Wellington, FL — (SBWIRE) — 05/30/2013 — HSMN’s clients are asking what new system they should be using to help with the transition of their revenue cycle management team to the ICD-10-CM/PCS environment. There are many systems whose vendors have done a great job in creating innovative and accurate systems. There is only one problem: culture, history, and practice values of the organization must be the basis for creating the specifications for the purchase of any new system to support the revenue cycle.
Understanding clinical practice documentation, communication between and among each part of the revenue cycle and the culture of the organization must be the first consideration in choosing.
If the Medical staff is having difficulty with the specificity essential to ICD-9-CM and the Coder/Biller Teams are redoing work and sending many inquiries to the Medical staff about documentation, then some intervention is essential. It must start with an assessment of the quality of documentation done by each of the clinical disciplines. Without that diagnosis, it is impossible to find systems.
The next most important item is to have Clinical Leaders Partner with the Coding/Clinical Documentation Specialists in deconstructing documentation of current active cases to determine where the strengths and weaknesses are. Once deconstructed, the Coder and Clinical Team must look at where and why the gaps occur.
HSMN’s experience is that often there is no bridge between the “Clinical Decision Making Mind of the clinical person” and the essential need to document in a way that supports the care. For over 30 years HSMN have worked with clinical staff on every iteration of coding and it has found that clinicians resent being told how to document by coders or anyone else.
Even with the “Build” that occurs with the enterprise wide systems such as Epic and others, large gaps exist. So the medical staff and each component of the revenue cycle management team must create a bridge that all can cross together. How does an organization accomplish this after so much effort has been placed in “building the system”?
HSMN believes it begins when everyone on the Team looks at “live” cases to understand what is going on clinically and then focuses the clinical decision makers on how to use the logic of ICD-10-CM.
The truth is that while some have called the specificity of the new system absurd, in reality the best clinical practices are built upon specificity. So there is where the bridge must be built. Together the Revenue Cycle/Coder/Clinical Team must reconstruct the active case with the specifics. This must be an ongoing exercise.
Then each and every member of the Revenue Cycle Team must also learn from first contact with patient how specific and correct data collection must be. Thus the new paradigm not only affects the clinical documentation but the way each of the members of the RCM Team relate to the events of the patient encounter.
HSMN is not only focused on the specificity but also on integration of documentation so that everyone on the team understands what is going on clinically. The goal is to focus on the patient, the patient problems and to clearly express both in the clinical language and the translation of the clinical event into a claim that can be paid.
For many years HSMN has worked in reorganizing not only the structure of the revenue cycle team but the way it thinks about clinical care. Please call us 866-908-4226 or email us at firstname.lastname@example.org so that we can share our Teams’ knowledge perhaps help model some of the processes we have described. For more visit – http://www.hsmn.com