BATON ROUGE, LA – Preparing for Medicare changes is an annual event at Baton Rouge General Hospital.
The facility, located in Louisiana’s capital, is already anticipating changes Medicare may make under its proposed rule for fiscal year 2009, said Trudy Rioux, the supervisor in charge of its clinical documentation management program.
It’s a way of life for the 544-bed community hospital - as it is for most facilities in the country, which are used to an annual list of changes from Medicare.
Still, last year’s move to Medicare’s severity-adjusted system of diagnosis-related groups involved a major adjustment. The move to MS-DRGs is considered to be the biggest change to the Medicare payment system in the 25 years since the program moved to a prospective pricing system.
Other changes have forced the system to do a better job of detailing patients’ conditions when they are admitted, said Don Shaw, Baton Rouge’s vice president of revenue cycle.
Primarily, the organization worked to achieve greater teamwork among various caregivers documenting care, and coders worked to look deeper into documentation for clues that would influence what was to be submitted on claims.
“We knew it would take more analytical thinking skill,” Rioux said. “We had to look at more areas of the chart to find query opportunities.”
The facility emphasized educating a variety of staff, not just coders. It used Webinars from J.A. Thomas Associates, a consulting firm that provides coding education and ongoing benchmarking of case mix performance.
Nurses at the facility also have experience working with physicians to ensure that patient charts contain accurate documentation of patient care, Rioux said.
“Doctors were used to us talking with them and having a dialogue about documentation,” Shaw said.
Coders at Baton Rouge General work concurrently with physicians, and the hospital has a physician advisor for medical records who is “fluent in coding.”
The training was essential for coders, many of whom had 25 or 30 years of experience.
“This was a whole new ballgame for them, particularly in looking for complications,” Rioux said.
“We were back up to speed in about six months.”