eCAC CDI Flashcards
What is Optum’s eCAC CDI solution?
It’s an Enterprise Computer-Assisted Coding and Clinical Documentation Improvement platform by Optum that uses AI (NLP) to automate medical coding and enhance documentation quality. In practice, it reads electronic health records, suggests accurate diagnosis/procedure codes, and flags missing or unclear documentation, all within one integrated system . This unified tool helps coding and CDI teams work together to produce cleaner charts and claims.
What are the core benefits of using the Optum eCAC CDI platform?
Core benefits include significantly improved coding accuracy and consistency (thanks to NLP-driven code suggestions), higher productivity (coders can code more cases faster, reducing backlogs), and better documentation completeness concurrent with patient care  . Hospitals also see fewer claim denials and more appropriate reimbursement because documentation and codes are right the first time, leading to a stronger case mix index and overall revenue integrity.
What are common use cases for Optum’s eCAC CDI solution in a hospital?
Hospitals use eCAC CDI to automate and streamline coding and documentation reviews. For example, coding professionals rely on it to automatically assign and validate codes from physician notes, while CDI specialists use it to concurrently scan inpatient records for missing diagnoses or clarification opportunities . It’s also used to manage physician queries (by identifying what needs clarification) and to flag high-risk cases for pre-bill audits, ensuring potential billing issues are resolved before claim submission .
What distinguishing features make Optum’s eCAC CDI solution unique?
A key differentiator is its fully integrated platform that combines computer-assisted coding, CDI, and auditing in one solution – rather than separate tools – which fosters collaboration and data sharing across teams . It also leverages Optum’s advanced clinical NLP engine (Clinical Language Intelligence), which not only suggests codes but intelligently finds documentation gaps that a human might miss . This means the system simultaneously improves documentation clarity and coding, helping to reduce denials and optimize reimbursement in a way traditional coding software or manual processes cannot. Additional unique features include built-in compliance rules, an infusion charge capture module for complex billing, and mobile query capabilities for physician engagement.
How does the eCAC CDI solution support a hospital’s revenue cycle management?
It strengthens revenue cycle performance by ensuring coding and documentation are correct upfront, so bills can be processed promptly and accurately. By catching errors or omissions early, the platform reduces discharged-not-final-billed delays and prevents costly claim denials  . In essence, eCAC CDI ties clinical documentation directly to billing: as documentation quality goes up, claims are more likely to be paid without issue. This leads to faster reimbursement, maintained compliance (through audit checks), and maximum appropriate revenue capture for the hospital  .
