In cardiovascular (CV) services, and today’s healthcare landscape as a whole, achieving seamless collaboration across departments is a necessity. Unfortunately, many healthcare organizations struggle with structural & data silos, inconsistent communication, and disjointed processes – this heavily impacts their ability to streamline coding data. Outsourcing coding audits to a trusted partner not only provides a powerful solution to these challenges, but it facilitates compliance, higher quality healthcare, and invaluable interdepartmental collaboration.
Before an Audit: The Challenges
Inconsistencies Impede Ability to Hit Quality Benchmarks
Quality clinical registry benchmarks provide CV services with a method to compare performance to other similar providers and identify areas of improvement. By obtaining consistent & accurate coding data, healthcare organizations can ensure alignment between these two datasets and reduce reporting errors from systems that rely on coding data. This, in turn, leads to more informed changes rooted in evidence-based care. Unfortunately, without a clinical registry data-based audit performed in partnership with a trusted CV data partner, many organizations face significant roadblocks that stand in the way of collaboration and quality improvement efforts, such as:
- Data Silos: Tracking data in silos across teams leads to inconsistencies in data reporting and makes it challenging to gain a unified view of patient outcomes and system-wide performance.
- Inconsistent Quality Metrics: Inconsistent metric tracking across various departments can lead to confusion and misaligned priorities, hampering the ability to identify and address system-wide CV trends that need intervention.
- Fragmented Communication: While a coder who has worked with the same provider for many years may understand shorthand or abbreviations, confusing notes and ineligible provider handwriting can still make it difficult for coders to decipher a provider’s EMR notes. Because many coders likely find it uncomfortable to approach a busy provider to ask for clarification on a specific note, coders may try to guess what the provider meant. Unfortunately, that usually results in more work long term. A clinical documentation improvement (CDI) process, or program, may help minimize these errors by checking coding data for an accurate reflection of the patient’s condition. By engaging in this exercise, practices proactively address any mistakes that may stand in the way of proper reimbursement.
- Missed Opportunities for Improvement: Healthcare organizations rely on coding data to inform performance improvement and maintain quality benchmarks. In the absence of robust clinical registry-driven data analysis and reporting, it’s more challenging to make informed decisions about improving care processes, which can negatively impact patient outcomes and financial performance.
- Coder Turnover: Coders not only experience a steep learning curve, but they must keep up with constantly evolving payer requirements. High turnover in the field only makes it more difficult for departments to keep up with these changes and avoid denials. Furthermore, there are 11,000 CPT codes for coders to learn, 225 new codes added in 2023, 75 deleted, and 93 revised. In fact, anesthesia represented the only section of the coding guidelines the American Medical Association didn’t change that year.1
After an Audit: The Benefits
Data-Driven Decision-Making Leads to Actionable Insights
Organizations that introduce clinical registry data-based audits with hbRecon experience more clarity, structure, and accountability – primarily driven by our tool’s intense focus on interdepartmental collaboration. In fact, after an audit using hbRecon’s three-phased approach rooted in integration, investigation, and reconciliation, many CV practices experience the following advantages:
- Reliable, Centralized Data: One of the most valuable outputs of an audit with hbRecon is the consolidation of data from disparate systems into one single platform. This allows all departments to access consistent information, eliminates discrepancies, and enables unified decision-making.
- Crystal Clear Accountability and Transparency: The hbRecon audit involves developing standardized metrics that support comprehensive reporting. This enables departments to clearly see how their contributions impact overall outcomes and builds a sense of shared responsibility.
- Matching Goals and Priorities: Rather than making sense of disparate goals and priorities, the audit process brings departments together to establish common quality benchmarks and objectives that set everyone on the same path toward the same goals.
- Uplevel Communication Channels: hbRecon fosters cross-departmental communication between clinical and coding teams, fostering a more collaborative environment built in proactive and effective dialogue that is open and constructive so issues can be addressed before they escalate.
- Consistent Quality Improvement: Clinical registry data-based audits deliver actionable insights that build momentum for cross-departmental initiatives focused on addressing specific challenges.
- Seamless Collaboration: By weaving clinical registry data-based audits into the fabric of organizations, departments learn to trust one another and work together seamlessly, creating lasting partnerships that extend beyond the scope of the audit.
While clinical registry data-based audits provide outsized benefits in terms of compliance, they are also catalysts for cross-departmental collaboration and long-term improvement. In today’s complex healthcare environment, a trusted CV data partner can be the difference between hitting quality benchmarks or falling short.
Given the collaborative nature of our clinical registry data-based audits, we inherently help CV teams build transparency, alignment, and communication around coding data. But the results of these types of audits don’t stop at hitting quality benchmarks – they produce a culture that benefits patients and your bottom line.
It’s all about collaboration.
References:
- HFMA. Common coding challenges hospitals face and how to fix them. HFMA. Published August 7, 2023. https://www.hfma.org/revenue-cycle/coding/common-coding-challenges-hospitals-face-and-how-to-fix-them/