Some things to note: Please send Questions in chat to the 1. - - PowerPoint PPT Presentation

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RESULTS EXPERIENCE VALUE | |

Welcome to today’s webinar!

Some things to note:

1.

Please send Questions in chat to the Organizer – will have Q&A at the end.

2.

Please mute your phones, computers.

3.

Today’s webinar will be recorded and posted to iData’s blog.

4.

Please send an email to jcosta@idatamedical.com for CEUs

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Sandra Routhier, RHIA, CCS, CDIP AHIMA-Approved ICD-10-CM/PCS Trainer

sandy.routhier@cloudmedsolutions.com Sandy is an HIM & Coding professional with more than 30 years of experience with a strong emphasis on inpatient coding and reimbursement, medical record documentation requirements, HIM operations, electronic records, regulatory and accreditation requirements. Sandy worked in acute care hospitals for 25 years in a variety of roles including inpatient coding and CDI specialist, HIM director, revenue cycle director and information systems director. Sandy is currently the SVP of Auditing Services at CloudMed, a Revint Solution. CloudMed provides a unique full- coverage software and auditing solution to assure the accuracy of coding and documentation on inpatient cases.

CloudMed, A Revint Solution

https://revintsolutions.com/ Revint Solutions is an industry-leading full-service healthcare solutions and consulting services provider that offers revenue integrity and recovery services for hospitals and health systems to ensure accurate and timely reimbursement for their

• services. Serving over 1,600 healthcare organizations in the United States, Revint

helps recover over $475 million of underpaid or unidentified revenue for its clients

• annually. Revint’s suite of products includes transfer DRG/IME revenue recovery, DRG

validation, zero balance underpayment recovery, Medicare reimbursement, complex claims, consulting, and interim management, offering solutions of a full revenue integrity “safety net” for all types of healthcare provider organizations. Revint is backed by New Mountain Capital, a growth-oriented investment firm that currently manages over $20 billion in assets.

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RESULTS EXPERIENCE VALUE | | RESULTS EXPERIENCE VALUE | |

From Accurate Patient Story Documentation to Coded Data Integrity: Auditing for Consistency, Accurate Reimbursement, and more!

Wednesday, October 17, 2018 at 12:00 noon

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From Documentation to Coded Data

Medical Record Documentation Reimbursement Code Assignment

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Hospital Inpatient Reimbursement

From Documentation to Coded Data

Physicians Coders Medical Records Billing Claim

“Congestive heart failure (acute on chronic systolic), Hypertension, and Chronic Kidney Disease (stage IV)” I13.0 I50.23 N18.4 MS-DRG 291 Heart Failure with MCC

Projected DRG Reimbursement: MS-DRG Relative Weight: 1.4761 Hospital’s Blended Rate: X $5,000 $7,380

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Accuracy Needed for all the Reasons Coded Data is Used

q Vital statistics related to population health q Quality projects such as core measures q Comparative Data – hospital and physician q Severity of Illness (SOI) and Risk of Mortality (ROM) q Hospital acquired conditions (HACs) q Patient Safety Indicators (PSIs) q Readmission rates q Clinical Research q Disease Maintenance q Registries (i.e., tumor, trauma, birth defects) q Physician credentialing and privileging q Payer contract negotiations, market share analysis, transparent pricing q MEDPAR data

From Documentation to Coded Data

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From Documentation to Coded Data

Paper-based Electronic Hybrid

Hospital Medical Records

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Center for Medicare and Medicaid Services (CMS) 482.24 Condition of participation: Medical record services

q A medical record must be maintained for every individual evaluated or

treated in the hospital.

q All patient medical record entries must be legible, complete, dated, timed,

and authenticated in written or electronic form by the person responsible for providing or evaluating the service provided, consistent with hospital policies and procedures.

q The hospital must have a system of coding and indexing medical records.

The system must allow for timely retrieval by diagnosis and procedure, in

• rder to support medical care evaluation studies.

From Documentation to Coded Data

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Center for Medicare and Medicaid Services (CMS) 482.24 Condition of participation: Medical record services

q Evidence of q History and Physical (H&P) q Consultative evaluations q Practitioner’s orders q Discharge summary with outcome of hospitalization, disposition of

case, and provisions for follow-up care

q Documentation of complications, hospital acquired infections, and

unfavorable reactions to drugs and anesthesia

q Completion of medical records within 30 days following discharge

From Documentation to Coded Data

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Accreditation Requirements

q The Joint Commission q Record of Care, Treatment, and Services (RC) q https://www.jointcommission.org/

q DNV

q Integrates the CMS Conditions of Participation with the ISO 9001

Quality Management Program

q http://www.dnvglhealthcare.com/accreditations/hospital-accreditation

From Documentation to Coded Data

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ICD-10-CM Official Guidelines for Coding and Reporting

q General Guideline I.B.14: Code assignment is based on documentation by

the patient's provider

From Documentation to Coded Data

AHA Coding Clinic

q First Quarter 2014 (pages 11-13): Medical record documentation from any

physician involved in the care and treatment of the patient, including documentation by consulting physicians, is appropriate for the basis of code assignment.

q The issue of whether a resident's documentation needs to be confirmed by

the attending physician is best addressed by the hospital's internal policies, medical staff bylaws, and/or any other applicable local/state/ federal regulations.

q Code assignment may be based on other physician (i.e., consultants,

residents, anesthesiologist, etc.) documentation as long as there is no conflicting information from the attending physician.

q

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What’s the impact of poor documentation?

From Documentation to Coded Data

q Unfavorable patient outcomes q Medical errors q Lack of coordination of care q Lower reimbursement q Low Case Mix Index (CMI) q Denials q Marred public image q Increased costs q Duplicate tests q Administrative costs q Software & Support q Legal q Clinician dissatisfaction

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Building Safety Nets – Internal Quality Checks

q Review documentation for completeness q Validate code assignments are accurate q Utilize internal staff or outside vendor q Perform pre-bill or post-bill

From Documentation to Coded Data

Physicians

CDI Specialists

Coders Medical Records

Clinical Documentation Improvement (CDI) Code and DRG Assignments

Billing

Audit Pre- and/or Post-Bill Analyze for Deficiencies

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From Documentation to Coded Data

Clinical Documentation Improvement Physician and clinician terminology CDI and coding reconciliation Clinical Validation Coding Coding education and support Process improvement Systems EMR configuration Document creation options System-related issues Optimization

Trending of internal quality checks, external audits, and denials Taking action on what is discovered

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Please write your question in the chat!

Questions?

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Sponsor: iData Medical focuses on creating quality clinical documentation documents and overall medical records (accurate patient’s “story”), performs document integrity audits for small and large facilities, and provides back-up services as part of facility contingency and business continuity plans. www.iDataMedical.com

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Upcoming:

• Our Webinar Series continues in February with another
• utstanding line-up of speakers and experts in the field
• f medical documentation integrity“
• A video of this webinar will be available on iData’s

blog shortly.

• CEU Certificates are available with request by email to:

jcosta@idatamedical.com