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

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
WinterGreen Research, 303
WinterGreen Research Methodology 304

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
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

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