How Outsourcing Coding Contributes to Improvements in both the Coding and the Medical Staff Clinical Documentation

While ICD-10-CM implementation/transition looms in front of all providers, and many vendors are poised to offer solutions, it should not escape those in both finance and the Medical Director’s office that this transition can’t be done by vendors no matter what they say or sell.

Hospitals and practices are sending staff to seminars and webinars as though somehow through osmosis, that staff will learn what to do.  HSMN has learned from its 30 years of experience in transitioning its clients through all of the iterations of coding, reimbursement and Conditions of Participation regulations that until the medical and revenue cycle staff become involved intellectually in the process of change, there cannot be a successful transition.

As an example HSMN was called in to a client who had recently implemented an “Enterprise Wide Electronic Medical Record” for which the medical staff were very grateful. However, as claims began piling up in “Work Queues” it became apparent that the transition had not been internalized and truly understood.  HSMN was asked to review and correct thousands of claims in the “Work Queues” for both the professional and hospital billing efforts.  What we found was a compelling case for doing not only the corrections but also in providing “Root Cause” analysis to determine why so many cases would not pass the editing mechanisms of the new systems.

After three months HSMN reported to the client that a very large percentage of the diagnoses were incorrectly done and those that were correct suffered from insufficient supporting clinical documentation despite the use of “Smart Phrases” available in the enterprise-wide system.

HSMN after turning in its report found that the client wanted to do some education of the staff and asked the firm to handle the coding so that the hospital and professional coders could take some time in reviewing their work and to interact with the physicians on Clinical Documentation Improvement.

The HSMN experience has been that if you don’t know where you are in the present scenario how do you transition to the new one beginning in Oct of 2014?  The medical staff of our client has found “Clinical Champions” in many of the disciplines to (those that really get it) help peers understand their gaps in both diagnosis and supporting documentation.  Cases are parsed and then the medical staff is shown how they look currently and then what they would look like in the ICD-10-CM/PCS world.  The methodology of treating the clinical documentation just as one would treat the case management as a parallel practice seems to be catching on. HSMN was able to provide support with handling the coding and then working with both the coders and clinical staff to make improvements.

There are many great firms but the ones that you should think about choosing should follow a protocol in which they review the current codes, make corrections using analysis and root cause for the teaching.  Outsourcing for the sake of offloading work load may have worked in the past but using a methodology in which there is feedback and teaching are what is needed to prepare for the transition.

Readers can find additional information about ICD-10-CM/PCS and Revenue Cycle Management throughout the website. You are welcome to contact us here or call 866-908-4226866-908-4226 to find out more about how we can help your hospital or practice.