ChartWise cracking the code for medical billing

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. / 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. / PBN FILE PHOTO/MICHAEL SALERNO

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. Elion said his “aha” moment for the business, which has 15 out-of-state clients, came while he was sitting in a hospital auditorium in 2008, listening to a consultant describe the “horrible” notes doctors write and why those “weren’t going to cut it” for coding and billing purposes in the future.
ICB9 codes and a new incarnation coming called ICB10 are sets of codes used to describe illness and disease when determining reimbursement rates for insurance Medicare, and Medicaid.
“He was telling us all to memorize 17,000 ICB9 codes that the hospitals use,” Elion recalled. That’s when Elion asked himself: “How come nobody’s figured out how to do a computer program that can help with this?” The dilemma spoke to Elion’s combined passions of computer technology and medicine.
As a practicing, board-certified cardiologist, and an associate professor of Medicine at Brown University, where he earned his undergraduate and graduate degrees, Elion had always been advised that he could develop a career in one discipline or the other, but not both. Now, he’s demonstrating, he said, that he can in fact do both.
Clients across the country include hospitals from Georgia, Ohio, California and Oklahoma, as well as a hospital chain in Nashville. Seeking to avoid even the appearance of a conflict of interest, Elion avoided contracting with The Miriam Hospital, he said.
What makes ChartWise different than its peers, he added, is that it provides concurrent reviews of data in real time. In addition, instead of just feeding the clinical-documentation reviewers information, ChartWise gets the medical records to the quality manager, keeping paperwork in line and getting “right to the front lines, taking care of the patients and improving outcomes.”
“We reanalyze a hospital’s data every 10 minutes and send alerts and emails if [we] find something out of line,” he said.
In 1994, 15 years before founding ChartWise, Elion founded Heartlab Inc., a designer and supplier of digital image and information networks for cardiology, and sold it to Agfa Healthcare in 2005. Fifteen of the company’s 200-plus employees migrated to ChartWise, Elion said. As a group, employees now working for him include engineers writing software, quality-assurance workers, trainers, technical writers, project managers and support personnel.
“We argue all the time with a smile on the face, a twinkle in the eye and great trust and respect for each other,” he said. “There’s no ego involved, the customer always wins.” •

COMPANY PROFILE
ChartWise: Clinical Document Intelligence
OWNERS: Jon Elion, president and CEO
TYPE OF BUSINESS: Medical software
LOCATION: 1174 Kingstown Road, South Kingstown
EMPLOYEES: 18
YEAR ESTABLISHED: 2009
ANNUAL SALES: WND

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