Managed Healthcare Executive - December 2008 - (Page 30)

Proper coding key to quality outcomes MEDICAL RECORDS CODING feeds the information ow that is the lifeblood of the healthcare system. “Coding a ects such critical factors as outcomes, care pathways, cost, reimbursement and quality,” says David Hochheiser, vice president, data analytics solutions, Ingenix. “Without proper coding, these decisions may be made on faulty data, and that helps no one.” Executives can look to top-ranked hospitals to identify best practices for accurate and complete coding. Ingenix’s “Top 200 Coding Hospitals in the U.S.” ranks hospitals according to the completeness and accuracy of their medical coding practices used to bill Medicare for inpatient medical services. The “Top 200” identi es hospitals that have adapted best to CMS’s updated policies, including a new Medicare payment methodology (MS-DRGs), reduced payment for hospital-acquired conditions, and increased pressure for correct coding via its Recovery Audit Contractors (RAC) program. “In particular, they would be least likely to be subject to particular RAC recovery areas when compared with their counterparts within their benchmark grouping,” Hochheiser says. To promote accurate and complete medical coding practices, it is important to engage the touch points along the way: physicians, documentation, medical records coders and IT. The current state of healthcare is still focused around reimbursement, believes Penny Osmon, CHC, CPC, coding and reimbursement educator at the Wisconsin Medical Society, in Madison. “but Medicare and commercial payers are beginning to tie reimbursement to quality,” Osmon says. CMS pays an incentive to physicians 30 DECEMBER 2008 TOP 25 TEACHING HOSPITALS BY COMPLIANCE WITH CODING PRACTICES Rank Medicare Provider # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 360245 250151 450241 010138 060043 200031 430081 050758 230055 050417 370029 370036 110150 450283 530011 260059 390122 440148 340160 110130 110209 510082 060036 320065 320033 Hospital Name Glenbeigh Hospital and Outpatient Centers Alliance Health Center Faith Community Hospital Hill Hospital of Sumter County Keefe Memorial Hospital Cary Medical Center U. S. Public Health Service Indian Hospital Montclair Hospital Medical Center Dickinson County Healthcare System Sutter Coast Hospital Integris Clinton Regional Hospital Harmon Memorial Hospital Oconee Regional Medical Center Cozby-Germany Hospital Memorial Hospital of Sweetwater County St. John’s Hospital - Lebanon Titusville Area Hospital DeKalb Community Hospital Murphy Medical Center Irwin County Hospital Turning Point Hospital Summersville Memorial Hospital Arkansas Valley Regional Medical Center Lea Regional Medical Center Los Alamos Medical Center City Rock Creek Meridian Jacksboro York Cheyenne Wells Caribou Pine Ridge Montclair Iron Mountain Crescent City Clinton Hollis Milledgeville Grand Saline Rock Springs Lebanon Titusville Smithville Murphy Ocilla Moultrie Summersville La Junta Hobbs Los Alamos State OH MS TX AL CO ME SD CA MI CA OK OK GA TX WY MO PA TN NC GA GA WV CO NM NM Source: “Top 200 Coding Hospitals in the U.S.” from Ingenix. “The speci city and granularity of ICD10 will enable us to capture even more detail,” Osmon says. “It will not necessarily a ect how physicians practice, but will impact our reporting, data, etc. The role of the coder may evolve more toward analyst or auditor, as physicians will most likely have the clinical knowledge necessary to appropriately apply these codes. “Take a serious look at your quality proBEST PRACTICE CODING HOSPITALS grams . . . to assure they are growing with The future of medical coding will con- the times and are able to report quality meatinue to be driven by quality reporting, sures accurately,” Osmon says. MHE as evidenced by the push for ICD-10 —Tracey Walker implementation. Commentary is independent of source data who successfully report the Physician Quality Reporting Initiative (PQRI) measures, while HEDIS measures may be used for contracting purposes to pay di erentially based on quality performance. “There is no denying that CMS’s move to value-based purchasing eventually will have a signi cant impact on reimbursement,” Osmon says.

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Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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