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Free MHIMA Member Webinar

Please join us for a FREE MHIMA member webinar on September 27th. 

Session Details 
Date: Friday, September 27th, 2019 
Time: 12:00 PM – 1:00 PM 
Topic: How Provider Documentation Impacts Coding and Reimbursement 
Presenter: Kelley Haddox, RHIT, CCS, NPB 

About the Presenter 
Kelley Haddox, RHIT, CCS, NPB is a manager in client auditing with over 30 years of coding and supervisory experience. She is responsible for managing single and multiple facility client audits as well as the auditing colleagues assigned to the audits, beginning with the transition from the business development service through delivery and explanation of the audit reports. 
  • Responsible for RAC denial secondary reviews. 
  • Coordinates and participates in orientation and mentoring schedules for new colleagues. 
  • Uses her expertise by serving as a subject matter expert performing medical record coding and documentation reviews. 
  • Performs coding and documentation assessments for inpatient and outpatient records, including Emergency Department, Outpatient Surgery, Clinics, Diagnostic Services, Observation Professional Fee, and other outpatient services. 
Prior Healthcare Experience
  • Served as a corporate coding manager for a corporation with over 40 hospitals, which included auditing and mentoring coders. 
  • Set up remote coding for several facilities with a large hospital corporation. 
  • Performed and managed inpatient DRG coding assessments for compliance, appropriate reimbursement, coding quality , hospital acquired conditions (HAC), present on admission indicators (POA), discharge dispositions, and clinical documentation. 
  • Performed and managed Emergency Department, Outpatient Surgery, Clinics, Diagnostic Services, Observation, and other outpatient services coding assessments. 
  • Performed and managed professional fee facility and provider assessments. 
  • Managed an on-site and remote retrospective HCC review project for a division of a large national healthcare corporation, with an end result of greater than expected projected financial impact. 
  • Created and provided in-depth monthly education for a large multi-facility health system including pertinent anatomy, pathophysiology, and coding guidelines. 
  • Performed professional fee ticket review with updates and revisions, as well as physician education on fee ticket completion. 
  • Reviewed, corrected, and updated the ICD-9-CM diagnosis and CPT procedure data dictionaries for a division of a large national healthcare corporation. 

About the Presentation 

Title: How Provider Documentation Impacts Coding and Reimbursement 

Summary: Medical billing and coding are integral for health care revenue cycle processes. They are the cornerstone of the health care revenue cycle as reimbursement is primarily based on accurate coding. The new era of health care requires renewed focus on ensuring that patient records are as accurate as possible. Clinical Documentation Improvement (CDI) in hospitals is key to achieving this goal. Quality measure initiatives, health care reform-related financial penalties, and missed revenue optimization are issues that warrant a coordinated effort to improve clinical documentation. Understanding and addressing the root causes of poor clinical documentation is critical to patient record accuracy and revenue cycle success. 

Clinical documentation improvement is a fundamental cornerstone for data quality, accurate reporting, streamlined claims reimbursement and robust public health information tracking. More than an essential component of the health care system, CDI quantifiably affects revenue. According to Black Book Market Research, 90% of hospitals with 150 beds or more that outsourced clinical documentation functions realized at least $1.5 million increase in revenue and claims reimbursement. 

Most hospitals are not well-equipped hospitals to solve the most prevalent CDI problems, which may result in in not collecting the appropriate reimbursement to which they are entitled. 

Several common challenges affect clinical documentation improvement: 
  1. Incomplete or inaccurate documentation. DRG assignments and codes affect billing and, if assigned erroneously, can lead to denied claims or inaccurate reimbursements. Truth time – how thorough is your physicians’ documentation? The latest health care technology can recommend potentially missed clinical indicators or documents lacking required specificity that, if caught early, can lead to higher quality care, exact coding and accurate reimbursement. 
  2. Physician query fatigue. The extraordinary time demands placed upon physicians is no secret. They are frequently pulled in multiple directions and workflows, whether it’s a request from the patient care team, a required signature, or patient order clarification suffice to say physicians are spread thin. An EMR workflow provides physicians the ability to answer all requests in a single platform. 
  3. Communication gaps between CDI specialists (CDIS), coders and auditors. Physically and organizationally, CDIS and coders may work in two different areas, making collaboration difficult. Implementing a single technology platform that encompasses workflows for all stakeholders and provides visibility into the same work queues eases the burden of rework and redundancies. 
  4. Prioritization of work. Hospitals can improve productivity by implementing a workflow that surfaces the most valuable cases first with automated case prioritization. The user can quickly parse out different review types – by DRG, patient status, length of stay or query status. Cases flagged by an auditor or coder are visually identified so they can be addressed first. 

By eliminating CDI challenges that impede quality and reimbursement success will improve cash flow and quality scores. 

Learning Objectives: 
  • Review common opportunities for poor documentation.
  • Identify coding struggles based on poor documentation.
  • Understand benefits of routine audits .
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