Handheld Technology

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• Handheld Technology

Coder Friend or Foe?
Presented to MHIMA Fall Meeting
Cynthia Trapp, CHFP, CMPE, CPC, CCS-P September
15, 2006
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Learning objectives

• The purpose of a handheld coding solution
• What mobile coding and charge capture does
• Who uses handheld coding technology
• How this affects the professional coder role
• Physician/coder adoption/communication
• A case study review
• How this affects technical/hospital charges

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The purpose

• To provide an automated solution to ensure
  capture of all professional charges at the point
  of service that would
• Provide coding assistance for the
  physician/clinician and the coder!
• Include all elements required for the claim
• Streamline the amount of hands touching the claim
• Assist the physician/clinician in daily workflow
  of administrative functions
• Pay for itself

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What is handheld coding and charge capture
technology?
A step above
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Its a technological solution to a physician
charge capture challenge!!!

• Enormous administrative overhead
• Significant loss from missing charges
• Lost due to missed filing limits
• Lost due to missing information
• Lost due to manual data entry error
• Lost due to lost paper encounters
• 6-7 people handle paper claim

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Its a technological solution to a physician
coding and compliance challenge!!!

• Enormous administrative overhead
• Encounter form updates burdensome
• Compliance risk for coding inaccuracy
• Revenue risk for coding inaccuracy
• CCI edits, LCDs (LMRPs), NCDs payer edits
  impossible to manage manually

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Its a solution

HELP!!
To an outdated paper process!
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Its a solution for

• Coding and Charge Capture
• Dictation
• E-prescription
• Clinical Content
• Clinical Results
• Personal Information Management
• (Contacts, Calendars, e-mail)

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Who uses handheld technology?

• The physician

in the daily workflow of his administrative
functions.
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What does the physician do on the handheld?

• Views schedule/locates patient room
• Dictates visit
• Writes prescriptions
• Codes service
• Sends the charge to billing
• Research Clinical Resources
• Review Results
• Manages his personal schedule

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MD chooses the E/M level and procedures
Unlike paper encounters, all CPT-4 codes are
available
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Review of Systems and E/M Components
E/M Wizard assists MD to choose most accurate E/M
Code!
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MD is warned for CCIs and other edits
Modifiers are available and flagged if required
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MD is warned for CCIs and other edits
All ICD-9-CM Codes are available and edit for
medical necessity.
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Additional coding benefits
Linking Diagnoses to Procedures is imperative to
proper billing.
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Additional coding benefits cont
CCI Edit
LCD Edit
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What is the coders role?

• Professional vs. hospital coder
• Inpatient vs. outpatient
• Episode of care vs. individual services
• Codes may be the same
• But the responsibilities may be different
• Coders as coders vs.
• Coders as editors, auditors, and educators

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What is the professional coders role with
handheld technology?

• Without technology.
• Hands-on Coding
• Editing
• Auditing
• Compliance
• Physician Education
• Revenue Capture

• With technology.
• Hands-on Coding
• Editing
• Auditing
• Compliance
• Physician Education
• Revenue Capture

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So, How does this affect the professional coder?

• Electronic solution for physician edits
• Improved accuracy from physician
• No more manual paper review of encounters
• No missing/illegible information
• No more chasing physician
• No more lost/missing charges
• MD communication/interraction

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Web reconciliation
Department level
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Web reconciliation
Physician level
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Coder view via the web
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Coder view via the web cont
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Coder view via the web cont
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Coder view via the web cont
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Coder view via the web cont
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Some coder comments.

• has helped me to capture charges that were
  inadvertently indicated as post-ops
• has given us the opportunity to interact more
  often with the physician with regard to overall
  coding issues
• the reality is they (MDs) now have the coding
  toolsresulting in more coding inquiries and
  opportunities for education and awareness.
• the ability to see each code that each
  physician has reported via the web alerts us to
  any problems that may need to be addressed as
  opposed to looking at each and every paper
  encounter.
• It saves time. There is no paperwork so there
  is no running around the hospitalno problems
  with legibility.

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Lahey Clinic, Inc.

• A Case Study

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What we hoped to see

• To improve revenue capture
• To eliminate ø missing charges
• To improve cash flow
• To reduce denials
• To improve coding accuracy
• To pay for itself

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The big picture
Server
IDX scheduling
Patient Encounter
Server
Mobile PDA
Meditech registration
.totally wireless network
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The bigger picture
Pharmacy
Near Future
Speech Rec./Transcription
E-prescription
Physician Notes
Electronic Billing
92934 29125 813.50 92932
92934 29125 813.50 92932
Encounter Data/coding
Charge Approval
IDX Billing
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And even bigger...
Appointment
Coding
LMRPs
Reconciliation
Edits
Problem List
Patient Visit
Dictation
Billing
ABNs
Documentation
Reference Tools
Medical Necessity
Order Entry
Prescription
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What we looked for in a coding software?

• CPT-4 / HCPCS codes
• ICD-9-CM codes
• Highest degree of specificity
• Modifiers
• Edits to meet coding requirements
• CCI Edits, NCDs, LCDs, Age/Gender edits, etc.
• Medicare Rules and Regulations
• Outpatient, Inpatient, Surgical Integration
• Reconciliation Capability

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What we looked for from a compliance standpoint

• A system that can handle complex regulatory
  requirements
• A software that can assist the clinician to code
  accurately
• A software that provides a mechanism to open
  lines of communication between the language of
  the coder and the language of the
  physician/clinician.
• A software company that updates their system to
  meet regulatory requirements on time.

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The case study

• What was studied
• Over 22,000 encounters
• Recovery of lost/missing charges
• Change in distribution and intensity of codes
• Time to charge entry
• Time to claim submission
• Time of claim submission to payment
• What was not studied
• Change in collection performance due to change in
  claim denial/rejections.
• Decrease in costs of follow-up activities for
  claim denial/rejections

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The case study results

• Pre
• 1.1 lost charges
• 48 missing charges
• 2.29 average days to charge entry
• 35.3 average days from claim to payment

• Post
• 0 lost charges
• Zero missing charges
• .46 average days to charge entry
• 31.1 average days from claim to payment

22,000 claims studied
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The case study results

• 79 improvement in average time from patient
  visit to billing system entry.
• 11.9 improvement in average days from claim to
  payment
• 1.1 recovery of missing charges
• Recovery of over 11,000 claims yearly for Lahey
  or over 1,000,000.
• Hold encounters not studied

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Coding study results

• New Patient Visits
• Coding intensity ? 7.59
• Gross charges per visit ? 7.04
• Established Patient Visits
• Coding Intensity ? .91
• Gross charges per visit ? 1.04
• Consult Visits (outpatient office)
• Coding Intensity ? .8
• Gross charges ? 1.03

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A few interesting findings

• Some surgeons using level ones when they
  shouldnt be.
• Some MDs not charging for inpatient subsequent
  care visits.
• Some MDs not charging because they send the
  residents to visit the patient.
• Encounters show revenue, but were not going out
  the door on-hold
• OVNC

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Benefits to our clinic

• Eliminated missing charges
• Developed sound reconciliation process
• Reduced Lag days to charge entry
• Instant documentation of patient visit
• Wireless access to patient history
• Wireless access to patient demographics
• Improved quality of coding

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Benefits to our clinic

• Reduced denials due to inaccurate codes
• Provided educational/collaborative tool for
  coding support
• Improved quality of information available
• Coding, Edits, Reference tools
• Improved quality of information flow
• Registration, appointments, patient demographics
• Improved operational efficiencies

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Technical/hospital charges

• Inpatient remains the same
• Outpatient visits
• Intergrated/interfaced systems
• Improved coding accuracy
• Improved reconciliation of charges
• Improved time to billing
• No change to hospital coder workflow

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Yesterdays solution to coding and charge
capture
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Todays version
A powerful handheld computer-based solution
designed for use by the physician at the point of
care.
Charges in Hand Mobile Coding Solution
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Thank you

• Contact information
• Cynthia Trapp, CHFP, CMPE, CPC, CCS-P
• Director, Professional Coding
• Lahey Clinic, Inc
• 41 Mall Road
• Burlington, MA 01805
• 781-744-8266
• cynthia.a.trapp_at_lahey.org