Medical Records Coding|
HTSI's coding objectives are to provide process improvements and solve identified coding problems. To ensure meeting these objectives, HTSI's coding philosphy incorporates the provision of certified coders, HTSI ClickBill software, and process improvements to improve third party revenue and compliance.
Solving these problems will:
HTSI coding services provide service throughout the revenue process to improve third party revenue by:
- maximize the effectiveness and economy of the billing practices
- improve organizational policy development, decision making, management and administration
- improve the effectiveness of management processes and procedures.
Our Medical Records Coding Support includes:
- ensuring the code assignments accurately reflect the complexity of care
- ensuring provider documentation is compliant with Government and insurance company regulations and payment criteria
- improving processes to identify billable encounters
- improve provider documentation.
On-Site and Off-Site Professional Certified Coders for Inpatient and Outpatient Care
Certified coders are tested before employment and a 100% audit is conducted for the first 30 days of employment. Weekly audits, statistical process control techniques and software, and bonus incentives are used to provide the highest coding quality in the industry.
Data Entry for Coding and Billing Systems
Data entry services are available for entering coding and billing information. These services include abstracting, data entry, pulling and filing medical records, and data quality reviews.
HTSI ClickBill Application
Commercial, Military, and VA versions of this decision support software support data analysis for the entire revenue cycle. Specific analysis and reporting functionality includes:
- Coder Accuracy and Productivity
- Provider Coding Accuracy and Compliance
- Third Party Revenue Analysis and Reporting
- Consolidated Billing Report
- Microsoft Access Tables and Data Entry Forms
Provider Education on Documentation Requirements
HTSI provides accredited continuing medical education to providers to improve documentation that leads to improved revenue by: (1) documenting the complexity of care actually provided (more revenue per claim); and (2) reducing the number of un-billable records (greater volume).
HTSI offers services to conduct quality reviews on coding accuracy of providers and coders. HTSI/PlanetGov will provide quarterly audits of their coding accuracy and provide a database capability for the audits provided by the Government. The following are the specifics of our audit process HTSI provides feedback to customers regarding physician trends to included patterns of up-coding, down-coding, lack of medical necessity, codes reported but not supported by documentation, incorrect or inappropriate diagnostic or procedural codes, wrong types of E&M codes, incorrect principal diagnosis, incorrect principal procedures, and lack of identification of co-morbid condition and complications. In addition - HTSI will use this information to provide recommendations for policy changes and for identifying topics for continuing education of providers and staff involved in the revenue and budgeting process.
Data Extractions from Clinical Information Systems
Creation and Maintenance for Coding and Audit Databases
Coder Accuracy Analysis and Reporting
HTSI will perform coding quality reviews of the contracted staff monthly and an official written report of the review findings will be provided to the customer within 10 business days after the end of the review period
Provider Coding Accuracy Analysis and Reporting
Provide staffing and establish processes that maximize the identification of patients for collection of third party insurance. The process will improve identification and reporting through all phases of the revenue cycle to include registration, appointment, point of service information collection, documentation, coding, filing claims, claims follow-up, utilization review, and auditing.
Provider Education on Documentation Requirements
Provide accredited continuing medical education to providers to improve documentation that leads to improved revenue by: (1) documenting the complexity of care actually provided (more revenue per claim); and (2) reducing the number of un-billable records (greater volume).
Provider Analysis and Reporting for Non-Billable Documentation
Provide continuous improvement throughout the revenue cycle by establishment of metrics, training, and implementation of a statistical process control processes;
Automated Reporting and Consolidation of Coding Information for the Billing Department
In addition to coding accuracy, our software supports the automated analysis and reporting of data entry quality by capturing the ID of the person entering the data and the changes made to the data. The software also supports pulling the information directly from in-house applications.
Audits will be conducted throughout the life cycle of the contract to review coding accuracy of providers and HTSI/PlanetGov coders. HTSI/PlanetGov will provide quarterly audits of their coding accuracy and provide a database capability for the audits provided by the Government. The following are the specifics of our audit process
Automated Audit Reports and Data Analysis Application
HTSI provides monthly feedback to customers regarding physician trends to included patterns of up-coding, down-coding, lack of medical necessity, codes reported but not supported by documentation, incorrect or inappropriate diagnostic or procedural codes, wrong types of E&M codes, incorrect principal diagnosis, incorrect principal procedures, and lack of identification of co-morbid condition and complications. In addition - HTSI will use this information to provide recommendations for policy changes and for identifying topics for continuing education of providers and staff involved in the revenue and budgeting process.
Outsourcing Coding and Billing Services
All certified coders are tested before being hired using our standard coding test. They must pass to be hired. After services start, our company compliance plan requires the audit of three random records per outpatient coder per week and one per inpatient coder. Issues are corrected immediately upon discovery and we report the results monthly to our customer. We employ statistical process control and data analysis software to plot data points and provide analysis based on the criteria set for the individual metrics in our/facility compliance plan. The software and the data is made available to front line staff so they get an opportunity to review and solve their own errors. We use a goal of 95% coding accuracy. The importance of achieving this degree of accuracy is the impact on compliance and subsequent revenue. The 95% accuracy is used for the assignment of CPT, diagnosis, and procedure codes. The accuracy of the diagnosis code is based on both the right numerical assignment and the position it should appear (e.g., 1st, 2nd, 3rd, 4th diagnosis code).
Information collected that may fall under the Privacy Act will be afforded the required protection and non-disclosure procedures. All individually identifiable health records will be treated with the strictest confidentiality. Access to records will be limited to essential personnel only. Records will be secured in locked areas and/or kept from access by unauthorized individuals when not in use. At the conclusion of the contract, all copies of individually identifiable health records will be destroyed or returned to the facility. Information that contains data about users, patients, team members, etc., will be protected in accordance with The Privacy Act 38 USC 5701, and 38 USC 7332. A pop-up warning and markings will be in-place on web pages or files that contain information that requires protection under this act. Any databases will contain the required warnings and the data will be protected accordingly. All personnel and users will not disclose this information without the approved consent of the affected individual(s). OMB Circular A-130 reinforces the Computer Security Act requires Federal agencies to provide for the mandatory periodic training in computer security awareness and accepted computer security practices of all employees who are involved with the management, use, or operation of a Federal computer system within or under the supervision of a Federal agency, including contractors.
For our Federal Government and DoD customers, Both DoD Directive 5400.11-R and the Privacy Act Program require a computer security-training program as a safeguard to protect data and system; availability, confidentiality, and integrity. DoD Directive 5200.28 identifies "Security Training," as a minimum requirement, "establishment of a security training and awareness program that will ensure all persons responsible for the AIS or information processed and/or maintained by the AIS, or all persons who access the AIS, are aware of proper operational and security-related procedures and risks." We will adhere to all these guidelines. To help ensure adequate security safeguards are in place as a system is being developed, we will follow DoD Instruction 5200.40, DoD Information Technology Security Certification and Accreditation Process (DITSCAP). We are experienced in applying security solutions to meeting DITSCAP Process requirements. We will use an SSAA as a living document representing the formal agreement among the DAA, the CA, the user representative, and the program manager for any support application we use or install.