Wellington, FL -- (SBWIRE) -- 06/14/2013 -- Hospitals that received a federal bonus in 2011 and 2012 were sent surveys to confirm compliance with “meaningful use” but some of the survey pertained to how clinicians document and code their services. There is no free lunch when it comes to CMS and the almost 18 billion dollars in additional reimbursement paid to hospitals and their medical staffs as a result of meeting “meaningful use” requirements. The implementation of electronic medical records makes it much easier to cut and paste documentation from one visit to another, resulting in a higher E&M level contributing to the increase in physician reimbursement. CMS and HHS have warned that “High Tech” fraud will be prosecuted. HSMN’s coding and ICD-10-CM implementation team of consultants assist hospitals and physician practices with these new coding challenges.
Some have pointed out that ICD-10-CM is more voluminous, with a more complex set of diagnostic codes that require more granular documentation of patient encounters with specificity hitherto unknown in the medical field. Likewise, procedure coding under ICD-10-PCS requires choices to be made on the basis of evidence and then a construction of a code.
HSMN has been working with many clients who now have an electronic health record (EHR) and where the claims for encounters are finding themselves in work queues that are established in-house as part of the electronic system. These work queues have grown exponentially to the point at which outside coding staff is brought in to fix the coding issue so that the claim can be processed. However, the problems don’t go away because the “Root Cause” of the problems is not addressed.
Health Systems Management Network, Inc. was recently asked to assume responsibility for clearing up the work queues related to coding issues. HSMN made it clear that it would identify the problems, categorize them, and provide the hospital with the information to begin a process of getting at the root causes of the coding issues.
The graph and chart that follow display a categorization of the identified coding issues. And because the coding is done by highly trained and certified ICD-10-CM trainers, HSMN has been able to work with its client in going to the front end and the back end to begin fixing the problems of the work queues.
The OIG sees the electronic health record as the most fertile ground for recovery of Medicare and Medicaid reimbursement. When ICD-10-CM becomes effective in 2014, it will be easier for the auditors to find fault with the previous “cut and paste” documentation. The real question will be, “What did you do for the patient today?” Were you specific in the diagnostic documentation requirements, and the interventions?
HSMN has added a program in its arsenal to address three problems related to coding: They clean up the work queues, identify root causes for the coding problems, eliminate or reconfigure the work queues and use the information derived from the HSMN intervention to begin preparing both the electronic health record and the medical staff for the coming of ICD-10-CM. The program is called Work Queue Intervention and Preparing the System and the Medical Staff for ICD-10-CM for October, 2014.
Please visit our website http://www.hsmn.com, contact us by phone 866-908-4226 or email theo@hsmn.com for a consultation.