A – Assess
An assessment of the quality of the management of clinical data is an essential
step in preparing for APCs especially in the presence of ancillary legacy
systems. It is important for all organizations, regardless of size, to inventory
current systems in place. The inventory process should include:
- Identification of all data management systems in place at all sites.
- Review of how these systems are integrated to the main charge master and
billing systems.
- Review of how these systems are used to bill or produce reports used for
the billing of the professional fees (typically separately billed by Radiologists).
P – Prepare
Once Ancillary systems are identified, organizations must review operational
workflows and data management processes within these departments and understand
how APCs will impact both operational and financial management. Tasks include:
- A review of the Ancillary "ports" of data entry and data
flow procedures implicated under APCs.
- Review of registration, order-entry, procedure editing and clinical documentation
processes within the Ancillary areas.
- Assessment of the ability of the system to aggregate data to the individual
patient on date(s) of service.
- Identification of "default" system and data collection
practices which will significantly impact payment under APCs.
- Assessment of compliance-related issues based on findings from outpatient
data and medical record reviews.
- Assessment of the integration of the facility and professional fee billing
functions.
C – Communicate
Once again, education is key. Ancillary staff at all levels must understand
their role in the accurate collection of outpatient data, and the magnitude
of operational and financial implications of poor data management under APCs.
Resources must be committed to the education and training of staff to the
changes brought about by APCs, and to the necessity of their input and efforts
in the development of operational performance improvement plans.
