clintegrity Facility Coding 210

    3.7.7 Nuance Clintegrity Computer Assisted Coding (CAC) Features 211

    3.7.8 Nuance Clintegrity Physician Coding 212

    3.7.9 Nuance Clinician Reimbursement Calculation 214

    3.7.10 Nuance Clintegrity Compliance & ICD-10 Transition 215

    3.7.11 Nuance Clintegrity Facility Coding 216

    3.7.12 Nuance Clintegrity Abstracting 216

    3.7.13 Nuance Clintegrity ICD-10 Education Services 218

    3.7.14 Nuance Automated Coding 221

     

    3.7.15 Nuance Natural Language Processing 222

    3.7.16 Nuance Natural Language Understanding 222

    3.7.17 Nuance Mapping and Modeling Disparate Controlled Medical

    Vocabularies (CMVs); 223

    3.8 Artificial Medical Intelligence Emscribe CAC 223

    3.8.1 Artificial Medical Intelligence EMscribe Dynamic Search 225

    3.8.2 Artificial Medical Intelligence EMscribe Encoder 226

    3.8.3 AMI EMscribe® Dynamic Medical Term And Coding Search Tool 227

    3.8.4 Artificial Medical Intelligence Autonomous Coding 228

    3.8.5 Artificial Medical Intelligence (AMI) EMscribe Dx 229

    3.9 CodeCorrect 232

    3.9.1 CodeCorrect Capture Revenue and Maintain Compliance 232

    3.9.2 CodeCorrect knowledge 232

    3.9.3 CodeCorrect Medical Necessity Verification and APC Performance

    Tools 233

    3.9.4 QuadraMed 234

    3.10 M*Modal Coding 234

    3.10.1 M*Modal Workflow 236

    3.10.2 M*Modal Management Tools 236

    3.10.3 M*Modal Single Platform 236

    3.11 nThrive / MedAssets-Precyse and Equation 237

    3.11.1 Precyse Medical Coding and Computer Assisted Coding 237

    4. Computer Assisted Coding Research and Technology

     240

    4.1 Computer-Assisted Coding Technology 240

    4.2 Hybrid Technology 244

    4.2.1 Computer Assisted Coding Engine 244

    4.3 Optum Computer Assisted Coding Technology 246

    4.4 Preventable Medical Conditions 247

    4.5 Natural Language Processing (NLP) Medical Coding 248

    4.5.1 Rules Based Approaches 248

    4.5.2 Reports Based On Statistics 248

    4.5.3 Normalize the Data 249

    4.6 Reports Must Be In Some Kind Of Electronic Format 249

    4.6.1 NLP Software Statistical Analysis 250

    4.6.2 Workflow 250

    4.6.3 Feedback for Machine Learning 250

    4.6.4 Coding 251

    4.6.5 Accuracy And Specificity Of Retrieval 252

    4.6.6 Natural Language Programming (NLP) Vocabulary Processor 252

    4.6.7 Robust Underlying Terminological Model And A Component

    Architecture 253

    4.7 TeSSI® (Terminology Supported Semantic Indexing) 254

    4.7.1 L&C’s LinkBase® Medical Ontology 254

    4.7.2 Semantic Indexing With The TeSSI® Indexing Engine 255

    4.7.3 Semantic Indexing Solution Automates The Indexing Process 256

    4.7.4 Information Extraction with TeSSI® Extraction Engine 259

    4.7.5 Semantic Search with TeSSI® Search Engine 260

    5. Computer Assisted Coding Company Profiles 261

    5.1 CAC Key Market Players 261

    5.2 3M 262

    5.2.1 3M Business 263

     

    5.2.2 3M Health Care Segment 266

    5.2.3 3M Electronics and Energy Business 267

    5.2.4 3M Health Information Systems 267

    5.3 Artificial Medical Intelligence 271

    5.4 Cerner 271

    5.4.1 Cerner Business 272

    5.4.2 Cerner Acquired Siemens Health Services 273

    5.4.3 Cerner 2016 Fourth Quarter and Full-Year Highlights: 273

    5.5 Craneware 273

    5.6 Dolbey 274

    5.7 EPIC 274

    5.8 Group One / CodeCorrect 275

    5.9 M*Modal 276

    5.10 nThrive 277

    5.10.1 nThrive / Precyse 277

    5.11 Nuance 278

    5.11.1 Nuance Healthcare 279

    5.11.2 Nuance Business Description 279

    5.11.3 Nuance Key Metrics 280

    5.11.4 Nuance Healthcare Trends 281

    5.12 Quest Diagnostics 282

    5.13 TruCode 283

    5.14 UnitedHealth Group / Optum 284

    5.14.1 UnitedHealth Group / Optum 285

    5.14.2 UnitedHealth Group Optum Health Information

    Technology Acquires Clinical Data Analytics Vendor Humedica 285

     

    5.14.3 Optum Acquires Physician Practice Management And

    Revenue Management Software Firm, MedSynergies and Support

     Arm of ProHealth Physicians Group 286

    5.14.4 Optum MedSynergies Synergies 289

    5.14.5 Optum Life Sciences 291

    5.14.6 United Healthcare Revenue 292

    5.15 Selected CAC Companies 294

    Publisher, 295

    Publisher Methodology 296

     

    List of Figures

     

    Figure 1. Computer Assisted Coding of Medical Information

    Market Driving Forces 19

    Figure 2. Computer Assisted Coding of Medical Information

    Market Driving Factors 20

    Figure 3. CAC Workstation Coder Benefits 22

    Figure 4. CAC Management Tools 23

    Figure 5. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES 27

    Figure 6. ELECTRONIC CODING PRODUCT ISSUES 28

    Figure 7. Computer Assisted Coding Software and Services Market Shares,

    Dollars,  2016 30

    Figure 8. Computer Assisted Coding Market Forecast,  Dollars,

    Worldwide, 2017-2024 32

    Figure 9. Barriers to CAC 41

     

     

    Figure 10. Electronic Coding Integrated Database Issues 51

    Figure 11. Medical Necessity Online 52

    Figure 12. Physician Office Computer Assisted Coding Key Benefits: 53

    Figure 13. Natural Language Solutions System For Coding 55

    Figure 14. Computerized Workflow System Systems Features 57

    Figure 15. 3M Confidence Assessment Module System 59

    Figure 16. Computer Assisted Coding of Medical Information

    Market Driving Forces 62

    Figure 17. Computer Assisted Coding of Medical Information

    Market Driving Factors 63

    Figure 18. CAC Workstation Coder Benefits 65

    Figure 19. CAC Management Tools 66

    Figure 20. ELECTRONIC CODING SOLUTION MARKET DRIVING FORCES 70

    Figure 21. ELECTRONIC CODING PRODUCT ISSUES 71

    Figure 22. Computer Assisted Coding Software and Services

    Market Shares, Dollars, 2016 73

    Figure 23. Worldwide Computer Assisted Coding License

    Shipments and Cloud Services Market Shares, Dollars, 2016 74

    Figure 24. 3M CAC Research Areas 76

    Figure 25. 3M Core of NLP Computer Assisted Coding 78

    Figure 26. Optum CAC Key Benefits: 82

    Figure 27. Optum LifeCode®, CAC Functions 83

    Figure 28. Optum LifeCode®, CAC Reconciliation Functions 84

    Figure 29. Optum CAC Reconciliation Module Functions: 85

    Figure 30. Platocode® Computer Assisted Coding Solution Benefits 88

    Figure 31. Computer Assisted Coding Market Forecast, 

    Dollars, Worldwide, 2017-2024 92

    Figure 32. Computer Assisted Coding CAC Market Forecasts, Dollars, 2017 to 2023

     93

    Figure 33. CAC Market Segments Software and Services Key Topics 95

    Figure 34. Worldwide Computer Assisted Coding Hospitals and Facilities and

    Physicians Market Shares, Dollars, 2016 96

    Figure 35. Worldwide Computer Assisted Coding: Large Teaching Hospitals, Mid-

    Size and Small Hospitals, and Clinical Facilities, Market Shares, Units, 2016 97

    Figure 36. Worldwide Computer Assisted Coding, Hospitals and

    Facilities and Physicians, Market Shares, Units, 2016 100

    Figure 37. Worldwide Computer Assisted Coding, License

    Shipments, Services, and Cloud Services 101

    Figure 38. Worldwide and US Computer Assisted Coding Number of Large

    Physician Practices, CAC Installed Base, Market Forecasts, Number,

    2017-2023 104

    Figure 39. Worldwide and US Computer Assisted Coding Software and Cloud

    Services CAC Market Forecasts, Dollars, 2017-2023 105

    Figure 40. Worldwide and US Computer Assisted Coding for Physicians CAC

    Market Forecasts, Dollars, 2017-2023 107

    Figure 41. US Computer Assisted Coding Physician Software License /

    Maintenance and Cloud SaaS Services, CAC Market Forecasts, Dollars, 2017-2023

     108

    Figure 42. US Computer Assisted Coding Software License / Maintenance and

    Cloud SaaS Services CAC For Large Independent Physician Practices Market

    Forecasts, Dollars, 2017-2023 109

    Figure 43. US Computer Assisted Coding Software Units Retired CAC For

     Large Independent Physician Practices Market Forecasts, 2017-2023 110

    Figure 44. US Computer Assisted Coding Software Units Retired CAC For Large

    Independent Physician Practices Market Forecasts, 2017-2023 111

    Figure 45. US Computer Assisted Coding Software and Cloud SaaS

     Services CAC For Independent Radiology Clinics Market Forecasts, Dollars, 2017-

    2023 112

    Figure 46. US Computer Assisted Coding CAC Software License /

    Maintenance and Cloud SaaS Percent Penetration For Independent

    Radiology Clinics Market Forecasts, Dollars, 2017-2023 113

    Figure 47. US Outpatient Procedures Forecasts, Number of

    Procedures, 2016-2023 120

    Figure 48. US Computer Assisted Coding Outpatient Procedure Market

    Penetration Forecasts, % Penetration, 2017-2023 121

    Figure 49. 3M™ APR DRG Software Functions: 123

    2.5 Making The Shift To The Modern ICD-10 Requirements 124

    Figure 50. Computer Assisted Coding Regional Market Segments Dollars,

    Worldwide, 2016 127

    Figure 51. Computer Assisted Coding Regional Market Segments Dollars,

    Worldwide, 2016 128

    Figure 52. 3M 360 Encompass 1,500 Hospitals And Healthcare

    User Organizations 129

    Figure 53. 3M 360 Encompass 1,500 Hospitals And Healthcare

    User Organizations 131

    Figure 54. 3M  3M CodeAssist System Features 133

    Figure 55. 3M Codefinder Functions 135

    Figure 56. 3M Codefinder Features 136

    Figure 57. 3M Codefinder Intelligent Functions 138

    Figure 58. 3M APR DRG Solutions Aspects 139

    Figure 59. 3M Applications For Severity- And Risk-Adjusted Data 141

    Figure 60. 3M Classification System 144

    Figure 61. 3M APR DRG Software Features 145

    Figure 62. 3M Medical Coding Tools 149

    Figure 63. 3M DataScout Functions 151

    Figure 64. 3M Clinical Information Extraction Functions 152

     

    Figure 65. 3M Systems For Overcoming Documentation Shortfalls Focus 155

    Figure 66. 3M Systems Topics 156

    Figure 67. 3M Systems Metrics Included For Computerized Coding 157

    Figure 68. 3M Web-Based Coding Software Return On Investment Metrics 171

    Figure 69. 3M Web-Based Coding Software Key Benefits 172

    Figure 70. 3M Coding Software Functions 173

    Figure 71. 3M Coding Software Features 173

    Figure 72. 3M Internet-Based Computer-Assisted Medical Coding Target Markets

     175

    Figure 73. 3M CodeAssist Functions 177

    Figure 74. 3M CodeComplete Functions 178

    Figure 75. Dolbey Fusion CAC Benefits 180

    Figure 76. Dolbey Computer-Assisted Coding Solution Features 182

    Figure 77. Dolby Computer Assisted Coding CAC Fusion Suite Modules 185

    Figure 78. Optum Computer-Assisted Coding (CAC) Intelligent CAC

    Functions: 187

    Figure 79. Optum Coding Service 188

    Figure 80. Optum Medicare Fee Schedule 190

    Figure 81. McKesson Practice Management Priorities 192

    Figure 82. Cerner Discern nCode Functions 197

    Figure 83. Cerner Discern nCode Key Features 198

    Figure 84. Platocode Process 200

    Figure 85. PlatoCode Code Set Filters 201

    Figure 86. Nuance Personnel Impacted by Transition to ICD-10 206

    Figure 87. ICD-10 Critical Business Concerns: 207

    Figure 88. Nuance Clintegrity Facility Coding Healthcare Solutions Platform

    Functions 209

    Figure 89. Nuance Clintegrity Facility Coding Healthcare Solution Functions 210

     

     

    Figure 90. Nuance Clintegrity Computer Assisted Coding (CAC) Professional Fee

    Coding Functions 213

    Figure 91. Nuance Clintegrity Clinician Coding Features 214

    Figure 92. Nuance Clintegrity Facility Coding Features 216

    Figure 93. Nuance Clintegrity Platform Modules 217

    Figure 94. Nuance Clintegrity Platform, Modules Customizable Data Collection

    Fields Features 218

    Figure 95. Nuance Advantages Of Automating Coding With Clintegrity 220

    Figure 96. Nuance Coding Algorithms 221

    Figure 97. Nuance Mapping And Modeling Disparate Controlled Medical

    Vocabulary Functions 223

    Figure 98. Artificial Medical Intelligence EMscribe CAC 224

    Figure 99. Artificial Medical Intelligence EMscribe Dynamic Search 225

    Figure 100. Artificial Medical Intelligence (Ami) Emscribe™ Dx Benefits 231

    Figure 101. Precyse Coding Services 238

    Figure 102. PrecyseCode™ CAC Coding Functions 239

    Figure 103. Computer Assisted Technology Functions 241

    Figure 104. How ICD-9 and ICD-10 Are Different 245

    Figure 105. ICD-9 and ICD-10 Different Formats 246

    Figure 106. Semantic Indexing for Medical Ontology 257

    Figure 107. Semantic Process Flow Index Component Medical Ontology 258

    Figure 108. Information Extraction With Tessi® Extraction Engine Functions 259

    Figure 109. 3M 360 Encompass 1,500 Hospitals And Healthcare User

    Organizations 270

    Figure 110. Current EPIC Computer Assisted Coding CAC Integrations 274

     

     

    3M

    Dolbey

    Optum

    Artificial Medical Intelligence

    Cerner

    Craneware

    EPIC

    Group One / CodeCorrect

    M*Modal

    nThrive / Precyse

    Nuance

    Quest Diagnostics

    TruCode

    UnitedHealth Group / Optum

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