Exceptional Coders | Innovative Technology

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.

A recent Kaufman Hall survey found that an overwhelming majority of healthcare executives (96 percent) stated that cost transformation is a significant need for their hospital or health system. Yet, over 50 percent of organizations surveyed either do not have a healthcare cost reduction goal or have such a small goal that it will not, in reality, transform their cost structures.

A recent Becker’s Hospital Review article stated that Catholic Health had agreed to pay $6M to settle overbilling allegations. A nursing home subsidiary of the health system allegedly submitted claims to Medicare for the highest and most expensive levels of therapy when that type of therapy was not medically necessary or was unsupported by medical records. The allegations against Catholic Health were originally brought by a whistle-blower under the qui tam provision of the False Claims Act.

The medical sector has been undergoing a series of interminable changes over the last few years. In consequence, healthcare revenue cycle management (RCM) market is set to witness a marked growth because of the rising need for timely bill reimbursements and insurance claims. Increased complexity in the medical coding process has led to the necessity of RCM solutions that help reduce billing errors.

Not only is clinical documentation improvement (CDI) the key to better ICD-10 coding and reimbursement accuracy, but it's also vital for preparing healthcare organizations for the new care paradigm of population health management. To this end, AHIMA has designated the month of July as CDI Month with Aviacode joining in the recognition to CDI professionals nationwide.

Do you recall the year 1999, or as it became known "Y2K"? People were nervous, scared, and a little irrational with their fears towards the turn of the millennium. I have often reflected back on 1999 as I participate in conversations surrounding the October 1^st ICD-10 deadline.

The fears that people have expressed have been, well...somewhat irrational. For the most part, healthcare professionals have created an ICD-10 readiness plan. The eBook "The Definitive Guide to ICD-10" has helped many nationwide develop and implement or even reinforce their current ICD-10 transition plan. The supplemental "12 step guide infographic" has attempted to break the plan down into bite size chunks for healthcare professionals. Most of the healthcare professionals we speak with today have a solid plan. Most have reconfigured their systems to support the new requirements. Their IT transition appears to be on point. Many organizations have either already certified their own coders in ICD-10 or they have taken steps to outsource their medical coding to companies like Aviacode who have access to thousands of certified ICD-10 coders. Most, if not all, have set aside budget to accommodate some of the “unknowns” as we approach the ICD-10 deadline. So, is there really any reason to reach for the panic button?