A multi-hospital system, including research and teaching facilities, faced challenges associated with complex coding and reoccurring inaccuracies.
A multi-hospital system, including research and teaching facilities, faced challenges associated with complex coding and reoccurring inaccuracies. As a Level One Trauma Center, the severity of illness level was typically high, equating to high dollar claims, which resulted in inaccurate payment and or denials compromising data integrity and the hospital bottom line.
The Healthcare organization engaged AQuity Solution to conduct a coding audit to verify internal audit findings, proactively identify any problem areas, and develop a move-forward plan to monitor coding performance and eliminate issues.
By first identifying the root cause for coding errors, the coding review served as the benchmark for the organizations’ coding accuracy and a valuable tool to gauge progress. The AQuity team understood, and by pinpointing the strengths and weaknesses of coders, our review experts could better help with education and training goals. We studied the performance of coding teams to address errors, denials, and quality issues.
AQuity developed and successfully facilitated a coding accuracy improvement plan to accomplish a long-term and short-term scalable increase in accuracy and coder retention and efficiencies. We offered a strategy for a continual education and improvement program and a working plan tailored to specific coders, with consistent feedback on performance.
Integrating this process into standard procedures was received positively by coders as it was an addition to current methods and not perceived as an interruption of work. In an exit survey, responses showed changes were welcomed by coders, viewed as a positive function, yielding long term coding improvement.
AQuity reviewed 14,203 claims and provided 1,503 recommended changes at completion. Results showed an overall accuracy rate of 89% and a financial impact of $835,310 of lost, recouped revenue.