Provider services and solutions

Financial performance: Coding and documentation

The challenge

Accurate coding and documentation is often thwarted by the difficulty of compliance with ever-changing payer mandates. Yet fair payment requires accurate coding. Accurate coding requires good documentation. Mistakes can result in delayed or denied payments. Now comes the latest round of coding complexity: ICD-10 (International Classification of Diseases, 10^th revision). ICD-10 massively overhauls the current HIPAA-approved system of coding for diagnoses, services and procedures. Complying with ICD-10 coding requirements—which will become mandatory in 2013—will necessitate a huge effort throughout your entire organization. You will need to re-engineer your clinical and business processes. Upgrade your information technology and infrastructure.

New coding requirements and electronic claims systems are driving an industry-wide move toward electronic health records and better sharing of patient and claims data across your enterprise. At the same time, patients demand tighter protection of personally identifiable information. You need a health information management (HIM) system capable of integrating coding processes across different functional units capable of sharing patient information while preventing unauthorized access to it.

Recovery Audit Contractors (RACs) are focused on recouping inaccurate payments on a retrospective basis. Mitigate future RAC exposure by evaluating current processes, practices and infrastructure that are integral to the underlying issues of the RAC initiative.

How we can help you

• Managing health information successfully depends on accurate coding and clinical documentation, strong internal controls, and an information infrastructure able to support both. We have developed a suite of software applications, SMART ENTERPRISE that can analyze your coded data to improve your accuracy, help you manage your health information for greater benefit and track your documentation improvement efforts. These tools are designed to support our coding and documentation services. Our SMART coding accuracy software incorporates the Office of the Inspector General’s elements of effective compliance.
  
  SMART ENTERPRISE includes SMART Inpatient, SMART Outpatient and DOC TRAC. SMART provides the ability to:
  • Flag cases and visits identified by system edits that may have coding inaccuracies
  • Document findings of flagged case reviews
  • Correct inaccurate coding prior to billing
  • Analyze recovery audit contractor identified issues
  • Select focused samples for coding review
  • Compare ICD-9-CM and CPT-4 coding against MedPar national and regional benchmarks
  • Analyze trends in case- and service-mix indices
  • Analyze trends in MS-DRGs and APGs to improve coding accuracy and compliance
  • Use a reporting capability to drill time for further analysis or report trends to other stakeholders
  
  DOC TRAC provides the ability to:
  • Collect and measure documentation improvement outcomes
  • Link to SMART on the back end
  • Link to an ADT feed
  • Automate physician queries for systemic notification and escalation
  • Report on productivity of clinical documentation specialists and physician clarification and effectiveness

Common services include

• Implementing the transformation to ICD-10 coding requirements
• Analyzing patient and coding information to improve coding accuracy and manage health information for greater benefit
• Assessing the adequacy of current documentation and developing and implementing programs to improve and monitor documentation
• Assessing RAC preparedness and developing a RAC appeals strategy
• Coding, billing and clinical documentation improvement process redesign