SPICED 🌶️
Coding 101
Patient Access 🏥
Hospital RCM
Platform Potpourri
100

This is the "S" in SPICED, where you understand the prospect's current state and context before diving into their challenges.

What is Situation?

100

Julie and Bo explained that the same CPT code can have completely different meanings and billing criteria depending on whether you're coding for this type of billing versus facility/hospital billing.


 What is professional fee (or ProFee) coding/billing?

100

The 4 modules of the Patient Access Plus Platform 

What are prior authorization, eligibility and benefits, insurance discovery and patient pay estimation?

100


Charge capture sits in this part of the revenue cycle — after services are rendered but before claims go out.




What is mid revenue cycle?
100


This cloud infrastructure provider powers Infinx's "workflow-native healthcare revenue operating system" with governed revenue cycle automation, as announced in a 2026 press release.


What is AWS (Amazon Web Services)?

200

Jacco van der Kooij, founder of Winning by Design, says that in the last decades of SaaS-based sales, power has shifted from this party to this party in the buying process.

What is from sellers to buyer (or buyers)?

200

This type of violation occurs when a physician's documentation doesn't support the high E&M level billed, and can result in civil penalties or repayment.


What is upcoding (or overcoding)?

200
This company was one of the first to build a direct API connection with a payer for prior authorization, and was originally called Prior Auth Now.




What is Rhyme?
200

This type of Epic setup, used by smaller hospitals piggybacking on a larger system, makes integration more cumbersome because the smaller hospital has limited control over their own tech environment.


What is Epic Community Connect?

200

This AI platform, formerly called "Document Capture AI," was renamed in 2026 to better represent its role as a unified document intelligence solution supporting capture, classification, extraction, and routing.

What is Document Capture Plus?

300

In the SPICED framework taught by Winning by Design, this is the "P" that identifies the specific challenges, frustrations, or problems the prospect is experiencing in their current state.

What is Pain?

300

This code set supports medical necessity by providing diagnosis codes and was expanded from its predecessor many years ago.

 A: ICD-10

300
Patient Access Plus handles this workflow challenge when insurance eligibility changes between scheduling and service date.




What is eligibility reverification (or benefits reverification)?
300
Anthony Amaya explained that hospitals maintain this massive pricing database containing 12,000 to 50,000 items — compared to simple fee schedules in ambulatory settings — which lists every billable service, supply, procedure, and resource the hospital provides.





What is the Chargemaster (or CDM/Charge Description Master)?
300

This is the name of Infinx's software used to assess charge capture opportunities across both acute and professional billing.

 

What is ChargeView?

400

In SPICED, the "C" stands for Critical Event. Jacco van der Kooij teaches that a critical event must meet two conditions to be real — what are they?

It must have a hard deadline, and there must be a consequence if that deadline is missed. Without both, it's not a true critical event.

400

Julie and Bo emphasized in their Coding 101 presentation that everything in the coding process depends on this fundamental process completed by clinicians.


What is documentation?

400

This company was one of the first to build a direct API connection with a payer for prior authorization, and was originally called Prior Auth Now.

What is Rhyme?

400

This hospital-specific metric tracks claims for patients who have been discharged but whose bills have not been finalized and submitted to payers, often due to coding delays, missing documentation, or charge capture issues.

What is DNFB (or Discharged Not Final Billed)?

400

This underlying technology, combined with generative AI and machine learning, enables Document Capture Plus to extract data from unstructured healthcare documents without relying on templates or structured inputs.

What is natural language processing?

500

Nathan Skorick says salespeople should actually be listening for this topic when prospects call in about prior auth — because it points to problems across the entire revenue cycle.

What are denials (or the denial rate)?

500

This type of coding represents the "thinking" part of medicine, has the highest subjectivity and audit risk, and is used across all specialties.


What is E&M (or Evaluation & Management) coding?

500

Benefits accumulations to deductibles and out-of-pocket maximums typically update between these dates each month.


What is the 3rd and 5th of the month?

500


Anthony Amaya explained that these 3-4 digit codes appear on every UB-04 line to show WHERE and WHAT TYPE of service occurred in hospital billing — such as 0450 for Emergency Room, 0250 for Pharmacy, or 0360 for Operating Room — and have no equivalent in professional billing.





What are revenue codes?




500

When a prospect mentions this denial reason code as their top denial driver, it signals medical necessity is their critical pain point.

What is CARC code CO50?