Current Procedural Terminology (CPT) codes and diagnosis codes impact how insurance companies adjudicate claims and determine patient responsibility amounts. Healthcare providers can greatly impact the amount that the patient is liable for based on how services are coded and reported to the insurance company. Hospital and physician office staff who collect money from patients need to understand the basics regarding these procedure codes in order to minimize collection errors up front and reduce the likelihood of credit balances and claim re-work. So how can you help your front desk understand the impact of coding?
Hayes' Healthcare Blog
Hayes is pleased to introduce our Healthcare Leaders blog series. In this series, we ask some of healthcare’s most prominent leaders to comment on the current state of healthcare as well as discuss what they think the future holds. Our first Healthcare Leader blog is authored by John Halamka, MD, CIO, Beth Israel Deaconess Medical Center and co-chair of the national Healthcare IT Standards Committee.
Advice for the Modern IT Leader
Recently I gave a keynote address about the characteristics of the modern IT leader - call it my top 10 list of behaviors and tactics. As a pre-amble, I offered an environmental scan of the regulatory and business challenges we’re likely to face over the next five years.
All IT leaders have weathered the impact of the Meaningful Use program, ICD-10 implementation, HIPAA Omnibus Rule and Affordable Care Act. Over the past few weeks, the Sustainable Growth Rate fix, the 21st Century Cures Act, and the Burgess Bill have added even more complexity to IT tactical planning. Here’s my advice.
So, it looks like ICD-10 is finally going to happen. The U.S. Dept. of Health and Human Services (HHS) has finalized the previously tentative October 1, 2015 go-live date for ICD-10. Are you ready? Have you done your due diligence and remediated your systems and performed testing? Ideally, you have tested with some of your major payers. If not, here’s a quick punch list to help with your testing. For ease of use, I’ve grouped the list into an internal versus external focus.
While ICD-10 migration can sometimes feel like a test to be graded, it’s more of a process to embrace in the name of better patient care. The ICD-10 deadline, despite its delay, is rapidly approaching and with it comes a number enterprise-wide changes. These changes, of course, include your clinical documentation - otherwise known as the key source of patient services. It also communicates why the patient in there in the first place. Clinical documentation affects three key parts of your organization: patient care, healthcare data and reimbursement. How can your organization harness clinical documentation improvement (CDI) to ensure optimization of ICD-10 utilization? We have six recommendations to consider.
Implementing a clinical documentation improvement (CDI) initiative for outpatient settings is a crucial element of ensuring your coding is accurate and your claims are billable. CDI drives what can be coded and billed; it ensures descriptions of patient encounters, assessments, treatment planning and dates of service in the clinical note are correct.
Traditionally, when we discuss clinical documentation improvement efforts and resources; the focus has been primarily allocated for inpatient services. However, the Accountable Care Act (ACA) and the Institute for Healthcare Improvement (IHI) are encouraging medical communities to broaden the scope of reach to include outpatient settings. The quality of patient care and value of services rendered is determined by the comprehensiveness of the clinical encounter note and treatment outcomes.
In a recent survey, more than 270 hospitals were asked if they had an active clinical documentation improvement (CDI) program; 66% said yes, while 34% were in the discussion and assessment phase of determining where to begin, cost and value of establishing a formal CDI program. Statistics indicate that significant increases in reimbursements and revenue gains as a direct result of implementing a CDI platform.
So how do you fast track your organization to CDI excellence?