Introduction
The healthcare industry is essential to modern civilization. The healthcare sector produces and distributes medical supplies and services. Since it is the only market segment susceptible to swings, its growth rate is rather constant from year to year. Because of the growing population, this industry is shifting from being desirable to essential. A computer-assisted coding system (or CAC) is a piece of software used to assign a unique keyword to each occurrence of a predetermined phrase or term inside medical data. The administrative person's output may be increased and processing time decreased with the help of the keywords provided by (CACS).
To improve healthcare facilities' productivity and accuracy, computer-assisted coding software is becoming widely used. Some of the goods and services supplied by computer-assisted coding include software, structured input software, standalone software, services, integrated software, support and maintenance, education and training, and software. It is used in clinical coding audits, management reporting and analytics, and automated computer-assisted coding.
In 2019, the worldwide market for computer-assisted coding was estimated at USD 3.45 Billion. By 2029, that figure is projected to rise to USD 10.18 Billion, for a compound annual growth rate (CAGR) of 12.1%. Among the most important drivers fueling the market's rapid expansion are the rising use of EHRs, efforts to save costs in the healthcare sector, and the need to streamline all healthcare-related operations.
The significance of computer assisted coding
The use of computer-assisted coding as a supplement to manual encoding has been widely accepted. With less time spent on repetitive tasks, programmers are more efficient and productive, and expenses are lower thanks to increased efficiency. Because of the CACs, medical records can be easily organized, and maintained uniformity of data is maintained throughout the business. Medical case files may be distinguished from one another with the aid of the clinical notes included with each record. The coding of medical information extracted from clinical records follows World Health Organization (WHO) guidelines as outlined in the ICD-10. Abnormal findings, complaints, illnesses, damage causes, symptoms, and social conditions are all codified in ICD-10. Managing insurance claim reimbursement rules and minimizing audit inconsistencies are examples of how CACs save time and money.
Market Dynamics
Drivers
Growing Interest in CAC Solutions to Reduce Healthcare Costs
Enhanced EHR System Acquisition
The Use of Computer-Assisted Coding by Doctors in Outpatient Settings Is Getting More and More Notice
Restraints
Significant Initial Investment and Ongoing Expenses
Issues with Insufficient Local and Internal CAC Expertise
Opportunities
CAC Solutions Enabled by Natural Language Processing
The Rising Popularity of Online Services
Challenges
Aversion to Using CAC Solutions by Healthcare Providers in Emerging Markets
Restriction of current technology.
Cloning has become more visible.
Computer Assisted Coding Segments
The market is split into two categories:
The software segments
Services sectors based on the component that makes up the product.
The Software subsegment had the greatest share of the market in 2019, while the Services subsegment is expected to grow at a faster clip.
Software as a service, or SaaS, has become the standard method for rolling out computer-assisted coding. Production monitoring, code review, automated auditing, coding solutions, and management reporting are all included in this suite of modules that facilitate a streamlined process for coding-related tasks. Minimal setup is required for this deployment strategy.
It doesn't take long for healthcare institutions to implement the medical code automation process when the necessary software has been deployed. In addition to drastically reducing the number of mistakes made while storing and managing data, the CAC software services also significantly increase the efficiency and accuracy of coders.
However, competent medical coders are necessary for the optimal usage of such programs. Not to mention the high initial cost of getting the program up and running. Because outsourcing CAC services may save money, more and more businesses are making the switch. By offering CAC for the automation of billing services, documentation, and analytical & management services, CAC software firms may efficiently fulfill the needs of healthcare institutions.
The rising use of electronic health record systems will be a key factor propelling the expansion of the market for computer-assisted coding. Increased use of computer-assisted coding (CAC) systems as a means to curb growing healthcare expenses is another major reason fueling the market growth. The market will expand thanks to several factors, including the rise in importance of physician computer-assisted coding in outpatient settings and the expansion of regulatory requirements for patient data management.
Additionally, private and governmental institutions are reversing recent advances in healthcare infrastructure throughout the world and expanding insurance coverage that covers the costs of treatment. The need for these is on the rise since they help reduce the rising cost of healthcare for the general public. The pace of expansion of the computer-assisted coding market will be affected by factors such as the development of healthcare infrastructure and the increase in disposable incomes in both emerging and developed nations.
The requirement to handle a huge number of codes in the ICD-10 system is fueling the increase in demand for automation, which will further cushion the market's growth pace. The expansion of the computer-assisted coding industry will be helped by the rising popularity of cloud-based solutions and the development of new technologies. The future of computer-aided coding seems bright, with the increasing need for cloud-based data storage solutions and the untapped potential of emerging countries fueling the market's expansion.
However, the market expansion will be stymied by issues such as the large initial investment required for onsite CAC support and the deficiency of domain knowledge. Furthermore, the unwillingness of healthcare providers to adopt CAC solutions in developing economies would provide a problem for the expansion of the computer-aided coding industry. However, increasing market consolidation will serve as a restraint, slowing the expansion of the industry even more.
The global market for computer-assisted coding may be broken down into many submarkets defined by:
Product
Delivery method
Application, and
End user.
The expansion of these submarkets will aid in the analysis of slow-growing industry sectors and will provide end-users with a better grasp of the market as a whole and better insight into specific market opportunities.
The market for computer-assisted coding may be broken down into software and services. Separate from the integrated software market, there is also the standalone software segment. Natural language processing software and structured input software are two categories of standalone programs.
The Services market is broken down even further into two categories:
Upkeep and
Instruction
The market for computer-assisted coding is broken down into three different submarkets, depending on where the software is hosted: online, in-house, and in the cloud.
Automated computer-assisted encoding, management reporting and analytics, and clinical coding audits are the three main submarkets of the computer-assisted coding market. The market for computer-assisted coding may also be broken down into subsegments depending on the types of facilities that utilize it, such as hospitals, doctor's offices, universities, diagnostic labs, and others.
The Key Factors Influencing the Growth of Computer Assisted Coding
Increasing regulatory requirements for patient data management and the expanding use of electronic health record (EHR) systems are two of the primary factors fueling the expansion of this market. The public and commercial sectors are also continuously expanding healthcare infrastructure improvements and insurance reimbursement schemes. The expansion of the computer-assisted coding systems market may be attributed, in part, to the rising popularity of CAC solutions used to curb the rising cost of healthcare for the general populace. Additionally, several programs focusing on health data administration are being implemented.
In one example, since November 2021, nurses have been able to access patient data through mobile devices thanks to cooperation between worldwide interoperability business Enovacom and Nordic nursing application expert Medanets. With the help of Enovacom's Patient Connect interoperability technology, data from medical devices will be automatically collected and sent in real-time to the hospital's electronic health record (EHR) and the Medanets' mobile nursing app.
The Swedish government has recently revised its national e-Health goal, which states that all citizens 16 and older would have access to their complete medical and dental records in county-funded health and dental care facilities since the year 2020. As a result, Sweden has one of the highest rates of EHR adoption in Europe.
In April 2021, Cerner Corporation acquired Kantar Health, a subsidiary of Kantar Group, for USD 375 million in cash, subject to adjustment. Therefore, the growth of the market is predicted to rise due to the aforementioned causes. High maintenance costs and a dearth of educated people to maintain the systems have stymied industry expansion.
The growing need for electronic health records (EHRs) is also a primary factor propelling the expansion of the computer-assisted coding industry.
A further reason for the market's growth is the increasing interest in computer-assisted coding (CAC) systems for controlling healthcare expenditures.
Also contributing to the expansion of the market are the expanding regulatory requirements for patient data management and the increasing emphasis on physician computer-assisted coding in outpatient settings.
Meanwhile, private and governmental institutions are reversing recent gains in healthcare infrastructure throughout the world and in insurance plans that cover medical costs.
The pace of expansion of the computer-assisted coding market will be affected by factors such as the improvement of healthcare infrastructure and the increase of disposable incomes in both emerging and developed nations.
The rising need for automation is being fueled by the need to handle a huge number of codes in the ICD-10 system, which will further cushion the market's growth pace.
The expansion of the computer-assisted coding market will be aided by the rising popularity of cloud-based solutions and the development of related technologies.
Growth in the computer-assisted coding market is expected to be bolstered in the future by factors like the increasing need for cloud-based data storage solutions and the potential of undeveloped countries.
Computer assisted coding Application
The field of health information management is undergoing significant transformation as a result of a technological advancement that is revolutionizing medical coding. Medical codes may be generated precisely by CAC software using the information found in clinical notes. In addition to boosting profits, computer-assisted coding helps healthcare facilities meet reporting standards for both payers and patients. A significant number of electronic records come via EHRs (electronic health record systems). However, including electronic health record (EHR) data in the coding process may be a challenging procedure. A bridge between electronic health record (EHR) data, transcription data, and healthcare finance data are provided by computer-assisted coding.
With the use of natural language processing (NLP) technology, computer-assisted medical coding (CAC) can analyze and understand unstructured healthcare data using specialized algorithms, then extract the facts that justify the codes provided. Applications that handle structured input may include the coding into clinical documentation and generate documents with the codes appropriately incorporated.
Speech recognition and computer-assisted medical transcription are only two examples of how current NLP technology might combine with existing clinical recording processes that generate unstructured data language. Clinical documentation must be input into medical coding software, and the coded data must be received into the organization's billing system, both of which need data interfaces. The transfer of the clinical records may be accomplished via the use of interface formats like HL7 FHIR or XML. NLP-based systems make it possible for almost any document format to be accepted.
If an application programming interface (API) or similar medical coding automation technologies are already in place, then web-based services may be an excellent option. All the information needed to submit a complete claim, including CPT and ICD-10 coding, code linkage, patient data, modifiers, and units, is included in the coded records generated by healthcare coding software processes. The ideal procedure would include medical coding software automatically exporting data for billing. Human medical coders will still be needed even with the help of computer-assisted coding. This might be helpful for the medical coding procedure. Code may be reviewed and updated in real-time while simultaneously being validated against coding standards with the help of computer-aided coding tools.
Computer-assisted coding (CAC) is now the most popular kind of cloud computing in healthcare, supplied by CAC suppliers and used mostly in the coding of outpatient services. Medical fields that employ CAC coding include radiology, cardiology, pathology, and emergency medicine. The following figure highlights the areas where providers of medical coding software with CARC capabilities may enhance user results.
Performance:Performance improves as the mean time to write a case decrease. By automating and streamlining processes including document sorting, duplication checking, code search, and human data input, CAC medical coding improves efficiency and hence production.
Correctness: Accuracy increases when coding output conforms to both government and payer reporting requirements. Reduced rejections, fewer audits, and the identification of previously overlooked charges all contribute to increased accuracy. Improved accuracy achieved via the use of medical coding software guarantees that all of the charges for which a business is eligible are recorded.
Consistency: Maintaining uniformity in coding practices across time and between different coding resources is an invaluable tool. Using healthcare coding software may lead to more reliability and consistency in the data. Analysis for future decision-making is improved with consistent clinical and financial data.
Transparency: Transparency is improved when there is evidence of both the procedure followed and the reasoning that led to the coding results. The patient's medical records may be linked to the allocated codes in computer-assisted coding programs.
Compliance: There is less back-and-forth at the time of claim submission thanks to a prospective coding procedure and a prospective payment system that encourages a "do it right the first time" mentality. Accurate and consistent coding is the consequence when a medical software company includes enhanced compliance features in its solutions.
Together, these advantages lessen the time spent preparing for audits and improve the quality of the audits themselves.
The search for computer-aided coding tools that work with any coding process might be difficult. There should be seamless integration between the CAC vendor's computer-aided coding apps and other clinical decision support system tools and administrative applications. Advances in computer-assisted coding technology are being anticipated by the health information management and technology industries. Computer-assisted coding will not eliminate the need for medical coding professionals, but it will make them more efficient and precise while the industry is through a period of significant upheaval.
Competitive Landscape
The market for CAC tools is very competitive and splintered. Many new entrants, as well as well-known names in the IT sector, have entered the market in recent years. In today's global economy, the majority of market share is held by companies based in industrialized nations. However, developments in technology and cross-border knowledge transfer have enabled businesses in poorer nations to compete. Oracle, TruCode LLC, Optum Inc., Artificial Medical Intelligence, Inc., and 3M Company are just a few of the major industry competitors.
These top executives are executing strategic plans for the company's growth, including the introduction of new products, the establishment of new markets, and the creation of new distribution networks. In addition, these actors invest heavily in product development, which drives revenue growth. There is a great deal of competition in the worldwide market for computer-assisted coding, which is driven by factors such as the introduction of new products and the success of these products in clinical trials.
To strengthen their positions in this competitive market, the leading companies have implemented several different strategies;
· Introduction of new products,
· Conduct of clinical trials and market initiatives,
· Funding of extensive research and development, and
· Formation of agreements, joint ventures, partnerships, and acquisitions.
Regional Market
The market for computer-aided coding software is expected to remain regionally dominant in North America. Due to the rising demand for speedy and efficient & effective healthcare, the United States has been quick to accept technological advancement, which has contributed to the country's rapid economic growth.
Industry expansion in North America may be attributed, in part, to the presence of important market participants as well as substantial expenditures in digital healthcare infrastructure from both the public and private sectors. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, EHR and computer-assisted coding have both seen steady growth in their use throughout the United States. To encourage healthcare providers in the United States to adopt and use electronic health records (EHRs), the HITECH Act established an incentive scheme.
Over the next decade, the United States government intends to employ electronic health records to save healthcare spending while also raising service standards. Market expansion is also being driven by initiatives taken by major companies. For example, Atlanta's Piedmont Healthcare System has deployed Epic EHR at its five newest institutions. In August of 2021, Piedmont added the Piedmont Macon Medical Center, Piedmont Macon North Hospital, Piedmont Cartersville Medical Center, Piedmont Eastside Medical Center, and the Piedmont Eastside South Campus to its network of hospitals. Because chronic diseases like heart illnesses disproportionately affect and affect the elderly, the need for patient-centered healthcare applications in the country will increase as the senior population grows.
According to a July 2020 publication by Statistics Canada titled "Older Adults and Population Aging Statistics," there were about 6,835,866 Canadians aged 65 and over in 2020. Because of this, the need for the computer-aided coding market in the area will rise as the number of patients centered applications grows. As a result, the growth of the market is anticipated to expand due to the aforementioned elements.
However, with the growing need for fast operating systems and error-free medical data, Europe is seen as the next frontier in the worldwide CAC software industry. And because of the rapid economic development in Asia and Latin America, both areas are forecast to expand steadily in the next years.
More efficient healthcare infrastructure is being built in both areas thanks to the widespread usage of automated systems and cutting-edge technology. The data used to create the research on the computer-aided coding software market comes from a wide variety of sources, including interviews with market leaders, analysis of their data, and data provided by other market members all along the supply chain.
It is expected that the market for computer-assisted coding in this area would continue to expand at a healthy clip due to the rising demand for cost-effective healthcare and the improvements in healthcare infrastructure. Europe, however, is the next frontier in this industry as a result of the rising need for error-free medical data processing and speedy operating systems.
Not only that, but the Asia-Pacific and Latin American markets are expanding at the fastest rates because of their areas' burgeoning economies. Rising rates of adoption of modern technologies and automated systems for delivering rapid and efficient healthcare infrastructure are majorly driving the computer-assisted coding (CAC) market in these areas.
Inputs and actions from users, such as accepting or rejecting proposed codes, let next-generation CAC technology evolve and improve over time. As an added bonus, it underlines textual evidence that supports the system's suggested code, allowing users to quickly grasp the reasoning behind the recommendation. Coders now have access to tools that allow them to work faster and more accurately than ever before, including rapidly increasing automatic code recommendations, improved workflows, automated coding, and real-time auditing. In the beginning, CAC was slow to yield fruit. This led many healthcare companies to question whether or not implementing a CAC process was worth the effort. But under a value-based care paradigm that puts a premium on clinical coding, more and more hospitals are beginning to see the advantages of CAC software.
Conclusion
While clinical coding has always been a challenge, it was historically done more for future research and planning purposes than for the benefit of hospital management or public funding. Due to changes in healthcare funding and information technology, the clinical coding profession is under unprecedented stress. The advantages of CAC in inpatient settings are supported by evidence from the United States, especially concerning the clinical coding process and the reliability and quality of coded data. Those with extensive experience in clinical coding may find their roles changing as a consequence of CAC, but their skill sets will still be in demand. The need for ongoing monitoring and auditing of the system-generated clinical codes is an opportunity, not a danger, for clinical coding professionals in CAC. Clinical documentation improvement coders will gain from CAC since it will provide them the chance to learn more about their industry and become more proficient coders.
HCC Automation and NLP
Emedlogix NLP assists healthcare companies in enabling reporting capabilities through technologies such as automated patient risk adjustment and improved Medicare HCC coding. Emedlogix NLP employs AI/ML for HCC coding in order to provide extracted codes to Health Plan providers.
NLP for medical coding is often performed either proactively (before the patient visit) or retrospectively (after the initial claim has been submitted to the insurer). It focuses on clinical notes and selected clinical data points from EMRs, and it use technology to discover keywords and phrases that imply diagnosis codes that are most likely connected to an HCC disease. While this strategy is undoubtedly preferable to relying entirely on human labor, it still necessitates significant manual labor.
Suspect codes are used to describe potential HCC codes by the company. Presenting questionable codes to a provider during the pre-visit planning process might be difficult because providers are already overburdened with administrative responsibilities. Adding another work is difficult enough, but when the suspicious codes supplied are incorrect, the process becomes impossible. NLP is frequently used to manage retroactive reviews. Retrospective evaluations lengthen and complicate the process of providing accurate information to the payer.
Benefits of HCC coding
The Emedlogix HCC Coding Engine is used in conjunction with a contemporaneous review procedure. The software ensures that the correct coding is applied to the original claim. The HCC Coding Engine does this by integrating with an organization's existing process. The rules engine processes clinical encounters as they migrate from the EMR to the revenue cycle process. Any encounter that does not have an HCC coding gap is evaluated immediately.
This rules-based approach to HCC coding is extremely accurate. The platform employs filtering logic to help billing and coding teams choose and target the highest-value contacts, allowing them to maximize productivity and effectiveness. In reality, coders can act on 30-40% of the encounters identified by the HCC Coding Engine. The HCC code engine includes a strong set of HCC coding best practice principles, allowing the solution to discover coding issues that are not directly related to clinical data, but rather to the payer's ICD-10 coding requirements. These coding standards have a significant impact on our clients.
Medicare advantage program.
Medicare Advantage (sometimes referred to as "Part C") is a type of Medicare health plan provided by a private organization that has a contract with Medicare. These plans typically comprise Part A, Part B, and Part D. Plans may provide some additional benefits that Original Medicare does not. Your Medicare health plan choices determine how much you pay for coverage, what services you receive, which doctors you can see, and the quality of care you receive. According to the Medicare Payment Advisory Commission, risk scores for Medicare Advantage beneficiaries were approximately 9.5 percent higher in 2020 than they would have been for a similar beneficiary in conventional Medicare, resulting in approximately $12 billion in extra payments to plans.
Risk adjustment.
Medicare risk adjustment is a rule-based calculation based on seven variables: the patient's ICD Codes, age, gender, eligibility section, entitlement reason, Medicaid status, and whether or not the patient is disabled. All variables are collected from structured data, like as claims or EMR. NLP is used to determine missed ICD codes, which results in reduced risk adjustments for patients, which hurts the revenue of the provider/ACO taking the risk on them or underestimates the risk for payers insuring the patient.
A statistical strategy for predicting a person's future utilization and costs of health care services is known as risk adjustment. It is used in Medicare Advantage to adjust the capitated payments made by the federal government to match members' estimated medical costs. This, in turn, helps to guarantee that a plan's contracted providers have adequate resources to care for beneficiaries and are not incentivized to ignore sicker and more expensive patients.
Medicare Advantage plans have financial incentives to thoroughly document beneficiaries' illnesses since higher risk ratings mean greater payments. Traditional Medicare providers do not have the same incentives to adequately record diagnoses in medical claims since they are reimbursed based on services provided rather than the health status of their patients. This means that Medicare Advantage beneficiaries may appear to have more health issues than comparable traditional Medicare enrollees, driving increased plan payments.
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