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Cogdell Memorial Hospital in Snyder faced a challenge in 2007: how to get its coding work done when the coding staff went on vacation.
This is an especially tricky situation when you realize the coding staff at this 49-bed hospital consists of exactly one person.
“We didn’t have a backup. Rather than let the work wait, we decided to bring in an outside firm to fill in while she was away,” said John Everett, FACHE, chief financial officer of
Cogdell.
After interviewing numerous coding firms, the Cogdell team selected Healthcare Coding & Consulting Services, in large part due to word-of-mouth recommendations.
“Bill Cronin, the CEO of the firm, had an excellent reputation,” said Everett.
When the coder later left for another job, the hospital decided to expand HCCS’s contract to cover all coding work for the hospital rather than search for a replacement.
“Rural hospitals have a particularly hard time recruiting experienced coders,” said Cronin. “It’s specialized work that requires years of training, and these hospitals just don’t have a pool of qualified applicants.”
And that’s not the only issue when it comes to recruitment.
“Even if rural hospitals are able to find an experienced coder, they don’t have the volume to allow that person to focus solely on coding,” Cronin said. “The coder often has to wear several hats, which leaves little time for updating and training. Coding regulations change constantly, and if you don’t update your knowledge every quarter, your coding won’t be accurate.”
HCCS’ coders are specialists who only code one type of chart each. Emergency room coders, for instance, only work on ER charts. This specialization improves accuracy.
“Our coders can code very quickly because of their expertise, and they are much more accurate than a non-specialized coder could be,” Cronin said. “Our staff might code 100-120 ER charts a day, versus 20 or fewer for a coder at a rural hospital. Without a high level of repetition, they can’t become expert. We often see a 50-70 percent accuracy rate in rural hospitals because of the lack of expertise in specialty areas.”
Beyond the volume of work, constant training helps the firm’s 100-plus coders stay current on regulations and requirements.
“We have a large staff of coding auditors and trainers. Most hospitals don’t have the resources to provide that level of ongoing education,” said Cronin.
At Cogdell, turning over all coding work to HCCS has meant fast turnaround and improved accuracy of both the documentation and the coding.
“We now have concurrent coding, which allows us to give feedback to physicians immediately to ensure that the documentation supports accurate billing for the treatments and services the patient is receiving,” Everett said. “We also had
HCCS train our staff and physicians on better clinical documentation.”
Before the clinical documentation improvement training began,
HCCS staff conducted an audit of a random selection of inpatient charts to identify areas for improvement. Based on the results of the audit and current industry standards and requirements, they designed on-site education for clinical staff, health information management department staff and case managers.
Terrance Govender, M.D., director of medical consulting at HCCS, worked with Cogdell physicians to improve clinical documentation.
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“He was great to work with. The classes went over really well,” said Everett. “He gave the physicians an overview in group meetings and then met with individual physicians to go through their charts and point out specific issues in the documentation. The physicians had lots of questions, but they were receptive to the feedback and picked up on the important points.”
“Specificity is always an issue,” Cronin said. “A doctor might document pneumonia in the patient record, but due to a lack of explicit documentation, the true severity of the illness cannot be appropriately reported by the coder. The same goes for a long list of commonly encountered diagnoses.”
In training nurses, he added, the emphasis often is on providing more detail in the patient notes.
“For example, nurses often fail to note the stop times for infusions. Without a stop time, a hospital can only bill for a push, which is reimbursed at a much lower rate than an infusion,” Cronin said.
The results of such training can pay off quickly.
“The return on investment for a CDI program can be as fast as one day.
If a major complication or comorbidity is missed on just one chart, the loss of reimbursement revenue can be thousands of dollars. That quickly pays back the cost of the training,” Cronin said. “In outpatient services, failing to document the medical necessity of a treatment or service can result in denial of payment. Accurate documentation and coding really pays off. We had a client tell us recently that they had seen a 300 percent increase in their reimbursement for emergency services since we took over the coding.”
Everett can attest that his hospital has experienced similar success.
“The improved documentation has moved our case mix index from
0.9 to 1.05. That has meant an increase of about $250,000 to $350,000 in annual revenue for Cogdell,” Everett said.
Beyond the revenue implications, Cronin added, more specific and detailed documentation can improve patient care and give a more accurate clinical history for repeat patients.
With the move toward ICD-10 coding on the horizon, Cogdell has engaged HCCS to prepare hospital staff for the new coding and documentation requirements.
HCCS also can provide interim staffing for key financial and HIM leaders.
“At Cogdell, we placed our vice president of coding resources, Lynda
Starbuck, who worked with Dr. Govender on CDI training at Cogdell, as a combined HIM and business office manager,” said Cronin. “She was there eight months, and her work included helping Cogdell staff transition to their new electronic medical records system.”
Starbuck’s services helped the hospital tremendously, according to
Everett.
“Lynda really helped us organize those areas and bring together the HIM and business operations. We have since hired a full-time manager, and she now acts as a resource for that manager. The manager can call her to discuss thoughts and get some guidance and insight in areas where the manager has less experience,” said Everett. “Overall, Bill Cronin’s staff at HCCS has done a wonderful job for us.”
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Healthcare Coding & Consulting Services is a fullservice coding and consulting company founded on uncompromising values and dedication to clients. HCCS’ team of fully specialized, American
Health Information Management Associationcertified coders provides accurate and timely coding of all chart types and formats for hospitals on both a backup and a full outsource basis.
Accuracy is its first priority, and HCCS does not compromise it for any reason. HCCS offers the best coding around as well as assistance with and training on ICD-10 implementation.
Bill Cronin
239/443-3901 bcronin@hccscoding.com
www.hccscoding.com
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