Ingenix, a healthcare IT and consulting company, has released its fifth annual report on the "Top 200 Coding Hospitals in the U.S." The report ranks hospitals according to the completeness and accuracy of their medical coding practices used to bill Medicare for inpatient medical services.
This year's report identifies hospitals that have adapted best to the Centers for Medicare & Medicaid Services' updated policies, including a new Medicare payment methodology, reduced payment for hospital-acquired conditions and increased pressure for correct coding via its Recovery Audit Contractors (RAC) program.
"Our data shows that these hospitals are avoiding some of the pitfalls associated with severity-adjusted grouping - the same pitfalls that RAC auditors are looking for," said Warren Guillett, Ingenix's senior vice president for health systems optimization.
Consultants from the Ingenix Health Information Management consulting division reviewed more than 50 indicators for coding excellence in the Diagnostic Related Group and ICD-9-CM systems. According to Ingenix, 13 of the metrics reviewed exhibited a high correlation with coding accuracy.
Ingenix officials established the definitive metrics by comparing the frequency with which these scenarios occurred among a hospital's cases. For example, they used cases with DRG 124 (Circulatory Disorders except AMI with Cardiac Catheterization and Complex Diagnosis) and a diagnosis code of 411.1 (Intermediate Coronary Syndrome) as a percent of the total number of DRG 124 claims as one of the measures.
Ingenix consultants ranked 4,607 U.S. hospitals within their peer groups on each of the 13 metrics and identified overall top performers by establishing a percent rank for each measure. The hospitals were separated into four groups:
- 919 Rural, Non-Teaching;
- 1,459 Urban, Non-Teaching;
- 1,996 Minor Teaching;
- 233 Major Teaching.
The consultants' assessment revealed a list of 50 hospitals within each group with the most complete and compliant coding practices. Ingenix designated a top hospital in each group:
- Major Teaching: Northwestern Memorial Hospital, Chicago.
- Minor Teaching: Kimble Hospital, Junction, Tex.
- Urban, Non-Teaching: Adcare Hospital, Worcester, Mass.
- Rural, Non-Teaching: Glenbeigh Hospital, Rock Creek, Ohio.
To determine the hospital rankings, Ingenix consultants used the company's HospitalBenchmarks.com software to analyze the recently released 2007 Medicare Provider Analysis and Review file.
Ingenix officials claim the hospital rankings are especially pertinent given the healthcare industry's increasing reliance on code-based prospective payment systems, such as diagnosis-related groups and ambulatory payment classifications, which underscore the critical impact of clinical documentation and coding on hospital revenues.
Guillett said the study highlights the increasingly important roles medical records coding and healthcare information management are playing in the revenue cycle management process and emphasizes the value of using quantitative HIM measures of coding performance.