Claiming victory: speed and accuracy are the two linchpins for healthcare organizations involved in any aspect of claims and coding

Health Management Technology, Sept, 2006 by Richard R. Rogoski

No one can argue the importance of coding and claims processing in today's bottom line-driven healthcare business. With a record number of disease, diagnosis and procedure codes, and the growing dominance of payers in the healthcare equation, healthcare organizations (HCOs) are under the gun to make sure all their i's are dotted and their t's crossed.

The road ahead won't get any easier. The ICD-9-CM coding system that has been used for diagnoses and procedures for more 30 years is about to be a victim of progress and evolution, assuming the United States decides to keep pace with other medically advanced communities. Its successor, ICD-10-CM, is scheduled for release in federal fiscal year 2007 and threatens to increase the number of codes by a factor of 10.

Accuracy, therefore, becomes a priority, since coding errors or the filing of an incomplete claim almost always results in a claim delay or denial. No one knows better than cash-challenged HCOs that prompt reimbursement from payers depends on the speed with which completed and cleanly scrubbed claims are processed and filed. To achieve both accuracy and speed, healthcare organizations are, of course, turning to digital solutions.

Logic-based Coding

In its quest for increased efficiency and coding accuracy, DuBois Regional Medical Center (DRMC), a 214-bed facility in DuBois, Pa., chose a coding solution from Hamden, Conn.-based HSS Inc. Known for its industry-leading coding, regulatory and reimbursement solutions such as WinStrat and Web.Strat, and also known as a company whose products are embedded in other vendor solutions, HSS was acquired in May 2005 by Ingenix, based in Eden Prairie, Minn.

DRMC evaluated products from three vendors before choosing Web.Strat, says Lois Weir, the hospital's coding supervisor. The decision was relatively easy, since each member of the coding staff was involved in the evaluation of products and the final selection. "You have to get your coders on board from the beginning," Weir advises. "There was a little fear at first, but being part of the decision-making process eased their minds."

Price is usually one of the deciding factors, as it was for DRMC, but there also were others, such as ease of use and the fact that Web.Strat offers both book- and logic-based coding. "Because it's user-friendly with the logic built in, the computer is now doing some of the work and eliminates some of the decision-making process," she says.

Joanne Genevro, director of revenue management, adds that even though the seven full-time and two part-time coders were given the option of using either the logic or book functions of Web.Strat, they immediately began using the logic-based function and only used the book-based function to occasionally look up a reference.

Prior to going live with Web.Strat late last year, all coding at DRMC was done by book coding. Coders relied on hard-copy ICD-9 books and reference materials for the information they needed to code encounters. Since some of these books and references were kept in a central location, coders often had to leave their desks to locate the materials they needed. Because Web.Strat is a customizable Web-based solution, coders now can access a common database via a standard Web-browser interface, which allows them to work their way through various menus and questions to arrive at the correct codes. "All the reference materials are at their fingertips," says Weir.

Gains Are the Proof

Since no software installation is required on desktop computers, each coder consistently accesses the same regulatory content which is updated automatically using Web services technology, thus eliminating the need for coding staff and IT staff to manually install regulatory updates, which are required up to 24 times per year. In addition, coders who are in the habit of making handwritten notes in their hard-copy books aren't left out in the cold; they can continue to make similar notes through Web.Strat, which they can read from their monitors. Interestingly, coders at DRMC use dual monitors.

Supported by grant number 1 UC1 HS0156083 from the Agency for Healthcare Research and Quality, DRMC purchased an electronic medical record (EMR) from McKesson Corp. at the same time the coders went live on Web.Strat. "With the use of dual monitors, each coder is able to view the EMR on one screen and the Web.Strat coding information on the other," she explains. This is a lot more efficient than using a single monitor with a split screen because "you're not constantly opening and closing windows," Genevro adds.

Gains in efficiency and speed have resulted in marked productivity increases at DRMC. Before Web.Strat, the time from patient encounter to coding was five days. Now, coding takes place two to three days after the encounter. The hospital also has reduced its coding backlog from $5 million to $1 million. "At times in the past, we would get behind in coding due to staff vacations or illness and would end up coding at 17 or more days. It would take months to catch up," Genevro says. "Since going to Web.Strat and the new EMR, backlogs have not been a problem, and we have experienced several leaves of absence during this time. Also, with the EMR, physicians' response times to our inquiries and their documentation have improved."