GeBBS Healthcare RCM Blog

July is CDI Month – Let’s Celebrate!

Posted on Wed, Jul 06, 2016 @ 05:30 AM

AHIMA has designated July as CDI Month.

As the demand for accurate and timely clinical documentation increases, health information management (HIM) professionals are using their skills and expertise to improve clinical documentation. Because clinical documentation is at the core of every patient encounter, in order to be meaningful it must be accurate, timely and reflect the scope of services provided. Successful CDI programs facilitate the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality report cards, physician report cards, reimbursement, public health data, and disease tracking and trending. HIM professionals provide two key roles within a CDI program as a clinical documentation improvement specialist and coding professional. By working together, HIM professionals can support their organizations efforts to collect and provide meaningful information throughout the continuum of care.

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GeBBS Healthcare Solutions is proud to be an AHIMA CDI Month Spotlight Sponsor, in supporting the industry’s efforts to continually improve clinical documentation. New healthcare mandates and regulations are making accurate clinical documentation more important than ever. RAC, Medical Necessity, ICD-10, pay-for-performance, and the growth in volumes resulting from the ACA are all impacting healthcare organizations. The ability to get reimbursed is directly dependent on the quality of clinical documentation. Missing, poor, or non-specific clinical documentation will result in lost revenue.

Our outsourced CDI services can help ensure you are receiving accurate reimbursement by improving your clinical documentation. GeBBS’ CDI specialists are professionals of the highest caliber. They are credentialed, experienced and are passionate about getting even the smallest details right. Whether our CDI professionals are assessing your program or supplementing your staff, they will help develop, improve and maintain your clinical documentation.

Our services can quickly provide you with the interim or permanent CDI professionals you need, and our highly-skilled and experience staff will fit seamlessly into your current program. Our program includes comprehensive CDI audit solutions, which provide you with a complete overview of MS-DRG and APR-DRG metrics, severity of illness, risk of mortality, and financial opportunities. In addition, we provide a correlation of opportunities to physicians, specialties, nursing units, and coding professionals. The result of this detailed analysis is a clear view of how your current CDI methods can be enhanced or modified.

We honor our CDI professionals during CDI Month and look forward to seeing you at the AHIMA CDI Summit as a Spotlight Sponsor next month, as we advocate and are positioned to help make immediate improvements to your clinical documentation!

Tags: Clinical Documentation Improvement (CDI)

Big Data and 2016

Posted on Tue, Jan 26, 2016 @ 06:00 AM

Since the inception of the term “big data,” how to handle this data has been a challenge for healthcare providers. Big data has been around since computers were first harnessed to help the healthcare industry. The challenge has always been how to handle and make sense of this copious amount of information. In 2016, big data will continue to grow. Healthcare providers will have to develop an infrastructure, or scale up through outsourcing, the capabilities to use this big data to their best advantage. You can expect an increase in the use of relationship algorithms that formulate inferences, allowing decisions to be made in real-time.

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For big data to be effective, you need to provide the right tools to the right people in the right ways. The better healthcare providers understand the varying needs of their end users, the better they will be served by the big data they own.

A huge amount of data is being generated that needs to be part of the patient record and the hospital’s revenue cycle. This data needs to be available across the entire continuum of care.

Adoption and success in big data analytics is never going to happen overnight, certainly not by the end of 2016. For one thing, most healthcare organizations need help in the adoption and use of data analytics tools -- from revenue cycle improvement to medical coding.

If you want to improve your use of big data in 2016, consider outsourcing to scale up your infrastructure immediately. An experienced outsourced provider can offer in-depth healthcare industry expertise to help you use your big data to provide end-to-end solutions to successfully resolve your billing and medical coding challenges. Outsourcing can deliver, immediately, a world-class infrastructure of highly skilled professionals, robust processes, and proprietary workflow engines. This makes for an ideal partner to help you with your big data challenges and reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity.

Tags: Business Process Outsourcing (BPO), Clinical Documentation Improvement (CDI)

Clinical Documentation and Coding Audits Can Improve Your Performance in Multiple Ways

Posted on Fri, May 15, 2015 @ 01:00 PM

Clinical documentation and coding audits can improve your facility’s performance and help you achieve the following goals:
  •  - Improve overall coding accuracy
  •  - Improve clinical documentation
  •  - Improve capture of patient acuity levels
  •  - Increase reimbursement
  •  - Reduce compliance risk from RAC, MIC and MAC
  •  - Reduce risks from incomplete or unclear documentation
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Careful planning for your internal audit is the first step to success. You should select an external clinical documentation and coding auditing firm that provides highly-qualified coding auditors and CDI professionals to ensure you receive the best possible service. The company should have a nationwide reputation and their staff members should have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Their auditors should have five years of experience, at minimum, and be certified RHIA, RHIT, CCS, CCS-P, CPC, CPC-H, RN, PA, CDIP, CCDS or combination thereof.

Your facility should go into the audit with a clear understanding of the reason and purpose for the audit. The six goals mentioned earlier should always be kept in mind. Consistent auditing is key in order to improve clinical documentation and coding quality. You want to compare “apples to apples” in order to trend quality and provide educational opportunities. 

In addition to defining the purpose, obtaining buy-in from senior leadership is a crucial part of creating an effective audit program. This is especially important if audits reveal unfavorable findings related to physician documentation. Chief medical officers must be on board to ensure that all physicians—even those who bring in the most business for the hospital—are held to the same standards with respect to achieving improvements.

Your audit should not be based purely on financial performance. Conducting a coding audit solely to increase revenue in a particular area could raise a red flag and will probably not yield the anticipated results. It is often assumed that incorrect coding solely causes decreased revenue, but the decrease could be due to other factors, such as clinical documentation or lower volume of cases.

Your facility’s auditing and monitoring should be risk-based -- not driven by financial performance or a “check-off box”.

The focus and frequency of your coding audits—whether annual, quarterly, monthly, or concurrently -- should be based on identifying risks and driving quality care. Conducting audits at random intervals is not helpful. You will not be reducing your overall risk, and you will leave yourself vulnerable by not looking at and evaluating the true risks.

Auditing the same areas each year is not beneficial either. Areas of risks are moving targets. They may not carry over year to year, quarter to quarter, or even month to month.

Hospitals are increasingly requesting internal clinical documentation and coding audits to prepare for ICD-10. This trend combines a coding audit with a more formal documentation assessment that deals with an assessment of the more granular ICD-10 coding system to highlight the need for individual physician education.

A good audit will formally report the documentation assessment and follow-up for needed education opportunities. This helps prepare for ICD-10 because of the ability to identify physicians who do not document correctly.

Ensure a thorough post-audit follow-up. If your facility doesn’t intend to follow through with audit results and take corrective action when necessary, the audit will be essentially useless and even potentially damaging to your organization.

When conducting an internal audit, consider the objective, scope, and number of records to be audited; then create a plan of action that includes enlisting the help of an experienced external auditing firm.

 

Tags: Clinical Documentation Improvement (CDI)

The Importance of Physician Champions in the Transition to ICD-10

Posted on Wed, Jun 11, 2014 @ 11:20 AM

Do you have a "physician champion"? You should. A physician champion who will support your clinical documentation improvement (CDI) program and communicate the importance of an

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ICD-10 CDI program to his or her peers will go a long way in ensuring the success of your transition to ICD-10 in October of 2015.

Providers are now keenly aware of the ICD-10 billing requirements for claims beginning October 1, 2015. There has been, and rightly so, significant concern within the healthcare industry about the financial risks that will be incurred in the transition process, including the fact that utilization of the wrong code may result in reduced reimbursement or total rejection of a claim. Some have called this change the biggest challenge to face healthcare providers since Medicare came into being in the 1960s.

Much has been written about how to prepare for ICD-10. The emphasis has been on training the medical billing staffs and coders on how to make the transition from the 13,000 ICD-9 codes to the 69,000 ICD-10 codes. Unfortunately, there hasn’t been as much time spent or resources expended on physician education and support for the upcoming conversion. Physicians need to understand how important it is for them to properly document their care in order for coders and billers to be able to fulfill their important roles in the new billing scheme.

A report in the May 10, 2014 HIT Consultant e-Newsletter stated that 44 percent of physicians were uncertain whether or not they would have been ready for the October 2014 deadline, according to the 2014 Practice Profitability Index (PPI). In fact, another 25 percent were certain they would not have been prepared to face the transition and the ICD-10 upgrade costs.

Hospitals and medical practice groups of all sizes should be focusing on physicians and their documentation of patient care as a major aspect of how to prepare for ICD-10. Experts recommend that each healthcare entity select an ICD-10 champion from within their current staff. If possible, there should be a champion from each specialty area in a multi-specialty practice or a hospital’s medical staff in order to concentrate on how to prepare for ICD-10 within that specific area of medicine. 

Champions should be trained in the codes for their specialty area and documentation requirements to support the billing codes. They need to be willing to convey to their peers thevalue of the documentation and how it relates to proper reimbursement.

Physicians respond best when other physicians are the ones educating them on how to improve their documentation.  They are not interested in codes, but are primarily interested in providing the highest level of patient care possible. Champions can convey to their peers the connection between ICD-10 codes and how more specific documentation can improve patient care. With emphasis on patient care instead of coding, physicians will be more receptive to the change.

Champions can increase motivation of providers by emphasizing the positives of the new system, including more timely and accurate payments, fewer claim denials or returns for more information and improved patient care based on the documentation. A physician champion can engage their peers into viewing the new ICD-10 codes as management tools for improving patient care, instead of simply a burdensome bureaucratic requirement for getting paid.

Having a physician champion on your ICD-10 team will make your transition efforts easier and more successful.

Tags: ICD-10, Clinical Documentation Improvement (CDI)

How CDI Can Improve Your Cash Flow

Posted on Wed, May 28, 2014 @ 09:01 AM

The switch to ICD-10 is delayed, but not abated. With the new implementation date of OctoberIncrease cash flow 1, 2015 will your organization be ready for the best possible transition? The best place to start is by analyzing your clinical documentation improvement (CDI) program to determine the quality of documentation. Consider using you coder and case managers to identify educational opportunities for physicians and areas for improvement. Specifically, enlist the assistance of your case managers to focus on documentation trends across the board, and work with physicians who are your largest admitters.

Documentation improvement initiatives can be conducted parallel to coder education for ICD-10 preparation. Throughout the next 12 months, conduct coder gap analyses to determine strengths and weaknesses. Coders will need deep knowledge in anatomy and physiology, medical terminology, pathophysiology, and pharmacology. Your case managers should also be included in this assessment.

Multiple new mandates, including ICD-10, RAC, Medical Necessity and pay-for-performance are making accurate clinical documentation more important than ever, and the growth in volumes resulting from the ACA are impacting all organizations. Your ability to get reimbursed is directly dependent on the quality of your clinical documentation. As you are well aware, missing, poor, or non-specific clinical documentation will result in lost revenue.

You can be prepared to mitigate this loss by engaging professional CDI specialists. These professionals are credentialed, highly-trained, and they can ensure your documentation is ready for the transition to ICD-10.  Whether you use these CDI professionals to assess your program or supplement your staff, they can help you develop, improve, and maintain your clinical documentation. They can quickly get you “up to speed” with the interim or permanent CDI professionals you need. These highly skilled and experienced CDI professionals can fit seamlessly into your current program. 

Tags: ICD-10, Clinical Documentation Improvement (CDI)

The Key To A Good Night's Rest...

Posted on Wed, May 21, 2014 @ 06:23 AM

Good Sleep PhotoNow that the transition date for ICD-10 has been finalized – again! Don’t let concerns about severe reductions, or even the complete stoppage of your revenue stream caused by potential ICD-10 coding errors and slowdowns in your coding productivity keep you awake at night.

There are reasons to be concerned, but proper preparations can assuage them. Early ICD-10 test results reported in Becker’s Hospital Review from data gathered by HIMSS and WEDI indicate that only 63% of ICD-10 documentation was accurately coded.   In addition, coders averaged only two medical records per hour, compared with four per hour under ICD-9, which equates to a 50 percent drop in productivity.

There is hope and a good night’s rest – if you are prepared!

CMS officials are saying that good preparation and planning can keep providers’ accounts receivable from shutting down completely during the transition to ICD-10. The agency knows there are going to be claim denials, but they also contend there are ways to avoid many of them.

Include CMS policies in your plan. To deal with this critical change management, select a key person within your organization to be in charge of your ICD-10 staff training and education well in advance of the transition deadline.

Education on ICD-10 is going to be critical. Specialty associations, such as AHIMA, AMA, MGMA, HIMSS and several billing associations will be offering training programs and information. Take advantage of these opportunities. Every organization is going to need extensive education and training. The learning curve is going to be tremendous. Targeted, online educational programs that your staff members can access any place they have Internet availability will impact their daily productivity the least.

Industry webinars sponsored by various associations will focus on specific aspects of the ICD-10 transition. Monitor the topics of these webinars and ensure your staff members attend the appropriate ones. In addition, make sure the educational opportunities your staff attends are led and designed by true industry subject matter experts. There are going to be many educational opportunities offered in the next six month – select the ones that will provide your organization with the most return for time expended. If you select a customized educational program, ensure it is designed to maximize content retention, while minimizing interruptions to your staffing productivity.

What’s your take on ICD-10 education and training? We would like to hear from you.

Tags: ICD-10, Clinical Documentation Improvement (CDI)

How ICD-10 Can Lead To An Improvement In Patient Care

Posted on Thu, May 15, 2014 @ 07:33 AM

Doctor CoverFor all the negative press ICD-10 has gotten over the past few years, it has the potential to have a tremendously positive impact on the quality of patient care. The new system will require more accurate clinical documentation, increase the amount of data collected, improve quality measurements, streamline claims processing, and ultimately improve the quality of care provided to patients.

The new implementation date of ICD-10 October 1, 2015 will be important because it will provide updated terminology and increased specificity in a variety of areas, which ICD-9 does not currently provide. Most critical is the need to replace the ICD-9 procedure classification, which is outdated, can no longer be expanded, and is unable to keep pace with advances in medicine or medical technology, as well as demands for increasingly detailed healthcare data.

In addition, the enhanced specificity of ICD-10 provides assistance with delineating clinical populations. The expanded codes more effectively capture data about signs, symptoms, risk factors, time frames, laterality (left vs. right), complications, and comorbidities. The system also differentiates body types, procedure types, surgical approaches, and devices used in treatments.

The implementation of ICD-10 offers many quality benefits. The additional granularity of data collection and detail will require improved clinical documentation and care decisions, facilitate ongoing performance improvement, enhance evaluations of population health, and enable comparisons across the continuum of care.

The transition to ICD-10 in 2015 presents a perfect opportunity to establish a clinical documentation improvement (CDI) process at your facility, if you do not have one underway already. Following are some areas on which to focus your CDI:

Laterality: A renewed emphasis on laterality within documentation under ICD-10 is intended to enhance communication between providers as they formulate each patient’s story; all of the complexities and factors affecting the care of the patient are expected to be recorded. The goal is to improve the quality of care provided to the patient.

Disease pathophysiology: Disease pathophysiology, or the study of ongoing changes in the disease state, is much more detailed in the ICD-10 disease descriptions. Documentation must reflect the highest level of known pathophysiology for diseases so that CDI specialists can identify the most accurate level of severity.

Combination codes: Combination codes have been created to merge two diagnoses that typically are related to one another. In ICD-10, this means some codes now have six options, whereas they had one or two options previously under ICD-9.

Encounter timing: ICD-10-CM requires documentation of the type of treatment that is rendered for specific conditions, such as injuries, signs and symptoms, and external causes of morbidity. Stage of care is also a critical element of this documentation.

Identification of trimester in ICD-10: For obstetrics clinicians, new definitions of trimesters have been introduced. In addition, each episode of care must be reported along with the patient’s trimester.

Increased disease specificity: ICD-10-CM has expanded many code descriptions to connect complications and manifestations with conditions.

Alcohol and drug abuse: ICD-10 has clarified the way alcohol and drug abuse and dependence should be documented to mitigate confusion when attempting to accurately represent the patient’s condition. This will include effects, aspects, and manifestations of substance abuse.

Expansion of injury codes: Documentation of the sites and types of injuries will be required in ICD-10.

Post-procedural disorders: ICD-10-CM requires documentation to indicate if a condition or disorder is caused by or follows a procedure. Every physician needs to clearly state if a procedure caused a negative impact to a patient’s condition.

Documentation practices will be the primary driver for success in ICD-10. There will be significant changes required in clinical documentation, specifically in the areas of disease specificity, anatomical site and laterality, complication and manifestations, obstetrics, and correct use of medical terminology and naming. Providers must adhere to these changes to increase the specificity of the codes as well as decrease the potential for coding errors and unpaid claims that could impact reimbursement or quality of care.

Training is the key to preparedness for ICD-10 in 2015. Training your clinicians and providers on the code specificity is the first critical step in preparing for this transition. Your education programs should be well underway to ensure that your staff members are educated on the appropriate anatomy, physiology, and level of ICD-10-CM/PCS training required for each member’s role and work setting. October 2015 will be here before you know it!

 

Tags: ICD-10, Clinical Documentation Improvement (CDI)

Our Forward Thinking Series On Preparing For The ICD-10 Transition

Posted on Tue, Mar 11, 2014 @ 10:08 AM

Forward thinkingMost healthcare providers we talk to are worried (or at least concerned) about severe reductions, or even the complete stoppage, of their revenue streams caused by potential ICD-10 coding errors and slowdowns in their coding workflows – and rightly so! The transition to ICD-10 has the potential to produce a tremendous backlog of insurance claims.

The proper coding of medical documentation lies at the very heart of every healthcare provider’s revenue cycle. Accuracy of this coding is paramount. The efficiency of it is essential, and its timeliness is critical. Failure, even on the smallest scale, in any of these areas will significantly impact your bottom line.

The obvious end-goal for every healthcare provider -- during this transition -- should be to ensure there is NO reduction or stoppage of their revenue stream. The challenge is how to achieve that goal.

In a series of upcoming blogs, we are going to share with you some best practices for achieving this goal. If you already have these strategies in place, congratulations! If you do not, please feel free to adopt any or all of the strategies that we will discuss over the next few weeks. Our goal is to see a strong U.S. healthcare delivery system come out of this momentous transition -- unscathed.

Our upcoming blogs will address:

  • How to develop and execute a strategic plan of action
  • The specific strategies that need to be executed
  • Staff education and training activities
  • The importance of CDI and how to accomplish it
  • Dual coding and why it’s important
  • Adding outsourced coding expertise to get you through the transition
  • Using some form of ICD-10 computer-assisted coding (CAC) technology
  • Employing outside auditing assistance to ensure/validate you are READY

Feel free to join in our conversation with your comments any time you want.

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Tags: ICD-10, Clinical Documentation Improvement (CDI), Medical Coding

Don’t Overlook Clinical Documentation in Your ICD-10 Preparations

Posted on Tue, Nov 26, 2013 @ 10:29 AM

Is your clinical documentation ready for ICD-10? CMS has prepared a guide called Simple Steps to Improve Clinical Documentation; it’s worth your time to review it.

This little document is good place to start your preparation for ICD-10 implementation activities. By improving clinical documentation now, you will be ready to assign ICD-10 codes when the deadline hits.

Your time won’t be wasted between now and Oct. 1, 2014, and you will realize the following benefits:

  • Complete and accurate medical records that ensure patients receive the right treatment.
  • Your coders will be assigning the proper medical codes which will lead to fewer physician queries and improved medical billing and clinical workflows.
  • Fewer claims rejections because of improper coding and not enough documentation to support diagnoses.
  • Improved clinical documentation that makes it easier to protect against healthcare fraud and disputed fraud charges.

Practice ICD-10 coding with real cases. This will help everyone -- from the office staff to clinicians to medical coders -- understand where current documentation falls short. Dual coding will be a time-consuming and expensive exercise but a valuable way to demonstrate your CDI needs.

In addition, clinical documentation improvement (CDI) makes computer-assisted coding (CAC) systems work more efficiently. Enlisting technology to help you on your ICD-10 journey just makes sense. CAC is a proven technology that automatically derives and assigns medical codes from within clinical documentation. Many are already ICD-10-ready.

Your organizations can streamline your CDI and revenue cycle processes with CAC, while becoming increasingly more compliant with the requirements of payer and quality reporting.  These technologies can work with your electronic health record and financial systems to produce extremely accurate coding. These systems don’t replace your professional coders; they just aid them and ensure improved: accuracy, compliance, productivity and consistency.  How to improve clinical documentation

If you're creating a formal CDI plan, according to HIMSS, there are five key steps you need to take to improve your clinical documentation:

  • Assess documentation for ICD-10 readiness.
  • Analyze the impact on claims.
  • Implement early clinician education.
  • Establish a concurrent documentation review program.
  • Streamline clinical documentation workflow.

The time to start you CDI is NOW; your facility should avail itself to every resource possible to be ready for the October 1, 2014 deadline.

Tags: ICD-10, Clinical Documentation Improvement (CDI), Medical Coding