ChartWise cracking the code for medical billing

By Patricia Daddona
PBN Staff Writer

Terms doctors use when treating patients often don’t match the coding terms needed for billing and insurance records, says Jon Elion, president and CEO of ChartWise: Clinical Document Intelligence. More

To continue reading this article, please do one of the following.



MAIN STREET

ChartWise cracking the code for medical billing

PBN FILE PHOTO/MICHAEL SALERNO
CHARTING SUCCESS: ChartWise: Clinical Document Intelligence software helps match doctors' treatment records with the maze of insurance codes medical providers must follow. Pictured above are Kris Falcone, left, support manager for ChartWise, and company President and CEO Dr. Jon Elion, at the firm's South Kingstown office.

By Patricia Daddona
PBN Staff Writer

Posted 4/21/14

Terms doctors use when treating patients often don’t match the coding terms needed for billing and insurance records, says Dr. Jon Elion, president and CEO of ChartWise: Clinical Document Intelligence.

“Doctor’s notes that are fine to communicate medically may not have the exact content needed by the hospital’s coding department for billing purposes,” said Elion, a cardiologist at The Miriam Hospital in Providence. “So, we built software that has the extensive expertise built in to help identify those gaps.”

The SAAS, or software as a service, is a system that assists the reviewer of the chart while the patient is present.

The company’s software, used primarily by hospitals, can have the added benefit of boosting reimbursement rates, but that is not its primary objective, Elion said. The main purpose, he says, is to improve the delivery of health care.

“Our software is working to help the hospital get the most complete, high-quality documentation possible,” he added. “We want the medical record to reflect everything accurate happening with the patient, not just get higher reimbursement.”

By way of example, Elion explained that simply recording symptoms that include “a high white-blood-cell count, fever, cough, and green sputum” as pneumonia is not enough for a hospital to get reimbursed appropriately once the illness is treated with antibiotics. The coding term that has to be used explicitly in that case is “probable pneumonia,” he said.

The goal is to ensure that hospitals are not deprived of the reimbursements they are entitled to get, he explained.

With the introduction of the Affordable Care Act and upgrading of medical codes used to determine reimbursement rates, hospitals weren’t sure how to adapt, so initially there was some reluctance to sign on with ChartWise, Elion said. However, clients who got a return on their investment within eight weeks were eager to commit, he said, and there is now a backlog of 60 prospective clients.

Next Page
Calendar
PBN Hosted
Events

Join PBN for the best networking event and party of the winter - January 15, 2015 - the Book of Lists Party at the Providence Public Library. Reserve your spot early!
  • Best Places to Work
    Enrollment is now open for the 7th annual Best Places to Work program. Winners w ...
  • Manufacturing Awards
    Applications are now being accepted for the 2nd Annual Manufacturing Awards. Dea ...
Advertisement
Purchase Data
Book of Lists
Lists
Book of Lists cover
PBN's annual Book of Lists has been an essential resource for the local business community for almost 30 years. The Book of Lists features a wealth of company rankings from a variety of fields and industries, including banking, health care, real estate, law, hospitality, education, not-for-profits, technology and many more.
Data icons
Data can be purchased as single lists, in either Excel or PDF format; the entire database of the published book, in Excel format; or a printed copy of the Book of Lists.
  • Purchase an e-File of a single list
  •  
  • Purchase an e-File of the entire Book of Lists database
  •  
  • Purchase a printed copy of the Book of Lists
  •  
    National
    Local
    Latest News
    Advertisement