Revenue Integrity Boot Camp Coding...Revenue Integrity Boot Camp Coding Annie Lee Sallee MBA, RHIT, CPC, CPMA AHIMA Approved ICD-10-CM/PCS Trainer Revenue Cycle Education Specialist

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© 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)


Agenda

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� Defining Coding Standards

� Provisional or Concurrent Coding

� DRG Assignment

� Productivity Standards

� Define takeaways

� Ready, set, Drill Time!


Revenue Integrity Boot Camp

Coding

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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.”

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Coding

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Coding Standards



Coding

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Coding Standards

Inpatient Coding

� Coding

� Discharge Summaries and Coding

� OP note best practices

� Querying



Coding

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Coding Standards

Same Day Surgery

� Coding

� OP note

� Hard coded vs. soft coded

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Coding

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Coding Standards

Observation Coding

� Coding ED to OBS

� Injections and Infusions

� Modifiers



Coding

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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



CDI/Coding

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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

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Coding

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Coding Standards

PRO FEE side coding

• Physician participation (or presence)

• Mid-level involvement

• Signature requirements

• Documentation completion



Coding

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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



Coding

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• 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


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Coding

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• 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




CDI/Coding

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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



Coding

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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

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Coding

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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



Coding

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Work it out!!



Coding

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Provisional or Concurrent Coding

DischargeConcurrent

Coding Admission

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Coding

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Let’s discuss the types of coding

� Admission Coding

� Concurrent Coding

� Retrospective Coding



Coding

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What is concurrent coding?

What are the benefits?



Coding

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The Anticipated DRG will drive:

- Plan for Stay

- Plan for Anticipated Date of Discharge

(based on GLOS)

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Coding

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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



Coding

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Challenges of Concurrent Coding

� Requires additional staff (CDI/Coding)



Coding

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DRG Assignment

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Coding

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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


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.


Coding



Coding

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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

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CDI/Coding

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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.



Coding

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Defining Productivity Standards



Coding

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Why is productivity standards so important?

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Coding

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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



Coding

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Same Day Surgery


� Types of SDS coding


� Variances when looking at hard vs. soft coding




Coding

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Observation


� Types of OBS coding



� Charge entry


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Coding

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Emergency Department


� Types of ED coding



� Charge entry



Coding

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Outpatients Lab/RAD coding


� Types of OP coding




Coding

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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

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Coding

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� Benchmark survey

� Benchmark surveys with frequency

� Communicating the benchmark survey findings



Coding

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Impacts

� Data Entry requirements

� Abstracting requirements

� Systems

� Pending Excessively

� Questions to ask



Coding

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Tracking time

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Coding

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Coding

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Tracking Coding daily

Date: Number Coded Time Spent Coding

(total hours/minutes)

Inpatient Coded

SDS Coded

Observation Coded

Emergency Department Coded

Ancillary Records Coded



Coding

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Cool Down…

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Coding

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Defining Takeaways



Coding

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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!



Coding

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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

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Coding

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Defining Takeaways

DRG Assignment

� Understand the purpose and uses of DRGs

� Ensure proper diagnosis coding



Coding

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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


Learning Outcomes

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� Defining Coding Standards

� Provisional or Concurrent Coding

� DRG Assignment

� Productivity Standards

� Define takeaways

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CDI/Coding

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READY….

SET…….

LET’s DRILL!!


QUESTIONS?

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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.”

Documents

Revenue Integrity Boot Camp Coding...Revenue Integrity Boot Camp Coding Annie Lee Sallee MBA, RHIT, CPC, CPMA AHIMA Approved ICD-10-CM/PCS Trainer Revenue Cycle Education Specialist