North Carolina Medical Society

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Presented by Mary Jane McCracken, RN

• North Carolina Medical Society
• Quality of Care and Performance Improvement
  Committee
• August 7th, 2009

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A local medical record coding and data
abstraction service company

• Coding vacancy rate nearly 20 percent
• Payment backlogs
• Recent and emerging coding/documentation
  challenges
• MS-DRG, POA, RACs, MICs, ZPICs, ICD-10
• Increased public reporting initiatives/incentives
• PQRI, RHQDAPU, BTE, NCQA
• Lack of coding data abstraction staff expertise

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Two Core Business Services

• Health Information Consulting Services
• Inpatient/outpatient/EM coding
• Prospective or retrospective coding reviews
• Compliance auditing and monitoring
• Review of coding and supporting documentation
• RAC readiness review
• General and customized coding education
• Hot topics or review of frequently used codes
• Customization based on results of
  audit/monitoring

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Two Core Business Services

• Data Abstraction Services
• Data collection for quality measures
• PQRI, RHQDAPU, HEDIS, BTE, NCQA
• Facility specific performance measures
• State focused care studies
• Clinical research support
• Academic clinical studies
• Clinical registries abstraction
• Record review / data entry

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Our Coding Staff

• Experienced staff of gt 10 credentialed health
  information professionals located throughout the
  state
• Average coding/auditing experience gt 10
• ICD-9-CM, CPT, and EM
• Inpatient/outpatient hospital settings
• Same day surgery/ER and ambulatory
• OIG and RAC auditing
• Denial management of claims
• Superbill/chargemaster reviews

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Our Data Abstraction Nursing Staff

• Experienced staff of gt 30 nurse data abstractors
  located throughout the state
• Average abstraction experience gt 5 years
• Clinical studies
• Registries
• Quality measures
• Experienced working with physician
  offices/hospitals/surgical and dialysis
  centers/EDs and dental practices
• Proficient with electronic and paper records

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Provider Outcomes

• Revenue enhancement
• Backlog reduction, improved accuracy, cleaner
  claims
• Reduce the risk of a charge of fraud
• Improved compliance
• Documentation that supports medical necessity
• Understanding of regulations and how to stay
  up-to-date
• Local staff, quality work competitive pricing

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• Questions?