Billing codes insertion based on visit documentation

Purpose

1. Automate the extraction and insertion of correct billing codes (ICD-10, CPT, HCPCS) based on pediatric dermatology visit documentation and clinical notes, minimizing manual entry errors, expediting claim cycles, and ensuring accurate reimbursement.

2. Enable automators to seamlessly integrate EHR, dictation analysis, and coding resources for real-time, automated, and rule-based billing code population.

3. Automate compliance with payer-specific and regional guidelines by instantly updating codes as documentation is completed and new rules emerge.

4. Reduce provider administrative workload by automating the laborious, error-prone billing code selection linked to patient encounter types, procedures, and modifiers.

Trigger Conditions

1. Automated trigger on completion or saving of visit note within EHR or EMR.

2. Automatedly triggered when provider dictates or uploads clinical summary.

3. Automated rule-based initiated upon updating patient diagnosis or procedure fields.

4. Automation triggered by batch uploads of visit data from scribe or clinician queue.

Platform Variants

1. Epic Systems

 • Feature/API: App Orchard “Clinical Documentation Flowsheets” and SmartData Elements (SDE) extraction; configure automated POST to coding endpoints on Save Event.

2. Cerner

 • Feature/API: Millennium API “Clinical Event Listener”; automate HL7 result integration to call coding webhooks.

3. athenahealth

 • Feature/API: “Document API”; trigger automation on finalization event, pushing visit data to third-party code assignment endpoint.

4. NextGen Healthcare

 • Feature/API: “Patient Visit SOAP API”; automated polling or push for new notes, then auto-match and insert codes.

5. Allscripts

 • Feature/API: Unity API “Clinical Documentation Changed” webhook; automate code lookup and PATCH encounter.

6. eClinicalWorks

 • Feature/API: “Progress Notes API”; automate data extraction on completion event for automated code mapping.

7. ModMed EMA

 • Feature/API: Automated “Clinical Documentation” event notifications and FHIR endpoints for code insertion.

8. Practice Fusion

 • Feature/API: “Encounters API”; automate code match and injection on chart closure.

9. DrChrono

 • Feature/API: Automated webhook on “Clinical Note Submitted”; use direct billing code POST.

10. Kareo

 • Feature/API: “Clinical API” encounter finalized trigger; automate call to billing assignment endpoint.

11. Greenway Health

 • Feature/API: “Intergy SOAP API”; trigger automation on new completed note.

12. Meditech

 • Feature/API: “Clinical Integration Engine”; automate HL7 ORU message for billing code automation.

13. Google Cloud Healthcare API

 • Feature/API: FHIR-based automate DocumentReference watcher and automated code insertion.

14. Microsoft Azure Health Data Services

 • Feature/API: Automated Event Grid event on FHIR Document create; automate function app for code lookup.

15. AWS HealthLake

 • Feature/API: Automate FHIR API DocumentReference monitoring; lambda-based billing code update.

16. Symplr

 • Feature/API: “Clinical Workflows” automation triggers; set to extract note data on save and run code mapping script.

17. Suki AI

 • Feature/API: Automated voice note completion triggers webhook to initiate code suggestion workflow.

18. Nuance Dragon Medical One

 • Feature/API: Voice command or end-of-dictation event triggers automated code mapping engine.

19. 3M M*Modal

 • Feature/API: “Clinical Documentation Integrity” event triggers; automate code proposal step.

20. Athena Text

 • Feature/API: Automated note completion detected; use direct automate code API for insertion.

21. Medisoft

 • Feature/API: Automated interface with “Patient Transaction API”; automate creation and insertion of relevant billing codes.

22. HL7 FHIR

 • Feature/API: “Encounter” resource changed triggers automate Procedure/Condition to code mapping.

Benefits

1. Automated billing code insertion reduces claim denial rates and related rework.

2. Automates repetitive administrative tasks, freeing up provider time for patient care.

3. Accelerates revenue cycle by automating immediate billing-ready documentation.

4. Enhances compliance by automatedly adjusting for real-time payer and regulatory changes.

5. Increases claim coding accuracy through consistent, automated, context-based code selection.

6. Supports audit-readiness by keeping a complete, automated log of billing code insert events.

7. Automates reduction in delays from manual coder handoff or missing information.

8. Enables scalable, automatable workflows as visit volumes grow without additional coding staff.

9. Automates flagging and escalation of ambiguous cases to expert human review only when needed.

10. Strengthens patient satisfaction by automating faster billing and explanation of benefits turnaround.