Revenue Cycle

Audits, education, and collaboration are key to reducing query rates

Briefings on Coding Compliance Strategies, January 1, 2016

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by Doreen V. Bentley
 
The transition to ICD-10-CM/PCS has certainly added another layer to the clinical documentation improvement (CDI) puzzle.
 
While some providers may decide to tackle documentation and coding challenges through coder and physician education alone, the audit piece is perhaps just as important, since delayed claims submission due to physician queries directly affects cash flow and, therefore, a hospital's operating income.
 
Simply put: Coding delays can negatively impact hospital cash flow. "We want to be proactive by submitting accurate claims and receiving reimbursement in a timely manner in order to maintain all hospital operations," says Gwen S. Regenwether, BSN, RN, a clinical documentation specialist at Denver Health and Hospital Authority, a 525-bed hospital. While this can, admittedly, be a frustrating and time-consuming process, identifying financial vulnerabilities by taking a proactive approach is necessary to minimize any financial disruption due to the transition to ICD-10-CM/PCS.
 
"We assessed our procedure documentation prior to ICD-10 implementation, provided education to our surgical staff, and evaluated our financial risk pre- and post-educational intervention," Regenwether says. 
 
A look at Denver Health
Denver Health's CDI team, which consists of five CDI nurses and one business analyst, started by conducting monthly audits, and then they transitioned to quarterly audits. Incidentally, their CDIteam works closely with one physician director and three physician advisors (i.e., hospitalists).
 
"Our hybrid medical record is, by far, our biggest challenge that we work with daily," says Cheree A. Lueck, BSN, RN, a former clinical nurse and a current clinical documentation specialist at Denver Health. Physician documentation (e.g., history and physical, progress notes, consults, and admissions) at the facility, which admitted 25,000 inpatients in 2014, is done completely on paper, which is then scanned into their electronic records. In addition to challenges that result from illegible physician handwriting, Lueck notes that it is time-consuming and difficult to extract data from the facility's hybrid system.

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