New York, Wallis And Futuna – August 23, 2012 – Health Systems Management Network, Inc. announces the formation of its clinical documentation improvement teams for the Northeast, Southeast, Southwest, Midwest and Western parts of the country specializing in medical, hospital billing and coding initiatives. HSMN believes that all of these activities must be coordinated with medical staffs in order to achieve optimization and the required compliance.

Medical billing and coding is only as good as the best clinical documentation sets regardless of the setting in which patients are seen. There is an additional burden for the hospital, clinics, ambulatory care centers and physician practices to be sure to report on quality. Such reporting is built in to the physician value system as an example. Not only do organizations need to be accurate, but they must also demonstrate value. There are a number of demonstration projects around the country whose only purpose, according to CMS’s Innovation Center, is to experiment with different programs to improve healthcare value. According to the most recent edition of the HFMA Journal, “commercial carriers are offering menus of value metrics and payment terms in provider contract negotiations, as well as analytical and clinical consulting services to assist provider organizations in understanding their patient populations and in improving care coordination.”

Therefore, coding, billing and the value metrics mentioned above are all dependent upon an excellent clinical documentation performance. Care coordination is not just restricted to Accountable Care Organizations (ACOs). All providers will be expected to show value, and value is created in the coordination of care. Evidence has to be overwhelming that care is integrated and coordinated.

HSMN has worked with clients for over 27 years to improve documentation and to show clinicians the ideal way for coordinating documentation. In HSMN’s experience there has always been evidence of clinical work by many specialties with complex patients. In many instances, HSMN has asked the questions: Who is managing this patient? Where is the evidence?

In creating the clinical documentation teams to work with medical staff, coders and billers, we have been able to launch innovative programs that have vastly improved the quality of the final claim and show the coordination of care. Of course, documentation should reflect reality, but if healthcare organizations and physician practices do not change their outlook from that of inventors to integrators, regardless of specialty, then reimbursement will be a problem in 2 years. This is the time to call in one of the HSMN teams and look at the entire continuum that drives reimbursement and care.

For more information about HSMN improvement strategies please visit our web site www.hsmn.com or call us at 866-908-4226.