Revenue Integrity Boot
Camp
Coding
Annie Lee Sallee MBA, RHIT, CPC, CPMA
AHIMA Approved ICD-10-CM/PCS Trainer
Revenue Cycle Education Specialist
Home Town Health
Jenan Custer CPC, CCS
AHIMA Approved ICD-10-CM/PCS Trainer and Ambassador
Director of Coding
Healthcare Coding and Consulting Services (HCCS)
© 2014 Healthcare Coding and Consulting Services
Agenda
Defining Coding Standards
Provisional or Concurrent Coding
DRG Assignment
Productivity Standards
Define takeaways
Ready, set, Drill Time!
2
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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.”
© 2014 Healthcare Coding and Consulting Services
3
1
Revenue Integrity Boot Camp
Coding
Coding Standards
4
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Coding Standards
Inpatient Coding
Coding
Discharge Summaries and Coding
OP note best practices
Querying
© 2014 Healthcare Coding and Consulting Services
5
Revenue Integrity Boot Camp
Coding
Coding Standards
Same Day Surgery
Coding
OP note
Hard coded vs. soft coded
© 2014 Healthcare Coding and Consulting Services
6
2
Revenue Integrity Boot Camp
Coding
Coding Standards
Observation Coding
Coding ED to OBS
Injections and Infusions
Modifiers
7
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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
8
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
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
© 2014 Healthcare Coding and Consulting Services
9
3
Revenue Integrity Boot Camp
Coding
Coding Standards
PRO FEE side coding
• Physician participation (or presence)
• Mid-level involvement
• Signature requirements
• Documentation completion
10
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Coding Standards
AHIMA 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
11
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Coding Standards
AHIMA 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
© 2014 Healthcare Coding and Consulting Services
12
4
Revenue Integrity Boot Camp
Coding
Coding Standards
AHIMA 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
13
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
CDI/Coding
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
14
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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
© 2014 Healthcare Coding and Consulting Services
15
5
Revenue Integrity Boot Camp
Coding
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
16
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Work it out!!
17
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Provisional or Concurrent Coding
Admission
© 2014 Healthcare Coding and Consulting Services
Concurrent
Coding
Discharge
18
6
Revenue Integrity Boot Camp
Coding
Provisional or Concurrent Coding
Let’s discuss the types of coding
Admission Coding
Concurrent Coding
Retrospective Coding
© 2014 Healthcare Coding and Consulting Services
19
Revenue Integrity Boot Camp
Coding
Provisional or Concurrent Coding
What is concurrent coding?
What are the benefits?
© 2014 Healthcare Coding and Consulting Services
20
Revenue Integrity Boot Camp
Coding
Provisional or Concurrent Coding
The Anticipated DRG will drive:
- Plan for Stay
- Plan for Anticipated Date of Discharge
(based on GLOS)
© 2014 Healthcare Coding and Consulting Services
21
7
Revenue Integrity Boot Camp
Coding
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
22
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Provisional or Concurrent Coding
Challenges of Concurrent Coding
Requires additional staff (CDI/Coding)
23
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
DRG Assignment
© 2014 Healthcare Coding and Consulting Services
24
8
Revenue Integrity Boot Camp
Coding
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
25
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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.
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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
27
© 2014 Healthcare Coding and Consulting Services
9
Revenue Integrity Boot Camp
CDI/Coding
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
28
begin with.
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
© 2014 Healthcare Coding and Consulting Services
29
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
Why is productivity standards so important?
© 2014 Healthcare Coding and Consulting Services
30
10
Revenue Integrity Boot Camp
Coding
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
31
Revenue Integrity Boot Camp
Coding
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
32
Revenue Integrity Boot Camp
Coding
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
© 2014 Healthcare Coding and Consulting Services
33
11
Revenue Integrity Boot Camp
Coding
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
34
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
Outpatients Lab/RAD coding
Industry standard
Types of OP coding
Variances in systems
© 2014 Healthcare Coding and Consulting Services
35
Revenue Integrity Boot Camp
Coding
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
© 2014 Healthcare Coding and Consulting Services
36
12
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
Benchmark survey
Benchmark surveys with frequency
Communicating the benchmark survey findings
© 2014 Healthcare Coding and Consulting Services
37
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
Impacts
Data Entry requirements
Abstracting requirements
Systems
Pending Excessively
Questions to ask
© 2014 Healthcare Coding and Consulting Services
38
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
Tracking time
© 2014 Healthcare Coding and Consulting Services
39
13
Revenue Integrity Boot Camp
Coding
Defining Productivity Standards
40
© 2014 Healthcare Coding and Consulting Services
Revenue Integrity Boot Camp
Coding
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
41
Revenue Integrity Boot Camp
Coding
Cool Down…
© 2014 Healthcare Coding and Consulting Services
42
14
Revenue Integrity Boot Camp
Coding
Defining Takeaways
© 2014 Healthcare Coding and Consulting Services
43
Revenue Integrity Boot Camp
Coding
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
44
Revenue Integrity Boot Camp
Coding
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
© 2014 Healthcare Coding and Consulting Services
45
15
Revenue Integrity Boot Camp
Coding
Defining Takeaways
DRG Assignment
Understand the purpose and uses of DRGs
Ensure proper diagnosis coding
© 2014 Healthcare Coding and Consulting Services
46
Revenue Integrity Boot Camp
Coding
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
47
Learning Outcomes
Defining Coding Standards
Provisional or Concurrent Coding
DRG Assignment
Productivity Standards
Define takeaways
© 2014 Healthcare Coding and Consulting Services
48
16
Revenue Integrity Boot Camp
CDI/Coding
READY….
SET…….
LET’s DRILL!!
49
© 2014 Healthcare Coding and Consulting Services
QUESTIONS?
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.”
© 2014 Healthcare Coding and Consulting Services
50
17