5 Reasons Why Coding and Documentation
Audits are More Important Than Ever
Auditingisacrucialcomponentofgovernanceandqualitycontrol.WhenICD10 (InternationalClassificationofDisease,10thversion)wasimplemented, numeroushealthcareorganizationsadoptednewelectronichealthrecord (EHR)technology.Itprovidedrecord-keepinginconsiderabledetail,outlining morethan71,000procedurecodescomparedtojustover3,800inICD-9.The eleventhrevisioncontainsaround17,000uniquecodes,andmorethan 120,000codableterms–addingtothecomplexityofcoding.Healthcare providerswoulddowelltoimplementtechnologiespoweredbyartificial intelligence(AI)andnaturallanguageprocessing(NLP)tomakethemostof thiscomplexcodingsystem.Leveragingtechnologycanresultinfewerbilling anddataerrors.
The Growing Need for Audits
Clinicaldocumentationimprovement(CDI)isimplementedandenhanced withthehelpoffindingsfrommedicalcodingaudits.AuditingCDIteamscan optimizediagnosis-relatedgroups(DRGs).TheCentersforMedicareand MedicaidServices(CMS)RecoveryAuditContractor(RAC)program,which
hasrecoveredmillionsinincorrectpaymentsinMedicareandotherinsurance schemes,hasillustratedtheneedforeffectiveCDI.
1. Enhanced Data Quality: Reliabledataisacornerstoneofhealthcare. Therightcomplianceauditingprogramsignificantlyimprovesdata quality,informsstakeholders,providesarigorousfeedbackloop,and supportsanypotentialfollow-upwithphysicians,coders,orpayers. Auditsenablebetterreportingandresearch,makingiteasierfor healthcareorganizationstosecurefundsorgrants.
2. Higher Operational Efficiency: Manualmedicalcodingandbillingisa significantchallengeforproviderseverywhere.Eachmanual transactioncosts$4.40morethaneachautomatedtransaction, accordingtothe2018CAQHIndexReport.Thereportalsosharedthat automatingclaims-relateddealingscansavehealthcareproviders around$11.1billionannually.However,theindustryhasmademodest progresstoshiftfrommanualtofully-automatedprocesses.Automated auditingcanspotmistakesandhighlighttherootcausesfor inconsistentcodinganddocumentation.Ifthisisperceivedas enhancingratherthanreplacingtheircurrentwork,itmayboost employeemoraleandproductivity.
3. Improved Patient Safety: AccordingtoanarticleintheInternational JournalforQualityinHealthCare,internalauditingdecreasedpatientrelatedadverseeventsby4.8%.Real-timeauditingcanimprovepatient safetybyquicklyidentifyingerrorsandprovidingfeedbacktomedical staff.Sinceauditingidentifiestheareaswheregapsexist,changesin clinicalpolicyandpracticecanbeimplementedwithconfidence.
Following are five reasons why audits are more important than ever.
4. Improved HIM-Physician Relations: Accuratelyconductedauditsby healthinformationmanagement(HIM)personnelweedout documentationerrorscausedbyallpartiesinvolved,including physicians.Withtheproperproceduresinplace,thesetwokeyparties involvedinpatientcarecanbetterunderstandhowoneanother'swork processesaffectthem.Physicianswhosubmitincompleteorincorrect documentationcancollaboratewithHIMstafftolearnmoreaboutthe bestprocedures.Greatertransparencyandconsistentfeedback guaranteehigher-qualitywork.
5. Enhanced Accuracy of Reimbursements: Hospitalsandcarefacilities havelongbeenplaguedbyunderpaymentsandoverpayments. AccordingtoaCMSreport,RACsidentifiedandcollected$162millionin overpaymentsduringFY2019alone.Correctauditingprocedures guaranteethatcomplicationsandcomorbidities(CCs)andtheir significantvariants(MCCs)areadequatelydocumented.The seriousnessofanyillnessis,ofcourse,decidedbythepresenceor absenceofCCsandMCCs,whichdeterminespaymentforhospital services.Inotherwords,properauditingidentifiestheseflawsinbilling proceduresandguaranteesthatbothorganizationsandpatientsreceive thecompensationtheyareentitledto.
Syracuse Hospital Halves DNFC, Saves $1 Million
WhilecompletingtheircodingandCDI-relatedwork,AuburnCommunity Hospital(ACH),anot-for-profitacutecarefacilityinSyracuse,NewYork, encounteredissueswiththeirencodersoftware.Theyhadaseven-day dischargenotfinalcoded(DNFC)andacasemixindex(CMI)of1.2024.
InadditiontoassigningspecificICD-10procedurecodesandincreasingcoder productivity,ACHneededtoeliminatecodingbacklogs.Thefacilityrequired specializedworklistsandanintelligentplatformtotracklostdocumentsand identifyCDIopportunities.Additionally,theirDNFCandCMIrequired immediateimprovement.
AtAGSHealth,webelievehealthcareorganizationsneedtoimplementthe properNLP-basedauditingapplication.Theseapplicationsautomatemanual processesonasinglecollaborativeplatform,enforceintelligentworklist prioritization,generateevidence-basedqueries,andmore.
ACHusedAGS’sNLP-basedtechnologiesandtheorganizationexperienced:
• 4.59%increaseinCMIbyimprovementofthecomplication/major complication(CC/MCC)capturerate,resultinginoptimizedDRGs
• 50%decreaseinDNFCdaysfromtheinitial7daysto3.5days,leading togreatercash-on-hand
• Over40%improvementincoderefficiencybytheprovisionof automatedcodesuggestionstocoders
• EliminationofallITsupportthroughourcloud-basedtechnology
AGSassistedACHinstreamliningitsrevenuecycle,whichhada$1million bottom-lineimpactafterayear.
Achieving New Heights with AI and NLP
Healthcareorganizationsmustimplementstringentauditingproceduresthat enhancestaffproductivityandorganizationalvisibility.Despitethegrowing popularityofAI-basedNLPauditingtools,onlybusinessesthatselectthebest vendorwillseeasignificantreturnoninvestment(ROI).AGScanhelpyour companyenhancepatientoutcomesandmodernizeyourhealthcare proceduresinthefuture.
AGS Health- Author
AGSHealthismorethanarevenuecyclemanagementcompany–we’reastrategicpartnerfor growth.Byblendingtechnologies,services,andexpertsupport,AGSHealthpartnerswithleading healthcareorganizationsacrosstheUStodelivertailoredsolutionsthatsolvetheuniqueneedsand challengesofeachprovider’srevenuecycleoperations.Thecompanyleveragesthelatest advancementsinautomation,processexcellence,security,andproblem-solvingthroughtheuseof technologyandanalytics–allmadepossiblewithcollege-educated,trainedRCMexperts.AGSHealth employsmorethan10,000teammembersgloballyandpartnerswithmorethan100clientsacrossa varietyofcaresettings,specialties,andbillingsystems.
Source of content:
https://www.agshealth.com/blog/5-reasons-why-coding-and-documentation-audits-are-more-important-than-ever/