Get to Know Your Data
From the moment I stepped on the hotel shuttle bus in sunny (yes--sunny!) Seattle, I have encountered countless convention-goers excited about all the week has to offer. From Allentown, PA to Topeka, KS, everyone was talking about EHR, the legal health record and impending RAC audits.
This morning’s coding community meeting was all about knowing your data. Attendees enjoyed a breakfast buffet of muffins, pastries, fruit, coffee and juices before settling in their seats for the educational sessions. Gloryanne Bryant, RHIA, CCS, corporate senior director for coding HIM compliance at Catholic Healthcare West in San Francisco spoke about MS-DRGs and clinical documentation improvement, boiling proper documentation down to “specificity, specificity, specificity.” She offered some creative tips to get both clinical and HIM staff up-to-snuff before the RAC comes a-knockin’:
Make a pocket-sized documentation guide for physicians. Each guide should feature a common MS-DRG and what documentation is required for proper coding.
Ask physicians to initial boxes when responding to queries. A simple mark isn’t sufficient, Bryant said. Initials provide stronger evidence during an audit.
Use a simple Excel spreadsheet to track physician queries. This can help determine if certain conditions frequently require clarification or if a particular physician consistently fails to provide complete documentation.
Send an MS-DRG “Tip of the Week” to all HIM and clinical staff. It’s a quick and easy way to keep everyone up to date.
Lynn Kuehn, MS. RHIA,CCS-P, founder of Kuehn Consulting, closed out the morning with a lighthearted approach to qualitative and quantitative case review. She offered some helpful hints, too, such as creating a spreadsheet comparing pro-fee and facility diagnosis and procedure codes. This provides a simple way to identify coding errors. When performing a review, Kuehn recommends taking 30 percent from “funny” or potentially non-compliant cases, 30 percent from a random sample of the top 10 to 25 MS-DRGs and 40 percent from a random sample of all cases in order to identify problems, missed opportunities and unidentified issues, respectively.
The highlight of Kuehn’s session, however, was her comical use of error-laden cases. She invited attendees to call out coding problems and inaccuracies, and an amusing anecdote about a problematic coder at a dermatologist’s office left the audience in stitches. “I can’t imagine there were that many patients with anaphylactic shock,” Kuehn recalled. “And they had an appointment no less!”
Now I’m off to attend the Super Sunday Sessions, and I’m sure the title won’t disappoint!