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Taking Steps To Attain Productive
Coding Measures In Emergency Department
           Claims Processing:
               Integrative
            Research Project



                            Presented by
                            Kristen Donovan
   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
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
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
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
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
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
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
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
Disposition Status

50

40
                   Home - 88%
30
                   Waiting to be
20                 Coded - 11%
                   Eloped - 1%
10

0
         Status
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
Tools for Improvement
   E/M Coding  Checklist
   Physician Query
   Peer Education
   Shadowing
   Complications & Comorbidities
   Software Measurement Tools
   Software Education  Modules
   MC Strategies
   Coder Credentials
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)
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
The Bell Curve
   A Model for the
    Future
   Evidence Based
    Medicine
   Remarkable
    Outcomes
   Specialty Medicine
   Teaching Hospital
   Government
    Funding
Claims Processing
   Workflow Process
     Developing an EMR
     Standard Templates
     Portability Online
     Turnaround Time Reduction
     Less Paper Trail
     Value of EMR Vendor
Financial Assistance

 Evidence Based Medicine
 Government offer grants for research

 no secret mission

 Hospital setting up Internal
  Committees
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
Summary
   Outcomes

     Documentation
     Waiting to be Coded

Solutions:
Education on Revenue Consequences
Software
Credentialed Coders
Portable EMR Vendors

More Related Content

IRP, CHOP

  • 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
  • 10. Disposition Status 50 40 Home - 88% 30 Waiting to be 20 Coded - 11% Eloped - 1% 10 0 Status
  • 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
  • 12. Tools for Improvement E/M Coding Checklist Physician Query Peer Education Shadowing Complications & Comorbidities Software Measurement Tools Software Education Modules MC Strategies Coder Credentials
  • 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