Health Systems Management Network, Inc.’s comprehensive implementation program for ICD-10-CM focuses on the entire revenue cycle.
All parts of the Revenue Cycle are at the same time dependent and independent functions equally important which rely on and affect each other. In almost every Hospital, Ambulatory Care Unit and large Physician Groups a new position exists for “Management of the Revenue Cycle”. This was and has been a terrific innovation that recognizes the interdependence of each aspect.
HSMN’s Consulting methodology projects start at the very beginning with the initial patient encounter and doesn’t end until a clean claim is out the door and paid. HSMN’s comprehensive approach and view has been developed over 30 years of consulting in this field and by the outcomes they have achieved for their many clients.
Health Systems Management Network Assessments begins with an in depth analysis in order to determine the accuracy at every point in the process where data are collected or inputted. They also look beyond what has been captured, asking the questions, “Based on what is known, what wasn’t captured in this encounter and should be?” Their data analytics take a look back at the previous two or three years to understand how well the Hospital or Faculty Practice has done under the ICD-9-CM scenario.
The next step is to concurrently round with and track current cases being treated by the clinical staff and view the cumulative clinical documentation of “live” cases.
An HSMN representative stated, “The goal is to find out: What does it tell us about clarity of diagnosis, treatments, outcomes and prognosis for the patient. Are the elements of patient care documented and reported/coded to the highest level of specificity to support Quality Indicators and produce a clear and clean claim with which the Coder and Biller can move forward for payment? Will it pass through the back end scrubber edits or will it end up in a work queue?”
When the assessment of a “live case” is done, HSMN compares the results of its assessment of the Case to the work done by the Hospital’s revenue cycle team. HSMN then shares its findings with the Medical staff using Case Deconstruction methodology so that each and every element of supporting diagnosis and treatments are clearly related to the reason for admission and subsequent findings that may change the final diagnosis.
Each of the “live” cases is then reconstructed in ICD-10-CM/PCS so that the Medical staff can see where the clinical documentation may have fallen short or could not be converted from ICD-9-CM to ICD-10 CM unless changed. Each of the members of the Revenue Cycle Team who handled the claim/case is invited to the presentation done jointly by a Coder/Biller Team and the Clinicians directly involved in order to understand the case for billing and coding purposes.
This method combines both didactic and practical approaches to the transitions necessary to change thinking about clinical documentation for ICD-10-CM. HSMN’s job is to assess, create a role and process model and leave the organization with a tool kit that is easily used by the Hospital Revenue Cycle staff and Clinical staff to continue improving Clinical Documentation.
HSMN focuses its efforts on how data flow through the System(s). Often mistakes can be made by anyone on the Team and HSMN provides a means for each member to recognize problems and identify them not in a Silo fashion but in an integrated process. It takes a Team to make a Clean Claim.
HSMN advises that once the techniques are learned, then some small percentage of cases should be handled in this way to begin preparing everyone for ICD-10-CM/PCS. There are no courses, webinars, classes or websites that can substitute for the hands on process they have successfully implemented for their clients. Everything about ICD-10-CM must be internalized, instinctive and critically thought through.
We invite you to contact us at 866-908-4226 or via email at firstname.lastname@example.org to discuss how our approach can be helpful to your organization.