This document discusses research at a children's hospital emergency department aimed at improving medical coding and reducing uncollected revenue. Key findings included incomplete medical records and a lack of test results or physician documentation as barriers. Recommendations included tools for coders like checklists, education on documentation standards, and investing in software to facilitate portable electronic medical records. The goal is to standardize processes and leverage technology to streamline claims submission.
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1. Taking Steps To Attain Productive
Coding Measures In Emergency Department
Claims Processing:
Integrative
Research Project
Presented by
Kristen Donovan
2. Introduction to the Childrens Hospital of
Philadelphia
1855
First Pediatric Hospital in US
Family and Specialized Pediatric
Medicine
Emergency Department 78,000 visits
per year
Teaching Hospital, the first to offer
medical training to pediatric doctors
3. Research Background
ED holds 72 beds including trauma
and beds for extended observation
Three shifts a day
4 attending physicians per shift
Volume per day 150-200 patients
Spring-Summer avg. 175-200 pts.
Winter Increased Volume
Medium of 12 registrars per shift
4. Computer Software/Vendors:
Medplus Corp.
Quantim hospital database
Chartmaxx secured patient record
solution
Criteria Analyzed in Comparison to Uncollected Revenue
Medical Record Status
Test Results
Physician Documentation
Physician Signature
Discharge Status
5. Steps to Improve Coding Issues
305 ED Accounts - Research
Uncollected revenue total
Coding Influence Work-flow Process
of Claims
Tools For a Coding Program that
safeguards
6. Research Medical Record Status
Sample of 305 ED
140
Incomplete- No ED
120 Chart - 41%
Waiting to be coded -
100
23%
80 Awaiting Provider
Number - 19%
60 Not in Chartmaxx -
7.5%
40
Not in Quantim - 3.2%
20
No Attending
0 Documentation - 1%
Status
7. Ancillary Test Results
160
140
No Report -
120
47%
100 Radiology -
80 15%
60 Lab - 13%
40
Waiting to be
20 Coded - 10.5%
0
Test Results
8. Physician Written Notes and
Signature
180
160 Missing - 35%
140
120 In Chart - 25%
100
Coded - 12/7/06
80
- 9.5%
60 Waiting to be
40 Coded - 6%
20 Coded -
0 11/27/06 - 6%
Status
9. Wellsoft Written Diagnosis
Measures
Waiting to be
35
Coded - 10%
30
Viral
25
Syndrome, nos
20 - 1%
Fever
15
10
Constipation
5
0
Wellsoft Written DX Croup
11. Uncollected Revenue Comparison
Data
Waiting to be Waiting to be coded
$1,200,000.0 coded Patient Type Error
0
$1,000,000.0 Incomplete-- No ED Chart
0 Patient Type Registration Error
Not in Chartmaxx
$800,000.00 Error Not in Quantim
$600,000.00 Awaiting Provider Number
$400,000.00 Incomplete-- Unbillable--No Att
Documentation
No ED Chart Coded
$200,000.00 Account not Discharged
Missing Physician Signature
$0.00 Registration
Bill this
Total of Error Incomplete-- Missing
Uncollected Pages/Notes
LWBS
Revenue Not in Cancelled Visit
Chartmaxx Direct Admit
Visit Cancelled
13. Integrating an EMR
Mistakes To Avoid
The Software is the solution
Designing and Implementing
My practice can effectively report my own
network infrastructure
Underestimating the required support staff
Taking too long to implement
No physician champion
Site visits
Not selecting software for the long term
Not taking advantage of regionally sponsored
initiatives
I will only have to make this transition once
(Whitham, J & Davis, S. Effectively Integrating Your EMR Initiative)
14. Where Can Coders & Medical
Practitioners Go
Online Resources Such as:
AHIMA
AAPC
American Academy of Family Physicians
American Medical Information
Association
TOWR Toward the Medical Record
mcstrategies.com Available 24/7
15. The Bell Curve
A Model for the
Future
Evidence Based
Medicine
Remarkable
Outcomes
Specialty Medicine
Teaching Hospital
Government
Funding
16. Claims Processing
Workflow Process
Developing an EMR
Standard Templates
Portability Online
Turnaround Time Reduction
Less Paper Trail
Value of EMR Vendor
17. Financial Assistance
Evidence Based Medicine
Government offer grants for research
no secret mission
Hospital setting up Internal
Committees
18. Ongoing Research
Taking steps to implement EMR
Hospital infrastructure - flexibility
Power of portabilility
Acting Soon Preparedness
Universal Healthcare State level
Grants and Funds for Evidence Based
Medicine
Avoiding Litigation
19. Summary
Outcomes
Documentation
Waiting to be Coded
Solutions:
Education on Revenue Consequences
Software
Credentialed Coders
Portable EMR Vendors