Post on 10-Jul-2020
1
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot
Camp
Coding Annie Lee Sallee MBA, RHIT, CPC, CPMAAHIMA Approved ICD-10-CM/PCS Trainer Revenue Cycle Education Specialist Home Town Health
Jenan Custer CPC, CCSAHIMA Approved ICD-10-CM/PCS Trainer and AmbassadorDirector of Coding Healthcare Coding and Consulting Services (HCCS)
© 2014 Healthcare Coding and Consulting Services
Agenda
2
� Defining Coding Standards
� Provisional or Concurrent Coding
� DRG Assignment
� Productivity Standards
� Define takeaways
� Ready, set, Drill Time!
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
3
Warm up time!
Home Town Health Drill Instructor Creed
“These recruits are entrusted to our care. We will train them and share our knowledge. We
will provide all the tools from a coding aspect to help develop a disciplined and fit Revenue
Integrity Process . The recruits will be fully indoctrinated in all things coding. We will
demand of them and demonstrate by our example, the highest standards of professional
skill set.”
2
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
4
Coding Standards
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
5
Coding Standards
Inpatient Coding
� Coding
� Discharge Summaries and Coding
� OP note best practices
� Querying
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
6
Coding Standards
Same Day Surgery
� Coding
� OP note
� Hard coded vs. soft coded
3
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
7
Coding Standards
Observation Coding
� Coding ED to OBS
� Injections and Infusions
� Modifiers
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
8
Coding Standards
Emergency Department Coding
� Coding/Charging ED Admissions
� Coding ED discharges
� Modifiers, who is doing what
� Charge entry, stream lining processes
� Looking at what is being hard coded
� Communication of documentation issues
� Compliant Querying
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
9
Coding Standards
Outpatient Lab/RAD coding
� Compliant orders
� What about the reports?
� Thinking about reimbursement
� Coding from other physicians (i.e. Radiologists)
� Other documentation (i.e. nursing)
� Knowing your rules and guidance
4
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
10
Coding Standards
PRO FEE side coding
• Physician participation (or presence)
• Mid-level involvement
• Signature requirements
• Documentation completion
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
11
Coding StandardsAHIMA Standards of Ethical Coding
• Coding professionals should: Apply accurate, complete, and
consistent coding practices for the production of high-quality
healthcare data.
• Report all healthcare data elements (e.g. diagnosis and procedure
codes, present on admission indicator, discharge status) required for
external reporting purposes (e.g. reimbursement and other
administrative uses, population health, quality and patient safety
measurement, and research) completely and accurately, in accordance
with regulatory and documentation standards and requirements and
applicable official coding conventions, rules, and guidelines.
American Health Information Management Association Standards of Ethical Coding. (2008, January 1). Retrieved February 26, 2015, from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2_001166.hcsp?dDocName=bok2_001166
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
12
Coding StandardsAHIMA Standards of Ethical Coding
• Assign and report only the codes and data that are clearly and consistently supported
by health record documentation in accordance with applicable code set and abstraction
conventions, rules, and guidelines.
• Query provider (physician or other qualified healthcare practitioner) for clarification
and additional documentation prior to code assignment when there is conflicting,
incomplete, or ambiguous information in the health record regarding a significant
reportable condition or procedure or other reportable data element dependent on
health record documentation (e.g. present on admission indicator).
• Refuse to change reported codes or the narratives of codes so that meanings are
misrepresented.
• Refuse to participate in or support coding or documentation practices intended to
inappropriately increase payment, qualify for insurance policy coverage, or skew data by
means that do not comply with federal and state statutes, regulations and official rules
and guidelines.American Health Information Management Association Standards of Ethical Coding. (2008, January 1). Retrieved February 26, 2015, from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2_001166.hcsp?dDocName=bok2_001166
5
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
13
Coding StandardsAHIMA Standards of Ethical Coding
• Facilitate interdisciplinary collaboration in situations supporting proper coding
practices.
• Advance coding knowledge and practice through continuing education.
• Refuse to participate in or conceal unethical coding or abstraction practices or
procedures.
• Protect the confidentiality of the health record at all times and refuse to access
protected health information not required for coding-related activities ( examples of
coding-related activities include completion of code assignment, other health record
data abstraction, coding audits, and educational purposes).
• Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal
coding practices, and fosters trust in professional activities.
American Health Information Management Association Standards of Ethical Coding. (2008, January 1). Retrieved February 26, 2015, from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2_001166.hcsp?dDocName=bok2_001166
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
14
Coding Standards
Coding Source Guidance (naming a few)
� AHA Coding Clinics
� CPT Assistants
� CMS and Local FI/MACS
� Coding Desk Reference (CM/PCS/CPT)
� ICD-9/10 CM and PCS Coding Guidelines
� CPT Coding Guidelines
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
15
Coding Standards
Credentials (naming a few) � CCA (AHIMA)
� CCS (AHIMA)
� CCS-P (AHIMA)
� RHIT (AHIMA)
� RHIA (AHIMA)
� CPC-A (AAPC)
� CPC (AAPC)
� CPC-H (AAPC)
� Why they are important in Coding Standards
6
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
16
Coding Standards
Standards: Credentialed Coders Why they are important in Coding Standards� Quality data
� More accurate payments
� Compliant Coding
� A better understanding of new procedures
� Improved disease management correct code capture
� Fewer miscoded, rejected, and improper reimbursement claims
� A better understanding of health outcomes
� Continuum of education through credentials
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
17
Work it out!!
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
18
Provisional or Concurrent Coding
DischargeConcurrent
Coding Admission
7
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
19
Provisional or Concurrent Coding
Let’s discuss the types of coding
� Admission Coding
� Concurrent Coding
� Retrospective Coding
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
20
Provisional or Concurrent Coding
What is concurrent coding?
What are the benefits?
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
21
Provisional or Concurrent Coding
The Anticipated DRG will drive:
- Plan for Stay
- Plan for Anticipated Date of Discharge
(based on GLOS)
8
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
22
Provisional or Concurrent Coding
According to a recent CDI poll on the ACDIS website, only 13% of nearly 170 respondents perform concurrent coding at their facility. The bulk of respondents (50%) indicated they do some concurrent coding primarily in order to assign a working MS-DRG, but coders perform coding retrospectively
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
23
Provisional or Concurrent Coding
Challenges of Concurrent Coding
� Requires additional staff (CDI/Coding)
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
24
DRG Assignment
9
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
25
DRG Assignment
Diagnosis-related group (DRG) is a system to classify hospital
cases.
Factors that affect the cost of delivering care:
� Severity of illness
� Risk of mortality
� Prognosis
� Treatment difficulty
� Need for intervention
� Resource intensity
© 2014 Healthcare Coding and Consulting Services
DRG Assignment
Classified by up to 8 diagnoses in addition to the primary
diagnosis & up to 6 procedures performed during one stay
as well as patient demographics.
Reimbursement
• PPS: Reimbursed at a fixed rate based on DRG.
• CAH: Reimbursed at 101% of reasonable cost for facility
charges.
• IP claims reimbursed at charges x interim rate after
deductible and coinsurance.
• CAH fully cost reimbursed on cost report settlement.
Revenue Integrity Boot Camp
Coding
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
27
DRG Assignment
Why are DRGs important to CAHs?
DRGs = ICD-9 diagnoses & procedure codes
Charges = Revenue codes & HCPCS/CPT codes as
well as ICD-9 procedure codes
10
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
28
Uses of DRGs
• Reimbursement
• Evaluation of quality of care
• Evaluation of the utilization of services
Diagnoses support medical necessity and gives the
entire reason for why a patient is at your facility to
begin with.
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
29
Defining Productivity Standards
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
30
Defining Productivity Standards
Why is productivity standards so important?
11
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
31
Defining Productivity Standards
Inpatient Coding
� Industry standard
� Types of IP coding
� CMI and why it is important
� Variances in systems
� Variances in HD versus Low dollar
� Querying impacts
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
32
Defining Productivity Standards
Same Day Surgery
� Industry standard
� Types of SDS coding
� Variances in systems
� Variances when looking at hard vs. soft coding
� Querying impacts
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
33
Defining Productivity Standards
Observation
� Industry standard
� Types of OBS coding
� Variances in systems
� Variances when looking at hard vs. soft coding
� Charge entry
� Querying impacts
12
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
34
Defining Productivity Standards
Emergency Department
� Industry standard
� Types of ED coding
� Variances in systems
� Variances when looking at hard vs. soft coding
� Charge entry
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
35
Defining Productivity Standards
Outpatients Lab/RAD coding
� Industry standard
� Types of OP coding
� Variances in systems
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
36
Defining Productivity Standards
Professional Coding
• Industry standard Types of Professional service • E/M, Surgical, Pathology, Radiology, Diagnostic tests or medical
services
• Charge Lag
• Variances in systems
• Charge entry vs. Code extraction/documentation
completion
13
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
37
Defining Productivity Standards
� Benchmark survey
� Benchmark surveys with frequency
� Communicating the benchmark survey findings
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
38
Defining Productivity Standards
Impacts
� Data Entry requirements
� Abstracting requirements
� Systems
� Pending Excessively
� Questions to ask
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
39
Defining Productivity Standards
Tracking time
14
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
40
Defining Productivity Standards
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
41
Defining Productivity Standards
Tracking Coding daily
Date: Number Coded Time Spent Coding
(total hours/minutes)
Inpatient Coded
SDS Coded
Observation Coded
Emergency Department Coded
Ancillary Records Coded
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
42
Cool Down…
15
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
43
Defining Takeaways
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
44
Defining Takeaways
Coding Standards
� Establish ground rules by chart type
� State the Coding mission to all stakeholders
� Identify coding requirements
� Look at current processes and identify barriers
� Collect data
� Identify possible solutions by brainstorming
� Make changes in your coding process!
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
45
Defining Takeaways
Provisional/Concurrent Coding
� See if concurrent is right for your facility
� Do you have the resources
� Is there benefits your facility can obtain with
concurrent coding
16
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
46
Defining Takeaways
DRG Assignment
� Understand the purpose and uses of DRGs
� Ensure proper diagnosis coding
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
47
Defining Takeaways
Productivity
� Identify current process
� Benchmark
� Consolidate tasks and responsibilities
� Identify opportunity areas
� Define Standards to staff
� Define who monitors weekly/daily
� Reiterate quality standards
© 2014 Healthcare Coding and Consulting Services
Learning Outcomes
48
� Defining Coding Standards
� Provisional or Concurrent Coding
� DRG Assignment
� Productivity Standards
� Define takeaways
17
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
49
READY….
SET…….
LET’s DRILL!!
© 2014 Healthcare Coding and Consulting Services
QUESTIONS?
50
Home Town Health Drill Instructor Creed“These recruits are entrusted to our care. We will train them and share our knowledge. We will provide all the tools from a coding aspect to help develop a disciplined and fit Revenue Integrity Process . The recruits will be fully indoctrinated in all things coding. We will demand of them and demonstrate by our example, the highest standards of professional skill set.”