Healthcare System Improves Coding Quality and Optimizes Reimbursement

A healthcare system partnered with GeBBS Healthcare Solutions to assist with coding documentation and validation review services, increasing their overall reimbursement by 5% and reducing rebills by 9%.

Client: A healthcare system located in Florida partnered with GeBBS Healthcare Solutions to assist with coding documentation and validation review services, increasing their overall reimbursement by 5% and reducing rebills by 9%.

Challenge

• Understaffed HIM team
• Untrained coding team for ICD-10 implementation
• Keeping DNFB down during ICD-10 training
• Lack of coding accuracy/productivity with existing vendors
• New system, CAC implementation
• Lack of coding quality assurance audits from existing vendors

The GeBBS Solution

In conjunction with the healthcare system’s HIM & CDI management GeBBS was able to perform a baseline audit utilizing iCode Assurance — identifying the system’s weaknesses and determining which areas of their coding and CDI efforts were in need of more attention. iCode Assurance operated jointly with the health system’s existing EHR and coding platforms eliminating any delays in the auditing process. The results of the audit identified the areas in which the healthcare system needed to ramp up their workforce.

Highlights of this partnership:

• Began by performing a Comprehensive Audit. Pulled a percentage of charts over a selected period of time,reviewed the quality of clinical documentation and accuracy of assigned ICD-9-CM diagnosis, procedure codes, DRG’s, APC’s, HAC(s), discharge dispositions, and POA indicators.
• Secondary, conducted a Focused Audit. Targeted specific DRGs on a concurrent basis. During this time our internal auditors searched for inconsistencies, and tracked and trended results.
• Staffing Support. GeBBS provided resources to help the client stay current and keep their DNFB down to their desired level.
• QA Reports. The client is now receiving bi-monthly QA reports on all coders servicing their account. With access to iCode Assurance they now have the ability to see the latest QA reports and exactly how coders are performing, simply by logging-in to their iCode Assurance account.

Results

• Improved overall coding accuracy from 93.5% to 95.8% • Improved client’s ROM and SOI by 3.9%
• Improved client’s CMI from 1.5873 to 1.6507
• Captured missed revenue opportunities, exceeding $350K • Tailored education for coders and physicians and provided staffing support.