The financial and quality pressures that come with healthcare reform and the conversion to ICD-10 are putting a lot of stress on coding accuracy and use of the information gathered, according to a Monday education session at the Healthcare Financial Management Association's ANI conference in Las Vegas.
The session focused on documentation improvement best practices developed by the Cleveland Clinic. Through a collaboration with medical staff, officials said they learned that more precise physician documentation not only led to more accurate quality scores and performance ratings, but also resulted in more accurate measurement of resource consumption and improved revenue through better capture of patient acuity and more accurate reimbursement.
"If you aren't checking your coding, then you may be giving away reimbursement that you could save," said Garri Garrison, director of acute care consulting services for Minneapolis-based 3M Health Information Systems and a presenter for the session.
Susan E. Belley, manager of coding for the health data services department at the Cleveland Clinic, a not-for-profit healthcare organization, said it was difficult to manage a hybrid EMR, but the rewards upon implementation were noticable.
Cleveland Clinic saw an increase in case mix index of 3 percent in the first three months after initiating a program to analyze its data and improve documentation, she said.
The presenters outlined a process for addressing quality benchmarks in the face of new and changing regulations:
- Compare your hospital's performance with industry norms and peer groups to identify variances.
- Quantify your organization's most significant opportunities for improvement, including change in case mix; CC and MCC capture rates and the impact on reimbursement; service-line performance under MS-DRGs; and understatement of severity of illness and risk of mortality in quality report cards.
- Establish appropriate goals and areas of focus, such as improving the accuracy of hospital and physician quality report cards; using the data to reduce costs and LOS; providing better information for planning, measuring patient care and performing physician profiling; appropriate and supportable reimbursement; decreasing chart completion issues, denials and A/R days; and better staff understanding of compliance issues and regulatory standards.
- Sustain financial gains while maintaining regulatory compliance with automated tools and processes:. including automated flags, alerts and clinical indicators, generated concurrently; ongoing education and monitoring for documentation specialists and coders; and more precise and complete physician queries.
"Taking a proactive stance in addressing payment reform challenges can have a profound impact on a healthcare provider's efficiency, quality of care, reputation and profitability," Cleveland Clinic offficials said during the session. "As competition gets tighter and the rules governing payment continue to evolve and change, meeting such performance objectives will help build market share and protect revenue – the two best hedges against evolving federal and state payment changes."