CACs vs Human Auditors & Coders

2018 is the year of the ICD-10 audit! Two years after ICD-10 was implemented, coding and documentation regulations have finally stabilized, after some providers experienced tumultuous transition periods. Now is the perfect time for providers to run ICD-10 audits to identify any current errors and opportunities to improve their coding practices for the future.

Providers looking to improve their coding practices may turn to automation systems after an audit delivers unfavorable insights into their coding practices. While automation systems such as CACs may appear cost-effective and accurate for coding and auditing, it is crucial that providers also realize the value of skilled human coders and auditors as a supplement to these systems. ECLAT Health Solutions offers ICD-10 coding and auditing services, provided by a staff of medical coding and billing experts. Below, we explore why providers who use automation systems must not forget the importance of human coders and auditors:


1. Coders & auditors may catch coding mistakes a computer may miss

Although automation software can certainly streamline parts of the revenue cycle, it cannot completely replace the human touch. Coders and auditors may be able to detect nuances and errors that a CAC may not pick up. CACs are designed to analyze the context around the keywords listed on documentation, which can prevent false codes from being assigned for symptoms that do not require codes, saving the provider from a coding mistake and potential claim denial. However, on the other hand, this also means a false code may be assigned when it is not required, which may also lead to a claim denial and lost revenue.

A coder or auditor will better be able to notice clinical indicators that define the severity of the illness and intensity of required service, along with the specificity of the type and acuity of the condition. This closer eye for detail is essential for minimizing coding errors as much as possible.

To ensure the utmost accuracy, providers must not strive to fully automate the coding process, but to instead supplement automation software with the assistance of a medical coding provider. ECLAT Health Solutions has a team of expert coders and auditors who are dedicated to providing our clients with accurate coding to prevent claim denials. We are skilled in CPT and ICD-10-CM coding and have a comprehensive 3-Tier Quality Assurance Process to ensure accuracy. We also offer thorough auditing services to identify our providers’ coding errors and identify opportunities for improvement. We offer support for all chart types, specific chart types, specific coders, high alert cases (RAC, OIG, etc.), or other focused areas (MS-DRG, ROM, SOI, APR DRG, APC, POA, etc.).


2. Coders & auditors may identify errors in clinical documentation

Because CACs analyze medical documentation to assign codes, they only review and understand the data provided on each piece of documentation. If a document was filled out incorrectly or inefficiently, the code that CAC assigns may not be the most accurate code for the diagnosis or treatment provided, and CAC may not be able to detect the flaw in the documentation. Similarly, to return to our example, if a document states that a patient exhibited symptoms of heart failure but did not in fact suffer heart failure, a CAC may code it incorrectly.

A coder, however, may better understand the context surrounding the patient experience and the data reported on the documentation, which will affect the code that will need to be assigned.  A coder will understand that the symptoms did not result in heart failure and should not be coded as such. Repeated errors or inefficiencies are best spotted with human eyes of a skilled credentialed coder. A seasoned coder or auditor will be better equipped to identify misinterpreted patterns and propose suggestions for how to improve to the proper staff.  They will also be more aware of any query or clarification opportunities that would lead to optimal quality statistics and accurate reimbursement. A CAC is not as capable of detecting these nuances and patterns.

The best way for providers to identify errors in their coding and documentation processes is to partner with a medical coding company like ECLAT. Our coding and auditing staff thoroughly reviews our clients’ coding processes to not only detect errors but make suggestions for improvement. Our clinical documentation improvement services are also designed to address issues in a provider’s documentation processes to help reduce coding mistakes and claim denials.


Facilities who are struggling to earn their full revenue or have coding errors should perform an audit through a medical coding provider. ECLAT Health Solutions’ auditing staff holds a wide variety of specialties, including inpatient medical records, outpatient same-day surgery, emergency department medical records, and clinical documentation improvement opportunities. We can perform audits for providers large and small and detect errors that CACs may not be able to. Our audit platform includes “audit to educate” and we pride ourselves in providing deliverables that include graphics, executive summary, audit details and education. Although complete automation may seem appealing to providers looking for cost-effective, productive solutions, we believe there is no complete replacement for human coding and billing staff. Our auditing and coding staff are here to ensure accuracy, efficiency, and a true ROI.

Why Choosing a Billing Company That Practices Billing Transparency is Crucial

One of the biggest issues plaguing healthcare providers is implementing the best billing practices and receiving full, on-time payment from patients. The need to improve billing practices is more important than ever, with roughly 30% of healthcare revenue being paid by patients.

Because the stakes are high, many healthcare providers turn to billing companies to handle and improve their billing and collections practices. The billing staff at ECLAT Health Solutions are dedicated to helping our clients improve their billing and collections practices to foster a healthier revenue cycle in the utmost professional manner. While many billing companies frequently call and hound customers for payment, ECLAT understands that these conversations require professionalism, discretion, and compassion. We never harass customers and strive to make paying as easy as possible for them. Furthermore, we strive to meet our clients’ financial goals and billing needs and recommend actions that will help them improve areas other than patient payment.

Allow us to provide some insight into why a transparent, cooperative relationship between a billing company and a provider is so crucial:


1. More On-Time, Complete Payments

With the increase of financial accountability and burden for patients, having a cooperative, transparent relationship between the billing company and healthcare provider will help boost on-time payments. Of course, patients not paying their bill on time means less revenue for a provider, but an added strain is the time and money it can take for a provider to pursue a collections battle. Therefore, when a patient does not pay on time, it is usually not viable for a facility to take legal action, and they may never see that revenue.

A billing company like ECLAT will assess the current billing and collections practices and determine where the provider can improve to ensure on-time payments to prevent these errors. For example, if a provider does not currently have staff explain a patient’s charges directly with them, this patient may feel overwhelmed by the charge or uncertain of how to pay, and therefore may pay late, if at all. A billing company can provide this crucial conversation (or train the provider’s administrative staff to do so) and help encourage patients to pay on time—and pay in full, too.

ECLAT Health Solutions is your trusted partner for ensuring your billing and collections practices translate to more on time payments. We offer EFT/ERA enrollment to our clients, and our billing staff post and reconcile ERA/EOB/Denials to the PMS every day. For collections, we offer weekly, bi-weekly, or monthly follow up to remind your patients of their outstanding payments, and always practice compassion, discretion, and professionalism in these conversations. We work to earn our clients the revenue they need while keeping their patients satisfied and coming back for any necessary future treatments.

Read our post “3 Medical Billing Best Practices for Receiving More On-Time Payments” for payment collection tips.


2. Improved Billing Practices

Transparency between a billing company and provider is necessary for improving the provider’s end-to-end billing practices and revenue cycle, even beyond increasing the rate of on-time payments. Providers must have accessibility and accountability for their practice and partnering with a billing company can establish this. Having a secondary set of experts review their medical coding practices translates not only to increased revenue from patient payments but more efficient, accurate processes that lead to fewer costly mistakes.

ECLAT Health Solutions billing expert Dorothy Lodato, who has years of experience with medical billing, stated, “In many cases, a provider’s in-house staff receives payment regardless of how much money is collected from patients, while a billing company gets paid a percent of the money collected.” Therefore, it is mutually beneficial for billing companies to be transparent with their clients and offer effective suggestions for improvement; the provider receives the revenue they need from patients, and so does the billing staff.

We work on a personal level with our clients to determine what is currently missing from their billing and collections processes. Our clients’ billing goals become our billing goals, and we always hold open communication with our clients to determine opportunities for improvement.


When it comes to improving billing practices, it is crucial that providers choose the right billing company for the job. Providers must partner with a billing company that promotes cooperation and transparency to best foster a healthy revenue cycle and see an increase of payments. ECLAT Health Solutions’ medical billing experts specialize in helping our clients remedy their current billing issues and take advantage of opportunities for improvement. Our open collaboration with our partners allows us to get to know their practice and meet their billing goals.

Benefits of Offshore Medical Coding for Your Domestic Staff

More and more healthcare providers are utilizing offshore medical coding and are enjoying a variety of benefits. One of the biggest appeals of offshore medical coding for many providers is the bottom line – hiring overseas coders is more cost-effective than searching for employees at home. This is a huge asset for providers, but it certainly is not the only one. Financial incentives aside, outsourced medical coding also has several benefits for a facility’s domestic staff. Below, we explore some of the ways that offshore coding can benefit your domestic employees.


Freedom to Focus on the Administrative Side

Outsourcing your medical coding practices leaves your domestic employees with more time and resources that they can put toward bolstering and reworking other areas of your facility that need help, such as your administrative tasks. Refining the administrative side can help improve your facility’s billing and collections practices, patient experience, and claims submissions process, all of which will help increase efficiency and foster a healthier revenue cycle. Any staff who may have been doubling as coders or assisting with coding processes will now be free to focus on their main roles and responsibilities.


No Need to Re-Train Domestic Employees

Healthcare providers that feel their domestic employees’ lack of training has affected their efficiency or revenue may dread the effort, money, and resources that they will need to put into retraining them. Offshore coders are joining the workforce with the same qualifications, skills, and training as new coders in the United States at a reduced cost, making them capable of providing accurate medical coding and maintaining security. When providers look overseas for their coding solutions, they eliminate the need to spend valuable funds on training programs for their domestic staff. Offshore coders will need to receive some training to become familiarized with your facility’s best practices and procedures, but this is minimal and spares your facility the cost of a complete training overhaul that your domestic employees may need. No re-training for domestic employees also saves them time and stress, and allows them to focus on other, more important tasks and processes.


Fewer Errors and Less Stress

Using skilled offshore coders for your medical coding needs can help drastically reduce medical coding errors. In some facilities—often small or understaffed ones—busy staff may be prone to making coding errors, especially if these domestic staff are new to the workforce or have been struggling with the switch to ICD-10. Highly trained outsourced coders will likely make fewer errors, which means the rest of your staff will not need to scramble to fix mistakes such as claims denials. Often, the stress involved with fixing errors can actually lead to more mistakes being made, which compromises the health of your revenue cycle.

To earn the benefits of offshore medical coding, both for your finances and your staff, partner with an expert international medical coding company!


Offshore Medical Coding – The ECLAT Difference

ECLAT Health Solution’s team of outsourced medical coding experts are highly trained in ICD-10 coding procedures and are trained to maintain HIPAA and HITECH compliance. Not only is our coding secure and accurate, but our 3-Tiered Quality Assurance Process ensures we deliver superior work every step of the way. During this process, we closely analyze and review any cases that our coding team have questions on and prevent or fix errors. We go above and beyond to help your practice enjoy a healthy revenue cycle and increased revenue with our 24-hour turnaround and holiday and weekend coverage at no additional cost.

Contact ECLAT today to learn more about our offshore medical coding services.

Why HIPAA & HITECH Compliance Is Increasingly Crucial in Today’s World

Healthcare fraud and security breaches have been making headlines recently. It seems that almost everywhere we turn, we hear about a new threat to banking or health information security. After the Equifax breach compromised 143 million Americans’ credit and financial information earlier this year, individuals and organizations are shifting their best practices and regulations to prevent this from happening again.

In the healthcare sector, protecting patients’ personal and financial information should always be the highest priority of any healthcare provider, insurance agency, or healthcare support companies. With the number of these breaches steadily increasing, it has become even more necessary to closely follow HIPAA guidelines and prevent security risks at your facility.


Why Compliance Matters

Regulations and security measures change as new threats arise and as legislation is proposed or adjusted. Healthcare providers must make sure they always maintain compliance, even as these regulations constantly change and evolve. The procedures, practices, and policies enforced by HIPAA and HITECH ensure that confidential patient information and records stays secure, whether stored on paper or online.

HIPAA compliance was not common when the act was first introduced, as many organizations, especially small businesses, found it difficult to maintain compliance. The improvement of technology and the increase of security breaches has made compliance much more widespread, however. In fact, non-compliance is now incredibly detrimental to healthcare and healthcare support providers.

Organizations and facilities who do not comply with these regulations not only face increased risk of a security breach but can also be hit with hefty fines or even jail time for violators. Some of these fines may reach up to $1.5 million per violation per calendar year. In addition, any healthcare provider or organization that does not practice compliance will have a hard time earning and keeping patients or customers.


How ECLAT Maintains HIPAA & HITECH Compliance to Protect Sensitive Information

ECLAT Health Solutions, offering offshore medical coding and medical billing services to hospitals, ambulatory surgery centers, Independent Practice Associations, physician offices, and more, proudly complies with all HIPAA and HITECH regulations. To ensure we are always protecting our clients’ sensitive personal and financial information, we take a variety of measures:

  • Hold bi-annual meetings in which we review our privacy and security standards with all employees
  • Use firewalls, encryption, and restricted Internet access on all of our computers
  • Prohibit patient information from being removed from our offices
  • Disabled all external drives on our computers
  • Monitor and guard our coding facilities 24/7

We always exercise these practices among many others to ensure all of our clients’ confidential information remains secure in our facilities. In addition, we are also SOC 2 Type 2 compliant and have earned ISO Certification. To receive SOC 2 Type 2 certification, an organization have accurate and compliant policies and procedures in place that protect all sensitive information. ISO certification verifies that an organization meets all the necessary requirements for security and quality assurance.

As an organization, we strive to uphold our accreditations and adapt to the changing healthcare security landscape. ECLAT’s medical coding services are always secure, efficient, and accurate. We work as an extension of each our clients’ organizations, and we treat their security concerns just like our own. This is why we are vigilant regarding compliance with regulatory and best practice standards, keeping our clients’ and their patients’ sensitive information as secure as possible.

Contact us today to learn more about how we maintain the highest security and compliance in our offshore medical coding and billing services!

Highlights and Trends from AHIMA 2017

The feeling of absolute exhilaration was in the air lining up to receive pre-registration packets at the AHIMA 2017 Convention and Exhibit in “the city of angels”, Los Angeles.   For many of us, it had been a year since we had seen colleagues, reconnected with prior co-workers and reunited with friends in the health information profession.  Flipping through the agenda, the hard work of all the sponsors and contributors was evident; this would be a convention to remember!

Pre-conference meetings and events as well as post-conference meetings and events were available.  Saturday and Sunday were packed with the Clinical Coding Meetings.  Truly there was something of interest for everyone.  AHIMA celebrated another year of “go green” with limited printings, replaced with easy to follow download links to access all the conference handouts.

Clinical Coding Meetings

Highlights of the Clinical Coding Meetings include FY 2018 ICD-10 CM and ICD-10 PCS code and guideline modifications as well as inpatient prospective payment system (IPPS) changes that impact coding and documentation were presented by Sue Bowman, MA, RHIA, CCS, FAHIMA and Anita Rapier, RHIT, CCS.  New codes were discussed including the types of acute myocardial infarction and pulmonary hypertension.  Garry L. Huff, MD, CCS, CCDS held a separate session that further defined acute myocardial infarction and the types of myocardial infarctions, acute coronary ischemia and demand ischemia.    Bowman and Rapier continued with clarification regarding the word “with” or “in” to be interpreted to mean, “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List was discussed.  The exception was further clarified to be “unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).   Procedure Coding System (PCS) codes were revised and deleted to mostly simplify certain body part values or to correct clinical discrepancies and add new devices.    There were a few DRG shifts that coders need to be familiar with when grouping discharges from October 1, 2017 forward.

Audit was a hot topic during the sessions, highlighting the need for auditing, what and why to audit and what to do with the data being analyzed as a result of an audit.  Frequency and volume of auditing was also discussed.  Data analytics, revenue integrity adventures, coaching the team, goal setting and risks were all included in sessions.  There were physician tracks, HIT, coding and CDI tracks as well as international sessions, population health, workforce development, payment reform and information governance.

AHIMA General Session

General Session was certainly a highlight with Dr. Don Rucker, National Coordinator for Health Information Technology, Barbara Boxer, former U. S. Senator, and Newt Gingrich, Former Speaker of the U. S. House of Representatives.  AHIMA Triumph Awards, AHIMA Grace Award and the Presidential address set the tone for the 2017 Convention themed, Inspire, Innovate, Lead.

Exhibitors were armed with the latest in technology, practice and support.  This was one of the most enjoyable events with demonstrations, prizes and entertainment, not to mention all the wonderful giveaways to assist in recalling the name and number of the vendor when the need arises.  The AHIMA Foundation Silent Auction is always a fun event and this year was no exception.  The paper auction was replaced with an APP that provided on-the-spot notification when your bid was overtaken, allowing an up-bid to take place with the touch of a button.

AHIMA Gala to Remember

Time to dress for the red carpet came on Tuesday evening at the AHIMA Appreciation Celebration:  Lights! Camera! ACTION! Gala.   This was the event of all events as guests were met with a real-life feel of celebrity, cameras flashing upon entering.  Delicious food, drinks, entertainment, picture-taking with Pirates of the Caribbean, Alice-in-Wonderland, Dinosaurs, a candy bar, dancing to a live band and entertainment by the Star Wars Storm Troopers.   A great time was had by all!

Wrapping up the 2017 AHIMA Convention was the inspiring Viola Davis, followed by sessions for Coding, Consumer Engagement, HIM Practice Standards, Hot Topics, Information Governance, Innovation, Privacy and Security, Quality Measures  and Leadership.  On my way back home, I was filled with new ideas and renewed spirit of success.  I’m already planning my trip to Miami, Florida September 22 – 27, 2018 for the AHIMA 90th Convention & Exhibit, “Inspiring Leadership – Influencing Change”.

4 Tips for Reducing Claim Denials

Claim denials are a nuisance for hospitals and other healthcare facilities, and can end up costing millions of dollars in revenue every year. There are, unfortunately, many reasons that a claim may be denied, with anything from a patient simply not having the proper coverage to a coder using the wrong ICD-10 code, and everything in between. Fixing and resubmitting a claim can cost more money and give your staff additional paperwork to work through—in other words, no good comes from a high number of claim denials.

Although it is not likely that you will completely eliminate all claim denials, most claim denials are preventable. It’s crucial that you take the measures you can to reduce claim denials and save valuable revenue. Below are some of our tips for reducing the number of claim denials at your facility.


  1. Improve Employee Training

Undertrained staff can create a myriad of problems for your hospital or facility, and claim denials is one of the most common of these. If your medical coders are not properly trained in ICD-10 procedures or your billing staff continues to make clerical errors, it may be time to take another look at your training procedures. Tweak and refine your process, and retrain current staff if necessary. Make sure your employees are being properly managed, too, with clear policies and best practices in place.


  1. Look for Patterns

Make sure your employees are closely monitoring every step of the claims process, so they can identify any issues that happen over and over again. Investigate why a claim gets denied immediately at the time of denial; it is much more difficult to look back at the claim later and find out what went wrong. When your staff keeps an eye on the claims process and immediately follows up with denied claims to determine the cause, they will be able to spot common patterns and learn how to put an end to them much faster.


  1. Check Patient Coverage Before Treatment

It seems too obvious to say that checking to make sure your patients’ insurance covers the necessary treatment prior to giving this treatment can reduce your facility’s number of claim denials, and yet a whopping number of healthcare providers fail to check patients’ insurance before providing service, or at all! Ensure your administrative employees are checking each new patient’s insurance to find what they are or are not covered for. Routinely doing this will help prevent any surprises after submitting the claim.


  1. Improve Medical Coding Practices

Entering a similar yet incorrect code for a given treatment, or having incomplete documentation that leads to an unspecified code can cause a claim to be denied. Some coders are still catching up to the 2015 transition to ICD-10, and are still making mistakes. Unfortunately, there is no room for mistakes on a claim, and a coding error will most likely lead to the claim getting denied. Your coding processes should be air-tight to ensure your claims will be accepted. An excellent way to improve your medical coding accuracy is to partner with an expert healthcare support provider.


The ECLAT Advantage

ECLAT Health Solutions provides outsourced medical coding services nationwide. We provide 24-hour turnaround and can guarantee a score of 95% or higher coding accuracy, making us the key to helping your facility reduce its claim denials. Our satisfied customers—which include hospitals large and small, physician offices, ambulatory surgery centers, and much more—call our ability to go above-and-beyond with our service The ECLAT Advantage.

Contact us today by filling out this form or calling (703) 665-4499 to learn more about our medical coding services.

The Truth About Domestic vs. International Medical Coding

There’s a lot of debate in the world of healthcare about international coding. “Does international coding really save that much money? How safe is it? Aren’t there enough coders here in the United States?”—these are all common questions that healthcare providers ask when addressing their medical coding needs.

There is a lot of misleading information and false rumors floating around that make some providers shudder at the thought of using coders abroad. However, the truth is that international coding is a great model that offers US healthcare providers a multitude of benefits.


Often, the biggest reason many healthcare facilities hesitate to use international medical coding is security. They may fear that looking overseas for coding services means compromising security, and that this alleged increased security risk will outweigh the benefits of a more affordable option. They are, of course, right to be cautious when it comes to their security, but what many of them don’t realize is that international coding does not actually compromise security. International coding providers are well-aware that a security breach would mean a loss of business for their clients, not to mention would compromise patients’ confidential medical records. Because of this, coding providers take extra measures to ensure their clients’—and their patients’—security.

These companies build secure facilities in which the international coders will work. Even though the work is being conducted overseas, an expert medical coding provider will maintain the tightest security measures and ensure that all sensitive information and practices are kept private. As an added measure, most international coding companies will promote transparency and report to their clients about their processes.

An Abundance of Work

The adaptation to ICD-10 procedures in recent years has contributed to draining the pool of qualified coders here in the United States. Healthcare facilities have struggled to spend time and money retraining their coding staff, and many coders who were certified in the former coding practices did not want to learn a brand new set of procedures and left the field. This has created a gap of time in which the newest set of medical coders have yet to be trained and enter the coding workforce, leaving a shortage of US-based coders.

However, there is an abundance of well-trained and qualified overseas medical coders who can meet the demand. International coding companies require their coders to earn the necessary certifications, such as from AAPC and AHIMA, making them just as qualified for medical coding as domestic coders. This abundance of workers overseas also helps keep cost down for healthcare providers without sacrificing quality and accuracy.

Reduced Cost

Outsourcing coding services might seem like a costly endeavor to some healthcare providers, but using international coders is a very financially-appealing option. It’s far more affordable to use an experienced coder from another country than to find, hire, train, and pay a US-based coder who is new to the industry. As mentioned, the abundant pool of candidates in other nations helps to keep costs down, where the smaller availability of coders in the US with a rising demand can end up costing you more than you bargained for.

Partner with the Right International Coding Company

Of course, the key to reaping in these benefits of international coding is to select an expert outsourced coding company. ECLAT Health Solutions offers the most secure, efficient, and accurate international medical coding services. All of our coding experts are well-trained in ICD-10 procedures in addition to maintaining HIPAA compliance. We love working closely with our clients as an extension of their company to help them reach and exceed their operational goals by customizing our services to fit your facility needs. This unique approach is what our satisfied customers call ‘The ECLAT Advantage’.

To learn more about how we can serve you, call us today at (703) 665-4499, or fill out our contact form!

A Fresh Look at Obstetric Coding