The Georgia Scroll
April 1998
Health Information
Management:
Your Bridge Over Troubled Waters
Laura Pait, RRA, CCS
Crisp Hughes Evans LLP
For today’s hospitals, goals are set high. "Quality Outcomes", "Decreased Costs", "Compliance with Federal Regulations" and "Continuous Quality Improvement" are only a few of the objectives that today’s hospitals must achieve. The implementation of a Concurrent Documentation Program, which can "bridge" the gap between financial and clinical arenas, provides a means to achieving these goals.
Through the years, Health Information Management (HIM) professionals have demonstrated strong understanding of medical necessity and clinical pertinence. We use this knowledge to assist you in assigning appropriate codes, obtaining compliant reimbursement and managing medical records. Documentation provided by all of the persons involved with the medical record assists us in this task. It is time for us to "bridge the gap" and be an active player in the clinical environment, assisting your facility in becoming the best it can be, financially and clinically. HIM professionals act as the hospital’s "bridge" between financial and clinical worlds.
A Concurrent Documentation Program assists facilities in medical necessity, clinical pertinence, expected outcomes and quality patient care. HIM working with a diverse multidisciplinary team of professionals, can facilitate improvement of daily challenges with the medical record ensuring documentation completely reflects the care provided to the patient. Monitoring medical records allows many facilities an increase in case mix by managing patient population through understanding of a common goal.
Questioning a set "plan of care" and challenging documentation is beneficial for both the patient and the facility. Why not train a case manager to identify the expected final diagnosis and the working DRG? Using a multidisciplinary team when managing a patient’s "plan of care" assists coders on a daily basis. If documentation in the medical record does not provide evidence of "medical necessity," any member of the team should be able to address the issue with the physician in charge. When using a Concurrent Documentation Program, final coding and DRG assignment remain the responsibility of medical records and the program should reduce the number of days in accounts receivable significantly.
Education and Training
Joint Commission of Accredited Healthcare Organizations (JCAHO) measures hospitals on their performance improvement efforts. The federal government is measuring hospitals’ compliance with the Medicare programs, and hospitals are looking for ways to promote ownership of process and outcomes throughout the organization. The development of a Concurrent Documentation Program using a diverse consulting team is a proven way to address these concerns without adding staff. Clinical departments have traditionally been required to solve today’s patient care issues without foreseeing the patient’s length of stay and discharge. HIM professionals provide education on coding and reimbursement issues, APR-DRG severity scoring and the use of outcomes management to assist clinical departments in developing strategic plans. Hence, non-clinical departments have become "the bridge" of communication between financial and clinical environments.
The use of clinical staff provides a much wider opportunity to address documentation concerns. It is the clinical staff’s association with the medical staff during the patient’s stay that provides us the chance to be involved in documentation as it happens. Medical staffs have demonstrated for years their reluctance to work retrospectively on documentation issues, especially with HIM. Use of current clinical staff creates positive outcomes for everyone.
The Team
A Concurrent Documentation Program allows a facility to capture complete and accurate documentation by ALL involved with the medical record. This provides greater specificity and medical necessity to code assignments, higher outcome severity scoring, justification for continued stay and direction for the plan of care. HIM personnel cannot be in every setting, and with cost containment on everyone’s agenda, it is important to engage resources currently on hand, i.e. nursing, case management personnel and medical staff. Using readily available staff makes this a multidisciplinary team approach and provides an opportunity to work collaboratively as a team on related issues.
What does it take to be a team player?
HIM professionals are the educators of coding and reimbursement. Together as a team we assess and influence final outcomes.
Continuing to Grow
For too long, HIM professionals have been burdened with responsibility for final outcomes. With the development of Fraud and Abuse legislation, the documentation program should allow for monitoring and communication between care givers on questionable issues. Issues on code assignment and DRG grouping in relation to the documentation in the medical record, can be shared and resolved quickly. The opportunity for the Concurrent Documentation Program to assure complete and accurate documentation benefits all healthcare settings, i.e. rehab, outpatient clinic, emergency room, etc. Development of a program provides the complete documentation needed if efforts are ever challenged as "upcoding." Furthermore, monitoring and measuring the program demonstrates effort in following established guidelines with the support of complete documentation provided by the physician. We all become keepers of the information and its documented outcomes.
In the past, increase in the Medicare Casemix Index was through "Optimization Coding Reviews." These reviews were seeking ways for coders to improve. Today, performance improvement opportunities support facility wide goals and objectives resulting in an increase of the Medicare Casemix Index and development of strong clinical pathways. Coders facilitate the team effort through providing strong coding skills and a knowledge of reimbursement issues. The time has come to utilize coders in educating your facility, i.e. administration, medical staff, ancillary departments.
Clinical departments have become more dependent on outcomes information. Who better to help with challenging outcomes?
How can your facility develop a program?
HIM professionals look forward to working with strong, flexible professionals who are willing to look ahead and recognize the need to work together, creating successful documentation.
In summary, facilities with a Concurrent Documentation Program experience drops in length of patient stay, better ratios between complex and simple DRGs, increased Medicare Casemix Index and team ownership of process and change. Together, clinical and non-clinical teams can assist hospitals in accomplishing their goals.
I am pleased to say that I have had the opportunity to expand my boundaries and work with clinical departments. The clinical departments broadened my understanding of the clinical process.
About the Author: Laura Pait, RRA, CCS, a consultant with Crisp Hughes Evans LLP, has more than 10 years of experience in health information management. Her expertise includes ICD-9-CM and CPT coding and Performance Improvement. Special thanks to Garry Bowman, CPA, partner with Crisp Hughes Evans LLP and member of the NCHFMA, who contributed ideas to this article.
Crisp Hughes Evans LLP
Crisp Hughes Evans Healthcare Group is a specialized niche of the regional accounting firm, Crisp Hughes Evans LLP. The Healthcare Group provides accounting and consulting services to hospitals, long-term care facilities and medical practices. Some of the services provided by the Healthcare Group are:
For more information about the Crisp Hughes Evans Healthcare Group, call Larrey Beres at our Atlanta office, (404) 586-0133 or visit our web site at che-llp.com
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Last modified: June 22, 2001