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Accurate Coding and Documentation Are Critical in Today’s Value-Based Care Environment

Posted by David Fong on Apr 24, 2018 6:00:00 AM

At the American College of Cardiology’s Cardiovascular Summit in February, one presenter's PowerPoint slide showed how much proper documentation and coding could affect a hospital’s quality measures and bottom line.


Reported in Cardiovascular News, Linda Gates-Striby used a hypothetical example of a 76-year-old woman with diabetes and heart failure. If clinicians only documented basic information about this patient, her expected cost of care per month would be in the ballpark of $5,000. But by coding more specific designations for the diabetes and heart failure—and noting an interaction between the conditions—the total risk score value would balloon to $13,554 per month.


“Sometimes it’s not a matter of working harder but making sure it’s accurately capturing what you’re already doing,” said Gates-Striby, the director of corporate compliance at St. Vincent Medical Group in Indianapolis who led multiple sessions on coding at the CV Summit.


This issue is only growing in importance with medicine’s shift away from fee-for-service payment models and more toward value-based models. For reimbursement in the value-based models, payers including the Centers for Medicare & Medicaid Services typically use some form of risk-adjustment to come up with a target price.


Aviacode provides experienced and credentialed coders who are compliant with the latest coding and documentation guidelines, including those that impact value-based care and risk adjustment. Our advanced medical coding solution guarantees accuracy and turnaround for providers (practice managers, physicians, and hospitals) and payers. All our coders are AAPC or AHIMA certified, have years of experience, using our proven technology workflow, and are continually training to improve their productivity and to stay on top of changes in rules and regulations.


Gates-Striby commented that a lack of education is often to blame for inaccurate coding. She said an additional hurdle is the growing number of available codes and the struggles some clinicians have in selecting the correct one within the electronic medical record (EMR). Aviacode also offers experienced coders, as well as customized and flexible coding training solutions to help ensure accurate reimbursement, compliance and adoption of new concepts for coding under value-based reimbursement. We provide simple, effective, and affordable training tools that teach documentation techniques necessary to improve reimbursement for ICD-10 coding and can help identify areas of relevant compliance concerns to maximize revenue in today’s value-based care environment.

Topics: Medical Coding, Clinical Documentation, Outsourcing