Way back in 1976, as an elementary school kid in the suburbs of Philadelphia, I came across a book in the library called 2010: Living in the Future. In my then-current world of AMC Pacers and seersucker suits, the book promised great things. Apparently, when I turned 44, the skies would be filled with flying cars, and teachers would look at a wall of televisions containing the faces of their students, among other aspirational goals of the imagination.
In the end, I turned 44, and the only thing the book got right was the ability to have food delivered to my house via computer. I'm not zipping through the skies in my new Nissan Jetson, but I am overweight, thanks to DoorDash (baby steps…).
Which brings me to 2023, the year of Chat GPT and the 50/50 balance of promise and threat that is artificial intelligence (AI). There isn't a single industry that doesn't have the topic of AI front and center of their planning process right now, and medical auditing is no exception. It has led to a burst of Sturm und Drang in our industry, racing between existential dread and thoughts of innovation.
For this week's auditing tip, I'd like to try to calm those in the former camp who see AI as a threat.
Since the dawn of computing, all output from information systems has stemmed from programming on the front end. As programming languages evolved, binary code to basic to C++, they became more complex, but, at the same time, faster and more efficient. With each technological innovation tied to computing, such as graphics, communication, and the internet, this pattern repeated itself.
Now we find ourselves in the nascent world of artificial intelligence, with innovations in the space expanding so rapidly that it was recently being reported that Chat GPT now has the ability to speak, listen, and process images.
Based on this rapid rate of change, as it applies to medical auditing, auditors and CDI specialists need to get involved with AI now, rather than later.
For a corollary, think for a moment about electronic medical record systems and templates. As auditors, we all quickly learned and regurgitated the term "garbage in, garbage out" to describe templated documentation, specifically as it applied to the now (thankfully) retired 1995 and 1997 E/M guidelines. In other words, the output of any computer program or application is only as good as the information that is being fed into it.
Problems with early experiments in creating AI documentation of an encounter are already apparent. In short, the "smart phrase," or "phrase that pays" phenomenon of EMR templates tied to E/M guidelines is showing no signs of slowing down in the world of AI. To recap, there is no "phrase that pays," and every visit is not a level 4 or 5 encounter. The better approach, as has always been the case, is to link level of service to severity and intensity on an individualized basis.
AI can be of assistance in this area, but only if the AI being utilized to create documentation is also programmed to provide clinical decision support. Only physicians can create that, and it must be built as a separate piece of the puzzle prior to integrating it with decisions regarding levels of service. Thus far, early documentation examples indicate that the creation of AI documentation is putting the cart before the horse, generating verbose level 4 encounters that have only a passing reference to the specific severity and intensity of the patient.
As 2023 draws to a close, flying cars and effective remote schooling still find themselves in their infancy, but Moore's Law is rapidly bringing them closer to reality after years of testing. It is understandable to look upon AI as a possible savior to medical documentation, but it will take a few more years of work to refine AI applications to create clinically relevant documentation of a patient encounter.
Your next steps:
- Expand your compliance knowledge! Check out the agenda for the 15th Annual NAMAS Auditing and Compliance Conference and register to attend!
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E/M Guidelines.
- Subscribe to the NAMAS YouTube channel for more auditing and compliance tips!
By J. Paul Spencer, CPC, COC
NAMAS is a division of DoctorsManagement, LLC, a premier full-service medical consulting firm since 1956. With a team of experienced auditors and educators boasting a minimum of a CPC and CPMA certification and 10+ years of auditing-specific experience, NAMAS offers a vast range of auditing education, resources, training, and services. As the original creator of the now AAPC-affiliated CPMA credential, NAMAS instructors continue to be the go-to authorities in auditing. From DOJ and RAC auditors to CMS and Medicare Advantage Auditors to physician and hospital-based auditing professionals, our team has educated them all. We are proud to have helped so many grow and excel in the auditing and compliance field.
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