CODING COMPLIANCE

October 18, 2002

Shana K. Wolfe, CHC, CMA

Director of Business Integrity

Washington County Health System, Inc.

HistoryCoding not the basis for payment in 1965 (beginning of Medicare)

Patient volume and costs have climbed steadily

For-profit hospital chains have changed the landscapeManaged care and focus on cost containmentDRG system in 1983, then APC system in 2000

GREED!!!

Number and types of clinical interventions has skyrocketed

CasesPneumonia

Chest Pain

TIA/CVA

Cases w/cc vs. w/o cc

ConsequencesPersonal career impact

Financial loses to hospitals from fines and penalties

BIG public relations nightmare!

Expensive corrective strategies if placed under CIA

ResourcesAHIMA Standards of Ethical Coding

Guidelines of four Cooperating Parties – AHA, AHIMA, CMS, NCHS

UHDDS

Updated AHA Coding Clinics

Compliance programs and OIG guidance

Peer Review Organization Manual, section 4130 – DRG Validation Reviews

Personal ResponsibilityAdherence to Code of Ethics

QUERY PHYSICIANS!!

Participate in documentation improvement projects

The “big shots” go to jail, not coders (unless there is an incentive plan tied to CMI)

Preventative StrategiesSupport coder credentialing and

continuing education

Consider internal coding peer review

Utilize periodic third-party coding reviews

Profile your hospital coding patterns to state/nation

Monitor your hospital’s CMI

Develop a coding compliance policy

Consider a documentation specialist for coding support

Thank you for your time and attention. Any questions?