At home with coding: western healthcare system improves revenue cycle management via home coders.
A healthcare organization's revenue cycle is only as good as its coding. Too few coders results in a backlog of patient charts, which increases the number of unbilled un·billed
1. Not having been billed or charged for: unbilled medical charges.
2. Appearing, as in a movie, without being credited: an unbilled walk-on. accounts and accounts receivable accounts receivable n. the amounts of money due or owed to a business or professional by customers or clients. Generally, accounts receivable refers to the total amount due and is considered in calculating the value of a business or the business' problems in paying (A/R) days. Poor coding The poor cod, Trisopterus minutus, is a temperate marine fish belonging to the cod family (Gadiformes). It is red brown in color and has a pronounced chin barbel. It may grow up to a length of 40cm. means more claim denials and reworks.
Sometimes, an organization will settle for fewer coders or less experienced ones, but it doesn't have to--and it shouldn't.
Sisters of Charity of Leavenworth This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. Healthcare System (SCLHS SCLHS Security Certification Level for High Standards ) is an eight-hospital healthcare ministry with locations in California, Colorado, Kansas and Montana. It also owns four clinics, staffs a total of 2,066 beds, and employs more than 11,000 full-time equivalents Full-time equivalent (FTE) is a way to measure a worker's involvement in a project, or a student's enrollment at an educational institution. An FTE of 1.0 means that the person is equivalent to a full-time worker, while an FTE of 0.5 signals that the worker is only half-time. , only a small percentage of which are experienced medical record coders.
In January 2000, SCLHS executives initiated an effort to increase the ministry's cash flow by improving the revenue cycle. Each hospital formed a revenue cycle steering committee steer·ing committee
A committee that sets agendas and schedules of business, as for a legislative body or other assemblage.
Noun consisting of its directors of scheduling/admissions, case management, health information management (HIM), business office, managed care and finance. All steering committees made assessments of the revenue cycle across the facilities.
We identified seven key, monthly revenue cycle measurements to monitor, three of which were impacted by coding: unbilled accounts, A/R days and claim denials--areas in which SCLHS was performing below industry standards. We attributed these results to two primary factors affecting all facilities--a shortage in coders and coding workload issues---and concluded that these were the greatest concerns. Next, we proposed six projects to address revenue cycle concerns, two of which related to coding.
We designated Saint John's Saint John's, city, Antigua and Barbuda
Saint John's, city (1991 pop. 21,514), capital of Antigua and Barbuda, in the West Indies. St. John's, at the head of a harbor formed by an inlet, is the commercial center of the country. Tourism is important. Medical Center in Santa Monica Santa Monica (săn`tə mŏn`ĭkə), city (1990 pop. 86,905), Los Angeles co., S Calif., on Santa Monica Bay; inc. 1886. Tourism and retailing are important, and the city has motion-picture, biotechnology, and software industries. , Calif., for the coder shortage project, because 40 percent of its $18 million in unbilled accounts were due to a backlog of outpatient charts that had not been forwarded to its medical records department. Also, the organization had four unfilled coder positions, representing about one-third of its coder staff. Saint John's HIM Director Debora Hadeen suggested that the project involve eWebCoding, an application service provider of Web-based remote coding solutions, to determine whether a work-at-home option would boost recruitment of experienced coders.
For the coding management project, we chose a study of Providence Medical Center in Kansas City Kansas City, two adjacent cities of the same name, one (1990 pop. 149,767), seat of Wyandotte co., NE Kansas (inc. 1859), the other (1990 pop. 435,146), Clay, Jackson, and Platte counties, NW Mo. (inc. 1850). , Kan., since it employed several coder trainees and produced a coding error rate that was higher than desired, although still better than the national average. We wanted to examine the accuracy of interventional coding for high-revenue and high-volume specialties such as cardiology cardiology
Medical specialty dealing with heart diseases and disorders. It began with the 1749 publication by Jean Baptiste de Sénac of contemporary knowledge of the heart. Diagnostic methods improved in the 19th century, and in 1905 the electrocardiograph was invented. and radiology radiology, branch of medicine specializing in the use of X rays, gamma rays, radioactive isotopes, and other forms of radiation in the diagnosis and treatment of disease. .
Between 2000 and 2002, we presented all of our proposed projects to the CFOs council, which had to approve a charter for each project before it could begin. After reviewing our business case for the Saint John's project based on an eWebCoding ROI (Return On Investment) The monetary benefits derived from having spent money on developing or revising a system. In the IT world, there are more ways to compute ROI than Carter has liver pills (and for those of you who never heard of that expression, it means a lot). template (1) A pre-designed document or data file formatted for common purposes such as a fax, invoice or business letter. If the document contains an automated process, such as a word processing macro or spreadsheet formula, then the programming is already written and embedded in the , which demonstrated that the project would generate enough cash in the same fiscal year to match the upfront costs of implementing it, the CFOs approved the project. They also approved the Providence study based on a similar business case. Everyone agreed that the HIM steering committee should complete the Saint John's project before beginning the Providence study, since eWebCoding, although not involved in the latter project, might have a role to play following its completion.
Reaching Out to Coders
Saint John's Medical Center is a 450-bed multispecialty hospital in the competitive Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. healthcare market. We had difficulty attracting experienced coders, mostly because we could not match the pay offered by other area hospitals, and coders were not inclined to drive to Saint John's on crowded freeways for limited wages. We were so short of coders that we often had to settle for trainees who required a lot of teaching and oversight to assure compliance and quality performance.
We thought a work-at-home capability would attract experienced coders throughout the West, but we lacked sufficient technology to accommodate coding at home. For example, no facility had the ability to transmit document images securely. We didn't have adequate firewalls in place to permit remote access to our network, and we couldn't implement a quality-assurance program to monitor such activities.
By utilizing eWebCoding in summer 2002, we committed to providing remote coders with the Internet-enabled equipment necessary for them to code at home. In return for giving full-time remote coders flexibility in working 40 hours per week, we insisted that, as a sign of their commitment, they create specific work-only areas in their homes that our supervisors could visit. We also required at home coders to dial in for monthly administrative meetings.
The response from Los Angeles area coders was overwhelming. Some coders actually said they would gladly take a little less pay if it meant not having to drive the Los Angeles freeways to work. Within three months, we hired three new coders. Since then we have retained a full complement of coding staff at Saint John's, with about 70 percent of the total working from home.
Within the project's first month, we reduced our unbilled accounts by 18 percent. We accomplished this in part by installing scanning stations at remote care locations to process charts more quickly and by automatically routing coding denials from the business office to the staff who worked on them. Supervisors monitored remote coding as it occurred, and they communicated in real time with coders via e-mail instant messaging Exchanging text messages in real time between two or more people logged into a particular instant messaging (IM) service. Instant messaging is more interactive than e-mail because messages are sent immediately, whereas e-mail messages can be queued up in a mail server for seconds or .
Virtual Interventional Coding
In October 2000, we hired consultants to conduct a study of the interventional coding for cardiology and radiology cases at Providence Medical Center, a 400-bed, acute care community hospital. We were concerned about undercoding reimbursement Reimbursement
Payment made to someone for out-of-pocket expenses has incurred. issues as well as our interventional coders' knowledge.
We already knew that we lacked a sufficient number of experienced interventional coders. Because interventional coders have complex duties, they are difficult to find, and they must be compensated better than typical coders. Since we could not afford many experienced interventional coders, we outsourced some of these duties to contracted specialists. However, the responsibility of most interventional coding fell on our inexperienced in·ex·pe·ri·ence
1. Lack of experience.
2. Lack of the knowledge gained from experience.
The study offered three conclusions: We were losing reimbursement due to undercoding of charts; our interventional coding for cardiology and radiology cases was not consistent across facilities; and we could fix these problems if we assigned the correct codes during interventional coding.
Based on this, we decided to develop a virtual interventional coding support center (ICSC ICSC International Council of Shopping Centers
ICSC International Chemical Safety Cards
ICSC International Civil Service Commission
ICSC International Council of Shopping Centres
ICSC International Catholic Stewardship Council ) for interventional coding of cardiology and radiology cases using eWebCoding. Since different facilities might have different interventional coders who are specialists in particular areas, we can make these coders available to all facilities via the ICSC, regardless of the coders' or the facilities' locations. Sharing resources means we don't have to employ the same kinds of interventional coding specialists at each facility, so we will reduce our overall need for interventional coders.
Embracing Remote Coding
Based on these projects, SCLHS negotiated a systemwide contract with eWebCoding in October 2002. In the last fiscal year, our ministry reduced its A/R days by three days to a record low of 51 days across the entire enterprise. We now have more experienced coders performing more efficiently for all facilities. Additionally, since facilities can share coders if necessary and we can easily attract experienced coders, we no longer experience the number or duration of coder vacancies that we once did. This helps to ensure that SCLHS receives the correct reimbursement for its services.
In the near future, we plan to establish a central virtual coding office to receive member hospitals' scanned and uncoded un·cod·ed
Not coded, especially not having or not showing a Zip Code. charts during times of coder vacancies or spiked coding volumes.
For more information about remote coding solutions from eWebCoding, www.rsleads.com/309ht-210
Mary Anne Pace is the director of revenue cycle services for Sisters of Charity of Leavenworth Healthcare System, Kansas City, Mo.